Biomedical subjects

Orna Baron-Epel

Publications and source records attributed to Orna Baron-Epel.

18 recordsLinked to original sources

PubMed2007

A comparison of trends in incidence and mortality rates of breast cancer, incidence to mortality ratio and stage at diagnosis between Arab and Jewish women in Israel, 1979-2002.

In Israel, breast cancer is the most common malignancy in women, but there are large intra-population differences. The aim of this study was to compare the incidence and mortality, incidence to mortality rate ratio and stage at diagnosis of breast cancer between Arab and Jewish women in Israel. Data on all cases of breast cancer, stage at diagnosis and mortality were obtained from the National Cancer Registry and the Central Bureau of Statistics. Trends in age-specific and age-adjusted incidence and mortality rates, rate ratios and stage at diagnosis were examined for Arab and Jewish women during 1979-2002. Five-year survival rates for 1995-1999 were compared by stage. Among Arab women, age-adjusted incidence rates increased by 202.1%, from 14.1 per 100,000 in 1979-1981 to 42.6 in 2000-2002. Among Jewish women, the rates increased by 45.7%, from 71.1 per 100,000 women in 1979-1981 to 103.6 in 2000-2002. Incidence to mortality rate ratio increased for both population groups, but it is still lower among Arab women. In every age group, Arab women were more likely to be diagnosed at a more advanced stage of the disease. The rise in breast cancer incidence and mortality rates and the later stage of diagnosis among Arab women emphasize the urgent need for increasing early detection of breast cancer in the Arab population by improving rates of compliance with screening mammography.

Arabs↗

PubMed2007

Family history of breast cancer and compliance with mammography in Israel: findings of the National Health Survey 2003-2004 (EUROHIS).

A positive family history of breast cancer is an established risk factor for the disease. In Israel, screening is recommended annually for high-risk women aged > or =40 years and biennially for average-risk women aged > or =50 years. The current study aimed to assess the effect of having a positive breast cancer family history on performing screening mammography in Israeli women. This study is a cross-sectional survey based on a random sample of the Israeli population, conducted in 2003. The study was carried out by means of telephone interviews that included questions on the use of preventive medical services. The current study population consists of 1605 Israeli women aged 40-74 years. A positive family history for breast cancer was reported by 153 (9.5%) of the participants. A mammogram in the previous year was reported by 43.1 and 24.7% of the positive and negative family history subgroups, respectively (P<0.0001). Rates increased with age. Among women with a positive family history, only being married was a significant correlate for a mammography in the previous year. Over 60% and around 55% of high-risk women aged 40-49 and > or =50 years, respectively, are inadequately screened for breast cancer. Screening rates are not optimal in the average-risk group as well.

Adult↗

PubMed2006

Health promotion teams' effectiveness: a structural perspective from Israel.

This study addressed the question of how to structure coalitions in order to increase their engagement in multiple strategies for health promotion and consequently to improve their effectiveness. Three structural variables were chosen: (i) coalition's heterogeneity, captured by the professional diversity of its members; (ii) coalition's configuration, defined as the way members were involved in the coalition: full- or part-cycle membership, full- or part-time assignment, and core or peripheral membership; and (iii) coalition's contractual collaborations with external professionals. A large non-profit network of community centers served as the setting for this study. The sample consisted of 37 coordinators of local coalitions for health promotion in Israel. The study's design was a cross-sectional survey. Data were collected by a multimethod (semistructured interviews, self reported questionnaires and administrative data) approach. Effectiveness was assessed by a self-report questionnaire administrated to coalition coordinators. Engagements in multistrategies as well as structural variables were measured by semistructured interviews with coalition coordinators. Results demonstrated that while a homogeneous, bounded structure seemed to promote the implementation of health education programs, a more flexible coalition configuration with frequent use of professionals contributed more to working by multiple strategies and improved coalition's effectiveness. In addition, the use of external professionals promoted action for a healthier environment, but did not add to empowering the community. The results contribute to shifting the conception of a coalition as a tightly bounded, well-defined, stable entity to that of a more fluid and permeable structure interacting with an external environment. These findings highlight the importance of incorporating structural considerations into the management of coalitions and are discussed in light of the potential costs and benefits of alternative modes of structuring such coalitions.

Community Health Services↗

PubMed2006

Patients' knowledge regarding medication therapy and the association with health services utilization.

BACKGROUND: Upon discharge from the hospital, patients are significantly deficient in their knowledge of their medications. Provision of information has been shown to have an effect on health measures such as compliance to medication therapy, quality of life, and utilization of hospitalization services. AIMS: To assess patients' knowledge about their long term medication therapy and to measure the association between knowledge and health service utilization in the community. METHODS: A prospective study was performed, with home telephone interviews conducted 1 week and 1 month after discharge. The study population included 130 patients discharged to the community with new prescriptions for long term medications. RESULTS AND CONCLUSIONS: About 60% of the patients reported receiving no counseling regarding their new medication. About 30% utilized 3 or more types of service (family physician, specialist, nurse, etc.). Eighteen percent (18%) visited the ER during the month after discharge, of whom 35% visited twice or more. Higher levels of patient knowledge predicted higher levels of health services utilization (OR=4.76 95% CI: 1.74-13.06). The younger patients tended to utilize a larger variety of health services compared to the older patients (OR 0.32 95% CI: 0.13-0.79). The results of this study provide that patients with higher levels of knowledge utilized the health care system more often, perhaps indicating greater awareness and self care.

Age Factors↗

PubMed2005

Self-reported health as a cultural health determinant in Arab and Jewish Israelis MABAT--National Health and Nutrition Survey 1999-2001.

Subjective health (SH) status serves as a measure of health in many studies of health-related issues as it is a good predictor of mortality, morbidity, and use of health services. The measure is used in many population groups. However, the degree to which it measures the same condition in different ethnic groups is not clear. Within Israel's first National Health and Nutrition Survey (MABAT) conducted during 1999-2001, face-to-face interviews were held with 3222 Israeli interviewees, 2379 Jews and 843 Arabs, aged between 25-64 years. Respondents reported their SH, co-morbidity, and other socioeconomic characteristics. Arabs reported higher levels of SH than Jews. In logistic regression analysis, co-morbidity was a much stronger correlate of poorer SH in the Arab than in the Jewish population. The association between socioeconomic variables depended on ethnic group and sex. The findings indicate that SH in Jews and Arabs does not necessarily have the same meaning in relation to objective measures of health, and caution should be exercised in the use of this measure in different population groups with different cultures. Arabs tend to evaluate health better than Jews even though life expectancy is lower and morbidity and mortality are higher in the former population group. Yet diagnosis of a disease increases the frequency of reporting lower SH, more in Arabs than in Jews.

Adult↗

PubMed2005

What do discharged patients know about their medication?

Patient's knowledge is a necessity for empowering patients to perform self-care, especially when dealing with new, ill-defined and unknown situations. The aim of this paper is to assess patients' reported as opposed to correct knowledge about medication therapy after discharge from hospital and to identify factors that increase correct knowledge. Three hundred and forty-one patients were interviewed 7-14 days after discharge from six internal wards in a large medical facility in Israel. Most patients (73%) were aware of the course and purpose of their medication. They were, however, unaware of side effects, needed lifestyle changes, and correct medication schedules. A large difference was found between levels of reported and correct knowledge about various issues regarding medication treatment. No significant correlation was found between correct knowledge about medication therapy at discharge, and gender, age, education, patient satisfaction and wish for more counseling. The only factor which significantly affected levels of correct knowledge was whether the patient had received medication counseling during hospitalization. The findings illuminate the gap between patients' perception of knowledge and actual knowledge. The study indicates the need for patient counseling during hospitalization, with respect to medication therapy.

Aged↗

PubMed2005

Who are the sedentary people in Israel? A public health indicator.

BACKGROUND: Increasing physical activity and thereby reducing a sedentary lifestyle can lower the risk of chronic diseases. Raising the population's involvement in physical activity is a major challenge for public health and healthcare services. OBJECTIVES: To identify subpopulations with a sedentary lifestyle and low levels of adherence to physical activity recommendations. METHODS: The Israel Center for Disease Control performed two national surveys during 2002-2003, interviewing 7,307 Jewish Israelis and 1,826 Arab Israelis over age 21. Respondents were asked if they engaged in physical activity lasting at least 20 consecutive minutes, and if so how frequently: less than once a week, once or twice a week, nearly every day or every day. RESULTS: Arab respondents were less physically active than Jewish respondents after adjusting for gender, age, level of religiosity, marital status, education, self-reported health, smoking, body mass index, and type of survey. Multiple logistic regression analysis run separately for Jews and Arabs found a more sedentary lifestyle, in both groups, among women, the less educated, those who were married and those with poor subjective health. Among Jews, younger age, increased religiosity, smoking and high BMI were associated with a sedentary lifestyle. CONCLUSIONS: The Jewish population is in need of more targeted and specific interventions for lower adhering subpopulations, such as women, the less educated and those with other risk factors. In the Arab population a more thorough understanding of the benefits of physical activity is needed; however, it seems that a general intervention is required to decrease the prevalence of a sedentary lifestyle all round.

Adult↗

PubMed2004

Nursing students' perceptions of smoking prevention.

Smoking behaviors of student nurses may have a profound effect on the implementation of smoking-prevention activities in the future, as they are the future nurses. The aim of the study was to evaluate the prevalence of smoking among student nurses in Israel and to identify factors associated with the students' attitude to their role in smoking prevention and to nurses as role models regarding smoking. Student nurses from three large academic schools (782 respondents) answered a self-administered questionnaire. About 22% reported being current smokers. The latter more frequently reported positive attitudes to nurses' smoking and saw no ethical problems in their smoking. Smokers also reported less frequently that nurses should be active in smoking prevention. In a logistic regression model, attitudes to nurses' role in smoking prevention, smoking status, and having friends who smoked were associated with the attitude to nurses as role models. Attitude to nurses as role models was the main variable explaining variance in attitudes to nurses' role in prevention. Smoking status and students' social environment exerted a marked influence on students' attitudes to smoking role modeling. A more holistic approach to student nurses' education about smoking prevention is called for.

Adult↗

PubMed2004

Prediction of survival: a comparison between two subjective health measures in an elderly population.

A large amount of evidence shows that the subjective evaluation of health is a predictor of survival in many different populations. Subjective health (SH) is measured using different types of measures such as a general evaluation of health or a comparative evaluation of health. The aim of this study was to compare the prediction of survival by two measures of SH (a general measure and an age-related measure) and evaluate the association with other variables in an elderly population. The baseline survey was conducted during 1994, covering 1138 men and women aged over 70. The survival status was ascertained 7 years later. After adjustment for age, sex, education, marital status, perceived socioeconomic status and presence of diseases the two SH measures were found to be predictors of mortality, but only in men. In men, there was no significant difference between the two types of SH measures in their prediction of mortality. Also in men, when there was only one or no disease, being married had a protective effect compared with not being married when both types of SH measures were used. In elderly women, the association between the two types of SH and survival diminished after adjusting for the various variables. However, the general SH measure may be the preferable measure to use when needed. Education in women was associated with mortality only via the age-related SH measure.

Age Factors↗

PubMed2004

A participatory process for developing quality assurance tools for health education programs.

There is a constant need to find methods and tools for achieving high quality in health education and health promotion programs. The aim of this initiative was to develop standards and criteria for quality assessment of health education programs. Health educators participated in a process to develop these standards and criteria. A consensus was reached regarding the list of standards by participation of the health educators in two workshops. This list consisted of the three main stages of health education programs: planning, implementation and evaluation. Operational criteria for each standard were developed in order to be able to measure the standards. Four different subjects were chosen for the development of the criteria: menopause, smoking cessation, cardiac rehabilitation and prenatal care. A consensus regarding these criteria was reached by discussions in workshops. The tools developed were tested by interviewing health educators who were planning and running these programs. The tools built were found acceptable by the health educators as they provided information on the quality of the programs.

Attitude of Health Personnel↗

PubMed2004

Ethnic differences in reported smoking behaviors in face-to-face and telephone interviews.

Different modes of gathering data on self-reported health measures and self-reported risk factors are used frequently in research. However, data on the influence of the mode of collection of data on self-reporting are limited. The aim of the study was to identify associations between the mode of data collection and self-reported smoking in two distinct ethnic groups, Jews and Arabs in Israel. During the last 2 years, data were collected in two national surveys regarding the smoking behaviors of Jews and Arabs in Israel. In the telephone surveys 4713 Israeli residents were interviewed and in the face-to-face interviewees 3239 people were interviewed. The interviewees were between the ages 25 and 64. There was no significant difference in smoking rates between face-to-face interviews and telephone interviews among Jewish men or women after adjusting for other variables associated with smoking. However, there was a difference between the two methods of data collection in the Arab population also after the adjustment. In this group, respondents tended to report more often being a smoker in the face-to-face interviews. This was especially apparent in Arab women. There was no significant difference in the reported number of cigarettes smoked in the two modes of data collection. In Arabs compared to Jews there is a significant difference between reporting smoking during a telephone interview and a face-to-face interview. The mode of data collection can affect comparisons between different groups.

Adult↗

PubMed2004

Factors associated with age of smoking initiation in adult populations from different ethnic backgrounds.

BACKGROUND: The age at which the individual begins smoking may influence the health of smokers at an older age. Cultural and social factors effect the age of smoking initiation. METHODS: A cross-sectional national survey of a random sample of 6,021 Israeli residents over the age of 21 were interviewed by telephone. The sample consisted of 4248 Jews, 858 Arabs and 915 immigrants, 856 of them were from the former Soviet Union. RESULTS: Compared to the Jewish population the Jews who immigrated from the former Soviet Union began smoking at an earlier age and the Arabs started smoking at an older age. The young respondents in all ethnic groups reported starting to smoke at a younger age compared to the older respondents, and there was a decrease in smoking initiation at an older age. Father smoking during childhood predicted earlier age of smoking initiation but not mother or sibling smoking, significantly among Jews and immigrants and non-significantly among Arabs. CONCLUSIONS: Age of smoking initiation is dependent on the ethnic background in which the smokers grow up, however, the influence of the father smoking seems to be similar in all population groups. It seems that a higher percentage of young adults started smoking at an early age and there is a decrease in smoking initiation at older ages in all ethnic groups.

Adult↗

PubMed2004

Multiethnic differences in smoking in Israel: pooled analysis from three national surveys.

BACKGROUND: Smoking is a major public health risk and information regarding high-risk groups is needed to plan, implement and evaluate interventions aimed at lowering the number of smokers. METHODS: During the years 1999-2001 data was collected regarding the smoking behaviour of the Israeli population in three national surveys. All three surveys included ages 25-64 and two included also ages 21-25 and over 64. RESULTS: Smoking was associated with age, sex, ethnicity, education and religiosity after adjusting for the various demographic characteristics of the survey population. The prevalence of smoking among Arab and immigrant men from the former Soviet Union is higher than among Jewish men. Among women the opposite association exists. The older, religious and more educated reported smoking less frequently. In the Jewish population respondents, defining themselves as secular, reported higher rates of smoking. Only in women was marital status associated with smoking. A few specific high-risk groups for smoking can be identified such as young, less educated men, Arab men, single Jewish women and young immigrant men and women. CONCLUSIONS: The three ethnic groups residing in Israel differ in the prevalence of smoking; each has a distinct pattern of smoking, positioning them at different stages within the conceptual framework of the larger smoking pandemic. Ethnicity, religiosity, age and education are associated with smoking in both sexes. This calls for specific tailored interventions aimed at younger men with less education, Arab men, and young immigrants.

Adult↗

PubMed2004

Perceptions of breast cancer among Arab Israeli women.

The incidence of breast cancer is increasing among Arab Israeli women, yet few Arab women over the age 50 take advantage of free mammography available to them. In this study we attempted to identify social and cultural aspects of the Arab Israeli woman's life that may reduce screening attendance for early detection of breast cancer. This qualitative study consisted of 6 focus groups. The fundamental theme identified as a barrier to prevention behavior was the role of the Arab woman in society expressed as marrying, having children and being totally committed to her family. In this model, without these roles her life is purposeless and her place in society is lost. The women perceived the chain of events that begins with screening for breast cancer as possibly resulting in cancer diagnosis and having breast cancer will lead to an inability to fulfill female roles. This feedback mechanism inherent in the chain of events may be the cause of the low rates of compliance in performing early detection and mammography. Interventions aimed at increasing the rate of Arab women's performance of mammography should take these issues into consideration.

Aged↗

PubMed2003

What lies behind the subjective evaluation of health status?

The evaluation of health or subjective health (SH) is considered a legitimate indicator of overall health status, providing a valid, reliable and cost-effective means of health assessment. This study looks at factors reported by respondents as influencing their SH, it analyzes to which extent people compare themselves with others when evaluating their health, and examines the difference between people with optimal or sub-optimal SH. Face-to-face interviews were conducted with 383 Israeli residents. Three models for judging health status were identified: the biomedical or disease oriented, the emotional or "general feeling", and the functional-related model. The reported influence of some factors for the evaluation of health changed by age and by level of subjective health. Respondents with sub-optimal health reported tiredness and pain as more influential. Most interviewees spontaneously reported comparing their health to reference groups. Age and level of subjective health were associated with the way people compare their health to others. The young reporting sub-optimal health did not compare themselves to people their age, but a high percentage of the old did so. Among those with excellent health, the young rather than the old were more likely to compare themselves to people their age. These findings imply that each individual tries to find ways to evaluate his/her health in a more positive light. When old and not healthy they tend to compare themselves to friends or people their age, but if young and not healthy they do not perform the comparison so as not to feel worse. Understanding how people evaluate their health can contribute to the conceptual development of subjective health.

Adult↗

PubMed2003

The association between counseling, sun protection, and early detection of skin cancer in middle-aged Israelis.

BACKGROUND: Healthcare professionals' counseling is expected to prompt primary and secondary prevention of skin cancer. In this study, we evaluated the association between counseling on skin cancer prevention and early detection and the recommended behaviors in middle-aged people. METHODS: A random national cross-sectional telephone survey of 793 Israeli residents, aged 45-75 years, was conducted. The interviewees reported healthcare professionals' counseling and self-reported behaviors associated with sun protection and early detection of skin cancer. RESULTS: Counseling on sun protection was reported by less than 10% of respondents. The presence of self-reported skin-cancer risk factors was significantly associated both with sun protection counseling and behavior. However, there was no association between sun protection counseling and behavior in a regression model. The rate of counseling on self-skin examination among respondents with self-reported skin-cancer risk factors was 17%. Early detection behaviors were significantly associated with practitioner's counseling on this issue. CONCLUSION: Healthcare professionals' counseling on secondary skin cancer prevention seems to have a greater impact on behaviors than primary prevention counseling in middle-aged people and calls for improvement of primary prevention by health care professionals.

Aged↗

PubMed2003

Consumer-oriented evaluation of health education services.

The objective of this study was to evaluate the effect of the presence of formal health education units in health plans on the health education reported by the consumer. The research consisted of interviews with health educators in the Israeli health plans and a random sample of telephone interviews with 793 Israeli residents between the ages of 45 and 75. The interviews with consumers included measures of counseling on smoking, physical activity, weight reduction, hypertension and diabetes. Two of the four Israeli health plans have formal health education units. After adjustment for other variables, however, the quality and quantity of counseling reported by the consumers does not differ, in most subjects, between health plans with or without health education units. The presence of a health education unit within a health plan had little effect on the counseling reported by the consumer. The reasons for and implications of the results are discussed.

Aged↗

PubMed2003

Health promotion partnerships in Israel: motives, enhancing and inhibiting factors, and modes of structure.

Multisectoral cooperation is an important strategy in working for health promotion. Fifty-two health professionals completed a questionnaire measuring factors motivating, enhancing and inhibiting partnerships. The respondents also reported the type or structure of the partnerships. The results indicated that partnerships were formed primarily in order to promote the project; however, previous positive experience with partnerships was also very important as a motivating force for joining partnerships. The three most important facilitating factors were related to project management: effective leadership, aims of the project, and sharing a vision and goals. The two most frequent items mentioned as very important barriers to partnerships were related to dysfunction of the steering committee. Two types or structures of partnerships were identified. The first was fragmental, where partnerships existed only at specific stages of the project; most respondents reported working within this structure. The second type was continuous, where partnerships existed through all the project's stages. Using multiple regression analysis we found that health staff (mainly nurses) worked more frequently in fragmental partnership structures than did health promotion and welfare workers. In addition, the more experienced the respondents, the less they worked in fragmental partnership structures. These results highlight the importance of acquiring skills for working in partnerships and indicate a need for guidelines to be agreed by the partners at the beginning of the working process.

Administrative Personnel↗