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Shiri Shinan-Altman,1 Perla Werner2 1The Louis and Gabi Weisfeld School of Social Work, Faculty of Social Sciences, Bar Ilan University, Ramat Gan, Israel; 2Department of Community Mental Health, University of Haifa, Haifa, Israel Abstract: As the number of persons with dementia grows, an increasing number of families, professionals, and laypersons will come into contact with persons with cognitive deterioration. Assessing dementia illness representations (IRs) among these groups may have great importance for understanding their responses to dementia. The purpose of this study was to summarize and critically review the literature on dementia IRs. A total of 25 articles that satisfied the inclusion criteria were identified. The review revealed that conceptually, research attention on dementia IRs has increased over the past several years as a result of changes in the notion of IRs and in the dementia discourse. Regardless of the population examined, dementia was mostly described as a chronic condition, presenting more cognitive than behavioral symptoms, and as being caused mainly by age, heredity, and abnormal brain changes. Methodologically, the area of dementia IRs is characterized by design, sample, and data collection weaknesses. Findings suggest that although the literature in the area of dementia and IRs is increasing, several conceptual and methodological limitations still have to be resolved in order to advance knowledge in the area. The research and clinical implications of these findings stress the importance of IRs in the area of dementia. Keywords: dementia, illness representations, scoping review

Background: Nursing aides' attitudes to elder abuse may serve as predictors of a proclivity to it, and may be influenced by cultural and situational context such as immigration. The purpose of the current study was to examine attitudes to elder abuse in three groups of Israeli nursing aides, namely veteran Israeli Jews, Israeli Arabs, and new immigrants, and their associations to demographic and work-related factors.Methods: 188 nursing aides (31 veteran Israeli Jews, 38 Israeli Arabs, 119 new immigrants) at 18 nursing homes in Israel completed questionnaires on work stressors, attitudes to elder abuse, sociodemographic and work-related characteristics, and the Maslach Burnout Inventory.Results: New immigrant nursing aides reported a higher tendency to condone abusive behaviors than did veteran Jewish and Arab nursing aides. Some 23% of the variance in attitudes was explained by group, demographics, work stressors and burnout. Greater condoning of elder abuse was associated with belonging to the new immigrant group, being unmarried and reporting higher work stressors. There was an interaction effect of work stressors × group, indicating that higher work stressors were related to a stronger tendency to condone elder abuse in the new immigrant group than in the veteran Jewish and Arab groups. Burnout was correlated with greater condoning of elder abuse; this association was not significant when the other variables were controlled for in the regression analysis.Conclusions: Attitudes condoning elder abuse are related to work stressors, and may be accelerated by the additional stressors on new immigrant nursing aides. Careful planning of the professional guidance and support given to new immigrant nursing aides is important. [ABSTRACT FROM AUTHOR]

Background: The rising incidence of cancer has led to an increased number of adult children impacted by parental cancer. Previous research primarily focused on younger individuals, leaving a gap in understanding the experiences of adult children aged 20-35., Objectives: To examine a model that integrates the interrelationships among the disease's characteristics (i.e., disease stage), illness representations, coping strategies, and posttraumatic growth (PTG) in young adults with parents diagnosed with cancer. In addition, we examined indirect relationships involving illness representations as independent variables, coping strategies as mediators, and PTG as the outcome variable., Purpose: The rising incidence of cancer has led to an increased number of adult children impacted by parental cancer. Previous research primarily focused on younger individuals, leaving a gap in understanding the experiences of adult children aged 20-35. This study examines a model that integrates the interrelationships among the disease's characteristics (i.e., disease stage), illness representations, coping strategies, and posttraumatic growth (PTG) in young adults with parents diagnosed with cancer. In addition, we examined indirect relationships involving illness representations as independent variables, coping strategies as mediators, and PTG as the outcome variable., Methods: A cross-sectional survey was conducted with 109 adult children (ages 20-35) of cancer patients. Data were collected using the Posttraumatic Growth Inventory, the Brief Illness Perception Questionnaire, and the COPE questionnaire. Path analysis was performed to test the study's hypotheses., Results: The findings revealed that illness representations and coping strategies accounted for significant variance in PTG. Higher perceived severity of the parent's illness was associated with greater use of problem-focused and emotion-focused coping strategies, which were linked to higher PTG. Lower perceived control over the illness was associated with less use of problem-focused coping and subsequently lower PTG., Conclusions: This study underscores the importance of subjective perceptions and coping strategies in fostering PTG among young adults with parents diagnosed with cancer. The findings highlight the need for tailored psychosocial interventions to enhance adaptive illness representations and effective coping strategies, promoting resilience and growth in this unique demographic.

Background: This study examines the experiences of diabetic patients who were displaced during the Israel-Hamas conflict, highlighting the substantial challenges they face in managing their health under these circumstances., Methods: A qualitative-phenomenological approach was employed, focusing on the experiences of 14 individuals with diabetes who were displaced during the conflict. Data were collected through semi-structured interviews and subsequently subjected to content analysis., Results: Three central themes emerged: (1) "I left without clothes and medications": Participants described the chaotic evacuation process and the difficulty in maintaining diabetes care without their supplies. (2) "Dual coping": Participants struggled with managing their diabetes while adapting to new, temporary living conditions that disrupted their care routines. (3) Seeking inner resilience while drawing strength from external support: This theme reflected the importance of internal resilience and support from family, friends, and healthcare professionals in coping with health management and displacement challenges., Conclusions: The study underscores the significant challenges diabetes patients face during conflict evacuation, including disruptions in their routine care, heightened psychological stress, and the essential role of support systems. These findings underscore the need for emergency preparedness plans to ensure continuity of care for patients with chronic conditions during crises., (© 2024. The Author(s).)

Objective: Suicide is a critical global health concern. Research indicates that generative artificial intelligence (GenAI) and large language models, such as generative pretrained transformer-3 (GPT-3) and GPT-4, can evaluate suicide risk comparably to experts, yet the criteria these models use are unclear. This study explores how variations in prompts, specifically regarding past suicide attempts, gender, and age, influence the risk assessments provided by ChatGPT-3 and ChatGPT-4., Methods: Using a controlled scenario based approach, 8 vignettes were created. Both ChatGPT-3.5 and ChatGPT 4 were used to predict the likelihood of serious suicide attempts, suicide attempts, and suicidal thoughts. A univariate 3-way analysis of variance was conducted to analyze the effects of the independent variables (previous suicide attempts, gender, and age) on the dependent variables (likelihood of serious suicide attempts, suicide attempts, and suicidal thoughts)., Results: Both ChatGPT-3.5 and ChatGPT-4 recognized the importance of previous suicide attempts in predicting severe suicide risks and suicidal thoughts. ChatGPT-4 also identified gender differences, associating men with a higher risk, while both models disregarded age as a risk factor. Interaction analysis revealed that ChatGPT-3.5 associated past attempts with a higher likelihood of suicidal thoughts in men, whereas ChatGPT-4 showed an increased risk for women., Conclusions: The study highlights ChatGPT-3.5 and ChatGPT-4's potential in suicide risk evaluation, emphasizing the importance of prior attempts and gender, while noting differences in their handling of interactive effects and the negligible role of age. These findings reflect the complexity of GenAI decision-making. While promising for suicide risk assessment, these models require careful application due to limitations and real-world complexities., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Objective: This article uses the framework of Schwartz's values theory to examine whether the embedded values-like profile within large language models (LLMs) impact ethical decision-making dilemmas faced by primary care. It specifically aims to evaluate whether each LLM exhibits a distinct values-like profile, assess its alignment with general population values, and determine whether latent values influence clinical recommendations., Methods: The Portrait Values Questionnaire-Revised (PVQ-RR) was submitted to each LLM (Claude, Bard, GPT-3.5, and GPT-4) 20 times to ensure reliable and valid responses. Their responses were compared to a benchmark derived from a diverse international sample consisting of over 53,000 culturally diverse respondents who completed the PVQ-RR. Four vignettes depicting prototypical professional quandaries involving conflicts between competing values were presented to the LLMs. The option selected by each LLM and the strength of its recommendation were evaluated to determine if underlying values-like impact output., Results: Each LLM demonstrated a unique values-like profile. Universalism and self-direction were prioritized, while power and tradition were assigned less importance than population benchmarks, suggesting potential Western-centric biases. Four clinical vignettes involving value conflicts were presented to the LLMs. Preliminary indications suggested that embedded values-like influence recommendations. Significant variances in confidence strength regarding chosen recommendations materialized between models, proposing that further vetting is required before the LLMs can be relied on as judgment aids. However, the overall selection of preferences aligned with intrinsic value hierarchies., Conclusion: The distinct intrinsic values-like embedded within LLMs shape ethical decision-making, which carries implications for their integration in primary care settings serving diverse populations. For context-appropriate, equitable delivery of AI-assisted healthcare globally it is essential that LLMs are tailored to align with cultural outlooks., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Authors. Published by Elsevier Ltd.)

We examined differences between social workers in hospitals versus social workers in community health services regarding levels of professional quality of life (ProQoL), proximity to COVID-19, resilience, perceived social support, and preparedness for the next pandemic during waves 3-5 of the COVID-19 pandemic in Israel (December 2020-December 2021, the main COVID-19 variants were Alpha and Delta). We also examined the moderating role of resilience, social support, preparedness for the next pandemic, and health care service type in the association between proximity to COVID-19 and ProQoL. Participants were 163 social workers from four hospitals and 98 social workers from a major health maintenance organization in the community. Social workers in both settings revealed moderate-high levels of compassion satisfaction and moderate levels of burnout and secondary traumatic stress. The study's model indicated that after controlling for the effects of the covariates, higher levels of self-reported-resilience and greater perceived organizational support were associated with higher compassion satisfaction and lower burnout and secondary traumatic stress. Furthermore, a stronger sense of preparedness for the next pandemic was related to lower levels of burnout. The model indicated that the effects of organizational support, informal social support, and preparedness on compassion satisfaction were dependent on the study group (i.e., working in hospital or community settings). Findings indicate that intervention programs should be implemented to help increase compassion satisfaction and prevent/reduce burnout and secondary traumatic stress among social workers in health care settings during health care crises. Enhancing resilience and preparedness should focus not only on the social workers as individuals but also on the institutions for which they work. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This study sought to examine gender differences in emotional reactions and compliance with Ministry of Health (MOH) guidelines during the COVID-19 pandemic in Israel, with the goal of gaining a deeper understanding of these gender-related variations throughout the lockdown periods. A longitudinal study comprising 2509 participants was conducted during two of Israel's lockdowns: 1424 participants completed a questionnaire during the first lockdown (23 April-5 May 2020); of these, 1085 completed a follow-up questionnaire during the second lockdown (September 30-October 10, 2020). Participants exhibited higher levels of compliance with MOH guidelines (e.g., wearing face masks, maintaining social distancing) and knowledge about COVID-19 during the second lockdown, whereas they exhibited more negative emotional reactions during the first lockdown. Female participants scored higher than male participants on all measures. Multiple regression results showed that about 21% of the variance in compliance with MOH guidelines was explained by lockdown type (i.e., first or second), gender, and age, while knowledge and negative emotional reactions added another 19% to the explained variance. The results suggest that the impact of the pandemic on emotional reactions decreased over time, with people exhibiting greater compliance with MOH guidelines and more knowledge about COVID-19. Moreover, the behavioral and psychological impact of the pandemic was greater on women than on men. The results suggest that healthcare professionals should pay more attention to mental health issues during a pandemic. Moreover, policymakers should focus on women as a vulnerable group and suggest appropriate solutions to reduce their emotional distress. Furthermore, governments and employers should provide greater flexibility and support for single mothers during the pandemic. In addition, gender inequality during lockdowns may place women at greater risk of psychological distress., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Objective: Cervical cancer affects survivors' overall coping. Yet, specifically emotional and behavioral expression patterns among cervical cancer survivors have barely been examined. In addition, no study has focused on survivors' experiences of sequences related to coping. Understanding these perceptions can help provide a tailored response and improve psycho-social interventions. The aim of this study was to gain a better understanding of the emotional and behavioral motives involved in coping with cervical cancer recovery., Methods: Qualitative interviews were conducted with 15 survivors of cervical cancer (stages I and II), using a semi-structured in-depth questionnaire. The interviews were recorded, transcribed, and analyzed by three researchers using thematic analysis., Results: Six main themes emerged: (i) Reasons and benefits for keeping the disease a secret or sharing it with others; (ii) "When you get used to despair, there's also room for hope": Despair alongside hope; (iii) Self-guilt following the disease, but also knowing how to forgive yourself; (iv) Deep loneliness alongside a significant need for support; (v) Finding the way from passivity to activity; and (vi) When meaning in life is missing, and the importance of meaning when it is present. There was a balance between negative emotions and behaviors (despair, confidentiality, guilt, loneliness, passivity, lack of meaning) and positive emotions and behaviors (hope, openness, forgiveness, significant support, activity, meaning)., Significance of the Results: The study revealed that in some cases cervical cancer coping during the recovery period moves across sequences. The women's narratives portray past difficulties as the reason for present psychological health, and their experience of a healthy present is intensified by their past difficulties. Implications for practice are discussed.

The aim of this study was to evaluate the effectiveness of ChatGPT-3.5 and ChatGPT-4 in incorporating critical risk factors, namely history of depression and access to weapons, into suicide risk assessments. Both models assessed suicide risk using scenarios that featured individuals with and without a history of depression and access to weapons. The models estimated the likelihood of suicidal thoughts, suicide attempts, serious suicide attempts, and suicide-related mortality on a Likert scale. A multivariate three-way ANOVA analysis with Bonferroni post hoc tests was conducted to examine the impact of the forementioned independent factors (history of depression and access to weapons) on these outcome variables. Both models identified history of depression as a significant suicide risk factor. ChatGPT-4 demonstrated a more nuanced understanding of the relationship between depression, access to weapons, and suicide risk. In contrast, ChatGPT-3.5 displayed limited insight into this complex relationship. ChatGPT-4 consistently assigned higher severity ratings to suicide-related variables than did ChatGPT-3.5. The study highlights the potential of these two models, particularly ChatGPT-4, to enhance suicide risk assessment by considering complex risk factors., Competing Interests: The authors declare that they have no competing interests., (© 2024 Shinan-Altman et al.)

Background: Artificial intelligence (AI) has rapidly permeated various sectors, including healthcare, highlighting its potential to facilitate mental health assessments. This study explores the underexplored domain of AI's role in evaluating prognosis and long-term outcomes in depressive disorders, offering insights into how AI large language models (LLMs) compare with human perspectives., Methods: Using case vignettes, we conducted a comparative analysis involving different LLMs (ChatGPT-3.5, ChatGPT-4, Claude and Bard), mental health professionals (general practitioners, psychiatrists, clinical psychologists and mental health nurses), and the general public that reported previously. We evaluate the LLMs ability to generate prognosis, anticipated outcomes with and without professional intervention, and envisioned long-term positive and negative consequences for individuals with depression., Results: In most of the examined cases, the four LLMs consistently identified depression as the primary diagnosis and recommended a combined treatment of psychotherapy and antidepressant medication. ChatGPT-3.5 exhibited a significantly pessimistic prognosis distinct from other LLMs, professionals and the public. ChatGPT-4, Claude and Bard aligned closely with mental health professionals and the general public perspectives, all of whom anticipated no improvement or worsening without professional help. Regarding long-term outcomes, ChatGPT 3.5, Claude and Bard consistently projected significantly fewer negative long-term consequences of treatment than ChatGPT-4., Conclusions: This study underscores the potential of AI to complement the expertise of mental health professionals and promote a collaborative paradigm in mental healthcare. The observation that three of the four LLMs closely mirrored the anticipations of mental health experts in scenarios involving treatment underscores the technology's prospective value in offering professional clinical forecasts. The pessimistic outlook presented by ChatGPT 3.5 is concerning, as it could potentially diminish patients' drive to initiate or continue depression therapy. In summary, although LLMs show potential in enhancing healthcare services, their utilisation requires thorough verification and a seamless integration with human judgement and skills., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Interventions such as advance care planning (ACP), technology, or access to euthanasia may increase the sense of control over the end of life. In people with advanced dementia, the loss of cognitive and physical function limits the ability to control care. To date, little is known about the acceptability of these interventions from the perspective of persons with dementia and others involved. This study will examine the cross-cultural acceptability, and factors associated with acceptability, of four end-of-life interventions in dementia which contain an element of striving for control. Also, we report on the development and pilot testing of animation video vignettes that explain the interventions in a standardized manner., Methods: Cross-sectional mixed-methods vignette study. We assess acceptability of two ACP approaches, technology use at the end of life and euthanasia in persons with dementia, their family caregivers and physicians in six countries (Netherlands, Japan, Israel, USA, Germany, Switzerland). We aim to include 80 participants per country, 50 physicians, 15 persons with dementia, and 15 family caregivers. After viewing each animation video, participants are interviewed about acceptability of the intervention. We will examine differences in acceptability between group and country and explore other potentially associated factors including variables indicating life view, personality, view on dementia and demographics. In the pilot study, participants commented on the understandability and clarity of the vignettes and instruments. Based on their feedback, the scripts of the animation videos were clarified, simplified and adapted to being less slanted in a specific direction., Discussion: In the pilot study, the persons with dementia, their family caregivers and other older adults found the adapted animation videos and instruments understandable, acceptable, feasible, and not burdensome. The CONT-END acceptability study will provide insight into cross-cultural acceptability of interventions in dementia care from the perspective of important stakeholders. This can help to better align interventions with preferences. The study will also result in a more fundamental understanding as to how and when having control at the end of life in dementia is perceived as beneficial or perhaps harmful., Trial Registration: The CONT-END acceptability study was originally registered at the Netherlands Trial Register (NL7985) at 31 August, 2019, and can be found on the International Clinical Trials Registry Platform., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: This study aimed to compare self-management after bariatric surgery between support group participants (the study group) and patients receiving only individual follow-up by a dietitian (the comparison group), and to examine the differences between the two groups regarding the associations of cognitive and emotional factors with self-management., Materials and Methods: This cross-sectional comparative study was conducted among bariatric patients who either participated in bariatric support groups during the years 2018-2020 or received only individual follow-up with a dietitian since their surgery. The structured questionnaire included a self-management questionnaire, cognitive variables (eating self-efficacy, eating awareness as independent variables, weight control motivation) and emotional variables (positive and negative affect, emotional eating), and background control variables., Results: The level of self-management was better in the study group than in the comparison group. The hierarchical regression model showed that in the study group, the control variables contributed negligibly to self-management (step 1), while all independent variables contributed the most (27%) to the explained variance (31%) in self-management (step 2). In the comparison group, the contribution of the control variables was 11.5% of the explained variance, with only lower duration of time since surgery being related to higher self-management (step 1). The independent variables contributed significantly - an additional 14.5% to the explained variance (step 2). Emotional eating was the sole variable related to self-management., Conclusion: The findings emphasize the importance of encouraging patients after bariatric surgery to participate in support groups, as the skills acquired in these groups strengthen the capacity to manage self-care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A relationship was found between the COVID-19 pandemic and depression among older adults and between depressed mood and increased use of antidepressant medication among older adults during the pandemic. With the aim of broadening the understanding of these relationships, the study examined whether COVID-19 perceived susceptibility mediates the relationship between psychosocial resources (optimism and perceived social support) and depressive symptoms and medication use. Participants included 383 older adults ( M = 71.75, SD = 6.77) reporting on socio-demographics, health characteristics, depression, optimism, social support, and COVID-19 perceived susceptibility. Medication use was retrieved from participants medical files. Lower optimism, lower social support, and higher COVID-19 perceived susceptibility were associated with greater depression, related with higher medication use. The findings emphasize the buffering effect of psychosocial resources on the adverse effects of depression affecting older adults during the COVID-19 pandemic, and consequently, the increased use of medication in this population. Practitioners should focus interventions on enhancing optimism and expanding social support among older adults. Moreover, interventions focused on alleviating depression among older adults should aim at improving perceptions of perceived susceptibility in the older population.

Background: This study focused on changes in self-management as the main outcome of participation in bariatric psychoeducational support groups. We assessed the contribution of changes in cognitive and emotional variables to improved self-management among 155 participants., Method: Data for this longitudinal study were collected at the beginning (time 1) and at the end (time 2) of the support groups' 10-session program. The structured questionnaire included self-management (the Bariatric Surgery Self-Management Behaviors Questionnaire), cognitive variables (eating self-efficacy, eating awareness, weight control motivation), and emotional variables (positive and negative affect, emotional eating), as well as background variables., Results: Significant improvements in self-management and in eating self-efficacy, eating awareness, and emotional eating were found at time 2. The hierarchical regression model showed that the improvements in eating self-efficacy, and in positive and negative affect, contributed significantly to improved self-management. Additionally, a modification effect of negative affect was found., Conclusion: We conclude that participation in psychoeducational bariatric support groups is beneficial to improving one's self-management., (© 2022. International Society of Behavioral Medicine.)

This study examined work-family enrichment, protective resources and psychological implications among working Israeli parents during COVID-19. In this cross-sectional study, 409 working parents were recruited during Israel's third lockdown. Levels of FWC/WFC and resilience were moderate, psychological distress and fear of COVID-19 were low, and perceived social support was high. All the study variables showed significant associations with each other. A multivariate regression analysis explained 30% of the WFC and FWC variance. We found differences in FWC/WFC based upon children's age but not on parents' gender. FWC/WFC mediated the effect of perceived social support and resilience on fear of COVID-19 and psychological distress. The findings explain the importance of personal resources during the pandemic in buffering the negative effects of parents' work- and family-related burdens and have important implications for helping families with young children cope during challenging times.

This study examined differences regarding climate change pro-environmental behaviors (PEBs), comparing between individuals with chronic diseases and those without. A cross-sectional survey was conducted among 402 adults, of whom 25% had a chronic disease. Participants completed measures for PEBs, climate change exposure (i.e., exposure to its effects), climate change risk appraisal, environmental self-efficacy, collective efficacy, and sociodemographic variables. Results revealed a significant difference between participants with and without chronic diseases in climate change risk appraisal. Having a chronic disease was associated with higher climate change risk appraisal (β = 0.16, p < 0.001), which in turn was associated with higher collective efficacy (β = 0.29, p < 0.001). The latter was associated with more PEBs (β = 0.10, p = 0.049). Furthermore, higher climate change exposure was associated with higher climate change risk appraisal (β = 0.49, p < 0.001), which in turn was associated with collective efficacy (β = 0.29, p < 0.001). The latter was associated with more PEBs (β = 0.10, p = 0.049). In addition, higher climate change exposure was directly associated with both self-efficacy (β = 0.33, p < 0.001) and collective efficacy (β = 0.10, p = 0.049), which in turn were associated with more PEBs (β = 0.28, p < 0.001 and β = 0.10, p = 0.049, respectively). This study highlights the need to provide efficacy-enhancing information in climate change messaging for PEBs in general. A threat component in environment-relevant messages for people with chronic diseases, specifically, should also be adopted.

Teachers' psychological responses during a pandemic, such as COVID-19, play an important role in their adaptation to the new routine. This research aimed to explore the association between personal resources (sense of control, social support), perceived stress, and three psychological outcomes (resilience, depression, loneliness) among teachers during the third COVID-19 lockdown in Israel. A cross-sectional study was conducted among 208 teachers. Significant associations were found between perceived stress, resilience, depression, and loneliness. Sense of control was significantly associated with perceived social support. The research model was tested using Structural Equation Modeling. The model yielded appropriate indices of fit (χ2(10) = 10.31, χ2/df = 1.03, p = 0.413, NFI = 0.970, NNFI = 0.997, CFI = 0.999, RMSEA = 0.012, 95%CI RMSEA = 0.077), demonstrating that the model fits the data well. Findings suggest that in order to improve teachers' psychological health during a virus outbreak, it is recommended to pay attention to their personal resources and perceived stress.

Background: The number of studies that have assessed cognitive illness representations among people diagnosed with depression, and their relationship to health outcomes, has clearly grown. Nevertheless, the relationship between cognitive illness representations and health-related quality of life (HRQoL) has received very little research attention., Aims: This study examined cognitive illness representations, based on the self-regulation model (SRM), and the contribution of each dimension of these cognitive illness representations to health-related quality of life (HRQoL) among Israeli Arabs diagnosed with depression., Methods: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive illness representations (identity, timeline, consequences, personal control, treatment control, and coherence), HRQoL, and sociodemographic and health characteristics., Results: Participants reported high levels of negative perceptions in the identity, timeline, and consequences dimensions, and moderate levels in the dimensions of personal control, treatment control, and coherence. Also, participants reported low levels of HRQoL. Identity, consequences, and coherence were found to be the main determinants of HRQoL., Conclusion: This study underlines the crucial role of the identity, consequences, and coherence dimensions in the HRQoL of individuals diagnosed with depression. The findings indicate that clinical interventions targeting cognitive illness representations of individuals with depression, and in particular identity, consequences, and coherence, might be helpful in improving the HRQoL of this population.

The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on populations at large is emerging in the literature. However, the emotional response of persons with diabetes to the pandemic is only now beginning to emerge. Therefore this study aimed to identify factors contributing to emotional reactions towards this pandemic among persons with diabetes. A total of 205 persons with diabetes participated in this cross-sectional online survey between 14 May and 22 June 2020. Participants completed measures of emotional reactions towards COVID-19, perceived diabetes status, perceived susceptibility, knowledge about COVID-19, sense of mastery and sociodemographic questionnaires. Statistical analyses included Pearson correlations and regression analysis. According to the results, the mean score of negative emotional reactions towards COVID-19 was 3.45 (standard deviation 1.11, range 1-5), meaning that the score was relatively high. Higher levels of negative emotional reactions towards COVID-19 were associated with higher perceived susceptibility, greater knowledge about COVID-19 and a lower sense of mastery. The study's findings emphasize the need to communicate ongoing knowledge regarding COVID-19 and diabetes as well as to provide persons with diabetes with the necessary emotional support related to coping with diabetes and COVID-19., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Objective: Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors., Methods: In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years)., Results: Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner., Conclusions: The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Cervical cancer is known to affect survivors' intimate relationships, as well as their communication and coping. Yet little is known about the perspectives of these survivors on their intimate relationships in the context of their needs during and after medical treatment. Additionally, only a few studies have focused on survivors' perceived needs or on existing psychosexual support. Understanding these perceptions can help provide a tailored response and improve dyadic interventions. The aim of this study was to examine cervical cancer survivors' perspectives on their intimate relationships during and after their treatment., Method: The present study adopted a qualitative-phenomenological approach. In-depth, semi-structured interviews were conducted with 15 survivors of cervical cancer between the ages of 38 and 44 who were diagnosed at stages I-II and were treated with radiotherapy or chemo-radiotherapy and surgery. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis., Results: Analysis of the findings revealed two key themes: (1) Together and apart in the shadow of cervical cancer. This theme focuses on the recovery period as a potential opportunity for changing and improving the couple relationship, such that men no longer withdraw but rather provide their partners with needed support and encouragement. (2) Changes in sexual life and couple intimacy. This theme focuses on changes in sexual relations, which have become a burden, painful, and something to avoid., Significance of Results: The study provides a comprehensive picture of intimate relationships during and after cervical cancer treatment and highlights the women's needs and desires for support from their intimate partners. The discussion notes that oncology providers can better facilitate supportiveness on the part of cervical cancer partners by offering better couple-oriented education and interventions to promote couple communication.

This study describes the conditions under which Israeli social workers in hospital settings operated s during the COVID-19 pandemic, and assesses their perceived support (informal and organizational support) and preparedness for the next pandemic. It further assesses correlates for perceived support and associations between perceived support and preparedness. The participants were 163 social workers from four hospitals who completed an on-line survey. The findings revealed that the level of exposure to COVID-19 and fear of contracting COVID-19 were unrelated to perceived informal and organizational support. Age and having children who are minors living at home moderated the relationship between fear of contracting COVID-19 and both types of perceived support. Each type of perceived support was significantly associated with preparedness beyond age, having minors at home, exposure to COVID-19, and fear of contracting COVID-19. Implications for research and practice are discussed.

Although continuing to utilize health services remains a key determinant of health, the association between the COVID-19 pandemic and engagement with health services among people with diabetes (PWD) remains unknown. This cross-sectional online survey examined factors associated with PWD's engagement with health services among 205 Israeli PWD during the subsiding of the first COVID-19 wave in Israel. Participants completed measures of perceived diabetes status, perceived risk, emotional reactions toward COVID-19, sense of mastery, engagement with health services (fear of contracting the virus in health services, canceling a medical appointment), and socio-demographic questionnaires. Most participants were women, their mean age was 40.18 years, and mean years since diagnosis was 15.70. Participants were recruited mainly via diabetes internet forums. Logistic and multiple hierarchical regressions were calculated. The odds of canceling appointment were higher for younger participants and for participants experiencing greater negative emotional reactions. Higher fear of contracting the virus in health services was related to higher perceived risk and experiencing greater negative emotional reactions. Findings suggest that in order to encourage PWD to utilize health services during a virus outbreak, clinical interventions should address PWD's perceived risk of contracting the virus and their emotional reactions toward COVID-19.

Background: The current COVID-19 outbreak is seriously affecting the lives and health of people across the globe. While gender remains a key determinant of health, attempts to address the gendered dimensions of health face complex challenges., Methods: In a cross-sectional study 482 participants (men=237, women=245) completed questionnaires on precautionary behaviour, perceived knowledge about COVID-19 risk factors, emotional reactions toward COVID-19 and perceived susceptibility. We examined gender differences in perceived knowledge about COVID-19 risk factors, healthy behaviours, threat perceptions and emotional responses, as well as the role of gender as a moderating factor., Results: Women reported higher levels of precautionary behaviour (t(475)=3.91, p<0.001) and more negative emotional reactions toward COVID-19 (t(475)=6.07, p<0.001). No gender differences emerged in perceived susceptibility or knowledge about COVID-19. The multiple regression model is significant and explains 30% of the variance in precautionary behaviour, which was found to be higher among women and older participants, those with higher perceived knowledge about COVID-19 risk factors and those with higher emotional reactions. Gender exhibited a significant moderating role in the relationship between perceived knowledge and precautionary behaviour (B=0.16, SE=0.07, β=0.13, p=0.02, 95% CI 0.03 to 0.30)., Conclusion: Women exhibited higher levels of precautionary behaviour and emotional responses., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The present study is based on a 3-year evaluation of an Israeli training program for local paid elder care workers, called, 'community care'. Interviews were conducted with all stakeholders involved in the program, including program developers, facilitators, funders, trainees, dropouts, graduates, employers and older care recipients. Qualitative thematic analysis was used. Analysis was supplemented by quantitative data concerning the program's inputs, outputs and outcomes. The program had multiple strengths, including a substantial funding stream and a highly skilled and committed team. Yet, out of 130 participants, 94 completed the program and 31 worked as care workers afterwards. Three main challenges to the efficacy of the training program were identified. A first challenge stems from the gap between the program's vision and real-life requirements and constraints. The second challenge concerns a disagreement between stakeholders concerning the definition of the new community care profession as an opportunity to empower trainees and encourage personal growth versus the community care worker as being no different from the traditional direct paid carer. A third challenge concerns the program's lack of integration between personal/physical care on the one hand and emotional and psychological care, on the other hand. The findings stress the importance of adequately conducting a needs assessment prior to embarking on a new social program and the tension between an ideal prototype and real-life constraints. The findings also stress the necessity of top-down processes, supported by the government to the development of a new profession of community elder care., (© 2021 John Wiley & Sons Ltd.)

Background: Promoting a healthy lifestyle and achieving strict adherence to medical treatment among patients with diabetes are key objectives in public health. Yet health behaviors are often culturally driven, especially in closed religious communities. This study seeks to reveal key cultural-religious factors, attitudes and behaviors characterizing the lifestyle in one such closed community-the ultra-Orthodox Jewish community-by understanding the attitudes of ultra-Orthodox patients with diabetes toward coping with their illness and the factors impacting their adherence to medicinal treatment., Method: Qualitative interviews were conducted with 16 ultra-Orthodox patients with diabetes using a semi-structured, in-depth questionnaire., Results: Three main themes emerged: 1) "The disease as a secret": Hiding the disease among patients with diabetes in ultra-Orthodox society; 2) "Distinguishing between sacred and secular occasions": ultra-Orthodox diabetes patients distinguish between treatment adherence on weekdays and treatment adherence on holidays or special occasions; 3) "Ask the rabbi": In cases of dilemmas that involved conflicts between halakhic rulings and doctors' instructions, the rabbi's decision was usually the final one., Conclusions: The findings of this study may help provide an in-depth understanding of the obstacles and motives of ultra-Orthodox patients in adhering to medicinal treatment of diabetes in particular and to medicinal treatment in general, thus helping family physicians who treat this population provide optimal and appropriate treatment., (© 2021. The Author(s).)

This exploratory study focuses on the personal and professional concerns of Israeli social workers in hospitals and community health settings during the coronavirus (COVID-19) pandemic. Other studies omitted health care social workers' needs and concerns. Participants included 126 social workers (120 females, 5 males and 1 other gender identity) in hospitals and community health settings who completed an online survey during the height of the first wave of COVID-19 in Israel. Measures included questions on exposure to COVID-19, sense of safety at work, perceived support, and personal and professional concerns. Two open-ended questions about the social workers' concerns and the perceived concerns of their patients were included. The results showed that 17 per cent reported one of their inter-disciplinary team testing positive for COVID-19. Only one-third of the social workers felt safe from COVID-19 infection in their workplace. Mothers of dependent children were more concerned about income loss and about balancing work and family requirements than mothers of older children. 'Home-work conflict' was also a main theme in the qualitative data. In conclusion, the work-home role conflict took an especially heavy toll during the COVID-19 pandemic on social workers who were mothers to dependent children., (© The Author(s) 2021. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.)

Background: The COVID-19 pandemic has had a profound impact worldwide. This study sought to assess the pandemic's psychological impact on the Israeli public., Methods: Using mixed methods we assessed Israeli adults during the COVID-19 outbreak. In the quantitative study, participants (N=1407) completed an online battery of measures assessing psychological variables and perceived threat related to COVID-19. Statistical analyses included tests for between-group differences and Pearson correlations. The qualitative study entailed in-depth, semistructured interviews conducted by telephone (N=38)., Results: The quantitative findings indicate that about 48% of the public had negative emotional reactions and 20% perceived they were liable to contract the virus. Moreover, a positive correlation was found between these feelings and the degree of perceived threat. Three major themes emerged from the qualitative study: 1) a sense of shock and chaos; 2) gradual adjustment to the new reality; and 3) fears and concerns for self and family members. The study's results revealed the following sources of participants' emotional responses and sense of threat: health concerns regarding themselves and their loved ones; employment concerns; problems with children and spouses caused by being together at home; and difficulties entailed in working at home., Conclusions: The study reveals many of the psychological variables and perceived threats related to COVID-19 in Israel. While social distancing may make people feel safer, it can also increase their feelings of isolation, stress and frustration and cause difficulties in many life situations. The findings point to the necessity of addressing the public's perceived susceptibility and emotional reactions about COVID-19., (© The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Objective: Cumulative knowledge indicates that cancer patients, among them breast cancer patients, are more susceptible to COVID-19 than individuals without cancer. Therefore, these patients need to take additional precautions against the COVID-19 outbreak. This study aimed to examine factors associated with precautionary behavior among Israeli breast cancer patients during the COVID-19 pandemic., Methods: A cross-sectional study was conducted among 151 women with breast cancer. Participants completed measures of knowledge about COVID-19, perceived threat, sense of mastery, social support, precautionary behavior, and socio-demographic questionnaires. A multivariate regression model was calculated with precautionary behavior as the dependent variable., Results: The mean of precautionary behavior score was relatively high. Participants perceived their health as relatively good, had relatively high knowledge about COVID-19, and moderate perceived threat. Sense of mastery was relatively moderate and perceived social support was relatively high. In the multivariate regression analysis, after controlling for the background variables, knowledge about COVID-19 (F(2,149) = 8.68, p < 0.001; beta = 0.36) was significantly associated with precautionary behavior. This variable explained 15.4% of the precautionary behavior variance., Conclusion: Findings suggest that in order to enhance precautionary behavior among women with breast cancer during a pandemic outbreak, it is recommended to pay attention their knowledge about the virus.

Background: In order to examine subjective well-being (SWB) among persons with asthma, most of the existing studies have focused on disease-related variables or concentrated on illness representations, alexithymia and coping, making it difficult to determine whether the relationship between illness representations, alexithymia, coping and SWB is just an artifact of the disease's severity., Objective: Based on the Self-Regulation Model, this study aimed to examine the interrelationships between the disease's characteristics (annual mean of asthma attacks, preventive treatment), illness representations, alexithymia, coping strategies and SWB among persons with asthma., Methods: A convenience sample of 208 persons with asthma completed measures of the disease's characteristics (annual mean of asthma attacks, preventive treatment), illness representations (identity, causes, timeline, consequences, control, coherence, emotional representations), alexithymia, coping strategies, SWB, and socio-demographic questionnaires. A hierarchical multiple regression was calculated with SWB as the dependent variable., Results: The regression model was found significant ( F (14, 133) = 6.42, p  < 0.001), explaining 34% of the variance in SWB. Higher levels of alexithymia, identity, cause and emotional representations and lower levels of control were related to lower levels of SWB. The addition of coping strategies did not add to the explained variance of SWB., Conclusion: This study contributes to a better understanding of the determinants of SWB among persons with asthma. The findings indicate that clinical interventions targeting persons with asthma illness representations and alexithymia may assist persons with asthma to improve their SWB.

Objectives: Self-stigma is common among persons with depression. Still, studies that examined the process of self-stigma concentrated mostly on younger adults (ages 18-65) with mental illness in general, with a limited number of studies examining older adults with depression. This study was aimed to examine and compare the self-stigma formation process and its relation to self-esteem among younger (ages 18-64) and older Israeli Arabs (age 65+) diagnosed with depression. The study was based on a self-stigma model which defines the self-stigma formation process as composed of three stages: stereotypes awareness, stereotype agreement, and self-concurrence., Method: A total of 160 younger and older Israeli Arabs with depression completed measures of self-stigma formation process, self-esteem, and socio-demographic and health characteristics., Results: The self-stigma formation process was found as a multi-level and progressive model for both younger and older adults, despite that older adults reported significantly higher levels of self-stigma in all stages of the process. Low self-esteem was significantly associated with higher levels of stereotype agreement and self-concurrence in both age groups., Conclusion: The self-stigma formation process provides an adequate model for understanding depression self-stigma in both younger and older adults. Appropriate intervention programs aiming to reduce self-stigma should be developed, focusing on reducing the three stages of self-stigma.

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), The Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and The Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in The Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in The Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in The Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

The general consensus is that COVID-19, the virus spreading rapidly across the globe, affects physical health but also mental health and mental well-being. This study aimed to assess the associations among emotional reactions toward COVID-19, knowledge about COVID-19, perceived susceptibility to this disease, and subjective health status. This study was a cross-sectional study conducted among 1,085 Israeli adults who completed an online survey between April 23 and May 5, 2020. The self-administered questionnaire included questions about emotional reactions to COVID-19, knowledge about COVID-19, perceived susceptibility, subjective health status, and sociodemographic variables. Participants (aged 18-96) reported high levels of emotional reactions to COVID-19. Most respondents were worried (77.4%), afraid (62.8%) or stressed (55.3%). Emotional reaction scores were higher among women than among men. In the regression model, emotional reactions were higher for older participants, those who rated their subjective health status as poorer, and those who were employed, with the final model explaining 11.6% of the variance in emotional reactions. Perceived susceptibility significantly mediated the relationship between subjective health status and emotional reactions. The high prevalence of emotional responses among women, older people and those with lower subjective health ratings points to the need for intervention programs primarily targeting these groups.

Aim: This study aims to assess how optimism, social support, and perceived susceptibility are associated with depressive symptoms and health-related quality of life among elderly patients during the COVID-19 pandemic in Israel., Methods: In a cross-sectional study, 256 participants age 60 through 95 completed the following self-administered questionnaires: Perceived Susceptibility, Life Orientation Test (LOT-R), Multidimensional Scale of Perceived Social Support (MSPSS), Symptoms of Depression (CES-D) and health-related quality of life (SF-12v2 Health Survey). Data were collected from June to July 2020, 3 months after the COVID-19 state of emergency was declared in Israel. Participants were interviewed by family medicine residents via telephone. Statistical analyses included Pearson correlations, t -tests between groups, regression analyses, and Hayes' PROCESS to analyze a moderated mediation model., Results: Of the elderly participants, 37.5% were classified as having depression. Optimism, social support and health-related quality of life were positively associated. Higher optimism and social support were related to lower perceived susceptibility and lower depression. Results of a multivariate regression explained 29% of the variance in depression and 19% of the variance in health-related quality of life. The relationships assessed by 4 Process models were significant, such that higher optimism and social support were related to lower perceived susceptibility, which in turn was related to higher depression and lower health-related quality of life., Conclusions: Optimism and social support may be effective in coping with challenges and buffering depression. Perceived susceptibility may mediate the association of optimism and social support with higher depression and lower health-related quality of life. The conclusions of this study underscore the need to treat depression among older adults during this period. Hence, healthcare providers should also support elderly patients living at home. In giving this type of help, healthcare providers should strive to increase social support and optimism among older adults.

There has been a noticeable increase in the number of studies assessing perceptions regarding depression (illness representations) among people diagnosed with the disorder. However, these studies have examined mainly younger adults (ages 18 to 65), and very little is known about older adults. This study examined illness representations among younger and older Israeli Arabs with depression based on the Self-Regulation Model (SRM). A total of 12 Israeli Arabs (six younger adults aged 18-64 and six older adults aged 65+) diagnosed with depression took part in semi-structured, in-depth interviews. The majority of the participants in the younger group were female and married, compared to the older group which has a gender equal ratio, half of which are married. The data were analyzed thematically, guided by the SRM illness representations' dimensions (identity; timeline; cause; consequences; control/cure; cyclical and coherence; and emotional representations). Differences between younger and older adults were found in some of the illness representations. Older adults described depression as a chronic illness associated with somatic symptoms, and did not believe in psychological treatment. Younger adults did not perceive depression as chronic, reported cognitive and emotional symptoms, and believed in the efficacy of psychological treatment. Our findings indicated that participants' perceptions about depression appeared to be associated with their age, along with their unique cultural background as they are traditional but undergoing processes of modernization. This study stress the importance of illness representations in intervention programs tailored for different age groups, and considering their specific cultural needs.

Background: The lay public's behavioral responses during a virus spread, such as the COVID-19, play an important role in bringing the outbreak under control, and provide insights into development of risk communication messages to the public. Therefore, this study aimed to explore the association between knowledge about COVID-19, perceived susceptibility, emotional reactions and precautionary behavior among the Israeli lay public at the beginning of the COVID-19 outbreak., Method: A cross-sectional study was conducted among 1407 participants, aged 18 + . Participants completed measures of knowledge about COVID-19, perceived susceptibility, emotional reactions, precautionary behavior, and socio-demographic questionnaires. A hierarchical regression model was calculated with precautionary behavior as the dependent variable., Results: Findings indicated that precautionary behavior was higher for females, older participants, participants with higher levels of knowledge about COVID-19, and participants with greater negative emotional reactions. A negative curvilinear relationship was found between perceived susceptibility and precautionary behavior, so that the latter was highest for participants with moderate perceived susceptibility. All interaction terms were non-significant., Conclusions: Findings suggest that in order to enhance precautionary behavior in the initial stage of a virus outbreak, it is recommended to pay attention to the public's knowledge about the virus, perceived susceptibility and emotional reactions. Although negative feelings about the virus may motivate preventive behavior, it is important to address these feelings.

Using the theory of diffusion of innovations, this study examined differences between American and Israeli older adults who decided to move to continuing care retirement communities (CCRC) and American and Israeli older adults who decided to stay at home. A total of 101 American participants (52 residents, 49 nonresidents) and 154 Israeli participants (104 residents, 50 nonresidents) completed measures of attitudes toward CCRCs, well-being, limitations in daily living, health status, proximity to services, and collectivism. Americans were more likely to relocate to CCRCs compared with staying at home when they reported positive attitudes toward CCRCs, higher well-being, and poorer subjective health. Among Israelis, positive attitudes toward CCRCs, better subjective health, and higher collectivism were associated with moving to CCRCs compared with staying at home. This study has implications for facilitating older adults' decision-making and CCRC policies, as findings point to potential sources of influence on older adults' decision to relocate.

Background: Studies that examined health-related quality of life (HRQoL) and related factors among people diagnosed with depression, have only focused on sociodemographic and clinical factors. This study examined the contribution of illness representations (IRs), self-stigma, self-esteem, and age group (younger adults aged 18 to 64 and older adults aged 65+) to HRQoL among Israeli Arabs diagnosed with depression., Methods: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive and emotional IRs, self-stigma, self-esteem, HRQoL, and sociodemographic and health characteristics., Results: Participants reported low levels of HRQoL, with the older adults reporting significantly lower levels of HRQoL in comparison to those reported by the younger adults. Low levels of HRQoL were significantly associated with negative cognitive and emotional IRs, high levels of self-stigma, and low levels of self-esteem. Cognitive IRs, self-stigma, self-esteem, and age group were found to be the main determinants of HRQoL., Limitations: Limitations of the study include use of a cross-sectional design among culturally homogeneous sample. This limits the generalizability of our results and conclusions, and prevented us from determining causal relationships., Conclusions: This study emphasizes the role of cognitive IRs, self-stigma, and self-esteem, as well as age, in the HRQoL of individuals diagnosed with depression. Intervention programs should be mindful of these determinants in order to improve the HRQoL of individuals diagnosed with depression., Competing Interests: Declaration Of Competing Interest None, (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study explores the process of turning elder care into a profession, by giving a voice to different professionals who took part in developing and implementing a new Israeli training program for community care workers. The program attempts to offer a response to the shortage of paid long-term carers for older adults by turning community elder care into a profession. Interviews with graduates, trainees who dropped out of the program, developers, employers and supervisors from three regions of the training program were conducted. Analysis explored attempts to transition community care from an occupation to a profession. The community care worker's role and its uniqueness in comparison to the traditional paid long-term care worker are discussed. The difficulties that stem from the ambiguity of the definition of this new occupation are described.

Objective: Continuing to utilize healthcare as needed during an epidemic outbreak is significant, in general, and especially for cancer patients. Therefore, this study aimed to explore factors associated with health services utilization among breast cancer patients during the coronavirus disease (COVID-19) outbreak., Method: A cross-sectional online survey was conducted among 151 women with breast cancer. Participants completed measures of perceived health status, perceived susceptibility to COVID-19, anxiety, coping resources, health services utilization (contact with healthcare professionals and cancellation of an appointment to the oncology/hematology clinic), and socio-demographic questionnaires. A multiple hierarchical regression was calculated; contact with healthcare professionals was the dependent variable. In addition, a logistic regression was calculated; cancellation of an appointment to the oncology/hematology clinic because of the COVID-19 was the dependent variable., Results: Breast cancer patients' contact with healthcare professionals was lower than their contact prior to the pandemic. A higher extent of contact with healthcare professionals was related to patients' perception of health as bad/reasonable, lower perceived susceptibility, a lower sense of mastery, and higher social support. In addition, the odds of cancelling an appointment to the oncology/hematology clinic were higher in the presence of additional chronic illnesses and a higher sense of mastery., Significance of Results: The results could provide public health agencies with a more complete picture of the impact of the COVID-19 epidemic among breast cancer patients. This is significant because, in the event that COVID-19 re-emerges, the findings of the current study could help guide public health officials and possibly prevent the future avoidance of health services' use among this high-risk population.

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

Purpose: This study examined a comprehensive model that integrates the interrelationships among health-related-quality-of-life (HRQoL), disease duration, disease severity, illness representations, and coping resources regarding patients with Rheumatoid arthritis (RA), based on the Self-regulation model., Method: A convenience sample of 164 patients with RA completed measures of disease's characteristics (disease duration, disease status), illness representations (timeline, consequences, self-control, treatment control, symptom burden, concern about RA, understanding RA, emotional representations), coping resources (resilience, social support), HRQoL, and socio-demographic questionnaires. The research model was assessed through path analysis., Results: Perceptions of higher treatment control, lower consequences of RA and lower symptom burden were directly related to HRQoL. The perceptions of higher self-control, higher treatment control, less concern about RA, and lower emotional representations were associated with higher resilience, which in turn was associated with higher HRQoL. The perceptions of higher treatment control, greater understanding of RA, and lower emotional representations were associated with higher perceived social support; however, social support was not associated with HRQoL., Conclusions: This study contributes to a better understanding of the determinants of HRQoL among RA patients. The findings indicate that clinical interventions targeting RA patients' illness representations and resilience may assist patients with RA to improve their HRQoL.

ABSTRACTObjective:With the aging of the population, the demand for long-term services is increasing accordingly and the recruitment of paid caregivers to older adults has become a critical issue. Hence, there is a great need to train people in the care of older adults. This study examined motivations to participate in a new program, which aims to train young people (ages 19-25) to become paid caregivers for older adults., Methods: The study is based on focus groups with program participants (N = 33) and on phone interviews with former participants (N = 8) and face-to-face interviews with staff members (N = 14). Transcripts were analyzed using qualitative content analysis., Results: Three major themes emerged: (1) "Motivations to participate in the program," referred to participants' motivations to work with older adults. (2) "Reduced motivations due to ambiguity of roles," referred to the unclear definition of the care worker's role, which created a decrease in participants' motivations to provide care. (3) "Inadequate financial compensation," concerned participants' reduced motivation to participate in the program as a result of financial promises that were not realized., Conclusions: Findings suggest that it is important to be cautious about the motivations for participation in the program because by emphasizing the difficult situation of older adults, one stresses the low status assigned to older adults, rather than positive attributes. It is also suggested that care workers should be financially rewarded, so that despite the difficulties that may arise during work, they will feel valued and will want to remain in the profession.

Objective: To examine perceived control among live-in and live-out home care workers and to identify factors that contribute to perceived control among both types of caregiving., Method: 338 migrant live-in home care workers and 185 local live-out home care workers were asked to report their perceived control. Burnout, satisfaction with the relationship with the care recipient and the care recipient's family, and satisfaction with social relationship were also gathered., Results: Both types of caregivers reported high levels of perceived control, although live-in home care workers expressed more perceived control. Higher age, higher levels of satisfaction with the relationship with the care recipient and the care recipient's family and lower levels of burnout, predicted perceived control. Satisfaction with social relationship was a stronger predictor of one's perceived control among live-in home care workers., Conclusions: Promoting social relationships outside the home care context by allowing migrant live-in home care workers to take part in social gatherings is recommended as this can strengthen their sense of perceived control.