Israel Journal of Psychiatry and Related Sciences, 2010
The current report presents an example of the path taken from identification of a public health p... more The current report presents an example of the path taken from identification of a public health problem at the primary health service level, to conducting research documenting the scope of the problem and nature of the risk factors, disseminating the findings, and fostering development and application of relevant policy. The example presented is the case of postpartum depression, an issue with bio-psycho-social implications. Public health nurses identified the problem, prompting epidemiological research. The findings encouraged the Ministry of Health (MOH) to conduct a pilot program for screening and early intervention among pregnant and postpartum women reporting depressive symptoms. Based on the results of the pilot program, the MOH is expanding the program to all Mother-Child Health (MCH) clinics. Israel?s largest Health Maintenance Organization has followed suit and is including this program in its own clinics. This Israeli experience may serve as an instructive example of a locally identified problem evolving into a national policy.
Purpose: To determine feasibility and acceptability of incorporating IPT for postpartum depressio... more Purpose: To determine feasibility and acceptability of incorporating IPT for postpartum depression (PPD) into Israeli social work practice. Method: Women who were 4–24 weeks postpartum with PPD, at least 18 years old, had telephone access, and had a score of 10–18 on the Edinburgh Postnatal Depression Scale (EPDS) were eligible to participate in this two-group, nonrandomized repeated measures pilot. The intervention group received eight 50-min IPT sessions and the comparison group received treatment-as-usual. Primary outcomes were measured with the EPDS, Postpartum Adjustment Questionnaire (PPAQ), and Client Satisfaction Scale-8. Results: There was a significant reduction in both groups in EPDS scores at the end of treatment ( t = −4.68, 95% CI [−6.49, −2.57], d = 1.07) and 4 weeks posttreatment ( t = −5.09, 95% CI [−7.14, −3.08], p < .001, d = 1.21), a significant reduction in PPAQ scores at the end of treatment ( t = −2.09, 95% CI [−0.29, 0.00], p < .05, d = 0.44), and high patient acceptability. Discussion: This study provided preliminary evidence supporting IPT use by social workers in Israel.
Background: Parents of infants in Neonatal Intensive Care Units (NICU) suffer extended periods of... more Background: Parents of infants in Neonatal Intensive Care Units (NICU) suffer extended periods of stress. The staffs of these departments have a major role in assisting them through this period. Aim: To describe services, programs and facilities to support parents of these infants, during and following hospitalization. Methods: Social workers of 23 NICU's completed a structured questionnaire, and the responses were summarized. Results: The majority of units have paramedical staff in addition to social workers. Twenty-two units offer structured instruction for parents, and 12 offer lecture series. Topics include: coping with the birth of a premature infant, the infant's development and care, breastfeeding, discharge preparation, etc. In 19 departments grandparents are allowed to visit and nine also allow siblings. Most departments have breast-pump facilities and a lounge for parents; some also have refrigerators, personal lockers, etc.. Twenty units employ the "Kangaroo" method of skin-to-skin contact, and three practice elements of "individualized developmental care". Communication with parents is conducted both formally and informally. All departments have guidelines for contact with community health providers - some regularly, and some as-needed. Conclusion: Despite the multiplicity of programs reported in the survey, many are conducted in only a few departments. It is recommended that national guidelines be developed, which would integrate many existing activities, taking into account the needs of parents and families, medical and paramedical staff, as well as economic constraints. Clear policy guidelines and standards are necessary for this aspect of care, as they are for the medical aspects.
Postpartum depression (PPD) is a relatively frequent and serious condition, with negative consequ... more Postpartum depression (PPD) is a relatively frequent and serious condition, with negative consequences for the mother, her infant, and the family. From research and clinical experience in many countries, it has been found that PPD can be identified early, and women at risk for developing PPD can be identified before delivery in the framework of primary health care service. The Edinburgh Postnatal Depression Scale (EPDS) has been found valid for this purpose, both in the original English version, and in translation to numerous languages. The Hebrew translation of the EPDS is presented, and it is recommended that Israeli researchers use the same translation to facilitate accumulation of knowledge regarding the epidemiology of PPD and intervention strategies in various Israeli population groups, and for comparison with data from other countries.
Obesity is a serious health problem, and is becoming increasingly common in affluent societies. I... more Obesity is a serious health problem, and is becoming increasingly common in affluent societies. In 1998, an Expert Committee published guidelines regarding obesity evaluation and treatment. The purpose of this study was to assess the attitude of primary care physicians in Israel toward diagnosis and treatment of childhood obesity, as related to the recommended guidelines. Primary physicians caring for children and adolescents were asked to complete an anonymous questionnaire including personal and professional details, methods of diagnosis, documentation and treatment of childhood obesity, and familiarity with and implementation of the Expert Committee recommendations. One hundred forty-four physicians, treating approximately 100,000 children monthly, completed the questionnaire. Ninety-four percent were considered to have diagnosed obesity properly. Furthermore, only 19% reported weighing all children examined, while 99% of the physicians suggested some treatment for obesity. The most frequent recommendations for managing obesity were referral to a dietitian (92%), physical exercise (85%), and group treatment (27%). The majority of physicians (78%) were not familiar with the new Expert Committee recommendations regarding obesity treatment. This study suggests that the majority of primary physicians diagnose obesity properly and recommend accepted modalities to manage obesity. A comprehensive program to prevent and treat obesity is recommended to improve the health status of the population.
Journal of Psychosomatic Obstetrics & Gynecology, 2000
Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied p... more Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied prospectively in a community cohort of 288 Israeli women. An Edinburgh Postnatal Depression Scale score of > or = 10 at 6 weeks postpartum was the criterion for PPD. Psychosocial risk factors were found to be the most potent. Lack of social support, marital disharmony, depressive symptoms during pregnancy, history of emotional problems and prolonged infant health problems were most predictive of PPD. The major role of psychosocial factors in PPD was similar to that found in other countries. The results were somewhat different for new Russian immigrants. These findings indicate that early identification of women at risk for PPD is feasible, and that consideration should be taken of subgroups that may be at heightened risk, or for whom risk factors play different roles.
Objective.We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap ... more Objective.We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap between the reason for encounter (RFE) described by girls entering an adolescent health service and the ultimate diagnosis.Methods.The sample, 547 consecutive 12- to 18-year-old girls visiting an adolescent health service, first underwent a structured intake procedure, including a self-administered form on which they described their RFEs and other health concerns, as well as a psychosocial interview and medical evaluation performed by staff members. The RFEs, HCC items, and diagnoses, grouped into somatic, sexuality-related, and psychosocial categories, were then compared.Results.Among the 399 girls expressing specific RFEs on entering the clinic, one-third were diagnosed with psychosocial disorders and one-fifth with sexuality-related concerns. Of the patients receiving a sexuality-related diagnosis, 57% presented with a sexuality-related request; another 26% noted it on the checklist. For those diagnosed with psychosocial problems, 22% stated this as the RFE, and another 50% indicated it on the HCC. The contribution of the HCC to the diagnosis was higher among adolescents not stating a specific RFE.Conclusion.The findings highlight the HCC's contribution in identifying health problems, especially among adolescents who find it difficult to verbalize sensitive issues.
Social Psychiatry and Psychiatric Epidemiology, May 16, 2001
In Israel, some population characteristics and lifestyle patterns make epidemiological research o... more In Israel, some population characteristics and lifestyle patterns make epidemiological research on suicide of particular interest. The Israeli population is characterized by ethnic diversity, with a multi-religious, multi-national mosaic of Jews and Arabs. These subgroups also vary in their suicidal behavior. The aims of the present study were to examine the trends in suicide incidence rates in Israel from 1984 to 1994, to identify sub-populations at high risk for suicide and to identify suicide methods associated with increased risk. Suicide rate trends in Israel over the period from 1984 to 1994 were examined for four subgroups: Jewish men and women, and Arab men and women. Cases of undetermined external cause (UEC) of death were also considered. Mortality data were obtained from the computerized data files of the Israeli Central Bureau of Statistics, which includes cause of death and sociodemographic variables. Suicide was classified according to the ICD-9 codes. Suicide rates were higher for Jews than for Arabs, and higher for men than for women. The rates among both population and sex groups increased directly with age. A significant increase over the years studied was found for Jewish men, particularly in the 18- to 21-year-old age group. An increase in the use of firearms was noted, mainly in the groups in which total suicide rates increased. The findings of this study highlight the need for further studies to identify both sub-populations at high risk for suicide, and societal trends such as lifestyles, immigration, military service, and media exposure to violence, as first steps toward planning of intervention programs to reduce suicide rates.
Israel Journal of Psychiatry and Related Sciences, 2010
The current report presents an example of the path taken from identification of a public health p... more The current report presents an example of the path taken from identification of a public health problem at the primary health service level, to conducting research documenting the scope of the problem and nature of the risk factors, disseminating the findings, and fostering development and application of relevant policy. The example presented is the case of postpartum depression, an issue with bio-psycho-social implications. Public health nurses identified the problem, prompting epidemiological research. The findings encouraged the Ministry of Health (MOH) to conduct a pilot program for screening and early intervention among pregnant and postpartum women reporting depressive symptoms. Based on the results of the pilot program, the MOH is expanding the program to all Mother-Child Health (MCH) clinics. Israel?s largest Health Maintenance Organization has followed suit and is including this program in its own clinics. This Israeli experience may serve as an instructive example of a locally identified problem evolving into a national policy.
Purpose: To determine feasibility and acceptability of incorporating IPT for postpartum depressio... more Purpose: To determine feasibility and acceptability of incorporating IPT for postpartum depression (PPD) into Israeli social work practice. Method: Women who were 4–24 weeks postpartum with PPD, at least 18 years old, had telephone access, and had a score of 10–18 on the Edinburgh Postnatal Depression Scale (EPDS) were eligible to participate in this two-group, nonrandomized repeated measures pilot. The intervention group received eight 50-min IPT sessions and the comparison group received treatment-as-usual. Primary outcomes were measured with the EPDS, Postpartum Adjustment Questionnaire (PPAQ), and Client Satisfaction Scale-8. Results: There was a significant reduction in both groups in EPDS scores at the end of treatment ( t = −4.68, 95% CI [−6.49, −2.57], d = 1.07) and 4 weeks posttreatment ( t = −5.09, 95% CI [−7.14, −3.08], p < .001, d = 1.21), a significant reduction in PPAQ scores at the end of treatment ( t = −2.09, 95% CI [−0.29, 0.00], p < .05, d = 0.44), and high patient acceptability. Discussion: This study provided preliminary evidence supporting IPT use by social workers in Israel.
Background: Parents of infants in Neonatal Intensive Care Units (NICU) suffer extended periods of... more Background: Parents of infants in Neonatal Intensive Care Units (NICU) suffer extended periods of stress. The staffs of these departments have a major role in assisting them through this period. Aim: To describe services, programs and facilities to support parents of these infants, during and following hospitalization. Methods: Social workers of 23 NICU's completed a structured questionnaire, and the responses were summarized. Results: The majority of units have paramedical staff in addition to social workers. Twenty-two units offer structured instruction for parents, and 12 offer lecture series. Topics include: coping with the birth of a premature infant, the infant's development and care, breastfeeding, discharge preparation, etc. In 19 departments grandparents are allowed to visit and nine also allow siblings. Most departments have breast-pump facilities and a lounge for parents; some also have refrigerators, personal lockers, etc.. Twenty units employ the "Kangaroo" method of skin-to-skin contact, and three practice elements of "individualized developmental care". Communication with parents is conducted both formally and informally. All departments have guidelines for contact with community health providers - some regularly, and some as-needed. Conclusion: Despite the multiplicity of programs reported in the survey, many are conducted in only a few departments. It is recommended that national guidelines be developed, which would integrate many existing activities, taking into account the needs of parents and families, medical and paramedical staff, as well as economic constraints. Clear policy guidelines and standards are necessary for this aspect of care, as they are for the medical aspects.
Postpartum depression (PPD) is a relatively frequent and serious condition, with negative consequ... more Postpartum depression (PPD) is a relatively frequent and serious condition, with negative consequences for the mother, her infant, and the family. From research and clinical experience in many countries, it has been found that PPD can be identified early, and women at risk for developing PPD can be identified before delivery in the framework of primary health care service. The Edinburgh Postnatal Depression Scale (EPDS) has been found valid for this purpose, both in the original English version, and in translation to numerous languages. The Hebrew translation of the EPDS is presented, and it is recommended that Israeli researchers use the same translation to facilitate accumulation of knowledge regarding the epidemiology of PPD and intervention strategies in various Israeli population groups, and for comparison with data from other countries.
Obesity is a serious health problem, and is becoming increasingly common in affluent societies. I... more Obesity is a serious health problem, and is becoming increasingly common in affluent societies. In 1998, an Expert Committee published guidelines regarding obesity evaluation and treatment. The purpose of this study was to assess the attitude of primary care physicians in Israel toward diagnosis and treatment of childhood obesity, as related to the recommended guidelines. Primary physicians caring for children and adolescents were asked to complete an anonymous questionnaire including personal and professional details, methods of diagnosis, documentation and treatment of childhood obesity, and familiarity with and implementation of the Expert Committee recommendations. One hundred forty-four physicians, treating approximately 100,000 children monthly, completed the questionnaire. Ninety-four percent were considered to have diagnosed obesity properly. Furthermore, only 19% reported weighing all children examined, while 99% of the physicians suggested some treatment for obesity. The most frequent recommendations for managing obesity were referral to a dietitian (92%), physical exercise (85%), and group treatment (27%). The majority of physicians (78%) were not familiar with the new Expert Committee recommendations regarding obesity treatment. This study suggests that the majority of primary physicians diagnose obesity properly and recommend accepted modalities to manage obesity. A comprehensive program to prevent and treat obesity is recommended to improve the health status of the population.
Journal of Psychosomatic Obstetrics & Gynecology, 2000
Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied p... more Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied prospectively in a community cohort of 288 Israeli women. An Edinburgh Postnatal Depression Scale score of > or = 10 at 6 weeks postpartum was the criterion for PPD. Psychosocial risk factors were found to be the most potent. Lack of social support, marital disharmony, depressive symptoms during pregnancy, history of emotional problems and prolonged infant health problems were most predictive of PPD. The major role of psychosocial factors in PPD was similar to that found in other countries. The results were somewhat different for new Russian immigrants. These findings indicate that early identification of women at risk for PPD is feasible, and that consideration should be taken of subgroups that may be at heightened risk, or for whom risk factors play different roles.
Objective.We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap ... more Objective.We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap between the reason for encounter (RFE) described by girls entering an adolescent health service and the ultimate diagnosis.Methods.The sample, 547 consecutive 12- to 18-year-old girls visiting an adolescent health service, first underwent a structured intake procedure, including a self-administered form on which they described their RFEs and other health concerns, as well as a psychosocial interview and medical evaluation performed by staff members. The RFEs, HCC items, and diagnoses, grouped into somatic, sexuality-related, and psychosocial categories, were then compared.Results.Among the 399 girls expressing specific RFEs on entering the clinic, one-third were diagnosed with psychosocial disorders and one-fifth with sexuality-related concerns. Of the patients receiving a sexuality-related diagnosis, 57% presented with a sexuality-related request; another 26% noted it on the checklist. For those diagnosed with psychosocial problems, 22% stated this as the RFE, and another 50% indicated it on the HCC. The contribution of the HCC to the diagnosis was higher among adolescents not stating a specific RFE.Conclusion.The findings highlight the HCC's contribution in identifying health problems, especially among adolescents who find it difficult to verbalize sensitive issues.
Social Psychiatry and Psychiatric Epidemiology, May 16, 2001
In Israel, some population characteristics and lifestyle patterns make epidemiological research o... more In Israel, some population characteristics and lifestyle patterns make epidemiological research on suicide of particular interest. The Israeli population is characterized by ethnic diversity, with a multi-religious, multi-national mosaic of Jews and Arabs. These subgroups also vary in their suicidal behavior. The aims of the present study were to examine the trends in suicide incidence rates in Israel from 1984 to 1994, to identify sub-populations at high risk for suicide and to identify suicide methods associated with increased risk. Suicide rate trends in Israel over the period from 1984 to 1994 were examined for four subgroups: Jewish men and women, and Arab men and women. Cases of undetermined external cause (UEC) of death were also considered. Mortality data were obtained from the computerized data files of the Israeli Central Bureau of Statistics, which includes cause of death and sociodemographic variables. Suicide was classified according to the ICD-9 codes. Suicide rates were higher for Jews than for Arabs, and higher for men than for women. The rates among both population and sex groups increased directly with age. A significant increase over the years studied was found for Jewish men, particularly in the 18- to 21-year-old age group. An increase in the use of firearms was noted, mainly in the groups in which total suicide rates increased. The findings of this study highlight the need for further studies to identify both sub-populations at high risk for suicide, and societal trends such as lifestyles, immigration, military service, and media exposure to violence, as first steps toward planning of intervention programs to reduce suicide rates.
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