"I'm 'just' a community pediatrician" views and challenges of pediatricians working in the community in Israel

BACKGROUND

There are ongoing changes around the world in the training and practice of pediatricians who work in the community. These changes are driven by the understanding that pediatricians are required to provide not only acute primary care but also to address more comprehensive concerns, particularly the 'new morbidities'. The present study examines the professional identity of Israeli pediatricians in the community in light of these changes, the barriers and challenges to their work and professional adaptations in the field.

METHODS

We used a mixed-methods approach, collecting the perspectives of 137 pediatricians who work in the community through an anonymous online survey, followed by in-depth semi-structured interviews with 11 community pediatricians.

RESULTS

The survey results show that community pediatricians in Israel have limited knowledge on a variety of developmental, behavioral and emotional issues; that they lack working relationships with medical or other professionals; and are rarely engaged with other community services. Three main themes arose from the interviews that support and deepen the survey results: perceptions of the profession (pediatrics in the community vs. community pediatrics), the stature of pediatricians in the community (during residency, the choice to work in the community, their daily work) and barriers and change in community pediatrics (isolation, limited resources and challenges arising from the nature of community work).

CONCLUSIONS

The present study sheds light on the professional identity and the day-to-day challenges and successes of pediatricians working in the community. Continuing medical education, providing a supportive framework and professional community, better resources, more time with patients, and tools and opportunities for professional development would help pediatricians who work in the community to overcome some of these challenges. The research findings reinforce the need for policy change in the field of community pediatrics with a specific community training curriculum, provision of more resources and ongoing support for pediatricians. This requires partnership between the HMOs, the Ministry of Health, the Scientific Council (Israel Medical Association, professional organizations) and NGOs in order to turn individual-level solutions into system-level and policy-changing solutions.

Contributors to COVID-19-Related Childbirth Anxiety among Pregnant Women in Two Pandemic Waves

COVID-19 has impacted all levels of daily life for people everywhere, with particularly serious implications for pregnant women. This paper examines the COVID-19-related childbirth anxiety (CCA) of Israeli women in the first two waves of the pandemic. We first present two psychotherapeutic case studies with pregnant women in the two waves. This is followed by an empirical study that compared the contribution of background variables, psychological distress, economic concerns, and personal resources to CCA in two samples, Wave 1, March-April 2020 (n = 403) and Wave 2, September-October 2020 (n = 1401), and two subpopulations, Jewish and Arab women. Findings reveal that CCA was significantly lower in Wave 2 than in Wave 1. Furthermore, poorer health, higher education, being an Arab, later gestational week, at-risk pregnancy, wave, higher psychological distress, greater economic concerns, and lower self-compassion contributed to higher childbirth anxiety. Wave moderated the association between optimism and anxiety. The findings of the empirical study, together with insights from the case studies, provide evidence of a decrease in CCA later in the crisis, and indicate the significance of resources for coping with the psychological implications of the pandemic. Moreover, they suggest the importance of empowering self-reliance techniques, such as self-compassion, which was significantly associated with lower anxiety, above and beyond the background and psychological variables. Clinical Impact Statement: Using both psychotherapeutic cases and empirical findings, this study points to the risk and resilience factors that contributed to pregnant women's COVID-19-related childbirth anxiety (CCA) in the first two waves of the pandemic. The study suggests that CCA was higher in the first wave, as well as among women from a minority group. At the same time, the research shows that resilience resources of optimism and self-compassion contributed to the reduction of anxiety. These findings may guide interventions for the vulnerable group of pregnant women in times of crisis.

Mothers' experience of their daughters' fertility problems and treatments

Fertility treatments are a stressful experience. However, the support provided by meaningful support figures, such as a mother, may contribute positively to the mental health of women with fertility issues. The present study therefore explored the experience of Israeli mothers whose daughters encountered fertility problems and underwent treatment to bring their first child into the world. In a retrospective qualitative study, face-to-face semi-structured interviews were conducted with 16 women aged 49-73. Women in the study had a daughter in a spousal heterosexual relationship who conceived her first child via fertility treatment, and this child was up to 4 years old at the time of the interview. Three main themes emerged: (a) The stressfulness of a daughter's fertility problems and treatments for the mother; (b) The mother's supportive role; and (c) The mother's own need for support. The results suggest that due to the unique nature of the mother-daughter relationship, a daughter's fertility problems and treatments are also stressful for her mother. Nevertheless, mothers can be, and wish to be, an important source of support for their daughters. Empirically, further research to extend this understanding is recommended. Practically, professionals should be aware of the mother's distress and the fact that she is likely to deny her own need for support, and make an effort to relate to the stress of these women and help them to be a more effective resource for their daughters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pre-term delivery, optimism and initial personal growth as predictors of mothers' long-term personal growth

Introduction: Positive outcomes in the aftermath of childbirth have increasingly been studied in the last decade. However, most of the studies concentrate on short-term outcomes. The current study examined the perceived personal growth of mothers four years after childbirth, investigating the contribution of the event characteristics (full-term/pre-term birth), internal resources (optimism, self-esteem) and personal growth as measured one year after the birth. Methods: Mothers (n=259) participated in the study by completing a set of self-report questionnaires one and four years following the birth of their child/ren. Results: Personal growth after four years was found to be higher among mothers of pre-terms than of full-terms, and higher four years after the birth than it had been three years earlier. Furthermore, regression analysis indicated the significant contributions of being a mother to pre-term baby/ies, optimism and personal growth one year after the birth to women's personal growth three years later. Discussion: The results highlight the potential long-term effects of giving birth to a pre-term baby on personal growth, as well as the contribution of optimism as an important internal resource. They also indicate the development of personal growth over time. Explanations for the findings are offered and their practical implications are discussed.

Contributors to Women's Perceived Stress at the Start of Assisted Reproductive Technology

Clinicians are often called upon to treat the stress that accompanies Assisted Reproductive Technology (ART). In this study, we sought to examine the contribution of the internal resources of meaning in life and attachment style and the interpersonal resource of self-disclosure to her mother to a woman's level of perceived stress upon commencement of ART. In addition, we examined the association between age and perceived stress. The sample consisted of 180 Israeli women (106 aged 20-34; 74 aged 35-44) who completed a series of self-report questionnaires after their initial meeting with a fertility specialist. Regression analysis indicated that older age, lower attachment anxiety, higher perception of meaning in life, and greater self-disclosure to the mother were related to lower levels of perceived stress. Self-disclosure was also found to mediate the association between avoidant attachment and stress. The study highlights the importance of a woman's personal and interpersonal resources for reducing the experience of stress in the early stages of ART. The results have practical implications for the development of professional interventions seeking to enhance these resources among women embarking on fertility treatment.

Contributors to young drivers' driving styles - A comparison between Israel and Queensland

Among the numerous factors that contribute to young novice drivers' driving styles, personality characteristics, sociodemographic variables, family atmosphere, and friends' norms are known to have an important impact. However, cross-cultural comparisons are relatively rare in the safety literature concerning young drivers. This study aimed at comparing young drivers from Israel and Queensland (Australia) and examining the contribution of personality, sociodemographic, family and friends' aspects to their driving styles (reckless and careless; hostile and angry; anxious; patient and careful). More specifically, this study examined the associations between young drivers' driving style and their perceptions of separation-individuation, the family climate for road safety, and the safe driving climate among friends. We also examined sociodemographic and driving history variables such as gender, the marital status of parents, and personal exposure to traffic crashes. The study consisted of two samples of male and female young drivers (age 17-22) from Israel (n=160) and Queensland (n=160), who completed a set of valid and reliable self-report questionnaires. Findings indicate that in general, maladaptive driving styles are associated with lower family tendency to engage in promoting road safety, higher pressure and costs of driving with peers, and unhealthier separation-individuation aspects. The opposite is observed for the patient and careful driving style that relates to higher engagement of the family in road safety, lower pressure from friends, and healthier separation-individuation. Some differences were found regarding specific styles between the two samples. In addition, women scored lower than men in the reckless and careless style, and higher (in the Israeli sample) in the anxious as well as the patient and careful styles. Overall, similarities in the associations between the study variables in the samples exceed the differences, and the importance of examining variables on multi-levels when referring to young drivers' driving styles, is confirmed. The findings attest to the universal utility of the MDSI, together with the understanding that only a wider examination of personal and environmental contributors enables true insights into the complex behavior of driving among young drivers.

Mental health of women entering fertility treatment: What role do age and internal resources play?

Drawing on Lazarus and Folkman's (1984) model of stress and coping, the study aimed at (a) examining the associations between the mental health of women entering fertility treatment and their internal resources (hope and two aspects of self-consciousness: reflection and rumination); (b) indicating whether mental health is associated with age (above or below 35), and whether this association is mediated by the internal resources. The sample consisted of 137 women (76 aged 20-34; 61 aged 35-44) at the start of fertility treatment who completed a series of self-report questionnaires. Results indicated that younger women reported higher distress and rumination than older women. Higher hope was associated with greater well-being, and higher rumination was associated with greater distress. Furthermore, hope and rumination were found to mediate the association between age and mental health. These findings highlight the importance of developing age-based interventions for women entering fertility treatment, aimed at strengthening their resilience to effectively cope with the demanding process ahead.

Satisfaction in life among fathers following fertility treatment

OBJECTIVE

The study aimed at (a) gaining a better understanding of how fertility history (ART/spontaneous) is associated with life satisfaction among new fathers; and (b) identifying personal and interpersonal risk factors for lower satisfaction in life during the transition to fatherhood.

DESIGN

This cross-sectional study comprised 172 Israeli fathers (76 who became fathers following ART and 96 following spontaneous pregnancy), who completed a series of self-report questionnaires 5-18 months after the birth of their first child.

RESULTS

No differences were found in life satisfaction between fathers in the two fertility history groups. Regression analysis indicated that younger age and higher economic status, as well as lower attachment anxiety and avoidance and better marital relationship, were associated with a higher level of life satisfaction among new fathers.

CONCLUSION

Although the life satisfaction of new fathers does not appear to be affected by their fertility history, it may be hampered by personal and interpersonal risk factors. These results have practical implications for professionals who come into contact with this population.

The multidimensional driving style inventory a decade later: Review of the literature and re-evaluation of the scale

The Multidimensional Driving Style Inventory (MDSI; Taubman - Ben-Ari, Mikulincer, & Gillath, 2004a), a self-report questionnaire assessing four broad driving styles, has been in use for the last ten years. During that time, numerous studies have explored the associations between the MDSI factors and sociodemographic and driving-related variables. The current paper employs two large data sets to summarize the accumulated knowledge, examining MDSI factors in samples of young drivers aged 17-21 (Study 1, n=1436) and older drivers aged 22-84 (Study 2, n=3409). Findings indicate that driving-related indicators are coherently and systematically related to the four driving styles in the expected directions, revalidating the structure of the MDSI. The results also help clarify the relationships between the driving styles and variables such as gender, ethnicity, car ownership, age, and experience, and suggest that driving styles are largely unaffected by sociodemographic characteristics, except for gender and ethnicity, and appear to represent a relatively stable and universal trait. The two studies highlight the validity and reliability of the MDSI, attesting to its practical value as a tool for purposes of research, evaluation, and intervention.