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Maxfield M, Peckham A, James DL, Koffer RE. "Why miss today worrying about tomorrow?" A qualitative investigation of ways middle-aged and older adults manage dementia-related anxiety. ANXIETY, STRESS, AND COPING 2024:1-15. [PMID: 39211960 DOI: 10.1080/10615806.2024.2396419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/02/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Dementia-related anxiety (DRA) is the fear or anxiety about a current or future diagnosis of Alzheimer's disease or another type of dementia. The purpose of the present study was to examine management of DRA. METHODS AND DESIGN In semi-structured qualitative interviews, 50 community-dwelling adults (58-89 years old, M = 70.80, SD = 6.02) without dementia diagnoses reflected on their thoughts and feelings about dementia. A reflexive inductive thematic approach was used to examine ways people managed DRA. RESULTS We identified five themes related to managing DRA: monitoring cognitive status (e.g., self-monitoring or objective assessment); active coping strategies (e.g., using external reminders, normalizing age-related change); interpersonal relationships and support (e.g., anticipating benefit of support from others); planning and preparing for potential outcomes (e.g., securing power of attorney, saying goodbyes); and personal responsibility to manage risk or accept diagnosis (e.g., lifestyle factors to reduce dementia risk, thereby reducing risk for burdening others). CONCLUSIONS Findings suggest internal and external means for coping with DRA that are likely to vary in degrees of usefulness. We consider findings within the context of relevant, established theories, attending to potential clinical interventions for individuals experiencing DRA.
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Affiliation(s)
- Molly Maxfield
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
| | - Dara L James
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Rachel E Koffer
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
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AboJabel H, Werner P. Validating the Hebrew Version of the Modified Dementia Worry Scale (H-MDWS). J Cross Cult Gerontol 2024; 39:73-88. [PMID: 38112907 DOI: 10.1007/s10823-023-09494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
The body of knowledge regarding dementia worry - people's sense of threat about developing dementia - is still limited. Additional studies are essential to better understand levels of dementia worry and its correlates, especially in cross-cultural contexts. To reach this goal, it is critical to use structured and valid measures to assess dementia worry and to verify these measures in different languages. Therefore, the aim of the current study was to evaluate the psychometric properties of the Hebrew version of the Modified Dementia Worry Scale (the H-MDWS). A cross-sectional study using an online survey was conducted with 368 Israeli laypeople who were 18 years of age or older (53% women, 76% Jewish, mean age = 40, average years of education = 14). In addition to the H-MDWS, participants were asked to report their fear of Alzheimer's disease (using a dichotomous single item), stigma, health anxiety, and demographic characteristics. Reliability analyses showed that the Cronbach's alpha for the H-MDWS was excellent (α = 0.95). The results of the factor analysis demonstrated that the scale has a unidimensional structure, explaining over 66% of the variance. In addition, we found significant correlations between fear of developing Alzheimer's disease, stigma, and health anxiety, on the one hand, and the H-MDWS on the other. The H-MDWS is a reliable and valid tool for assessing dementia worry. The validation of the tool not only allows expanding the body of knowledge related to dementia worry, but will also allow professionals and caregivers to identify people who are at risk of reporting dementia worry and develop interventions accordingly.
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Affiliation(s)
- Hanan AboJabel
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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AboJabel H, Welsch J, Schicktanz S. Cross-cultural perspectives on intelligent assistive technology in dementia care: comparing Israeli and German experts' attitudes. BMC Med Ethics 2024; 25:15. [PMID: 38326778 PMCID: PMC10848426 DOI: 10.1186/s12910-024-01010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Despite the great benefits of intelligent assistive technology (IAT) for dementia care - for example, the enhanced safety and increased independence of people with dementia and their caregivers - its practical adoption is still limited. The social and ethical issues pertaining to IAT in dementia care, shaped by factors such as culture, may explain these limitations. However, most studies have focused on understanding these issues within one cultural setting only. Therefore, the aim of this study was to explore and compare the attitudes of Israeli and German dementia experts toward IAT in dementia care, to contribute to a more cultural-comparative perspective. METHODS Semi-structured interviews were conducted with 35 experts (15 Israelis and 20 Germans) in key roles in health and community services for people with dementia as well as in the fields of dementia and IAT (e.g., computer science, electrical/biomedical engineering, ethics, nursing, and gerontology). Thematic content analysis was used to analyze the data. FINDINGS Israeli and German experts identified the same social accelerators in the development and implementation of IAT in dementia care (i.e., changes in family structure and social digitization) and benefits of adopting IAT (e.g., enhancing the safety of people with dementia and increasing their independence). However, there were differences in inhibitor/risk assessments between the two groups. Namely, economic considerations and the cognitive capacity of people with dementia were identified by both groups as inhibitors, while Israeli experts additionally reported stigma and ageism. Whereas both groups agreed that IAT might reduce human connection, and that the technology is not yet reliable enough, German experts highlighted concerns regarding privacy; in contrast, Israeli experts prioritized safety over privacy. CONCLUSIONS Our research findings allow for the identification of relevant similarities but also important differences between German and Israeli experts' perspectives. As such, an important basis has been provided for a more in-depth discussion regarding where, why, and how culturally-sensitive technology development is needed.
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Affiliation(s)
- Hanan AboJabel
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany.
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Johannes Welsch
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Angelidou IA, Stocker H, Beyreuther K, Teichmann B. Validation of the "Perceptions Regarding pRE-Symptomatic Alzheimer's Disease Screening" (PRE-ADS) Questionnaire in the German Population: Attitudes, Motivations, and Barriers to Pre-Symptomatic Dementia Screening. J Alzheimers Dis 2024; 97:309-325. [PMID: 38189757 PMCID: PMC10789340 DOI: 10.3233/jad-230961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Attitudes, motivations, and barriers to pre-symptomatic screening for Alzheimer's disease (AD) in the general population are unclear, and validated measurement tools are lacking. OBJECTIVE Translation and validation of the German version of the "Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening" (PRE-ADS) questionnaire. METHODS A convenience sample (N = 256) was recruited via an online platform. Validation of the PRE-ADS-D consisted of assessments of reliability, structural validity using Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) and construct validity using known-group tests. A subscale "Acceptability of Screening", with 5 PRE-ADS-D items, was extracted to measure acceptance of screening in clinical practice. The STROBE checklist was used for reporting. RESULTS EFA revealed a three-factor model for the PRE-ADS-D. Acceptable to good internal consistency was found for the 25-item scale (α= 0.78), as well as for the three factors "Concerns about Screening" (α= 0.85), "Intention to be Screened" (α= 0.87), and "Preventive Health Behaviors" (α= 0.81). Construct validity was confirmed for both the 25-item PRE-ADS-D and the "Acceptability of Screening" scale (α= 0.91). Overall, 51.2% of the participants showed a preference for screening. Non-parametric tests were conducted to further explore group differences of the sample. CONCLUSIONS The PRE-ADS-D is a reliable and valid tool to measure attitudes, motives, and barriers regarding pre-symptomatic dementia screening in the German-speaking general population. Additionally, the subscale "Acceptability of Screening" demonstrated good construct validity and reliability, suggesting its promising potential as a practical tool in clinical practice.
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Affiliation(s)
| | - Hannah Stocker
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | - Birgit Teichmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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Werner P, Ulitsa N, Alpinar-Sencan Z, Shefet D, Schicktanz S. Identifying Stigmatizing Language Used by Israelis and Germans With a Mild Neurocognitive Disorder, Their Relatives, and Caregivers of People With Alzheimer's Disease. Alzheimer Dis Assoc Disord 2024; 38:42-50. [PMID: 38194484 DOI: 10.1097/wad.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The purpose of the study was to examine and compare the dementia-related discourse and language used by people with mild neurocognitive disorder (MND), their family members, and family caregivers of people with Alzheimer's disease in Israel and Germany. DESIGN This secondary qualitative analysis included focus groups and semistructured interviews. Thematic analysis was used to reveal the main discourses and stigmatic language used regarding dementia and people with dementia. SETTING Israeli and German stakeholders. PARTICIPANTS Forty-four Israeli and 44 German participants: 28 people with MND, 20 family members of people with MND, and 40 family caregivers of people with Alzheimer's disease. RESULTS Two main discourses were identified: the tragedy and the biomedical discourse. The tragedy discourse included several subthemes: "Dementia as the worst-case scenario," "Nothing can be done about dementia," and "People with dementia are not human." The biomedical discourse stressed pathologic aspects of the condition. Similarities and differences were found between Israeli and German participants. CONCLUSIONS The study indicates that, despite culture and language differences, the use of stigmatic discourse and stigmatizing language is common among people with close exposure to dementia in Israel and Germany. Efforts should be increased to develop a person-centered and dementia-friendly language.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa
| | - Natalie Ulitsa
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa
| | - Zümrüt Alpinar-Sencan
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Daphna Shefet
- The Division of Geriatric Psychiatry, Shalvata Mental Health Center, Hod Hasharon
- Faculty of Medicine, Tel Aviv University
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Noguchi T, Nakagawa T, Komatsu A, Shang E, Murata C, Saito T. Role of Interacting and Learning Experiences on Public Stigma Against Dementia: An Observational Cross-Sectional Study. DEMENTIA 2023; 22:1886-1899. [PMID: 37857447 DOI: 10.1177/14713012231207222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: Overcoming dementia stigma is a global challenge. Contact and education on dementia may be promising approaches for reducing public stigma; however, the current evidence is insufficient. This study examined the moderating factors associated with the public stigma against dementia, focusing on experiences of interacting with and learning about people with dementia. Methods: This cross-sectional study recruited 710 adults aged 20-69 years who were not involved in any medical or care work. Participants were recruited via a web-based questionnaire survey for a large internet survey agency's panel in Japan. In terms of the public stigma about dementia, four domains were assessed using a multidimensional assessment scale: personal avoidance, fear of labelling, person-centredness, and fear of discrimination. We compared the stigma scores according to the participants' experiences of interacting with people with dementia ('none', 'talking or activities together', or 'living together') and learning about dementia ('yes' or 'no'), adjusted for demographic and socioeconomic factors.Results: Compared with those without interaction experiences, those with experiences of talking or activities with people with dementia had lower personal avoidance (p = .001), fear of labelling (p = .026), and fear of discrimination (p = .031); those with experiences of living together with people with dementia had lower personal avoidance (p = .014) and fear of discrimination (p = .031). Compared with those without learning experiences related to dementia, those with such experiences had lower personal avoidance (p < .001) and higher person-centredness (p = .048).Conclusions: The findings suggest that the promotion of interaction with and learning about people with dementia may be important for addressing the public stigma.
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Affiliation(s)
- Taiji Noguchi
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
- Japan Society for the Promotion of Science, Japan
| | - Takeshi Nakagawa
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| | - Ayane Komatsu
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| | - Erhua Shang
- Department of Human Health, Aichi Toho University, Japan
| | - Chiyoe Murata
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
- Department of Health and Nutrition, Tokai Gakuen University, Japan
| | - Tami Saito
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
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Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes. Int Psychogeriatr 2023; 35:77-93. [PMID: 36330686 DOI: 10.1017/s1041610222000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study investigated the views of people living with dementia and their families/care partners on (i) what they find helpful or unhelpful regarding behavioral changes, i.e. which coping strategies they used for themselves and/or which responses from others, and (ii) what they consider to be appropriate terminology to describe behavioral changes. DESIGN & SETTING One-on-one semi-structured interviews were conducted with people living with dementia and families/care partners face to face, online, or over the telephone. MEASUREMENTS Data from open-ended questions were analyzed inductively. Common themes were derived from the data using an iterative approach. RESULTS Twenty-one people living with dementia and 20 family members/care partners were interviewed. Four main themes were derived for helpful responses, and three main themes for unhelpful responses. Helpful responses included providing clear professional support pathways and supportive environments where people living with dementia can engage in physical, cognitive, social, and spiritual activities. Unhelpful responses included discriminatory treatment from others and use of medicalized terminology. Views toward terminology varied; people with lived experience most favored using "changed behaviors" over other terminology. Areas for improvement included targeting dementia stigma, societal education on dementia, and building confidence in people living with dementia by focusing on living well with dementia. CONCLUSION Knowledge of the views of people living with dementia may assist healthcare professionals to provide more appropriate care for people living with dementia.
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Maxfield M, Pituch KA. Profiles in Dementia-Related Anxiety: A Latent Profile Analysis. J Gerontol B Psychol Sci Soc Sci 2022; 77:2182-2191. [PMID: 35678193 DOI: 10.1093/geronb/gbac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Dementia-related anxiety (DRA) is the concern about current or future cognitive decline and potential diagnosis of Alzheimer's disease or related dementias (ADRD). Existing research suggests that DRA likely develops due to diverse reasons (e.g., family ADRD history, self-perceived risk, and health-related anxiety), and approaches to managing DRA likely differ as well (e.g., future planning). This study aimed to identify profiles in DRA. METHOD In a cross-sectional study, a convenience sample of U.S. adults ranging in age from 18 to 82 (N = 492, Mage = 49.25, standard deviation [SDage] = 15.43) completed online assessments of characteristics associated with DRA. Latent profile analysis was used to uncover distinct DRA profiles and promote understanding of individual characteristics associated with varying levels of DRA; multinomial regression assessed if the profiles are further distinguished by covariates. RESULTS The resulting four-profile model reveals profile differences are largely due to DRA, self-perceived ADRD risk, and preparedness for future care needs; health-related anxiety, age, ADRD exposure, and anticipated ADRD stigma contribute to profile differences as well. Profiles of the youngest and oldest groups reported the lowest and highest levels of preparedness for future care, along with the lowest DRA and self-perceived risk. Several covariates, particularly those assessing general psychological functioning, were also related to profile membership. DISCUSSION The resulting profiles point to several factors associated with elevated anxiety about ADRD, which do not fully match the risk factors for ADRD.
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Affiliation(s)
- Molly Maxfield
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.,Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Keenan A Pituch
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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Werner P, Kim S. How Are Sociodemographic, Health, Psychological, and Cognitive Factors Associated with Dementia Worry? An Online Survey Study among Israeli and Australian Laypeople. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11313. [PMID: 36141584 PMCID: PMC9516982 DOI: 10.3390/ijerph191811313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Dementia worry is a widespread phenomenon and the most common emotional reaction elicited by the threat of developing dementia in the future. The cultural factors of dementia worry have not been examined widely, although dementia can be perceived differently between cultures and lead to varying levels of dementia worry. The purpose of this study was to examine the level of dementia worry and factors associated with it cross-nationally in Israel and Australia. METHODS A cross-sectional, online survey was conducted with two age-matched adult samples (447 participants in Israel and 290 in Australia). The primary outcome measure was the 12-item Dementia Worry Scale. RESULTS Israeli participants (mean age = 42.5 years; 50.1% female) reported statistically significantly (p < 0.05) higher levels of concern about developing dementia in comparison to Australian participants (mean age = 43.7 years; 49.8% female). Increased ageism and increased perceptions about the likelihood of developing dementia were the most important factors associated with increased worry. CONCLUSIONS Our findings suggest that country may not be the best criterion to assess cultural differences and should be accompanied by the participants' assessment of their cultural tendencies. Our study also stresses the importance of conceptualizing and assessing affective and cognitive aspects of dementia worry, as people from different cultures might perceive dementia worry cognitively differently but affectively similar and vice-versa.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa 3498838, Israel
| | - Sarang Kim
- School of Psychology, University of New South Wales, Kensington 2052, Australia
- Neuroscience Research Australia, Randwick 2031, Australia
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Idilbi N, AboJabel H, Werner P. Examining hospital staff members' preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer's disease. Geriatr Nurs 2021; 42:787-791. [PMID: 34090221 PMCID: PMC8096197 DOI: 10.1016/j.gerinurse.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022]
Abstract
The COVID 19 pandemic has led to an increase in the number of patients in need of ventilation. Limitations in the number of respirators may cause an ethical problem for the medical and nursing staff in deciding who should be connected to the available respirators. We conducted a cross-sectional survey among a convenience sample of 278 healthcare professionals at one medical center. They were asked to rank their preference in respirator allocation to three COVID-19 patients, one 80 years old with no cognitive illness, one 50 years old with Alzheimer's disease (AD), and one 80 years old with AD. Most respondents (75%) chose the 80-year-old AD patient as last preference, but were evenly divided on how to rank the other two patients. Medical staff have difficulty deciding whether age or cognitive status should be the deciding factor ventilator allocation. Determination of a set policy would help professionals with these decisions.
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Affiliation(s)
- Nasra Idilbi
- The Max Stern Yezreel Valley College, Mobile Post Emek Yezreel, 1930600, Israel; Galilee Medical Center, P.O. Box 21, Nahariya 22100, Israel.
| | - Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave., Haifa 3498838, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave., Haifa 3498838, Israel
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