Health-promoting Factors Research Articles

Salutogenic qualities of midwifery care: A best-fit framework synthesis

BackgroundAlthough midwifery care is wellness-based and promotes normal physiology, it exists within a medical model that focuses on risk aversion and disease prevention. Salutogenic theory could provide an alternative approach to midwifery care, supporting health-promoting factors, rather than solely avoiding adverse events. AimsThe aim of this study was to explore women’s experiences of their midwifery care and identify salutogenic aspects of midwifery care. MethodsBest-fit framework synthesis was used to analyse 349 quotes about women’s experiences of midwifery care from 31 qualitative studies in ten high-income countries. Key salutogenic concepts of comprehensibility, manageability and meaningfulness were used as the basis for coding, and thematic analysis was used to expand and clarify the framework to best fit the data. FindingsDefinitions for the salutogenic aspects of midwifery care were developed. Comprehensibility (cognitive aspects of health): ways that midwives help women increase predictability and preparation during childbearing through apredictable caregiver, a predictable system and preparation for an unpredictable experience. Manageability (behavioural aspects of health): ways that midwives enhance and support a woman’s internal resilience, adding extra support when needed, and strengthen women’s external resources through connections to family, community and specialist care. Meaningfulness (emotional/spiritual aspects of health): ways that midwives encourage the commitment and engagement of childbearing women by providing care through a personalised relationship, by cultivating a woman’s autonomy. ConclusionFindings of this study may be used to further research into ways that salutogenic theory can bring a health and wellness-focused agenda to midwifery policy and practice.

Potential Application of Tetrapleura tetraptera and Hibiscus sabdariffa (Malvaceae) in Designing Highly Flavoured and Bioactive Pito with Functional Properties

Sorghum beer (pito) is an indigenous alcoholic beverage peculiar to northern Ghana and parts of other West African countries. It is overwhelmed with calories, essential amino acids (such as lysine, etc.), B-group vitamins, and minerals. In recent years, there has been a growing demand for highly flavoured yet functional pito in Ghana; however, the local producers lack the prerequisite scientific expertise in designing such products. We propose the utilization of Tetrapleura tetraptera (TT) and Hibiscus sabdariffa (HS) as cheap and readily available materials in designing functional flavoured pito. The addition of TT and HS would not alter the fermentation profile but rather augment the starter with nutrients, thus improving the fermentation performance and shelf life of the final pito. In vitro and in vivo studies provide substantive evidence of antioxidant, nephro- and hepato-protective, renal/diuretic effect, anticholesterol, antidiabetic, and antihypertensive effects among others of the TT and HS, hence enriching the pito with health-promoting factors and consequently boosting the health of the consumer. Herein, we summarise the phytochemical, biological, pharmacological, and toxicological aspects of TT and HS as well as the technology involved in brewing the novel bioactive-flavoured pito. In addition, we also report the incidence of heavy metal in conventional pito.

Physical activity as an important factor for health promotion and long-term life extension

Physical activity as an important factor for health promotion and long-term life extension

Socio-Cultural Barriers to Early Detection of Breast Cancer Among Malaysian Postgraduate Students

The present study focuses on societal factors influencing the breast cancer incidence and deaths due breast cancer. The delayed detection and late presentation of tumour is influenced by the knowledge and understanding of disease by women herself, family and people in her surroundings. The sociocultural behaviour is key component of delayed detection of breast cancer and delayed presentation which leads to higher rates of morbidity and mortality. Though Breast cancer is the most common malignancy among females all around the world including Malaysia. Breast cancer accounts for 2.4% of deaths among women among Malaysia every year. The study was a quantitative questionnaire-based survey. The study includes female postgraduate students 25-30 years of age studying at University Sains Malaysia. The questionnaire was divided into five sections and total of 19 questions. A total of 50 women, between 30-39 years of age were interviewed. This study set out to explore the health promotion concepts and factors that impede health promotion as well as the barriers were also explored which might hinder women to go through mammogram. The results obtained in the study validated and confirmed the literature.

Veganism, aging and longevity: new insight into old concepts.

Plant-based diets are associated with better health and longevity. Veganism is a strict form of vegetarianism, which has gained increasing attention in recent years. This review will focus on studies addressing mortality and health-span in vegans and vegetarians and discuss possible longevity-enhancing mechanisms. Studies in vegans are still limited. Epidemiologic studies consistently show lower disease rates, such as lower incidence of cancer and cardiovascular disease, but mortality rates are comparable with rates in vegetarians and occasional meat eaters. Reasons for following strict vegan diets differ, which may affect diet quality, and thus health and life-span. New insights into some characteristics of veganism, such as protein restriction or restriction in certain amino acids (leucine or methionine) show potentially life-span-enhancing potential. Veganism improves insulin resistance and dyslipidemia and associated abnormalities. Gut microbiota as mediator of dietary impact on host metabolism is more diverse in vegans and has been suggested to be a health-promoting factor. Vegan diets do not fulfill the requirements of children, pregnant women or old individuals who should receive adequate supplements. There is substantial evidence that plant-based diets are associated with better health but not necessarily lower mortality rates. The exact mechanisms of health promotion by vegan diets are still not entirely clear but most likely multifactorial. Reasons for and quality of the vegan diet should be assessed in longevity studies.

Health-promoting factors in higher education for a sustainable working life \u2013 protocol for a multicenter longitudinal study

BackgroundThe World Health Organization has highlighted the importance of health promotion for health service providers in order to ensure sustainable working life for individuals involved in providing health services. Such sustainability begins when students are preparing to manage their own future health and welfare in working life. It has been suggested that universities, employees and trainee health professionals should adopt or follow a salutogenic approach that not only complements the providing of information on known health risks but also favors health promotion strategies. This paper describes the study design and data collection methods in a planned study aiming to explore health-promoting factors for a sustainable working life among students in higher education within healthcare and social work.MethodsThis protocol describes a multicenter longitudinal study involving Swedish students on higher education programs in the healthcare and social work sectors. In 2018, the study invited students on seven education programs at six universities to participate. These programs were for qualification as: biomedical laboratory scientists (n = 121); dental hygienists (n = 87); nurses (n = 1411); occupational therapists (n = 111); physiotherapists (n = 48); radiographers (n = 60); and, social workers (n = 443). In total, 2283 students were invited to participate. Participants completed a baseline, a self-reported questionnaire including six validated instruments measuring health-promoting factors and processes. There are to be five follow-up questionnaires. Three while the students are studying, one a year after graduating, and one three years after graduating. Each questionnaire captures different health-promoting dimensions, namely: health-promoting resources (i.e. sense of coherence); occupational balance; emotional intelligence; health and welfare; social interaction; and work and workplace experiences/perceptions.DiscussionThis study focuses on the vastly important aspect of promoting a sustainable working life for healthcare and social work employees. In contrast to previous studies in this area, the present study uses different, validated instruments in health promotion, taking a salutogenic approach. It is hoped that, by stimulating the implementation of new strategies, the study’s findings will lead to education programs that prepare students better for a sustainable working life in healthcare and social work.

Grit as Perseverance in Physical Activity Participation.

Childhood is a critical period for the acquisition of healthy behaviors, and the promotion of sustainable healthy behavior among children is greatly important. Therefore, an increased understanding of the relationship between grit and physical activity in a school context is needed. The purpose of this study is to describe and develop an understanding of students’ and teachers’ awareness and experiences concerning grit as a health-promoting factor. Fifty-five students and three teachers participated in the study. Data were collected through the Short Grit Scale and focus group interviews. There were weak to non-significant correlations between the three teachers’ ratings of their students’ grit and the children’s own ratings. The qualitative results show that children and teachers understood the construct of grit but had slightly different perceptions of it and that grit is not considered to be set in stone. The participants made an association between grit, motivation, meaningfulness, and setting goals. The findings indicate that grit might be an ideal target for making physical activity interventions sustainable.

Social engagement pattern, health behaviors and subjective well-being of older adults: an international perspective using WHO-SAGE survey data

BackgroundSocial engagement forms the basis of social relationships by providing a sense of belonging, social identity, and fulfillment. Previous research demonstrates that social engagement was associated with positive health behaviors among older adults. However, the results have been different across health-related behaviors, and mostly based on data from high-income countries. For example, studies from the US and UK showed that social engagement was protective against smoking, while others found social engagement encouraged more smoking in many Asian cultures. In this study, we aim to examine the association between social engagement and a range of health-related behaviors and subjective well-being among older adults in six low- to middle-income countries.MethodsData from the WHO Study on Global Ageing and Adult Health (SAGE Wave 1) were used. A total of 33,338 individuals aged 50 and older in China, Russia, India, Ghana, South Africa, and Mexico were included. Social engagement, tobacco use, alcohol consumption, fruit and vegetable intake, physical activity, sedentary behavior, sleep duration, depression symptoms, self-rated health status, and quality of life were assessed using established self-reported measures. Multiple logistic regression models were used to examine the relationship between social engagement and nine outcome variables, adjusting for socio-demographic characteristics.ResultsLower levels of social engagement were positively related to physical inactivity, prolonged sitting time, unhealthy sleep duration, perceived depression, poor self-rated health, and low quality of life. However, the associations between social engagement and tobacco use, excessive drinking, and insufficient fruit and vegetable intake were mixed across countries.ConclusionThis international study found high social engagement as a potential health-promoting factor in some low- to middle-income countries. Although the impacts of social engagement on tobacco and alcohol use and diet were complicated and culture-specific, interventions at both individual and community levels should encourage healthy lifestyles through positive social engagement.

A ESTRATÉGIA DE SAÚDE DA FAMÍLIA E O ENFRENTAMENTO À VIOLÊNCIA E FATORES DE RISCO

The Brazilian health movement marked the 1980s and was based on the right of every citizen, on the principles of universality and integrality, with preventive and curative actions integrated into a single decentralized management system: the Unified Health System (SUS). In 1999, the Family Health Strategy was created, differentiating itself by broadening the concept of health promotion and by organizing, orienting, seeking answers and contributing to the health system. This research is qualitative and was based on a bibliographical and documentary survey, in the platforms Google Scholar, Pepsic, Redalyc and Scielo, by means of descriptors: Family Health Strategy, Unified Health System, health promotion, violence and risk factors. After reading the articles, it was observed that the actions of the Health Strategy program can have an effective impact on the living conditions of the population, when they act in the intersectorial dimension with the education and health policies, achieving greater involvement and social participation of the local community. It is possible to say that the field of health becomes viable in a relation between law and social justice.

Dislipemias en la edad pediátrica. Importancia del diagnóstico y tratamiento precoces

Las alteraciones de los lipidos o dislipemias son factores de riesgo principales para el desarrollo de aterosclerosis y enfermedad cardiovascular (ECV). La ateroesclerosis puede iniciarse precozmente en la edad pediatrica, pero se manifestaraclinicamente al llegar a la adultez.La prevencion mediante la promocion de salud y el control de los factores de riesgo debe iniciarse precozmente y el pediatra debe liderar este proceso.La epidemia de obesidad es una de las causas del aumento de las alteraciones de los lipidos en sangre en la edad pediatrica.Las dislipemias severas obligan a la busqueda de enfermedades geneticas, siendo la hipercolesterolemia familiar la mas frecuente. El diagnostico temprano de esta enfermedad tiene gran relevancia en la prevencion de la ECV, asi como en el diagnostico familiar en cascada.Es fundamental el trabajo en conjunto con los medicos de adultos, ya sea en la referencia de los padres de ninos diagnosticados con dislipemia, y de los hijos de adultos con esta enfermedad.Desde la pediatria debemos acompanar el desarrollo de programas de control de dislipemias creados por diferentes instituciones.Se han planteado nuevos aspectos en las recomendaciones de las principales sociedades cientificas internacionales y en nuestro pais es necesario una discusion de dichas recomendaciones para adaptarlas a nuestra realidad y necesidades.Este articulo tiene como objetivos principales exponer la importancia del conocimiento de esta patologia en ninos, sus caracteristicas y manejo, con el objetivo de mantener la salud del nino, iniciar precozmente la prevencion de la ECV del adulto, y promover la discusion de un tema en el que se plantean nuevas normativas de estudio y tratamiento.

대학생의 자아탄력성, 가족응집성, 사회적지지가 정신건강에 미치는 영향

Objectives: The purpose of the current study was to provide basic data for improving mental health of the university students by analyzing the relative effects of ego-resilience, family cohesion and social supports on the students’ mental health. Method: For this study, 400 university students were surveyed in Seoul, Gwangju, Daejeon, Busan, Gyeonggi, and Jeollabuk-do and 393 data were used for the final analysis. Results: Analysis on the influences of the related variables on the students’ mental health revealed that ego-resilience of the students served as a protection factor in mental health promotion. The family cohesion, on the other side, affected the students’ mental health significantly through various dimensions. Thirdly, social supports of friends, seniors, professors and the school were found to be useful resources for mental health improvement. Lastly, gender and religion among the socio-demographic variables also affected mental health significantly. Conclusions: In order to improve the mental health of the university students, individual and social exploration to develop the ego-resilience is necessary. It is essential to emphasize that family members have to try to enhance the family cohesion. It is also important to maintain a closer relationship with and to receive supports from college friends, seniors, professors and the school.

SUN-259 RISK FACTORS OF KIDNEY DISEASES AND RENAL BIOPSY RESULTS IN MACKAY, NORTH QUEENSLAND: A RETROSPECTIVE STUDY

Mackay region has one of the highest rates of overweight and obesity in Queensland, Australia, comprising 83.4 per cent of its adult population. In this retrospective clinical audit, we studied the results of renal biopsies, risk factors of renal impairment, and biopsy-related complications at the Mackay Base Hospital (MBH), Queensland, Australia. Based on this epidemiology data, we aim to have earlier identification of the modifiable risk factors of renal diseases, targeted and effective public health promotion, earlier renal surveillance and intervention for at risk population before developing chronic renal failure.

Associations between Health Behaviors and Factors on Markers of Healthy Psychological and Physiological Functioning: a Daily Diary Study.

Cross-sectional and experimental knowledge highlight the contribution of various health-promoting behaviors, such as physical activity, regular sleep, and healthy nutrition to mental and physical health. Beyond these well-studied lifestyle behaviors, music listening and perceived respect in social interactions are just recently proposed everyday life experiences, which may act as health-promoting factors. This study tested the simultaneous contribution of several health-promoting behaviors and factors and examined listening to music and positive social interaction by means of perceived respect as new potentially preventive and health-promoting behaviors and factors using an ambulatory assessment design. Seventy-seven young healthy adults (38 women, 23.9 ± 4.5 years) completed surveys on their psychological state (i.e., mood, stress, and fatigue) five times a day for four consecutive days. A saliva sample was collected with each data entry to explore the physiological stress markers salivary cortisol, alpha-amylase, and flow rate as further outcome variables. As predictors, perceived respect, self-reported physical activity, the sleep's restfulness, daily coffee, alcohol, vegetable/fruit consumption, and music listening behavior were recorded. Overall, restful sleep, mean daily perceived respect, and listening to music were most clearly associated with more positive psychological states, that is, better mood and lower fatigue and perceived stress. Associations with daily alcohol, coffee, and vegetable/fruit consumption appeared rather minor. While perceived respect scores were associated with lower daily cortisol output, coffee consumption was positively related to daily cortisol and alpha-amylase. Self-reported physical activity was unrelated to either outcome measure. These findings provide important insights regarding potential resources of health (i.e., music and respect), their covariation, and which psycho-physiological mechanisms may underlie the links between health factors and well-being. Findings also have implications for the development of interventions aiming to increase resilience and foster health. Here, strategies for improving sleep quality, the use of music, and approaches that emphasize mutual respect and appreciation appear useful additions.

Abstract MP49: Lower Levels of County Housing Affordability Are Linked to Worse Cardiometabolic Risk Profiles in Middle-Aged and Older Adults

Introduction: Housing is a fundamental social determinant of health. Past studies have shown that high levels of unaffordable housing raise residents’ chances of moving, often redistributing individuals into socioeconomically disadvantaged neighborhoods and dwellings. This may simultaneously expose individuals to health-detrimental factors while limiting their exposure to health-promoting factors. Residents within unaffordable housing areas may also experience adverse physical and mental health outcomes through various psychosocial, behavioral and material pathways. Yet few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans. Hypothesis: We investigated the hypothesis that lower levels of county housing affordability are linked to higher odds of incident hypertension, diabetes, obesity, and depression. Methods: Using a nationally-representative sample of 3,722 middle-aged to older adults from the National Longitudinal Survey of Youths 1979 and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent, mortgage) between 2000 and 2008 and individual-level odds of incident hypertension, obesity, diabetes, and depression during the follow-up period 2008-2014. Incidence of hypertension and diabetes was assessed through survey-reported physician diagnosis. Obesity was defined as a BMI ≥ 30 kg/m 2 , and depression was measured using the 7-item Center for Epidemiologic Studies Depression Scale and designated based on a cut-off score of 7. We employed fixed effects logistic regression models to reduce bias due to time-invariant confounding. Results: Each percentage point increase in the median county-level percentage of household income spent on rent or mortgage was associated with a 17% increase in the odds (OR = 1.17, 95% CI = 1.00 to 1.39; p = 0.047) of incident hypertension, a 37% increase in the odds (OR = 1.37, 95% CI = 1.00 to 1.87; p = 0.049) of obesity, and a 15% increased odds (OR = 1.15, 95% CI = 1.01 to 1.31; p = 0.030) of depression, controlling for individual- and area-level demographic and socioeconomic factors. No association was observed for diabetes. These associations were stronger among renters than among homeowners, and in men compared to women. In sensitivity analyses, these findings were robust when we limited the sample to non-movers and when we used alternative depression score cut-points. Conclusions: Our findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help to reduce the population burden of cardiovascular disease.

Abstract 016: Lower Levels of County Housing Affordability Are Linked to Worse Cardiometabolic Risk Profiles in Middle-Aged and Older Adults

Introduction: Housing is a fundamental social determinant of health. Past studies have shown that high levels of unaffordable housing raise residents’ chances of moving, often redistributing individuals into socioeconomically disadvantaged neighborhoods and dwellings. This may simultaneously expose individuals to health-detrimental factors while limiting their exposure to health-promoting factors. Residents within unaffordable housing areas may also experience adverse physical and mental health outcomes through various psychosocial, behavioral and material pathways. Yet few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans. Hypothesis: We investigated the hypothesis that lower levels of county housing affordability are linked to higher odds of incident hypertension, diabetes, obesity, and depression. Methods: Using a nationally-representative sample of 3,722 middle-aged to older adults from the National Longitudinal Survey of Youths 1979 and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent, mortgage) between 2000 and 2008 and individual-level odds of incident hypertension, obesity, diabetes, and depression during the follow-up period 2008-2014. Incidence of hypertension and diabetes was assessed through survey-reported physician diagnosis. Obesity was defined as a BMI ≥ 30 kg/m 2 , and depression was measured using the 7-item Center for Epidemiologic Studies Depression Scale and designated based on a cut-off score of 7. We employed fixed effects logistic regression models to reduce bias due to time-invariant confounding. Results: Each percentage point increase in the median county-level percentage of household income spent on rent or mortgage was associated with a 17% increase in the odds (OR = 1.17, 95% CI = 1.00 to 1.39; p = 0.047) of incident hypertension, a 37% increase in the odds (OR = 1.37, 95% CI = 1.00 to 1.87; p = 0.049) of obesity, and a 15% increased odds (OR = 1.15, 95% CI = 1.01 to 1.31; p = 0.030) of depression, controlling for individual- and area-level demographic and socioeconomic factors. No association was observed for diabetes. These associations were stronger among renters than among homeowners, and in men compared to women. In sensitivity analyses, these findings were robust when we limited the sample to non-movers and when we used alternative depression score cut-points. Conclusions: Our findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help to reduce the population burden of cardiovascular disease.

Process of Accreditation of Health Promoting Schools worldwide: A Systematic Review

The scope of this article is to analyze the accreditation criteria of the studies that evaluated actions of health promotion and risk factor prevention of Health Promoting Schools (HPS). A systematic review was conducted based on the recommendations proposed in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma)" protocol of articles that assessed HPS in the following databases: SciELO, Lilacs, Medline, PubMed and Portal Capes. From the analysis of the three pillars for accreditation of HPS, three of the studies analyzed did not include all the criteria for certification as HPS on the "Planning Process" and "Health Promotion Activities Developed" pillars. The schools cited in these studies perform health education, prevention and/or health promotion activities, however, it is misleading to refer to themselves as HPS. The main challenges for implementation, development and continuity of HPS were identified as being intersectionality and insufficient financial and qualified human resources. HPS need to be certified and submitted to an ongoing evaluation process. It is also suggested the topic of health promotion be included in the syllabuses of training courses of health education teachers and other health education professionals.

Decomposing Socioeconomic Inequality in Health Literacy in Iran: A Concentration Index Approach.

Background:Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors.Methods:In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families’ SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software.Results:The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168–0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor.Conclusions:The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

Chronic noncommunicable diseases multimorbidity and its association with physical activity and television time in a representative Brazilian population.

Lifestyle behaviors need to be more explored within the context of chronic noncommunicable disease (NCD) multimorbidity. This study aimed to investigate the association of multimorbidity with physical activity and sedentary behavior in a representative Brazilian population (n = 52,929). A cross-sectional survey (VIGITEL in the Portuguese acronym) was conducted in 2013 in the 27 Brazilian federal units. Multimorbidity is defined as the presence of two or more NCDs, that is, the outcome variable; and physical activity (commuting, domestic chores, leisure, and work domains) and sedentary behavior (television time < 2 hours/day and ≥ 2 hours/day) were the exposure variables. Poisson and multinomial logistic regressions (odds ratio - OR) stratified by age and their respective 95% confidence intervals were used, adopting a significance level of 5%. Among 37,947 adults, the presence of three chronic diseases was less frequent in subjects active in the work domain (OR = 0.60) and more frequent among those with longer daily television time (OR = 1.25). The presence of four diseases was less frequent in subjects active in the commuting (OR = 0.52) and work (OR = 0.42) domains. Among 14,982 older adults, the presence of two, three, and four chronic diseases was consistently more frequent in those with longer daily television time (OR = 1.33; 1.55 and 1.93, respectively). Finally, interactions between total physical activity level and daily television time were statistically significant in the multimorbidity in both age groups. Physical activity and sedentary behavior are associated with multimorbidity and should be considered independent factors for health promotion and for the treatment of patients with multimorbidity.

Research Progress on Microcapsulation Technology and Its Application in Food

Recently,a trend in food industry is the consistent rising in the demand for functional food. As one of the most important health promotion factors,probiotics have witnessed a huge increase in their products worldwide. Microcapsulation technology has been wildly used in food industry attributed to its ability to provide protection for probiotics during food processing and storage and improve the survival rate of probiotics in products. However,there are still significant hurdles to the successful application of probiotics microcapsules in food industry,which is mainly due to the fact that somecharacteristics of microcapsules appear to be in conflict with the requirements of food products. Based on this situation,the aim of this review was to give a critical overview of the current researches and the application of probiotics microcapsules in food industry,and the future development was also prospected.

1.A. Workshop: Key factors for effective school-based health promotion: lessons learned from Jerusalem communities

1.A. Workshop: Key factors for effective school-based health promotion: lessons learned from Jerusalem communities