Search

Research across a number of different areas in psychology has long shown that optimism and pessimism are predictive of a number of important future life outcomes. Despite a vast literature on the correlates and consequences, we know very little about how optimism and pessimism change across adulthood and old age and the sociodemographic factors that are associated with individual differences in such trajectories. In the present study, we conducted (parallel) analyses of standard items from the Life Orientation Test (Scheier & Carver, 1985) in three comprehensive data sets: Two-wave data from both the Berlin Aging Study II (N = 1,423, aged 60-88; M = 70.4, SD = 3.70) and the Midlife in the U.S. Study (N = 1,810 aged 60-84; M = 69.12, SD = 6.47) as well as cross-sectional data from the Survey of Health, Aging, and Retirement (N = 17,087, aged 60-99; M = 70.19, SD = 7.53). Using latent change-regression models and locally weighted smoothing curves revealed that optimism is on average very stable after age 60, with some evidence in Survey of Health, Aging, and Retirement of lowered optimism in very old age. Consistent across the three independent studies, pessimism evinced on average modest increases, ranging between .25 and .50 SD per 10 years of age. Of the sociodemographic factors examined, higher levels of education revealed the most consistent associations with lower pessimism, whereas gender evinced more study-specific findings. We take our results to demonstrate that age-related trajectories and correlates thereof differ for optimism and pessimism. Older adults appear to preserve into older ages those levels of optimistic expectations they have had at 60 years of age and show only modest increases in pessimism. We discuss possible reasons for these findings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19., (© 2022. The Author(s).)

Objective: The Community Rehabilitation of Persons with Mental Health Disability Law (2000a) is one of Israel's most important pieces of social legislation. It grants persons with psychiatric disabilities the right to receive rehabilitation in the community. This article is a case study of the development and implementation of a policy that led to the Rehabilitation Reform and that has become an important component in Israel's comprehensive mental health reform. The purpose of the study was to review and analyze the law and its elements, examine its implementation during its first two decades of operation, and to identify the issues it faces entering its third decade of application., Method: The study examined the key components of the reform such as intended beneficiaries, financing, workforce, and services provided. It used Israel's official statistical data and drew upon a series of interviews with officials and experts on rehabilitation, mental health and social services., Results: In 2020, 30,000 persons were receiving community psychiatric rehabilitation services, constituting about one fifth of the estimated eligible population. In addition to the reform's achievements, this article also identifies a number of issues. Toward the end of the second decade, problems between the psychiatric Rehabilitation Unit and the mental health services became apparent., Conclusions and Implications for Practice: As the Rehabilitation Law enters its third decade, it is recommended to establish an independent committee of experts to examine needed modifications in light of the conclusions drawn about the first two decades of its implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dengue virus (DENV) is a mosquito-borne single-stranded RNA virus of the Flaviviridae family with four serotypes (DENV1, DENV2, DENV3, and DENV4) circulating many tropical and subtropical regions of the world. Endemic in more than 100 countries, DENV results in over 400 million cases annually, a subset presenting with severe or life-threatening illnesses such as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). While no specific treatments outside of supportive management exist, vaccines are an area of major research with two vaccines, Dengvaxia ® (CYD-TDV) and Denvax ® (TAK003), recently licensed for clinical use. CYD-TDV is highly efficacious in children 9 years or older who have had prior DENV infection due to the high risk of severe disease in seronegative children aged 2-5 years. Meanwhile, TAK003 has shown efficacy at 97.7% and 73.7% against, DENV2 and DENV1, respectively, in phase 3 clinical trials across Latin America and Asia in healthy children aged 4-16 with virologically confirmed dengue. Other vaccines including TV003 and TV005 continue to be developed across the world, with the hopes of entering clinical trials in the near future. We discuss the current state of vaccine development against dengue, with a focus on CYD-TDV and TAK003 as promising novel vaccines to target this neglected tropical disease (NTD)., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2023.)

Poor water dissolution of active pharmaceutical ingredients (API) limits the rate of absorption from the gastrointestinal tract. Increasing the pH of a solid form microenvironment can enhance the dissolution of weakly acidic drugs, but data on this phenomenon in a physiologically relevant bicarbonate media are lacking. In this paper, we examined the effect of a microenvironmental pH modulator (Na 2 HPO 4 ) on the dissolution of a Biopharmaceutics Classification System (BCS) class II free weak acid (ibuprofen) at biorelevant conditions, including an automatic bicarbonate buffering system, as well as in compendial (50 mM) and low-concentration (10 mM) phosphate buffers with no external pH control. The tablets of 200 mg ibuprofen with either Na 2 HPO 4 (phosphate formulation, PF) or NaCl (reference formulation, RF) were manufactured using a compression method. In a pH 2 simulated gastric fluid, only PF produced a transient supersaturation of ibuprofen, dissolving a fourfold higher drug amount than RF. In a bicarbonate-buffered simulated intestinal fluid with a dynamically controlled pH (5.7, 7.2, and 5.8 to 7.7 gradient), PF dissolved more drug within 30 min than RF (p ≤ 0.019). Of note, the use of a 50 mM phosphate buffer pH 7.2 provided opposite results-RF dissolved the API much faster than PF. Moreover, 10 mM phosphate buffers of pH 5.6 and 7.2 could neither maintain a constant pH nor mimic the bicarbonate buffer performance. In conclusion, the use of a bicarbonate-buffered intestinal fluid, instead of phosphate buffers, may be essential in dissolution tests of BCS class II drugs combined with pH modulators., (© 2022. The Author(s).)

Data from the national, longitudinal Mid-Life in the US (MIDUS) study were used to examine work alienation and its relationship to biological health as well as psychological and social functioning. The alienation measure focuses on the autonomy and creativity the work provides. We hypothesized that alienated work would have negative associations with each of the three domains: in biology, higher 'allostatic load' (biological dysregulation); in psychology, poorer cognitive performance; and socially, negative impacts on family life. The outcomes are generally as predicted, though there are notable differences for men and women.

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Several studies have revealed differences in rumen-located microbes between greatly efficient and inefficient animals; however, how the microbiota vary in the hind gastrointestinal tract (GIT) has only been sparsely explored and how they vary in the small intestine remains to be determined. We therefore sampled the microbiota of the duodenum, jejunum, ileum, colon, and colorectally-obtained feces, in addition to the rumen of 12 lambs that, in a residual feed intake trial, were found to be at either extreme of feed efficiency phenotypes. The 16S rRNA gene (V3-V4 region) profiles of all samples were analyzed and revealed unique microbiota in all GIT locations except the jejunum and ileum (ANOSIM > 0.2, < 0.001). Measures of β-diversity revealed greater dissimilarity between more anatomically distant GIT locations (e.g., Rumen-Duodenum, ANOSIM = 0.365, < 0.001; Rumen-Colon, ANOSIM = 1, < 0.001) with the nearest distal region typically more similar than the nearest proximal location. The relative abundances of 13 operational taxonomic units (OTUs) from the duodenum, jejunum, colon, and feces, as well as the rumen, differed between efficient and inefficient animals (Bonferroni corrected, < 0.05), while another 2 OTUs trended toward significance. These OTUs were classified as taxa with known roles in fibrolysis (Fibrobacteres, Ruminococcaceae, and Saccharofermentans) and others that are commonly associated with health (Bifidobacteriaceae, and Christensenellaceae) and dysbiosis (Proteobacteria). Our findings show biospatial delineations of microbiota throughout the GIT and suggest that feed efficiency extends beyond the rumen, transcending these regions, and involves increases in both rumen- and colon-located fibrolytic taxa, increases in bifidobacterial species in the small intestine, and reductions in small intestine and distal GIT-located Proteobacteria.

A recovery-oriented approach to mental health involves creating person centered services and enhancing engagement in psychiatric rehabilitation. Israel's Rehabilitation in the Community of Persons with Mental Disabilities Law is a progressive initiative that shifted the locus of psychiatric care to community care supporting individualized rehabilitation and recovery-oriented processes. Yet over a quarter of applicants do not implement their assigned rehabilitation plans and services. This qualitative study investigated reasons and experiences related to lack of utilization from applicants' perspectives. Fifteen service users were interviewed face to face in semi-structured interviews analyzed using Grounded theory approach. Seven categories emerged: (1) Lack of knowledge and orientation; (2) Negative perceptions about rehabilitation services (3) Lack of active participation/shared decision-making; (4) Not feeling heard by the committee; (5) Lack of congruence between participants' goals and committee's final decisions; (6) Lack of escorting professionals' competencies; and (7) Family members' influence. The results are interpreted at the structural and human process levels. Suggestions are provided for augmenting systemic procedures and human interactions processes.

Although a number of common reproductive disorders in livestock involve bacterial infection, very little is known about their normal vaginal microbiota. Therefore, we sought to determine the species composition of sheep and cattle vaginal microbiota. Twenty Rambouillet ewes and twenty crossbred cows varying in age and reproductive status were sampled by ectocervicovaginal lavage. We amplified and sequenced the V3-V4 region of the 16S ribosomal RNA (rRNA) contents yielding a total of 907,667 high-quality reads. Good's Coverage estimates indicated that we obtained data on 98 ± 0.01% of the total microbial genera present in each sample. Cow and ewe vaginal microbiota displayed few differences. Cow microbiota exhibited greater (P ≤ 0.05) α-diversity compared to the ewe microbiota. Both livestock species differed (P ≤ 0.05) from all previously reported vaginal communities. While bacteria were numerically dominant, Archaea were detected in 95% of cow and ewe samples, mainly of the order Desulfurococcales. Both ewes and cows were predominately colonized by the bacterial phyla Bacteroidetes, Fusobacteria, and Proteobacteria. The most abundant genera were Aggregatibacter spp., and Streptobacillus spp. Lactobacillus spp. were detected in 80% of ewe and 90% of cow samples, but only at very low abundances. Bacteria previously described from culture-based studies as common to the cow and ewe vaginal tract, except for Escherichia, were variably present, and only in low abundance. Ewe and cow pH differed (P ≤ 0.05), with means (±SD) of 6.7 ± 0.38 and 7.3 ± 0.63, respectively. In conclusion, 16S rRNA sequencing of cow and ewe vaginal ectocervicovaginal lavages showed that cow and ewe vaginal microbiota differ from culture-led results, revealing a microbiota distinct from previously described vaginal ecosystems.

Objective: Both higher levels of educational attainment and a strong sense of control over one's life independently predict better health and longevity. Evidence also suggests that these 2 factors may combine in multiplicative ways to influence subjective reports of health., Method: In the Midlife in the United States (MIDUS) national sample (N = 6,135; age = 25 to 75 years), we tested whether stronger beliefs of control over one's life would moderate the effect of education on 14-year mortality risk., Results: Proportional hazards modeling indicated that both current levels of education and control beliefs were associated with lower risk of dying, over and above childhood socioeconomic level. In addition, there was a significant interaction between education and control beliefs. Among those low in education, higher control beliefs were associated with a decreased mortality risk. However, at greater levels of education, control beliefs were not associated with mortality risk. This effect remained after adjusting for potential confounding variables, including health behaviors, depressed affect, and general health (chronic illnesses, functional limitations, and self-rated health)., Conclusions: These findings demonstrate the importance of individual perceptions of control in buffering the mortality risk associated with educational disadvantage.

The rumen microbial ecosystem is known for its biomass-degrading and methane-producing phenotype. Fermentation of recalcitrant plant material, comprised of a multitude of interwoven fibers, necessitates the synergistic activity of diverse microbial taxonomic groups that inhabit the anaerobic rumen ecosystem. Although interspecies hydrogen (H2) transfer, a process during which bacterially generated H2 is transferred to methanogenic Archaea, has obtained significant attention over the last decades, the temporal variation of the different taxa involved in in situ biomass-degradation, H2 transfer and the methanogenesis process remains to be established. Here we investigated the temporal succession of microbial taxa and its effect on fiber composition during rumen incubation using 16S rRNA amplicon sequencing. Switchgrass filled nylon bags were placed in the rumen of a cannulated cow and collected at nine time points for DNA extraction and 16S pyrotag profiling. The microbial community colonizing the air-dried and non-incubated (0 h) switchgrass was dominated by members of the Bacilli (recruiting 63% of the pyrotag reads). During in situ incubation of the switchgrass, two major shifts in the community composition were observed: Bacilli were replaced within 30 min by members belonging to the Bacteroidia and Clostridia, which recruited 34 and 25% of the 16S rRNA reads generated, respectively. A second significant shift was observed after 16 h of rumen incubation, when members of the Spirochaetes and Fibrobacteria classes became more abundant in the fiber-adherent community. During the first 30 min of rumen incubation ~13% of the switchgrass dry matter was degraded, whereas little biomass degradation appeared to have occurred between 30 min and 4 h after the switchgrass was placed in the rumen. Interestingly, methanogenic members of the Euryarchaeota (i.e., Methanobacteria) increased up to 3-fold during this period of reduced biomass-degradation, with peak abundance just before rates of dry matter degradation increased again. We hypothesize that during this period microbial-mediated fibrolysis was temporarily inhibited until H2 was metabolized into CH4 by methanogens. Collectively, our results demonstrate the importance of inter-species interactions for the biomass-degrading and methane-producing phenotype of the rumen microbiome-both microbially facilitated processes with global significance.

Since the year 2005, in the field of general medicine, the legislature in Israel determined ways to implement medically advanced directives according to the power of the law. Different states in the world had implemented parallel legislation for patients who suffer from mental illness. Psychiatric Advance Directives is a legitimate document which is valid in Australia, New Zealand, Scotland, England and in 25 countries in the U.S.A. Psychiatric advance directives (PAD's) allow competent persons, through advance instructions, to state their preferences for future mental health treatment in the event of an incapacitating psychiatric crisis. Self Determination Theory, Self Care and Autonomy are dominant supportive approaches in the creation of Psychiatric Advance Directives. Research conducted on psychiatric advance directives shows positive potential benefits for mental health clients, therapists and psychiatrists. More research in that area must be conducted. Psychiatric advance directives are currently developed and implemented with the cooperation of the Tauber Foundation and the Beer Sheva Mental Health Center. This is the first step in learning of effective ways to use this intervention in Israel and change perceptions toward a positive connection between medical efficiency and client preferences.

Cardiac vagal control (CVC), an index of parasympathetic contribution to cardiac regulation, has been linked to enhanced executive functioning (EF). However, findings to date have been based on small or unique samples. Additionally, previous studies assessed the CVC-EF link only during rest or recovery period from a cognitive challenge, but not during both states. In the present study, data on 817 socioeconomically diverse participants were obtained from the Midlife Development in the United States (MIDUS) study. As part of this study, participants completed cognitive tests, including EF, along with laboratory-based measures of CVC during rest and following recovery from a cognitive challenge. Regression analyses adjusting for respiratory rate revealed no effect of CVC at rest or during recovery on a global index of EF. However, exploratory post-hoc analyses of the components of the global EF index revealed a significant association between faster vagal recovery and better attention-switching and response inhibition abilities, as indexed by faster reaction time to the mixed SGST. This association remained significant after controlling for demographic, clinical (BMI, diseases and medications altering cardiac autonomic functioning, etc.), and health behavior covariates (Beta = .148, p = .010). Our findings suggest that future studies may need to investigate the links of CVC to specific EF abilities, rather than global measures of EF. Additionally, our results highlight the importance of assessing CVC during both rest and recovery from a cognitive challenge. The authors discuss the putative neurobiological underpinning of this link, as well as suggestions for future basic and clinical research., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the value of viscosity measured with ultrasonographic (US) elastography in liver fibrosis staging and to determine whether the use of a viscoelastic model to estimate liver elasticity can improve its accuracy in fibrosis staging., Materials and Methods: The study, which was performed from February 2010 to March 2011, was compliant with HIPAA and approved by the institutional review board. Written informed consent was obtained from each subject. Ten healthy volunteers (eight women and two men aged 27-55 years) and 35 patients with liver disease (17 women and 18 men aged 19-74 years) were studied by using US elasticity measurements of the liver (within 6 months of liver biopsy). US data were analyzed with the shear wave dispersion ultrasound vibrometry (SDUV) method, in which elasticity and viscosity are measured by evaluating dispersion of shear wave propagation speed, as well as with the time-to-peak (TTP) method, where tissue viscosity was neglected and only elasticity was estimated from the effective shear wave speed. The hepatic fibrosis stage was assessed histologically by using the METAVIR scoring system. The correlation of elasticity and viscosity was assessed with the Pearson correlation coefficient. The performances of SDUV and TTP were evaluated with receiver operating characteristic (ROC) curve analysis., Results: The authors found significant correlations between elasticity and viscosity measured with SDUV (r = 0.80) and elasticity measured with SDUV and TTP (r = 0.94). The area under the ROC curve for differentiating between grade F0-F1 fibrosis and grade F2-F4 fibrosis was 0.98 for elasticity measured with SDUV, 0.86 for viscosity measured with SDUV, and 0.95 for elasticity measured with TTP., Conclusion: The results suggest that elasticity and viscosity measured between 95 Hz and 380 Hz by using SDUV are correlated and that elasticity measurements from SDUV and TTP showed substantially similar performance in liver fibrosis staging, although elasticity calculated from SDUV provided a better area under the ROC curve.

Objective: To assess the effectiveness of psychiatric clinical case management., Method: Subjects with at least three admissions in the previous 2 years were randomized into a clinical case management group (CMG; n = 122) and a standard care group (SCG; n = 95). Individuals who refused or were not located were included in a third, non-randomized no-treatment group (NTG; n = 153). Parameters assessed included utilization of in-patient services and psychosocial functioning., Results: We found no difference between the CMG and the SCG in psychosocial functioning as evaluated by interviewers, and no difference between the three groups in hospitalization. In subjects' self-ratings, the CMG showed slight improvement in psychosocial functioning., Conclusion: Clinical case management did not prove itself superior to standard care in a revolving door population.

We examined the public's preferences regarding the site of provision of mental health care and the basis for those preferences. A representative sample of the adult Israeli population (N = 1,583) was interviewed by telephone about their knowledge and attitudes. Self-referral to mental health professionals and primary medical doctors for milder disorders was low. Psychiatric clinics were preferred by 46% of the public; 35% preferred the general clinics, and the remaining 19% were indifferent. Quality of care was noted by 78% of respondents for their preference for psychiatric clinics. General hospitals were preferred for psychiatric inpatient care by 51% of the respondents compared to 23% who opted for psychiatric hospitals. Despite reasonable familiarity with mental health care, one-third of the respondents did not know whether there was a clinic in their neighborhood. Implications for action are discussed in light of the transfer of responsibility for psychiatric care from the Ministry of Health to the health maintenance organizations

Mental health-related stigma causes suffering and interferes with care and social inclusion. This study explored stigma as experienced by mental health service users. Particular attention is given to their use of coping mechanisms. Interviews were held with 167 adults undergoing outpatient psychiatric treatment; two-thirds of them had previously been hospitalized. Examples of frequency of stigma-related situations included the following: Over half of service users expect people to refuse to have a person with a mental disorder as a co-worker or neighbor, or to engage in other types of social contact. A sizeable group acknowledged that they feared or had experienced rejection. A third of respondents reported they feared or had experienced inappropriate treatment by their doctor. Service users utilize several coping mechanisms to deal with stigma, among them: education, withdrawal, secrecy, and positive distinctiveness. Although we studied a convenience sample of service users, our findings provide sufficient basis to suggest different types of intervention, i.e., to address stigma in the course of treatment in the specialist settings, to promote the establishment of mutual support groups, and to raise family physicians' awareness with regard to the stigma that may be present when caring for persons with mental disorders.

Major recent conceptual and legal advancements in Israel have generated a profound shift in the services provided for people with severe mental illness. Perhaps the most influential development has been the passage of the act for the rehabilitation of persons with a psychiatric disability in the community in the year 2000. In this paper we argue that the psychiatric rehabilitation services defined by the recent legislation lack explicit standards or criteria for selection, and thus could benefit from incorporating interventions that evidence has shown to be effective in assisting clients to achieve desirable outcomes. We propose a practical five-step plan to facilitate the implementation of these evidence-based practices including creating demand, selecting the EBPs, preparing practitioners and agencies, monitoring and feedback, and ensuring sustainability. The importance of an ongoing dialogue between stakeholders to facilitate the integration of research evidence, clinical expertise and rehabilitation values to improve the quality of service is discussed.

Objectives: This study examined the relationship between the SES level of localities and psychiatric hospitalization measures to determine the SES place in the planning of mental health services., Methods: The unit of analysis in this study was the city. Data collected from Central Bureau of Statistics (CBS), the National Insurance Institute and the national psychiatric hospitalization case register were used to investigate the association of SES for each city, the number of disability pension recipients for each city and the hospitalization measures: admission rates, length of inpatient episode and the length of tenure in the community., Results: The socioeconomic level of cities correlated significantly with the number of disability pension recipients in each city and the hospitalization measures: admission rates, length of inpatient episode and the length of tenure in the community. However, the relationship between the SES and both the psychiatric admission rates and the psychiatric disability rates differed between the lower and the higher parts of the SES scale: Both measures went up as the SES went up from level 1 to level 3 and went down as the SES level went up from level 4 to level 8., Conclusions: The demand for psychiatric hospitalization was higher in the poorer communities. Reaching equity in distributing community public mental health resources seems to be not only more appropriate but also more cost-effective.

This report describes a supported education program (SEP), a novel community-based program of rehabilitation for psychiatric patients, started in Israel in 1999. Objectives, target population and activities are described. In addition, initial findings of two program-related studies are presented. One study explored the relationship of psychological distress with students' coping strategies and perceived social support. The second study is a survey of mental health literacy and attitudes of heads of schools for adult education where the SEP was implemented. Studies' findings suggested a "case for action" with the following objectives: to develop interventions to prevent distress among SEP users, and to enhance mental health knowledge and foster positive attitudes among school personnel aimed at decreasing dropout rates and encourage the utilization of the opportunities provided by SEP.

Over the last two decades there has been growing interest in the subjective experiences of persons with severe mental illness (SMI). Despite this interest, little research has been carried out to understand whether and how such experiences are related to the course of SMI. In addition, few psychotherapeutic and rehabilitation interventions have been developed especially for persons with SMI that seriously take these persons' subjective experiences into account. In the present paper we discuss why the use and investigation of the subjective experience of people with SMI has been neglected, and we point out the potential importance of this experience. We then review the growing literature that focuses on the subjective experience of (1) the illness, (2) the self, and (3) the self as influenced by the social context of persons with SMI. Finally, the implications of this review for rehabilitation, recovery and research are discussed.

Israel has launched its program for Psychiatric Reform. However, the implementation of its three areas of action, as the Reform has been conceived thus far, is uneven. While the development of the rehabilitation component has progressed as planned, the one that refers to the insurance component remains stalled. The third one, dealing with dehospitalization and community care, has advanced only in part. Although many of the issues related to the three components of the Reform, of a curative and rehabilitative nature, have been adequately addressed, some crucial aspects are still awaiting a more extensive discussion by all mental health stakeholders. This paper reviews some value-laden and scientific issues as well as strategic measures that are suggested to be taken into account in a forward-looking and democratic Reform. Examples of these issues are: the quest for equity, at the time when the poor population is increasing in the country; scientific issues (e.g., the application of epidemiological data in planning for community needs, training for community-based personnel), that if left aside bear the risk of undermining the depth of the Reform; and strategic measures, purported to recruit the support of professionals and the general public that is essential in a movement that thrives on inclusion and promotes community-based care.

Objectives: Stigma constitutes the hidden burden of mental disorders. Its ubiquitous presence may be reinforced by iatrogenic factors, such as the terms used to name mental disorders and disability. This preliminary study examines opinions with regard to the use of these terms in Hebrew., Methods: Two samples of convenience, mental health professionals (n=330) and service users (n=75), were asked to complete a self-administered questionnaire about their respective acceptance of the current term in use to name psychiatric disorders and disability, as well as their preference for alternative terms that may carry a lesser degree of stigma. The distribution of responses was compared within and between these two groups., Results: There was consensus in both groups that a substantial proportion of service users reject the current term used to name mental disorder, mahalat nefesh (disease of the soul). Mental health professionals had a statistically significant acceptance of this term compared to service users. The term hafra'a nafshit (disorder of the soul) was reported to carry a lesser degree of stigma. No specific term was selected by more than a third of the respondents to best define disability resulting from a psychiatric disorder., Conclusion: A case for study and possible subsequent action was established by this pilot inquiry.

Background: Despite mounting evidence that breast tumors in African-American (AA) women are more aggressive compared with breast tumors in white (W) women, little is known regarding racial/ethnic differences in genetic alterations that may be of prognostic importance., Methods: In this population-based cohort of 322 AA women (45%) and W women (55%) who were diagnosed with breast carcinoma between 1987-1989, the authors evaluated available archived tumor tissue (n = 247 samples) for racial differences in selected genetic alterations and other prognostic indicators. Tumor characteristics were assessed by immunohistochemistry and/or expert review., Results: Alterations in p53 were significantly more common in AA women compared with W women (odds ratio, 4.00; 95% confidence interval, 1.77-9.01) and remained statistically significant in models that were adjusted for disease stage at diagnosis, according to American Joint Committee on Cancer (AJCC) criteria, and for other prognostic indicators. No racial difference with regard to HER-2/neu status was observed, but alterations in c-met were more common in AA women once the model was adjusted for negative confounders (not significant). Among other tumor characteristics, significant findings included later AJCC stage and higher histologic and nuclear grade tumors in AA women. In addition, the burden of aggressive tumor characteristics was greater in AA women because they were more likely to be at high risk on multiple factors (e.g., both high histologic grade and high nuclear grade [P = 0.03] and negative status for both estrogen receptors and progesterone receptors [P = 0.01])., Conclusions: Data from this population-based cohort confirmed that breast tumors in AA women most likely are more aggressive compared with breast tumors in W women and offer new evidence for possible racial/ethnic differences with regard to p53 alterations., (Copyright 2004 American Cancer Society.)

The study examined the social, personality, and cognitive correlates of self-reported future planning and the relationship of future planning to perceived control and life satisfaction. Using 2 probability samples of adults ages 25-74 (n = 2,971, n2 = 300) findings suggest, for Study 1, that education, income, social support, predictability, Conscientiousness. and Openness to Experience were positively related to future planning, whereas Neuroticism and Agreeableness were negatively related. Men were more future oriented; as age increased, future planning decreased. Study 2 replicated the findings with the exception of age, Agreeableness, and Neuroticism. For both studies, results supported a model in which the effects of future planning on life satisfaction were mediated by sense of control. A Planning x Age interaction for Study I indicated that although self-reported future planning decreased with age, the positive effects of future-oriented planning strategies on life satisfaction were most pronounced for the older adults, and this relationship was also mediated by control beliefs.

The study examined the relation among three types of control strategies (persistence, positive reappraisals, lowering aspirations) and subjective well-being across adulthood (N = 3,490). Specifically, the authors investigated whether age-adapted endorsement of control strategies is conducive to subjective well-being if individuals experience health or financial stress. The results reveal an overall enhanced reliance on control strategies in older as compared with younger adults. In addition, persistence showed a stronger positive relation to subjective well-being in young adulthood as compared with old age. In midlife and old age, positive reappraisals had a stronger positive relation to subjective well-being than persistence. Lowering aspirations was negatively related to subjective well-being, independent of age. Age differences in the relation of control strategies to subjective well-being were particularly salient in individuals who faced either health or financial stress.

Objectives: This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities., Methods: A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness., Results: High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6-month follow-up. No adverse health effects were encountered., Conclusions: These findings provide important evidence that home-based resistance exercise programs designed for older persons with disabilities hold promise as an effective public health strategy.

Past research has focused on general control beliefs with little attention to whether control beliefs vary across domains. Also, most age-comparative studies have examined control beliefs in younger and older adults but not in middle-aged adults. This study examined assessments of control in 7 domains for a large probability sample of adults 25-75 years in age. Results revealed differential age patterns across domains: Increases in control by age were found for control over work, finances, and marriage, whereas decreases were found for control over relationship with children and sex life. Control beliefs in some domains also varied by gender and education, but the age patterns were consistent across these sociodemographic groups. Domain-specific control beliefs were significantly related to a variety of domain-relevant experiences and outcomes.

A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.

With a sample survey (N = 266) of elderly adults residing in six housing developments in Massachusetts, we used logistic regression to: (a) identify covariates of fear of falling among all subjects and (b) identify covariates of activity curtailment among the subset of subjects who were afraid of falling. Fifty-five percent of respondents were afraid of falling; of those who were afraid, 56% had curtailed activity due to this fear. Factors associated with fear of falling were: being female, having had previous falls, and having fewer social contacts. Factors associated with activity curtailment among those who were afraid were: not communicating about falls; having less social support; and knowing someone who had fallen. Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.

This study identified factors associated with exercise participation and adherence in a sample of 102 sedentary, functionally limited, community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program. Stepwise regression analyses revealed that baseline physical factors (i.e., higher levels of mobility, weaker muscle strength, and fewer numbers of new medical conditions) were associated with higher rates of participation in the home program. Positive attitudes and a sense of control toward exercise, lower levels of confusion and depressive moods, and the development of fewer new medical problems during the program were related to higher levels of adherence to the program. Findings revealed that although physical health variables were the primary indicators of an older person's overall participation in the program, it was the psychological factors that were most important to adherence to this home-based program.

Objectives: Correlation of cervical smears and biopsy samples emphasizes the significance of atypical squamous cells of undetermined significance as a diagnostic category., Study Design: A retrospective study (October 1, 1995-March 21, 1997) was performed on all Papanicolaou smears diagnosed at DIANON Systems, Inc (Stratford, Conn)., Results: During this period 1551 patients with Papanicolaou smears had subsequent cervical biopsies performed within 90 days of cytologic sampling. There were 560 diagnoses of atypical squamous cells of undetermined significance. Tissue specimen results were positive in 203 cases (36.2%) and negative in 357 cases (63.8%). Of the positive biopsy results after a smear with atypical squamous cells of undetermined significance, 109 showed low-grade squamous intraepithelial lesions and 94 showed high-grade squamous intraepithelial lesions., Conclusions: This study, the largest cytologic and histologic correlation of atypical squamous cells of undetermined significance, demonstrates that a significant percentage of smears with atypical squamous cells of undetermined significance represent squamous intraepithelial lesions and that qualification of atypical squamous cells of undetermined significance as reactive or dysplastic is useful and should serve as a guide for patient management.

The authors examined social class differences in 2 aspects of the sense of control (mastery and perceived constraints) in 3 national probability samples of men and women ages 25-75 years (N1 = 1,014; N2 = 1,195; N3 = 3,485). Participants with lower income had lower perceived mastery and higher perceived constraints, as well as poorer health. Results of hierarchical multiple regression analyses showed that for all income groups, higher perceived mastery and lower perceived constraints were related to better health, greater life satisfaction, and lower depressive symptoms. However, control beliefs played a moderating role; participants in the lowest income group with a high sense of control showed levels of health and well-being comparable with the higher income groups. The results provided some evidence that psychosocial variables such as sense of control may be useful in understanding social class differences in health.

During the period between February 1996 and August 1997 51 infertile men were operated. The authors evaluate the results from 47 couples--25 cases of testicular azoospermia and 22 cases of obstructive azoospermia. The mean age of the men in the group was 33 years (22-48 years). The follow-up period is 1-18 months. In 17 cases, microsurgical epididymal sperm aspiration (MESA) was made, in five cases testicular sperm aspiration (TESA) and in 25 men, testicular sperm extraction (TESE) was performed. In the group with testicular azoospermia it proved possible to obtain sperm in 12 of 25 cases, i.e. in 48%. In men with obstructive azoospermia all aspirations were successful, i.e. the yield was 100%. In this group five children were born, seven pregnancies are under way. Thus regardless of the etiology of male infertility 12 of 47 cases, i.e. 25.5% were resolved successfully. When the results of the two groups are differentiated, the outcome is as follows: in the group with testicular azoospermia one child was born and two pregnancies are under way, i.e. 12%, in the group with obstructive azoospermia four children were born and five pregnancies are under way, i.e. 40.9%.

A new instrument was developed to assess the role of fear of falling in activity restriction. The instrument assesses fear of falling during performance of 11 activities, and gathers information about participation in these activities as well as the extent to which fear is a source of activity restriction. The instrument demonstrated good internal consistency reliability and showed convergent validity with other fear of falling measures. Concurrent (empirical) validity was demonstrated in that the scale was effective in differentiating among those who were expected to be afraid vs. not afraid of falling. Criterion validity was examined in relation to quality of life variables. Fear of falling was shown to be related to lower quality of life, even when controlling for related background factors. One advantage of this measure over existing measures is the possibility for differentiating fear of falling that leads to activity restriction from fear of falling that accompanies activity. This may provide useful information for those interested in treating fear of falling of promoting activity among the elderly.

A one-year study of 51 infertile couples, 47 couples evaluated--25 cases of testicular azoospermia and 22 cases of obstructive azoospermia. The mean age of the men in the group is 33 years (22-48 years). The follow-up period is 1-18 months. In 17 instances microsurgical epididymal sperm aspiration--MESA was made, five times testicular sperm aspiration--TESA and in 25 men testicular sperm extraction--TESE was used. In the group with testicular azoospermia it proved possible to obtain sperm in 12/25 cases, i.e. in 48%. In men with obstructive azoospermia all aspirations were successful, i.e. the yield was 100%. In this group five infants were born, another seven pregnancies are under way. Thus regardless of the etiology of male infertility 12/47 cases, i.e. 25.5%, were successfully resolved. When using differentiated evaluation of the two groups the results are as follows: in the group with testicular azoospermia one infant were born and five pregnancies are under way, i.e. 40.9%.

The relation between control beliefs and recall of spoken word lists and prose passages was assessed for 32 older adults, ages 62 to 85, in a task where they were given control over presentation of stimuli. They differed in the degree to which they believed that factors within their control (internals) or outside their control (externals) affected their intellectual functioning; they were similar in age, education, vocabulary, and digit span. They were required to stop the speech input at points of their own choosing to recall the stimuli on a segment-by-segment basis. Externals were more likely than internals to make inaccurate predictions of the number of words they could remember and to choose longer segments than they could recall. Results suggest that externals are poorer than internals in monitoring on-line memory processing.

Objective: Helicobacter pylori is a surface bacterium associated with gastritis. The triple stain (TS), combining silver, hematoxylin and eosin, and alcian blue at pH 2.5, is valuable in the detection of H pylori in tissue. We evaluated the usefulness of TS as compared with Papanicolaou stain in detecting H pylori in gastric brushings and biopsy specimens., Study Design: Gastric brushings and biopsy specimens were obtained from 21 patients. The Papanicolaou-stained slides were restained with TS, and the brushings and biopsy specimens were independently evaluated by the authors., Results: H pylori was found in 9 of 21 randomly selected cases using TS. Of these, two cases were positive on brushings alone and three on biopsy alone. Only three of the nine cases were positive by Papanicolaou stain. None of the 21 samples were positive with Papanicolaou stain yet negative with TS. Detection of H pylori was restricted to patients with gastric ulcerations but was not limited by paucity of glands., Conclusion: TS is useful for detecting H pylori in gastric brushings and provides excellent cytologic detail. Furthermore, TS is superior to Papanicolaou stain for H pylori detection and is a valuable adjunct to biopsy.

We examined three community samples to determine whether stressful episodes form a context for the development of coping resources in adulthood. The first study found that 81.9% of a sample of 845 older men reported drawing upon prior experiences in coping with a recent problem. Content analysis revealed that only 22.7% drew upon similar stressful episodes; the rest drew upon problems from work, the military, illnesses, deaths, etc. The second study replicated the earlier findings in 102 men and women, ages 24 to 84, who reported on a recent low point in semistructured interviews. In addition, 75% reported long-term effects, equally split between negative, positive, and mixed effects. Those individuals who perceived advantages from the low point were significantly more likely to report positive long-term effects. The third study replicated the findings from the first two studies in a sample of 941 men and women ages 23 to 62. Path analyses showed that coping strategies differentially predicted perceived positive or negative outcomes, which in turn predicted current mastery and depression levels. While the findings are cross-sectional and causality cannot be inferred, they are nonetheless supportive of the effects of stress and coping on personality.

This study examined the effects of list-making, and specific aspects of list-making such as intent (whether one expects to refer back to one's list at the time of recall) and organization, on memory performance in young and old adults. Young and old adults were randomly assigned to a list-making or a non-list-making condition. In both conditions, subjects performed two memory tasks in which they were presented with a word list followed by written recall and recognition tests. On one task, subjects were informed that they would not be allowed to refer to the list at the time of testing (internal-intent). On the other task, subjects were informed that they would be allowed to refer back to the list (external-intent), but actually were not allowed to. Planned comparisons found that list-making significantly improved older adults' performance on the recall tasks. Additionally, while the old performed significantly worse than the young in the non-list-making internal-intent recall task (the traditional memory test condition), these significant differences were not found on either of the list-making recall tasks. Both young and old list-makers who spontaneously organized their lists while studying the words recalled more items than subjects who did not organize their lists. These findings suggest future directions for both theoretical and applied research in the area of memory and aging.

Objectives: This paper describes a videotaped, home-based, strength training program, titled Strong-for-Life and reports on its effectiveness in improving muscle strength, psychological well-being, and health status in a sample of older persons., Design and Setting: We enrolled 102 nondisabled, community-dwelling older people aged 66 to 87, identified from the Medicare beneficiary list, into a randomized, controlled trial., Measurements: Effectiveness was based on change in isokinetic upper and lower extremity muscle strength, psychologic well-being, and health status., Results: Results revealed several statistically significant short-term benefits after 12 to 15 weeks of exercise, especially for men. Younger older adults demonstrated a 10% improvement in knee extensor strength relative to control subjects. Older male exercisers achieved significant differences relative to controls in perceived anger, tension, and overall social functioning. Male exercisers, in general, achieved significant improvement in perceived vigor. Women did not report psychological benefits following participation in the program., Conclusion: Study results reveal that the Strong for Life program, designed to be widely disseminated to the nondisabled older population, has many short-term positive benefits.