Satisfaction with Family Physicians and Specialists and the use of Complementary and Alternative Medicine in Israel

Higher utilization of complementary and alternative medicine (CAM) is commonly explained by dissatisfaction or disappointment with conventional medical treatment. To explore, at two points in time in Israel, the associations between six domains of satisfaction (attitude, length of visits, availability, information sharing, perceived quality of care and overall) with conventional family physicians' and specialists' services and the likelihood of consulting CAM providers. This is a secondary analysis of interviews, which were conducted with 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and multivariate analyses were used in the investigation. In 1993, users of CAM were less satisfied than non-users with both family physicians' and specialists' care. Lower satisfaction with the attitude of, the amount of information sharing by and in general with family physicians, and with the length of visits and perceived quality of care of specialists were significantly associated with CAM use. In 2000, lower satisfaction with specialists' attitude, length of visits, availability and in general was significantly related to the use of CAM. Lower satisfaction with family physicians and specialists is significantly associated with consulting CAM providers. However, with CAM becoming a mainstream medical care specialty in its own, lower satisfaction with conventional medicine specialists becomes the most important factor

Are Users of Complementary and Alternative Medicine Sicker than Non-Users?

Higher utilization of complementary and alternative medicine (CAM), both in cross-sections and over time, is commonly related to better socioeconomic status and to increased dissatisfaction with conventional medicine and its values. Little is known about health differences between users and non-users of CAM. The objective of the paper is to explore the difference in health measured by the SF-36 instrument between users and non-users of CAM, and to estimate the relative importance of the SF-36 health domains scales to the likelihood of consulting CAM providers. Interviews were used to collect information from a sample of 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and logistic regression analyses were used to explore the above associations. The results show that while users of CAM enjoy higher socioeconomic status and younger age, they tend to report worse health than non-users on the eight SF-36 health domains scales in both years. However, controlling for personal characteristics, lower scores on the bodily pain, role-emotional and vitality scales are related to greater likelihood of CAM use in 2000. In 1993, no scale had a significant adjusted association with the use of CAM. The conclusions are that CAM users tend to report worse health. With CAM becoming a mainstream, though somewhat luxurious, medical practice, pain and affective-emotional distress are the main drivers of CAM use

O Brasil na nova cartografia global da religião

Este artigo analisa as mudanças sociais, econômicas, culturais e religiosas que fizeram do Brasil um polo importante de produção do sagrado numa emergente cartografia global. Esta cartografia é policêntrica e entrecortada por uma miríade de redes transnacionais e multi-direcionais que facilitam o rápido movimento de pessoas, ideias, imagens, capitais e mercadorias. Entre os vetores que vamos examinar estão: imigrantes brasileiros que na tentativa de dar sentido ao processo deslocamento e de manter ligações transnacionais com o Brasil levam suas crenças, práticas, identidades religiosas para o estrangeiro, missionários e outros "entrepreneurs" religiosos, o turismo espiritual de estrangeiros que vão ao Brasil em busca de cura ou desenvolvimento espiritual, e as indústrias culturais, a mídia e a Internet que disseminam globalmente imagens do Brasil como uma terra exótica onde o sagrado faz parte intrínseca de sua cultura e natureza

Nurses in alternative health care: Integrating medical paradigms

The article is concerned with nurses in Israel who incorporate alternative health care practices into their work, and considers strategies used by them to reconcile a variety of theoretical and practice traditions. The analysis utilizes boundary theory and focuses on the following boundaries: territorial, epistemological, authority, and social. In-depth narrative interviews were carried out in 2004 with 15 nurses who were working or recently worked in both biomedical and complementary and alternative medicine (CAM) settings. The findings show that nurses using CAM practices do not seek to change the epistemological and authority boundaries of biomedicine. Even so many believe that CAM methods should be included within the cognitive boundaries of biomedicine. They are not disturbed that most of these techniques have not passed the test of biomedical research criteria, though they feel blocked by physicians who keep the cognitive boundaries of biomedicine closed.Nurse Israel Bio-medicine Boundary Alternative Complementary

Health in Israel: Patterns of equality and inequality

While Israel does not have a nationalized health care system, 94.5% of its population is covered by comprehensive health insurance which includes curative and preventive ambulatory care as well as hospitalization. There is formal equality in access, distribution, and quality of the health services; nevertheless, there are pockets of deprivation that affect certain segments of the population. The paper focuses on three topics: (a) structure of the health care delivery system in terms of coverage, geographical and social distribution, and the public/private balance of the services; (b) processes of health care delivery in terms of utilization and quality; (c) health outcomes in terms of mortality, morbidity, health behavior, and disease vulnerability. Inequality in Israel appears to be structured in terms of six dimensions: coverage of health insurance, distribution of health services, the balance of public and private sectors of health services, utilization of existing services, quality of health services, and health outcomes as expressed by mortality, morbidity, health behavior and risk factors. Only two types of health care are not covered by the general health insurance: (a) dental care, and (b) long-term nursing care. Given the small area of Israel there are striking differences in the geographic distribution of health personnel of various types. There is evidence gor gaps between needs and institutional services for many elderly who are on waiting lists for institutionalization. The ratio of primary care physicians to population is 1:2326 in development towns and 1:1852 in the older more established veteran communities. Kibbutzim, which are also located in large part in geographically remore areas, enjoy high quality health services and are not characterized by low ratios of health care personnel. In 1968-69, 6% of those insured by the sick funds purchased services at least once from a private physician, while in 1975-76 this figure rose to 32%. As in other countries, utilization of preventive services is generally correlated with socio-economic status and with education. While the network of primary care facilities in Israel is widespread and generally accessible, it is poorly integrated with the hospital system. Longevity has increased over the past years and is relatively high; 76.6 for women and 73.1 for men in 1984. Nevertheless, differences between Jews and non-Jews may still be seen among both men and women. The same may be said concerning mortality and especially with regard to infant mortality. Differences with regard to certain risk factors among Jews infants and adults are correlated with socio-economic class and country of origin.health inequality health services epidemiology Israel health health outcomes

The dynamics of professional commitment: Immigrant physicians from the former Soviet Union in Israel

The paper examines professional commitment among physicians who immigrated to Israel from the former Soviet Union during the early 1990s. This population faces severe limits regarding occupational continuity because of the highly saturated market in which non-negligible groups will, in the long run, of necessity undergo occupational change. The theoretical background for the analysis is drawn from the literature regarding recent changes in professional roles with particular reference to the shifting meaning of work in post-modern societies and its consequences for occupational commitment. The professional context of medical practice in the former Soviet Union and the social and economic constraints of Israeli society in the 1990s set the scene for the analysis. Several dimensions of professional commitment are examined empirically, on the assumption that there are a variety of ways to consider the notion of commitment and that no one measure tells a complete story. Prolonged processes of depressionalization of medicine in the Soviet Union, suggest that medicine for most immigrant physicians is not so much a 'calling' to which they are devoted; rather it is a necessary means to gain a livelihood, the only occupation for which they have been trained for many years after stringent selection to medical school and the only job in which they have worked consistently since completing their formal training. Two and a half years after arrival in Israel the immigrant doctors are characterized by a short-range time perspective which makes them unwilling to accept the constraints of the saturated market; intense efforts are made by most to obtain a license despite the fact that only a fraction of them will be able to work in their profession on a regular basis. Despite this over-riding reality, many hope that they will be among the selected few who will be able to obtain a medical post.immigrants physicians Israel Soviet Union commitment profession