Israel Journal of Health Policy Research最新文献

Background: Preserving new graduate nurses in the profession is an essential step for addressing the nursing shortage and sustaining the future of the profession. This study aimed to examine the relationship between employment characteristics and job satisfaction of novice nurses and their willingness to stay in the nursing profession in the next 5 years.

Methods: Novice nurses' intention to stay in the profession was assessed, considering demographics, employment characteristics, and components of job satisfaction. Among the sample of 216 novice nurses (93% response rate), four components of job satisfaction were extracted and included in the multivariable logistic regression model with the intention to stay in the profession as a dependent variable.

Results: Professional self-accomplishment was significantly and positively associated with the intention to stay in the profession, with an elevation of one standard deviation in this component associated with more than a two-fold increase in the odds of staying (OR = 2.3, 95% CI 1.3-3.9). This component contributed 10% to the variance in intention to stay. Independently, managerial support also contributed 10% to the variance and was significantly associated with willingness to stay (OR = 1.9, 95% CI 1.2-3.0). Overall, self-accomplishment, managerial support, and healthier organizational culture were significantly associated with novice nurses' intention to stay, whereas work conditions and rewards were not. The multivariable analysis model explained 38.0% of the variance in the intention to stay in the profession.

Conclusions: This study found that novice nurses' intention to stay in the profession is highly associated with their self-accomplishment and better managerial support. Thus, to enhance the retention of novice nurses, managers must establish an environment that fosters professional development and support. This involves providing engaging work assignments, facilitating the seamless integration of novice nurses into the team, and offering managerial support and guidance.

Background: Climate-related disasters have tripled in the past 30 years. Between 2006 and 2016, the global sea levels rose 2.5 times faster than the entire 20th century. More than 20 million people a year are forced out of their homes because of climate change impacts. Rapid urbanization and increasing population density in coastal mega-metropolitan areas will inevitably lead to more large-scale disasters due to extreme weather events, i.e., stronger storms and massive flooding. Despite the inevitability of these events, disaster risk reduction is still locally based in each country, many of which have scarce resources to devote to the activity. It is widely assumed that the global community will respond when a calamity occurs. This perspective article explores the appropriateness of the current international relief and aid paradigm in light of near and middle-term trends in global disasters.

Main body: After briefly summarizing the anticipated effects of global climate change, population growth, and progressive urbanization in low-lying coastal and riverine environments on the frequency and scale of future disasters, this paper examines how existing concepts of international relief following disasters are insufficient to address the challenges to come. Current paradigms are tested against selected case studies demonstrating the growing frequency of mega-disasters. For example, in 2010, the world saw a catastrophic earthquake in Haiti, very large-scale floods in Pakistan, a major earthquake in Chile, and heat waves that resulted in the death of tens of thousands of people in Russia and many more in other countries. However, the world exhausted most of its humanitarian aid, responding to Haiti in January of that year. The review closes with a proposition for a new paradigm to re-organize international relief to meet the challenge posed by our rapidly changing world - one that is more adaptable to the current challenges of climate change and other trends that will almost certainly increase the frequency and intensity of disasters.

Conclusion: The future of international disaster aid depends on our ability to foster greater cooperation between the various organizations and donor countries and more seamless cooperation between both groups and the affected countries or regions. Planning and relief operations should utilize new technologies and innovative financing where feasible. A holistic approach that focuses on building large-scale agreements and coordination mechanisms, teaching citizens how to help each other until aid arrives, and strengthening resilience at the local level will equip communities for adaptive action during a disaster, improve coping and long-term rehabilitation, will lead to a more efficient, fairer and more durable global aid system.

Background: Antibiotic treatment (AT) for patients with advanced dementia and pneumonia is a complex issue. AT can prolong life, but it can also prolong suffering for the patient and the family. In this study we evaluated physicians' attitudes to this issue.

Methods: A vignette-based survey among community-based physicians (CBP) and hospital-based physicians (HBP) who work in southern Israel. The physicians were asked to complete a questionnaire on their knowledge and attitudes to AT, based on a case description of a patient with advanced dementia and pneumonia.

Results: 211 physicians participated in the study including 134 CBP (63.5%) and 77 HBP (36.5%). 177 physicians chose the AT option for the patient presented in the case, with 59.7% of the HBP and 32.8% of the CBP choosing intravenous (IV) AT (p = 0.017). In contrast, in the same case, but with themselves as the patient, 68.8% of HBP and 32.8% of CBP chose the option of palliative care without AT, with only 14.3% of HBP and 10.4% of CBP choosing the option of hospitalization with IV AT. In two logistic regression models, physicians who chose IV AT for themselves were fourfold more likely to make a similar choice for their patients. Over 75% of the physicians were not knowledgeable about the administration of AT in accordance with the Dying Patient Act.

Conclusions: The results of this study indicate the need for an educational intervention among physicians to expand their knowledge and expertise on end-of-life treatment for patients with advanced dementia. In addition, we invite policy makers to convene a discussion on the possibility of changing the law to facilitate the conduct of studies of patients with advanced dementia. Such studies would make it possible to develop an evidence-based treatment strategy.

Background: Rising mental health challenges among children and adolescents are a global concern. However, a shortage of professionals, inadequate competence and lack of resources hamper necessary care, presenting a major challenge to health service provision. Community pediatricians, frequently the initial contact for mental health issues, are in a key position to improve access to care. The Delphi method was employed as an initial step toward redefining the role of pediatricians and the re-design of pediatric responses within Israeli primary mental health care.

Method: Ninety-two experts, including pediatricians, psychiatrists, mental health and child-development professionals, and parents of children with emotional-behavioral challenges participated in a three-round Delphi study. A survey including 6 topics (37 items, 9 demographic questions) was distributed, probing the envisioned role of pediatricians in children's mental health care.

Results: There was strong endorsement between experts regarding pediatricians' potential roles in risk identification, parental guidance, psycho-education, and health policy isuues such as referrals to mental health professionals, and the need for training in this domain. However, discord arose concerning changes in the service framework and pediatricians' role in psychiatric drug prescription. The majority agreed on the necessity of close support from mental health experts, despite differing in the form it should take.

Conclusions: This study underscores the critical need for mental health training among pediatricians and advocates for a structured, consensus-driven model to bolster early detection and initial treatment of mental health issues in children. The findings highlight the potential for leveraging this model to drive health policy changes and improve service delivery in pediatric mental health care, and might inform other health systems considering extending pediatricians' roles. By equipping pediatricians with essential competencies, this approach can broaden mental health service delivery and reduce stigma. Aligning the model with expert consensus paves the way for impactful policy reform, enhancing pediatricians' roles in mental health risk identification and intervention, and advancing child health services.

Background: Child safety in schools is paramount for decision-makers globally, with a focus on ensuring children return home safely. However, the prevalent issue of injuries across educational systems demands a comprehensive investigation into their causes, incorporating interdisciplinary perspectives and social dynamics, to develop effective prevention strategies. The objective of this study is to comprehensively analyze the factors contributing to school-related injuries and examine the impact of school climate on student safety. By employing advanced data analysis techniques, the research aims to develop targeted, effective strategies to enhance child safety in educational settings. This research aims to develop a multidimensional taxonomy to understand child injuries in elementary schools better, enhancing precision in decision-making.

Methods: Data from 363 Israeli primary schools and 10,855 school injuries attended to by MDA, the principal EMS provider, were analyzed. The study utilized a two-level taxonomy, employing clustering methodology to classify schools into distinct climate "patterns," with each pattern further delineating school injury characteristics into sub-patterns. The chosen method proved effective in revealing nuanced relationships between school injuries and climate characteristics.

Results: Analysis revealed five school climate clusters, ranging from "good" to "bad," each exhibiting two homogeneous sub-clusters of school injuries. Schools with a "positive" climate witnessed boys predominantly experiencing head injuries during breaks, while girls often sustained limb injuries from playing in corridors. Conversely, within the "negative" climate cluster, subgroups emerged based on injury nature, whether linked to playing or falling from a height.

Conclusion: The research delineates a nuanced association between school climate and injury rates, emphasizing the necessity for sophisticated analytical techniques beyond conventional methodologies. Utilizing a diverse dataset from various disciplines, the study highlights the multidimensional aspects of school health. The developed taxonomy reveals the complex dynamics within school environments, advocating for customized health policies to mitigate injuries. Critical findings prompt a reevaluation of established assumptions about the school climate-injury relationship, informing strategic policymaking. For example, it suggests collaboration to enhance school safety through targeted, gender-sensitive interventions and improvements. Integrating different data sources offers a holistic understanding crucial for effective health policy formulation in educational contexts.

Background: Over 1.9 million Arabs live in Israel and constitute 21% of the total population. Despite being a disadvantaged minority population with wide gaps in health indicators, Arabs have higher Human Papillomavirus (HPV) and Measles, Mumps, and Rubella (MMR) vaccination rates compared with the general Jewish population.

Methods: In-depth interviews with 21 health care providers, 16 Arab mothers, and 16 teenagers were conducted to collect information about health system enablers to HPV and MMR vaccination. All interviews were conducted in Arabic by an Arab researcher, audio-recorded, transcribed, and analysed using thematic analysis of the transcripts. Themes were mapped according to the WHO Health Systems Building Block Framework.

Results: We identified several health system enablers. On the service delivery level, accessible and availability of vaccination services, delivery of vaccines through the school system and mother child clinics, and framing vaccinations as the norm were themes. Personable characteristics of the health workforce, the health care providers belonging to the same cultural group, and high levels of trust towards healthcare professionals were reported. Vaccination provided at no cost was also identified. On the leadership/governance level, the Arab community felt equal treatment and distribution of services, which was also an enabler reported. Despite high vaccine uptakes, parents and teenagers had limited knowledge regarding vaccination, particularly HPV.

Conclusions: This study highlights that a combination of good access and delivery to vaccination, delivered by a culturally competent, available, accessible respectful workforce can enable disadvantaged minorities to achieve high vaccine coverage, in particular in a cultural context where the population trusts and follows medical advice. Such evidence can serve as a basis for developing policies, interventions, and guidance to improve vaccine uptake among other underserved minority communities.

Background: Hospital at Home (HaH) is an alternative care model that provides acute hospital-level services to patients at their homes. Despite its proven advantages and global experience, HaH did not gain significant traction in Israel until the COVID-19 pandemic. The issue was highlighted at the 2022 Dead Sea Conference on Health Policy. This study compares perceptions of HaH among the Israeli public and physicians, Jewish and Arab, identifying facilitators and barriers to its expansion in Israel.

Methods: Two online surveys were conducted, one with 342 physicians and another with 424 members of the public aged 35+. Respondents were sampled based on age, gender, district of residence, and population group. Descriptive statistics and chi-square tests explored perceptions, and logistic regression analyzed multivariate relationships.

Results: Results showed 39% of the public believed HaH care quality is as good as or better than hospitals, compared to 65% of physicians. 44% of the public felt HaH safety is as good or better, while 75% of physicians agreed. 58% of the public saw communication between patients/families and the healthcare professionals in HaH as good or better, contrasted with 91% of physicians. 78% of the public and 97% of physicians viewed HaH as a good alternative to hospitalization and would consider using it personally. Arab and lower-income respondents were less positive about HaH than Jewish and higher-income respondents. Community-based physicians preferred HaH more than hospital-based ones. Barriers to HaH expansion included lack of specialized manpower, resources, and awareness.

Conclusions: The findings suggest that both the public and physicians show confidence in HaH, and it is gaining popularity among both. Policymakers could use these insights to expand HaH, focusing on increasing awareness, reducing family burden, tailoring services for diverse populations, involving hospital staff, and investing in resources and training.

Background: Hospital staff frequently encounter high-stress situations, emergencies, and disasters, which profoundly impact their well-being and resilience. The aim of the study was to examine associations between perceived threats, well-being, individual resilience, and resilience at work among staff of a general hospital, following the unexpected Hamas assault on Israel on October 7, 2023, and during the Israel-Gaza conflict.

Methods: This cross-sectional study was conducted at a central Israeli public hospital, a level-two trauma center, surveying 434 staff members. Validated questionnaires were used to assess perceived threats, well-being, individual and work resilience, alongside demographic and professional characteristics. Data was collected via Qualtrics and paper questionnaires. Descriptive statistics, Pearson's correlation, T-tests, ANOVA, Chi-square, and linear regression models were used to analyze relationships, differences, and key factors associated with well-being, personal resilience, and work resilience.

Results: Key findings revealed that higher resilience at work and well-being are linked to greater individual resilience, while higher threat perception negatively affected well-being. Israeli-born individuals and those identifying as Jewish showed higher resilience. Men reported higher well-being than women, and physicians demonstrated higher well-being compared to nurses. Resilience at work was higher among administrative staff compared to nurses, with employment in the emergency department showing a significant negative relationship with resilience at work.

Conclusions: The study revealed significant predictors of well-being, individual resilience, and workplace resilience among hospital staff in conflict situations. The immediate threat of war was perceived as most significant, highlighting the dynamic nature of threat perceptions. Prolonged emergencies can severely impact well-being, necessitating timely support. The findings emphasize the importance of integrated programs that enhance individual well-being and foster resilience in both personal and professional domains. Significant gender differences and the positive role of religiosity in resilience underscore the need for targeted interventions and systemic organizational changes to better support healthcare workers during crises. These insights highlight the importance of a comprehensive approach for cultivating a robust and resilient medical staff capable of effectively managing future crises.

Background: Mass Casualty Incidents (MCIs) pose significant challenges for healthcare systems. While policies are typically crafted based on past experiences, the lessons learned from each incident play a crucial role in enhancing emergency preparedness. On October 7th, 2023, Israel came under the largest terror attack in its history. During an ongoing terror attack, more than 1300 Israelis were killed, and more than 200 were abducted to Gaza. During the first day of the attack, 1457 casualties were evacuated to a hospital, approximately half of them to Soroka University Medical Center (SUMC). This MCI surpassed conventional MCI challenges, necessitating a need to face the unexpected under fire. Through a description of this extreme MCI, we delve into the challenges faced, the strategic interventions deployed to address them, and the invaluable lessons learned.

Methods: Injury characteristics, severity and outcomes of casualties are presented based on the medical records of all casualties arriving to SUMC between October 7th 6:30 a.m. and October 8th 7:00 a.m. Data regarding patient influx, capacity and hospital resource utilization, were collected from the Patient Registration System and other hospital information systems.

Results: During the incident, a total of 673 injured arrived at SUMC within a mere 24-h period, at a peak rate of 83 injured per hour. The mean casualty age was 29.6, with male predominance. Gunshot wounds and shrapnel injuries were the dominant types of injuries. Out of the casualties arrived, about half were hospitalized or transferred to receive definitive care at other hospitals after initial care at SUMC. Mortality rate was low, at 2.9% of those admitted alive.

Conclusions: In this article, we describe the injury characteristics and outcomes of casualties seen at SUMC on October 7th 2023, during one of the largest MCIs in history. We present a detailed overview of the challenges encountered, strategies implemented to address them and lessons learned. These insights hold global relevance, offering actionable guidance for the refinement of future emergency protocols and policies on a global scale.

Background: The "Iron Swords" War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period.

Methods: A quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects.

Results: The final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0-40 and 0-20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p < 0.001).

Conclusions: Physicians working near conflict zones report higher levels of perceived danger, though their resilience is comparable to peers in less threatened regions. Enhancing personal resilience is crucial to mitigate the heightened sense of danger. This could include regular resilience training, psychological support, and specific programs for single and childless physicians to improve safety perceptions. Additionally, fostering a supportive community with clear communication and robust emergency protocols is essential for enhancing staff resilience and safety in hospitals.