Individual Parental Coaching (IPC) - an optional way to improve communication between parents and adolescents in conventionally structured families in Israel

This research explores the connection and influence that individual parental coaching (IPC) has on the teenager-parent relationship. Essentially, the research had two main goals, firstly to examine the possible influence of a parental coaching process, with respect to the parents’ ability to form better connections and communication with their adolescent children. Furthermore, it sought out to validate a certain perception of parenting - the notion that a parent must first establish a firm sense of "self" before taking part in parenting. As described by Ayn Rand (1943): "for one to say "I love you', one must first say the 'I', thus self-definition, purpose and meaning are the individual's significant guidelines when establishing relations with others, especially the demanding relations with teenagers. The initial assumption of the research was that individual parental coaching, would give parents an opportunity to undergo an extensive personal coaching process that would help strengthen the parents’ core values, boundaries and priorities. This would then enable them to address their parental role with confidence, conviction and flexibility, rather than confusion, fear of losing significance and control, and consequently effecting the teenager-parent equation for the better. This was a qualitative narrative research, since the parents' life stories, as perceived and related by them, were at the base of this research. Seven Israeli families participated; heterosexual married couples that had raised at least one teenager between the ages of 13 to 18. On the one hand, the parents took part in a comprehensive coaching process consisting of ten weekly sessions; on the other hand, the teenagers filled out questionnaires, and thus were a part of the research in an indirect manner. All the data that was collected from questionnaires, coaching sessions and open interviews were analyzed using the "Theme Analysis" method, which revealed some prominent individual and parental issues that contemporary Israeli parents deal with. Results indicate two central findings - a great appreciation on the parents' part for the opportunity to enter into a deep process of self-encounter and its benefits, despite all the difficulties along the way. The second one addressed the research question itself and showed an explicit change process in the communication and connection between parents and teenagers on varying levels, from both the parents' as well as the teenagers' points of view. Improvements included more time spent together, less anger and friction, more patience and tolerance, awareness to discourse style and word choices and an overall better atmosphere around the house. All participating parents without exception stated that it was a worthy journey, which they would recommend all parents experienced

Tropical tele-connections to the Mediterranean climate and weather

Some strong natural fluctuations of climate in the Eastern Mediterranean (EM) region are shown to be connected to the major tropical systems. Potential relations between EM rainfall extremes to tropical systems, e.g. El Niño, Indian Monsoon and hurricanes, are demonstrated. For a specific event, high resolution modelling of the severe flood on 3-5 December 2001 in Israel suggests a relation to hurricane Olga. In order to understand the factors governing the EM climate variability in the summer season, the relationship between extreme summer temperatures and the Indian Monsoon was examined. Other tropical factors like the Red-Sea Trough system and the Saharan dust are also likely to contribute to the EM climate variability

Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study

Objectives. We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older. Methods. We analyzed data from the 2003-2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions. Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men. Conclusions. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities

The failed liberalisation of Algeria and the international context: a legacy of stable authoritarianism

The paper attempts to challenge the somewhat marginal role of international factors in the study of transitions to democracy. Theoretical and practical difficulties in proving causal mechanisms between international variables and domestic outcomes can be overcome by defining the international dimension in terms of Western dominance of world politics and by identifying Western actions towards democratising countries. The paper focuses on the case of Algeria, where international factors are key in explaining the initial process of democratisation and its following demise. In particular, the paper argues that direct Western policies, the pressures of the international system and external shocks influence the internal distribution of power and resources, which underpins the different strategies of all domestic actors. The paper concludes that analysis based purely on domestic factors cannot explain the process of democratisation and that international variables must be taken into more serious account and much more detailed

Type of altitude towards disease distribution in clinical picture of elderly and old-aged patients suffering from boundary mental disorders

Among 96 elderly and old-aged dental patients which have organic anxious disorders ( F 06.4) there are on the average 43,0% of cases of co-existing depression and anxiety type of attitude. Melancholic type of attitude towards diseas e is detected in 15,8 of cases. The other types such as hyphondriacal, neurotic, egocentric, etc. are infrequent.Среди 96 стоматологических больных пожилого и старческого возраста с органическими тревожными расстройствами (F06.4) тревожно-депрессивный тип отношения к болезни выявляется в среднем в 43,0% случаев, меланхолический тип в 15,8%. Остальные типы составляют ипохондрический, неврастенический, эргоцентрйческий и другие

Mediterranean climate and some tropical teleconnections

Some strong natural fluctuations of climate in the Eastern Mediterranean (EM) region are shown to be connected to the major tropical systems, e.g., El Nino Southern Oscillation, South Asian Monsoon and hurricanes. Modelling of the severe floods suggests a relation to tropical hurricanes. For a, specific event, high-resolution modelling of the severe flood on December 3-5, 2001. in Israel suggests a relation to hurricane Olga. In order to understand the factors governing the Eastern Mediterranean climate variability in the summer season, the relationship between extreme summer temperatures and the South Asian Monsoon was examined. Other tropical factors, like the Red Sea Trough system and the Saharan dust, also contribute to the Mediterranean climate variability

Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation

Background: Acromegaly, an orphan disease usually caused by a benign pituitary tumour, is characterised by hyper-secretion of growth hormone (GH) and insulin-like growth factor I (IGF-1). It is associated with reduced life expectancy, cardiovascular problems, a variety of insidiously progressing detrimental symptoms and metabolic malfunction. Treatments include surgery, radiotherapy and pharmacotherapy. Pegvisomant (PEG) is a genetically engineered GH analogue licensed as a third or fourth line option when other treatments have failed to normalise IGF-1 levels. Methods: Evidence about effectiveness and cost-effectiveness of PEG was systematically reviewed. Data were extracted from published studies and used for a narrative synthesis of evidence. A decision analytical economic model was identified and modified to assess the cost-effectiveness of PEG. Results: One RCT and 17 non-randomised studies were reviewed for effectiveness. PEG substantially reduced and rapidly normalised IGF-1 levels in the majority of patients, approximately doubled GH levels, and improved some of the signs and symptoms of the disease. Tumour size was unaffected at least in the short term. PEG had a generally safe adverse event profile but a few patients were withdrawn from treatment because of raised liver enzymes. An economic model was identified and adapted to estimate the lower limit for the cost-effectiveness of PEG treatment versus standard care. Over a 20 year time horizon the incremental cost-effectiveness ratio was pound81,000/QALY and pound212,000/LYG. To reduce this to pound30K/QALY would require a reduction in drug cost by about one third. Conclusion: PEG is highly effective for improving patients' IGF-1 level. Signs and symptoms of disease improve but evidence is lacking about long term effects on improved signs and symptoms of disease, quality of life, patient compliance and safety. Economic evaluation indicated that if current standards (UK) for determining cost-effectiveness of therapies were to be applied to PEG it would be considered not to represent good value for money

Comparison of the novel START vascular stiffness index with the CAVI index, assessment of their values and correlations with clinical parameters

Aim. To compare the cardio-ankle vascular index (CAVI) and the novel START vascular stiffness index and assess their values and correlations with clinical parameters.Material and methods. This multicenter study included 928 (403 men and 525 women) randomly selected patients, aged 18 to 89 years (mean age, 41±15,8 years). Inclusion criteria were age over 18 years. There were following exclusion criteria: mental disorder, severe somatic diseases and cancer, contraindications for volume sphygmography using the Fukuda Denshi VS-1500 VaSera system, no patient consent, ankle-brachial index <1,0 and >1,3. Further, according to the main parameters obtained using volum sphygmography, a novel START index was calculated. Comparison of index values and analysis of their correlation with clinical indicators, such as age, systolic blood pressure, diastolic blood pressure, pulse pressure (PP), body mass index and heart rate (HR), were carried out using simple and multiple linear regression, dispersion analysis, calculation of the Pearson coefficient (r), in the software environment R version 4.0.2.Results. Statistical analysis revealed a high correlation between START and CAVI indices (r=0,986, p<0,001). The values of both indices increase significantly with age (ANOVA p><0,001). Both START and CAVI correlate with all studied clinical parameters. However, in men, there was no relationship of the indices with PP and HR (p>0,05). According to multiple linear regression, the relationship between diastolic blood pressure at the age of 30-60 years and PP at the age of 18-40 years with the START index is more pronounced than with the CAVI index. However, further study of the mathematical model did not reveal a significant difference in the index values for groups with and without high blood pressure.Conclusion. The START vascular stiffness index significantly correlates with the CAVI index, showing no significant differences from CAVI in quantitative relationships with blood pressure, body mass index, heart rate, and sex in various subgroups of the subjects

Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options