Biomedical subjects
I Levav
Publications and source records attributed to I Levav.
Bridges, the Israeli-Palestinian public health magazine.
Explore the source record for details and available documents.
Psychiatric services and training for children and adolescents in Europe: results of a country survey.
Mental health budgets, services and programs are seldom commensurate with mental health needs in the countries, particularly of population groups whose voice in advocacy is weak. In this inquiry we explored the adequacy of mental health care resources available for the young in Europe. To achieve this objective this survey investigated a few variables (e. g., number of services, degree of coverage, trained personnel) that were used as gross indicators of the discrimination suffered by this health sector. We sent a short postal questionnaire to the mental health focal points of the 51 countries included in the World Health Organization European Region. Thirty six countries (70.5 %) responded. The results showed that the degree of coverage and quality of services for the young were generally worse in comparison with those for adults, including for serious disorders. A lack of both specialized and in-training personnel was identified. The exposure of general practitioners and pediatricians to psychiatry for the young was limited. Generally, the lower the income level of the country the worse the situation. Our mapping confirmed findings of previous inquiries. European child psychiatry leaders had raised a set of recommendations to improve the current situation; their implementation can now benefit from novel strategies adopted by the World Health Organization to advance mental health worldwide.
Evaluation of the PAHO/WHO training program on the detection and treatment of depression for primary care nurses in Panama.
OBJECTIVE: This study evaluated the efficacy of a training program developed by Pan American Health Organization/World Health Organization (PAHO/WHO) for primary care nurses aimed at improving their capacity to detect and manage depression. METHOD: Changes in knowledge and clinical practice were assessed in a group of primary care nurses in Panama who underwent the program. They were compared with a group of controls. RESULTS: Nurses who underwent the training program showed a statistically significant improvement in knowledge and detection of depressive disorders. In addition, they increased their notification of patients with depression to the primary care physician. No change was noted in the control group. CONCLUSION: The results point to the benefit of the PAHO/WHO training program for primary care nurses in the care of major depression. Further studies are required to confirm these results.
[Risk factors for behavioral and emotional problems in childhood: a community study in Uruguay].
OBJECTIVES: To explore some of the demographic risk factors that are associated with the risk of behavioral or emotional problems in children, and to examine the possibility of an association between psychological stress in the parents and psychological problems in their children. METHODS: In this study, the presence of psychological stress in the parents and certain psychosocial characteristics that increase the risk of mental problems in childhood were examined in a sample of Uruguayan children from three communities, two urban and one rural. The study, which was carried out in Ciudad Vieja and Barrio Sur, in the city of Montevideo, and in Colonia de Sacramento, a rural town, comprised 115 children between the ages of 5 and 15. Mothers answered the Child Psychiatric Morbidity Questionnaire (QMPI), an instrument for the detection of behaviors pointing to the presence of emotional problems in children. Both parents also supplied the demographic information requested in the Psychiatric Epidemiology Research Interview Demoralization Scale; they answered the CAGE questionnaire, a screening tool for alcoholism; they responded to the Social Support Network Inventory; and they answered questions about their self-perceived mental health. RESULTS: Fifty-three percent of the children had scores greater than 6 on the QMPI, which indicates the possible presence of behavioral or emotional problems. Fathers' self-perception of emotional problems and mothers' feeling of being demoralized showed a statistically significant association with a greater risk of behavioral or emotional problems in their children. CONCLUSIONS: In light of our results, mental health in childhood is a social and public health problem that warrants further epidemiologic study in Uruguay.
World Health Day on April 7, 2001 the theme is mental health.
Explore the source record for details and available documents.
Rights of persons with mental illness in Central America.
This paper reports a diagnostic inquiry on the human rights situation of persons with mental disorders in four Central American countries. The study was conducted by teams constituted of mental health workers and human rights lawyers, using a standard questionnaire prepared by the World Health Organization (WHO) and adapted for regional purposes by the America-based WHO office. The inquiry identified violations in different areas, e.g., involuntary admissions, informed consent and others. In general, violations were not associated with the level of social development of the country but with the affiliation of the care-giving system (private vs. public). This study will be followed by activities aimed at improving the current situation.
PTSD an explanation for affective disorder among Jews: a critique.
Explore the source record for details and available documents.
Attitudes towards mental illness in the Commonwealth of Dominica.
Little is known about the perception of mental illness in the English-speaking Caribbean. This study was conducted in 1995 to determine the attitudes, knowledge, and help-seeking practices for emotional disorders in the Commonwealth of Dominica. Two groups in Dominica were surveyed: 67 community leaders, consisting of nurses, teachers, and police officers; and 135 community members grouped into five socioeconomic strata that were collapsed to three for the analysis. All the respondents were asked to identify and suggest management of individuals with psychosis, alcoholism, depression, and childhood hyperactivity, as depicted in case vignettes. The person in the psychosis vignette was diagnosed as suffering from mental illness by 84.0% of the leaders and by 71.2% of the community members. However, in each of the three other vignettes, fewer than 30% of the respondents thought that mental illness was present. The person with alcoholism was viewed as having a serious problem by only slightly more than half of the respondents. Fewer than half of the respondents thought that the individuals with depression or hyperactivity had serious problems. The community leaders did somewhat worse in recognizing mental illness than did the community members. Respondents were most likely to refer a family member with emotional problems to a medical practitioner. In conclusion, education about mental health problems is needed in Dominica. Especially disconcerting was the lack of knowledge on mental illness among nurses, teachers, and police officers, that is, professionals directly involved in the pathway to care.
Parenting and physical punishment: primary care interventions in Latin America.
Physical punishment is a form of intrafamilial violence associated with short- and long-term adverse mental health outcomes. Despite these possible consequences, it is among the most common forms of violent interpersonal behavior. For many children it begins within the first year of life. The goal of this study was to determine the feasibility of involving public sector primary health care providers to inform parents about alternatives to physical punishment. The study used a qualitative design utilizing focus groups and survey questionnaires with parents and providers at six clinic sites chosen to be representative of public sector practice settings in Costa Rica and in metropolitan Santiago, Chile. The data were collected during 1998 and 1999. In the focus groups and surveys the parents voiced a range of opinions about physical punishment. Most acknowledged its common use but listed it among their least preferred means of discipline. Frequency of its use correlated positively with the parents' belief in its effectiveness and inversely with their satisfaction with their children's behavior. Some parents wanted to learn more about discipline; others wanted help with life stresses they felt led them to use physical punishment. Parents reported they chose other family members more frequently as a source of parenting information than they did health care providers. Some parents saw providers as too rushed and not knowledgeable enough to give good advice. Providers, in turn, felt ill equipped to handle parents' questions, but many of the health professionals expressed interest in more training. Parents and providers agreed that problems of time, space, and resources were barriers to talking about child discipline in the clinics. Many parents and providers would welcome a primary-care-based program on physical punishment. Such a program would need to be customized to accommodate local differences in parent and provider attitudes and in clinic organization. Health care professionals need more training in child discipline and in the skills required to interact with parents on issues relating to child behavior.
Cancer incidence and survival following bereavement.
OBJECTIVES: This study investigated the effect of parental bereavement on cancer incidence and survival. METHODS: A cohort of 6284 Jewish Israelis who lost an adult son in the Yom Kippur War or in an accident between 1970 and 1977 was followed for 20 years. We compared the incidence of cancer in this cohort with that among nonbereaved members of the population by logistic regression analysis. The survival of bereaved parents with cancer was compared with that of matched controls with cancer. RESULTS: Increased incidence was found for lymphatic and hematopoietic malignancies among the parents of accident victims (odds ratio [OR] = 2.01; 95% confidence interval [CI] = 1.30, 3.11) and among war-bereaved parents (OR = 1.47; 95% CI = 1.13, 1.92), as well as for melanomas (OR = 4.62 [95% CI = 1.93, 11.06] and 1.71 [95% CI = 1.06, 2.76], respectively). Accident-bereaved parents also had an increased risk of respiratory cancer (OR = 1.50; 95% CI = 1.07, 2.11). The survival study showed that the risk of death was increased by bereavement if the cancer had been diagnosed before the loss, but not after. CONCLUSIONS: This study showed an effect of stress on the incidence of malignancies for selected sites and accelerated demise among parents bereaved following a diagnosis of cancer, but not among those bereaved before such a diagnosis.
Ethics in the practice of psychiatry in South Africa.
OBJECTIVE: To determine attitudes with regard to ethics in the practice of psychiatry in South Africa. DESIGN: Cross-sectional survey. METHOD: The study utilised clinical vignettes, with gender and race of the patient as potential modifying variables in diagnosis and management. Open-ended questions pertaining to potential abuses were included. SETTING AND SUBJECTS: Questionnaires were mailed to all practising psychiatrists in South Africa in 1993 and 1994. OUTCOME MEASURES: Responses to questionnaire. RESULTS: A 40% response rate was obtained (N = 73). Patient race and gender did not influence diagnosis or have a marked impact on the prescription of treatment. Pressure from the patient's family on the psychiatrist did alter case management, as did the psychiatrist's age and gender in some instances. Racial discrimination, sexual misconduct and economic abuses were the most frequently cited areas of observed abuse. CONCLUSION: The development of an ethical framework for the practice of psychiatry in South Africa would appear to be of critical importance.
Affective disorders among Jews: a historical review and meta-analysis.
Descriptions of affective disorders among Jews date back to biblical times. For over a century the psychiatric literature has debated whether Jews are more vulnerable to affective disorders. To ascertain the validity of this finding we undertook a meta-analysis of data extracted from the literature published to date. Forty-three studies were identified that could be analysed statistically using Cohen's d and a Mantel-Haenszel summary odds ratio. An increased, but weak overall risk was found for males. Possible biases of the literature are discussed, including differential help-seeking patterns, lack of accounting for readmission rates, failure to control for confounding variables, and an anti-Semetic orientation on the part of researchers. Reasons for why Jews have higher rates of affective disorders than non-Jews are explored.
Epilepsy in Latin America and the Caribbean: a survey on needs and resources.
A survey was done on the needs and resources available to control epilepsy in the countries of Latin America and the Caribbean. Responses came from ministries of health, prominent neurologists, and epilepsy advocacy organizations. A mailed questionnaire was used, and the response rate was excellent, 89%. The survey results showed that the private sector is better equipped to deal with epilepsy than is the public sector, in terms of both specialized personnel and access to a variety of drugs. Public policies are lacking, and linkages between medical personnel and social workers are almost nonexistent. Primary care doctors and nurses are somewhat able to diagnose some types of epilepsy but do less well with other types of the disorder. There is a strong justification for the new "Out of the Shadows" initiative, in which the International League Against Epilepsy, the International Bureau for Epilepsy, the World Health Organization, and the Pan American Health Organization are working to improve epilepsy health-care services, treatment, and social acceptance.
The psychiatric after-effects of the Holocaust on the second generation.
Explore the source record for details and available documents.
Epidemiology of youth suicide in Israel.
OBJECTIVE: This study examined sociodemographic correlates and temporal trends in suicide among young Jews, Moslem Arabs, Druzes, and Christian Arabs in Israel. METHOD: The average yearly rates (1975 through 1989) for suicide and undertermined causes of death were calculated for children, adolescents, and subjects of army age. Rates were examined by gender, national/religious affiliation, and place of residence for all groups and, in addition, by ethnic origin among the jews. Logistic regression was used to ascertain the statistical differences. Temporal changes were examined by plotting the rates over the 15-year period and fitting a regression line. RESULTS: Among the young, differences by gender, national/religious, and ethnic origin did not consistently follow the pattern found in adults. Male Jews and Druzes of army age, facing a period of enhanced stress and availability of weapons, showed increased risk for suicide. Temporal trends for suicide differed from the worldwide pattern of increasing risk; these changes, however, were not homogeneous across all groups. CONCLUSIONS: The suicide rates among the youth in Israel, as in adults, are among the lowest in the world. Army service may be a period of enhanced risk, justifying preventive action. The almost worldwide trend of increasing suicide among the young is only partially present.
In menstrual cycle stage a confounder in population-based psychiatric research?
BACKGROUND: It has been suggested that a failure to control for point in the menstrual cycle can lead to biased results in assessing psychiatric symptoms among women since state affects associated with premenstrual symptoms may lead to unreliability of symptom reporting as well as an artificial elevation of symptom ratings. We examine these hypotheses and the extent to which they can account for gender differences in symptom scale scores of demoralization and enervation. METHODS: The data are derived from an epidemiological study of Jews born in Israel between 1949 and 1958. The symptom scale scores of 2265 men and 1769 women (368 premenstrual, 458 menstruation and 943 postmenstrual) were compared regarding reliability, homogeneity and mean score. RESULTS: There were no differences among the menstrual groups, or between the men and women, in reliability of their responses as measured by the alpha coefficient and the coefficient of variation. There were no significant differences among the female groups on mean symptom scale score. The mean scale scores for each female group were significantly higher than the mean scores for men. CONCLUSIONS: Our results suggest that menstrual cycle stage does not influence the reliability of reporting, the variability of response or mean symptom levels. However, our conclusions may not apply to studies of drug effects or clinical studies of premenstrual dysphoria.
Vulnerability of Jews to affective disorders.
OBJECTIVE: Psychiatric literature over the past 100 years suggests that Jews are at higher risk for affective disorders than numbers of other religious groups. To examine these claims, the authors analyzed data from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study. In addition, the relationships among gender, alcoholism, and major depression were investigated. METHOD: The period prevalence and lifetime rates of DSM-III major depression among Jews, Catholics, Protestants, individuals in other religious groups, and individuals with no religious affiliation were examined in the Los Angeles and New Haven, Conn., ECA data. Logistic regression with covariates for site, gender, marital status, and socioeconomic status was used to estimate odds ratios and 95% confidence intervals. The calculated rates, based on the combined data from ECA study waves 1 and 2 for the white population, were weighted according to the 1980 U.S. population census. Female-to-male rate ratios and rates of alcohol abuse/dependence were also obtained. RESULTS: While no differences were found among females, Jewish males had significantly higher rates of major depression than Catholics, Protestants, and all non-Jews combined. Jews had a 1:1 female-to-male ratio for major depression, in contrast to the other religious groups, which approached the universal 2:1 ratio. Rates of alcohol abuse/dependence were inversely related to rates of major depression. CONCLUSIONS: The results support only in part the earlier reports that Jews have higher rates of depression. The equal gender distribution of major depression among Jews may be associated with the lower rate of alcoholism among Jewish males.