COVID-19 pandemic among adults with intellectual disabilities: Implementing a social model of disability in crisis and trauma situations.

A growing body of evidence has attested to the higher impact of COVID-19 on individuals with intellectual disabilities (IDs) than on members of the general population during the pandemic, mainly showing their higher vulnerability. However, we believe it is important to better understand how their situation interacts with the specific circumstances of the pandemic. In this article we discuss recent findings regarding individuals with IDs through the lens of two theories - the social disability model and the ecological model of trauma and recovery - and propose an integration, namely a social model of disability in crisis and trauma situations. Such a model allows for a wider perspective on understanding the way people living with disabilities (PLWDs) cope in these situations, integrating the individual aspects of coping with the social and environmental ones.

Self-management After Bariatric Surgery: a Comparison Between Support Group Participants and Patients Receiving Individual Dietary Follow-Up.

PURPOSE: This study aimed to compare self-management after bariatric surgery between support group participants (the study group) and patients receiving only individual follow-up by a dietitian (the comparison group), and to examine the differences between the two groups regarding the associations of cognitive and emotional factors with self-management. MATERIALS AND METHODS: This cross-sectional comparative study was conducted among bariatric patients who either participated in bariatric support groups during the years 2018-2020 or received only individual follow-up with a dietitian since their surgery. The structured questionnaire included a self-management questionnaire, cognitive variables (eating self-efficacy, eating awareness as independent variables, weight control motivation) and emotional variables (positive and negative affect, emotional eating), and background control variables. RESULTS: The level of self-management was better in the study group than in the comparison group. The hierarchical regression model showed that in the study group, the control variables contributed negligibly to self-management (step 1), while all independent variables contributed the most (27%) to the explained variance (31%) in self-management (step 2). In the comparison group, the contribution of the control variables was 11.5% of the explained variance, with only lower duration of time since surgery being related to higher self-management (step 1). The independent variables contributed significantly - an additional 14.5% to the explained variance (step 2). Emotional eating was the sole variable related to self-management. CONCLUSION: The findings emphasize the importance of encouraging patients after bariatric surgery to participate in support groups, as the skills acquired in these groups strengthen the capacity to manage self-care.

Participating in Bariatric Support Groups: the Effects on Self-management Changes.

BACKGROUND: This study focused on changes in self-management as the main outcome of participation in bariatric psychoeducational support groups. We assessed the contribution of changes in cognitive and emotional variables to improved self-management among 155 participants. METHOD: Data for this longitudinal study were collected at the beginning (time 1) and at the end (time 2) of the support groups' 10-session program. The structured questionnaire included self-management (the Bariatric Surgery Self-Management Behaviors Questionnaire), cognitive variables (eating self-efficacy, eating awareness, weight control motivation), and emotional variables (positive and negative affect, emotional eating), as well as background variables. RESULTS: Significant improvements in self-management and in eating self-efficacy, eating awareness, and emotional eating were found at time 2. The hierarchical regression model showed that the improvements in eating self-efficacy, and in positive and negative affect, contributed significantly to improved self-management. Additionally, a modification effect of negative affect was found. CONCLUSION: We conclude that participation in psychoeducational bariatric support groups is beneficial to improving one's self-management.

Framing the meaning of COVID-19 and the psychological responses to it: Insights gleaned from selected theoretical approaches.

This viewpoint article reviews theoretical approaches that are relevant to studying COVID-19 and the psychological reactions to it. We suggest that the published research can be viewed from four major theoretical perspectives: as a stress situation, traumatic event, shared reality/shared trauma, and loss and grief situation. We detail the terms and the main theory/ies underlying each approach and suggest how COVID-19 characteristics and the its' psychological consequences may be conceptualized in accordance with each approach. Additionally, we discuss the challenges and facets of each theoretical conceptualization that should be addressed in further research, and the necessity of exploring implications for practice.

Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel.

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009-2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.

Internalized homophobia and sexual risk behavior among HIV-infected men who have sex with men in Israel.

Sexual risk behaviors among men who have sex with men (MSM) have been linked to diverse demographic, psychosocial, and behavioral factors. This study assessed the association between internalized homophobia and sexual risk behavior among HIV-infected MSM and the mediating effects of safe-sex self-efficacy and depression on this association, using a theoretical framework based on the Theory of Social Action. Data were collected from 124 HIV-infected MSM attending an AIDS clinic in Israel. No significant association was found between internalized homophobia and sexual risk behavior (unprotected anal intercourse). Examination of mediation effects revealed full mediation by depression, but not by self-efficacy. Depression and self-efficacy were the only significant explanatory variables of sexual risk behavior. Diverse social work interventions with HIV-infected MSM aimed at reducing sexual risk behaviors should include routine screening of IH and its association with depression, and address depression and self-efficacy in CBT and other interventions.

Becoming a Home Care Worker: Job-Seekers' Push and Pull Factors.

This study examined "push and pull" factors associated with the decision to become home care workers among job-seekers in Israel. Participants completed measures of ageism, anxiety about aging, attitudes toward the home care profession, and personal relationship with older adults. Of 1,492 participants, 32.0% accepted the offer to become home care workers and were no longer in the job market, 36.7% accepted the offer but worked in the past, and 31.2% refused the offer. Compared to participants currently employed, the odds of being employed in the past were higher for participants who were younger, with poorer health and higher ageism; the odds of refusal were higher for males, Arabs, younger participants, with more education, lower ageism, and fewer personal relationship with older adults. The findings have implications for practice with job-seekers and for retaining current home care workers in the field. This may assist in expanding the home care workforce.

Risk and Protective Factors for Child Overweight/Obesity Among Low Socio-Economic Populations in Israel: A Cross Sectional Study.

Background and Aims: Scientific evidence regarding protective factors that contribute to healthy weight in childhood is limited and is particularly scarce in lower socio-economic populations in different ethnic groups. This study aimed to assess the prevalence of biological, behavioral and psychosocial factors for child overweight/obesity in Jewish and Arab population groups in Israel, and to compare their associations with child overweight/obesity in the two groups. Methods: Children aged 5-6 years were randomly selected from 20 Mother and Child Health clinics in towns and villages of lowest socio-economic ranking in Northern Israel. Children and mothers were invited for a special "One Stop Shop-Preparation for School" visit which included growth measurements. Questionnaires were distributed to mothers for self-report on biological, SES, psychological and lifestyle factors. Perinatal and early nutritional data were retrieved from clinic records. Multivariate analyses using logistic regression models predicting child overweight/obesity were conducted separately for Jewish (N = 371) and Arab (N = 575) children. Results: Overweight/obesity (BMI ≥85th centile) rates were higher in Jewish (25%) than Arab (19%) children. In both Jewish and Arab groups, respectively, maternal BMI (OR = 1.10 [95%CI = 1.04, 1.17]; OR = 1.08 [95%CI = 1.04, 1.13]), and child birthweight (OR = 1.33 [95%CI = 1.04, 1.71]; OR = 1.39 [95%CI = 1.11, 1.73]) were significant risk factors for overweight/obesity, and maternal self-efficacy regarding child's lifestyle was significantly protective (OR = 0.49 [95%CI = 0.28, 0.85]; OR = 0.54 [95%CI = 0.34, 0.85]). Additionally, four other maternal psychological and child behaviors were significantly associated with overweight/obesity in the Jewish group and two child lifestyle behavior factors in the Arab group. Moreover, significant interactions indicating moderation effects were found only in the Jewish group: maternal education and maternal age moderated the effect of maternal BMI on child overweight/obesity. No other moderation of risk factors was found. Discussion: In this study of children from low SES families, protective factors contributed to healthy child weight alongside risk factors for overweight/obesity. They differed between the population groups, and fewer variables explained overweight/obesity in Arab children. Although further expansion of these findings is required they point at the relevance of protective factors, maternal self-efficacy in particular, for understanding childhood obesity in specific ethnic contexts and for planning culturally adapted prevention programs in disadvantaged populations.

Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment.

OBJECTIVES: Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews. METHODS: We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004-2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087). RESULTS: Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57-2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53-0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%. CONCLUSIONS: Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.

Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges.

Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries. Nevertheless, life expectancy has remained lower among Israeli Arabs than Israeli Jews, and this gap has recently widened. Age-adjusted mortality as a result of heart disease, stroke, or diabetes remains higher in Arabs, whereas age-adjusted incidence and mortality of cancer were higher among Jews. The prevalence of obesity and low physical activity in Israel is considerably higher among Arabs than Jews. Smoking prevalence is highest for Arab men and lowest for Arab women. Health inequalities are also evident by the indicators of socioeconomic position and in subpopulations, such as immigrants from the former Soviet Union, ultra-Orthodox Jews, and Bedouin Arabs. Despite universal health coverage and substantial improvements in the overall health of the Israeli population, substantial inequalities in NCDs persist. These differences might be explained, at least in part, by gaps in social determinants of health. The Ministry of Health has developed comprehensive programmes to reduce these inequalities between the major population groups. Sustained coordinated multisectoral efforts are needed to achieve a greater impact and to address other social inequalities.

Glycemic control of diabetes patients under continuous rocket attacks.

BACKGROUND: Evidence regarding the detrimental effects of exposure to stress on glycemic control among diabetes patients has mainly focused on personal life events or acute trauma. However, the effects of continuous exposure to extreme stress on type 2 diabetes patients have rarely been studied. The aim of the current study was to examine the association of continuous exposure to rocket attacks with glycemic control and with risk factors for diabetes complications among civilian type 2 diabetes patients. We focus on patients residing in the Western Negev in the south of Israel that has been subjected to rocket attacks fired from Gaza since the end of 2001. METHODS: A two-arm retrospective cohort study of type 2 diabetes patients, aged 35-70 years, residing in a region with chronic exposure to rocket attacks (N = 1697) and in a non-exposed comparison region in Israel (N = 3000). Data were retrieved from the Health Maintenance Organization (HMO)'s database for four time periods representing exposure: chronic-2008; elevated-2009 (post'Cast Lead' operation); return to chronic-2010, 2011. Data included socio-demographic variables, HbA1c, BMI, LDL cholesterol, blood pressure. General Linear Models (GLM) were used for analysis. RESULTS: For HbA1c, the model yielded a significant main effect for time, a borderline significance main effect for region, and a significant time by region interaction: no differences in HbA1c levels between the regions in 2008 and 2009, followed by significant differences between the regions in 2010 and 2011 when HbA1c continued to increase in the exposed region but decreased in the comparison region. Regarding risk factors, a significant main effect for time for LDL cholesterol only, and significant main effects for region were found in all factors: BMI and LDL cholesterol were higher in the exposed than in the comparison region, but blood pressure values were lower. CONCLUSIONS: Continuous exposure to rocket attacks is associated with glycemic control and risk factors in a complex pattern. These preliminary findings require further studies of diverse types of civilian exposure to continuous extreme stress.

Preventive health behaviors and physician visits: relevance to health inequality.

Clear definitions and measurement of preventive health behaviors, as well as the relevant demographic and socioeconomic variables, is important to understanding what factors explain inequalities in health and in the use of health care services. This commentary addresses issues related to the measurement of preventive health behaviors and suggests a distinction between personal life style behaviors and preventive screening practices in order to better explain the associations between these practices and visits to general practitioners. The commentary notes that physician visits are a health-related behavior which is shaped by socioeconomic status: visits to general practitioners are more prevalent among the poor, while visits to specialists are more prevalent among the rich. Therefore, in any analysis of the factors contributing to socioeconomic inequalities in health, physician visits and preventive health behaviors ought to be included as two distinct sets of health-related behaviors. Changing these health-related behaviors is only one of the interventions that are better developed by healthcare services, while the majority of multi-level efforts to reduce inequalities should be outside of the health sector.

The Israeli National Committee for sex selection by pre-implantation genetic diagnosis: a novel approach (2005-2011).

BACKGROUND: Pre-implantation genetic diagnosis (PGD) for fetal sex selection raises complex dilemmas. In Israel, PGD is regulated by the Ministry of Health. It is basically prohibited, but exceptions can be made upon approval by the National Committee for Sex Selection by PGD for Non-Medical Reasons (the "Committee"). This report describes the Committee's work since its inception in May, 2005 through December, 2011. METHODS: Files were abstracted onto a structured form. Discrete variables were analyzed by chi-square analysis, and continuous variables by T-Test. RESULTS: During the study period 411 applications were received. Two-thirds of the applicants (n = 276; 67.2%) were Jewish and 26.8% were Moslem Arab. Over two-thirds (n = 285; 69.3%) had no children of the requested sex and ≥4 children of the opposite sex. Three-quarters of the requests were for a male (n = 308; 74.9%): 100% of Arab and 63% of Jewish applicants. Many noted more than one reason for their request. The most frequent category (n = 201; 48.9%) was a strong emotional desire, followed by medically-related reasons (n = 83; 20.2%). For 216 applications a decision was arrived at, with 46 (21.3%) approved. Of the remaining 195 for 192 over a year had passed since last contact with the Committee. The likelihood of approval was higher if applicants met the criterion of ≥4 same-sex children than if they didn't (33.7% vs. 11.6%, P = 0.001). The largest number of approvals were those requested for 'emotional' reasons, while the highest approval rate was for religious reasons. CONCLUSIONS: This study reviewed the first seven years of Committee activity. Most requested males, and the primary reason was the parents' intense emotional desire. Only one-fifth of the decisions were approvals, possibly reflecting reluctance to encourage non-medically-indicated PGD, a viewpoint not unique to Israel. Limitations include the relatively small number of cases and lack of access to Committee deliberation protocols. It is recommended that longitudinal studies be conducted to gain insight into the consequences to individuals, couples and families--both those whose requests were approved and those denied-- of this major step in reproductive technologies and in society's effort to respond to them.

Mothers of IVF twins: the mediating role of employment and social coping resources in maternal stress.

Twin pregnancies and births resulting from assisted reproductive technologies have been associated with adverse perinatal outcomes and maternal health complications leading to psychologically complex parenting. In the current study the authors assess the prevalence of clinical levels of maternal stress among mothers of twins resulting from in vitro fertilization and examine the association of social coping resources with three maternal stress sub-scales. During the years 2003-2005, 88 primiparous Israeli mothers of in vitro fertilization-conceived twins provided socio-demographic data during their third trimester of pregnancy, and at 6 months after birth provided data on delivery and medical condition of infants, coping resources (social support and marital quality), and a maternal stress scale. Forty-one percent of the mothers reached a clinically significant level of maternal stress. Social support and maternal employment were the most significant variables associated with experience of the stress in the early stages of adaptation to mothering in vitro fertilization twins. Primiparous mothers of in vitro fertilization twins are vulnerable to maternal stress in early stages of adaptation to the maternal role, some of whom reach clinical levels that may require professional interventions. Unemployed mothers with low social support were the most susceptible to the deleterious effects of in vitro fertilization treatment.

Disparities in the geography of serious mental illness in Israel.

OBJECTIVE: The aim of this research is to test and apply a model of the disparities and variations in serious mental illness (SMI) to estimating prevalence in local areas throughout Israel. METHODS: This study employs a secondary analysis of data from the 2003/2004 Israel National Health Survey of 4859 adults aged 21 and over from the household population of legal residents and citizens. It uses small area estimation methods (SAE), specifically to: (i) estimate and test a multivariate logistic model of disparities in the risk of serious mental illness; (ii) use the foregoing model for computing estimates, using census data, for local areas; (iii) validate these estimates against the rate of psychiatric hospitalizations. RESULTS: The model uses standard demographic and socioeconomic variables to successfully predict 92.5% of respondents' statuses as SMI, with a sensitivity of 26.9%, specificity of 95.9%, and an AUC index of .797. The resulting estimates of the percentage of adults with an SMI in the 16 subdistricts ranged between 3.7% and 7.7%, with a national mean of 5.0%. The estimates have a partial correlation of .63 with rates of psychiatric hospitalization in Jewish localities, but elevated rates have not been validated in Arab localities. CONCLUSION: The use of small area estimation methods demonstrated the capacity for deriving local prevalence rates of serious mental illness, ones that can be validated against psychiatric hospitalization for the majority population group in Israel.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia.

OBJECTIVES: To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. METHODS: Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. RESULTS: Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. CONCLUSIONS: This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Mothers of IVF and spontaneously conceived twins: a comparison of prenatal maternal expectations, coping resources and maternal stress.

BACKGROUND: This study explores the differences in prenatal maternal expectations, coping resources and maternal stress between first time mothers of IVF twins and first time mothers of spontaneously conceived twins. The role of prenatal maternal expectations in the prediction of maternal stress was examined, as well as the mediating and moderating effect of coping resources on the association between pregnancy-type group and maternal stress. METHOD: Mothers of twins from various regions in Israel were included in this prospective and cross-sectional study in which 88 mothers of IVF-conceived twins and 98 mothers of spontaneously conceived twins were interviewed twice. First, at 33-36 weeks of their pregnancy they completed a socio-demographic questionnaire and the maternal expectations questionnaire; then at 6 months after birth they completed a questionnaire regarding the delivery and medical condition of the infants, and their coping resources and maternal stress. RESULTS: Compared with mothers who conceived spontaneously, IVF mothers had more positive prenatal maternal expectations, but poorer coping resources and higher levels of maternal stress 6 months after birth. Maternal expectations had no predictive power regarding maternal stress, although the mother's coping resources were significantly related to maternal stress and mediated the association between pregnancy type and maternal stress. CONCLUSIONS: IVF-pregnant women bearing twins should be considered a high-risk group. Early identification of these mothers is essential for timely psychosocial interventions in order to enhance their resources and decrease maternal stress. Further longitudinal studies are required to determine causality in more ethnically-diverse mothers of twins.

Health inequalities in Israel: explanatory factors of socio-economic inequalities in self-rated health and limiting longstanding illness.

We examined an integrated multi-level model of psychosocial, community and behavioral factors as explanatory pathways to socio-economic inequalities in health in Israel. Using a random national sample of 1328 individuals aged 30-70 and measurements of socio-economic position (education, number of cars), health outcomes-self-rated health, limiting longstanding illness (LLI), we evaluated the contribution of psychosocial factors (stressors and psychosocial resources), community factors (individual and aggregate-level social participation and social capital) and health behaviors, to the explanation of health inequalities. Community factors contributed more than psychosocial factors or health behaviors. The integrative model provided an explanation of social inequalities in both health outcomes and a full explanation for the education-LLI association.

Educational inequalities in self-rated health within the Arab minority in Israel: explanatory factors.

BACKGROUND: Studies on factors explaining the socioeconomic inequalities in health within ethnic minorities are scarce. This study examines the contribution of material conditions, and psychosocial, community, cultural and behavioural factors to explaining educational disparities in self-rated health (SRH) within the Arab minority in Israel. METHODS: In 2005, a national random sample of 902 persons aged 30-70 was selected in a multistage sampling procedure for interviewing. We used multistage logistic regression modelling to examine the percent of attenuations in odds ratios (OR) of extreme categories for education (low vs. high) in the associations with SRH after inclusion of explanatory variables. RESULTS: Education was significantly associated with SRH [odds ratio (OR) = 3.86, 95% confidence interval (CI) = 2.30-6.47]. The separate inclusion of material conditions reduced the OR of poor SRH by 43%. Psychosocial, community or behavioural variables reduced it by 17%, 26% and 11%, respectively. Combining each group of factors with material conditions led to small additional reductions in OR. Integrating all explanatory variables reduced OR by 54%, with the association becoming non-significant. Cultural variables were not associated with SRH and were therefore not included in the multivariate analysis. CONCLUSIONS: Material conditions are a major factor in explaining the educational disparities in SRH among Arabs in Israel. Most of the impact of psychosocial and health behaviours, together with part of the community effects, operated through material conditions. Reduction of educational inequalities in SRH requires provision of educational attainment opportunities accompanied by employment opportunities assuring equivalent material gains. Further examination of factors explaining health inequalities among other minorities is warranted.