Israel Journal of Health Policy Research最新文献

Background: The October 7th, 2023, attack in Israel and the ensuing war exposed Israeli youth to intense and prolonged traumatic stress. This study aimed to: (1) examine the prevalence of probable post-traumatic stress disorder (PTSD) among Israeli adolescents, and (2) identify associated risk and resilience factors for PTSD symptoms within the context of prolonged exposure to threat and uncertainty due to ongoing war and conflict.

Methods: A cross-sectional digital survey was conducted between October and December 2024. Data were collected from 744 adolescents aged 14-18 years, including the Child PTSD Symptom Scale (CPSS-SR-5), questions about direct war-related consequences and indirect exposure. Personal resilience was assessed using the Connor-Davidson Resilience Scale. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Background questions addressed age, gender, health, and adverse events in the past year. Hierarchical multiple regression analysis was used to examine the contribution of background variables, war-related effects, indirect exposure, and resilience factors to PTSD symptoms.

Results: The study revealed that 41.9% of participants met the probable diagnostic threshold for PTSD. Gender (female), poorer health status, and previous adverse experiences correlated with increased symptom severity. Among the direct effects, economic status deterioration and direct war impact emerged as significant predictors. Among the indirect exposure factors, frequent news consumption was associated with higher PTSD symptoms. Personal resilience and family support were associated with reduced PTSD symptoms, although resilience factors did not significantly moderate the adverse impacts of war-related experiences.

Conclusions: The high prevalence of probable PTSD among Israeli adolescents in the wake of the October 7th, 2023 attack suggests an urgent need for action. Evidence-informed mental health policies and services should prioritize adolescents, with targeted support for high-risk groups. Our findings stress the need for a national mental health policy to incorporate youth-centered trauma response systems, including interventions for indirect media trauma. Strengthening personal resilience and bolstering family support systems is vital in order to mitigate the lasting psychological impact of war-related trauma on youth.

Background: The first five months of 2025 marked a sharp and troubling increase in child injuries involving All-Terrain Vehicles (ATVs) in Israel. During this short period, 17 children were reported as injured or killed in ATV-related incidents - three fatally - with a mean age of 12.5 years (median: 14). This represents a 263% rise compared to previous annual rates, highlighting serious concerns regarding the effectiveness of existing legislation, enforcement and public awareness. The purpose of this study is to analyze long-term trends in ATV-related child injuries and assess the urgent need for regulatory and preventive interventions.

Methods: We conducted a retrospective analysis of unintentional childhood injuries involving ATVs using Beterem Safe Kids Israel's media-based pediatric injury database, from 2008 until May 2025. Trends over time were analyzed using best-fit regression models, and group differences were tested using chi-square tests of independence.

Results: Between 2008 and May 2025, 378 ATV-related injuries among children and adolescents were documented, including 41 fatalities. A clear upward trend was observed, with the annual average rising from 21.9 cases per year (2008-2019) to 43 cases per year (2020-2025), and with 22 cases already reported in 2025. Severe and fatal cases more than doubled during this period. Arab children were overrepresented relative to their population share. Incidents peaked during weekends and holidays. A significant quadratic increase in mortality rates over time was identified (R² = 0.751, P < 0.001). ATV-related injuries were disproportionately concentrated among children from lower socioeconomic backgrounds, with 95% of Arab victims and 74% of Jewish victims residing in low- or mid-ranking municipalities.

Conclusions: ATVs present an escalating and preventable danger to child safety in Israel, with recent data signaling a critical and worsening trend. Immediate and decisive action is imperative. Policymakers must urgently implement a uniform minimum age for ATV operation, mandate safety technologies (e.g., Operator Protective Devices), require physical capability assessments, and launch targeted public awareness and enforcement campaigns-especially in rural and underserved communities. These measures are essential to safeguarding children and reversing the alarming trajectory of ATV-related harm.

Background: In recent years, there has been a rapid increase in disposable electronic cigarette (e-cigarette) use. Several countries have banned or are considering banning disposable e-cigarettes, which might affect adults who use disposable e-cigarettes for harm reduction. Understanding patterns of disposable versus non-disposable e-cigarette use among adults who currently use e-cigarettes is essential to inform possible regulations and policy. This study explored factors associated with disposable versus non-disposable e-cigarette use among adults currently using e-cigarettes in the U.S. and Israel.

Method: A cross-sectional online survey was conducted (October-December 2021) among 410 U.S. and Israeli adults aged 18-45 years (mean age 30.8 ± 7.6) who reported past 30-day e-cigarette use (62.9% of whom used non-disposables). A multivariate logistic regression assessed factors associated with disposable versus non-disposable e-cigarette use, stratified by country.

Result: In Israel, a greater perceived harm of e-cigarettes (aOR = 1.45, 95%CI: 1.20-1.76), cannabis/cannabinoid-containing e-liquid use ( aOR 0.36, 95%CI: 0.19-0.69) and purchasing from 'regular' shops (aOR = 6.30, 95%CI: 2.25-17.67) or 'specialty' shops (aOR = 3.71, 95%CI: 1.21-11.34) (compared to 'online' shops) were associated with disposable e-cigarette use. In the U.S., factors associated with disposable e-cigarette use included ever using other tobacco/nicotine products (aOR = 7.51, 95%CI: 1.49-37.87), sweet flavor preference (aOR = 4.42, 95%CI: 1.64-11.94), cannabis/cannabinoid-containing e-liquid use (aOR = 0.33, 95% CI: 0.13-0.82), and being 26-35 years old (vs. 36-45) (aOR = 0.36, 95% CI: 0.13-0.98).

Conclusions: U.S. and Israeli adults who use disposable versus non-disposable e-cigarettes differ, highlighting the importance of public health strategies tailored to the unique needs of each country. The high levels of cannabis or cannabinoid-containing e-liquid use among participants who use non-disposable e-cigarettes suggest the need for stricter regulation and enforcement of non-disposable devices and e-liquids in both countries. Findings also suggest that banning sweet flavored e-cigarettes will support the effort in reduction of disposable e-cigarette use in the U.S.

Israel's physician workforce crisis reflects long-standing dependence on foreign-trained doctors, limited domestic capacity, and the shrinking inflow of new graduates following the Yatziv Reform. Recent analyses underscore the need not only to expand local training but also to better track and support Israelis studying and training abroad. While new data such as that by Swechinsky and Berner-Shalem shed light on return patterns among students, a less visible challenge lies with physicians leaving the Israeli health system, and specifically those undertaking fellowship training overseas who choose not to return. Building reliable data systems and proactive engagement mechanisms for both students and fellows is essential to securing Israel's future medical workforce.

Background: Climate change is increasingly recognized as a major global health threat, highlighting the need to enhance climate resilience within health systems. The World Health Organization (WHO) defines key components for climate-resilient health systems, including governance, financing, workforce, and emergency preparedness. Israel is particularly vulnerable to climate change, which is expected to exacerbate the strain on a healthcare system already facing budget cuts, staff shortages, equipment deficits, and security challenges. We aimed to analyze the barriers to and facilitators of climate resilience initiatives in Israel's healthcare system from the perspective of decision-makers. Understanding the unique contextual factors within Israel's healthcare system can inform the development of a tailored climate and health framework and shape national policy.

Methods: In this qualitative study, semi-structured interviews were conducted with 25 decision-makers, administrators, and professionals from the Ministry of Health, hospitals, and health maintenance organizations (HMOs). Participants were selected using purposive sampling to ensure diverse representation. Data were analyzed through deductive thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR).

Results: The absence of a national policy framework, including dedicated funding and binding regulations, emerged as a central barrier to advancing climate resilience within the Israeli healthcare system. Additionally, the study revealed that climate issues are deprioritized due to security and budgetary constraints, coupled with limited awareness of climate risks. Economic incentives were frequently cited as enablers for promoting climate resilience. Despite challenges, the findings highlight the potential for integrating climate resilience into existing emergency preparedness systems.

Conclusions: The study underscores significant gaps in climate resilience within Israel's healthcare system, particularly the lack of a coordinated, government-led framework for climate adaptation. Although local efforts exist, they remain fragmented and unsustainable without national leadership and funding. Key recommendations include developing a comprehensive national health and climate plan, securing dedicated funding, and increasing awareness/training for healthcare professionals.

Background: Education of nurses may be compromised during a crisis. On October 7, 2023, the "Iron Swords" war broke out in Israel. The academic year was postponed, and nursing education was disrupted. Despite the acknowledged importance of continuing nurse training during emergencies, research on this topic is scarce.

Aim: To examine nursing school management activities and describe the adaptive strategies of academic frameworks during the war in Israel.

Design and methods: This qualitative study was conducted in nursing schools in Israel that were directly affected by the Iron Swords War (October 7, 2023). We interviewed five of the seven chairs of nursing departments in Iron Swords conflict zones, content analyzed the interview text, and employed COREQ reporting guidelines for this qualitative study.

Results: Six main themes were identified: Management and leadership under uncertainty; Resilience and preparedness; Supporting well-being and inclusivity; Adaptability and innovation in the educational process; Fostering a sense of community; and Engagement of students and faculties in the crisis response. One of the most remarkable findings was the blending of personal and professional roles, as manifested in the immediate response and re-organization by the academic and administrative staff.

Discussion: The ability of academia to maintain function and make decisions under conditions of uncertainty is of paramount importance. This requires collaborative decision-making, leveraging diverse perspectives, fostering inclusivity, and enhancing the effectiveness of responses. Maintaining routines creates a feeling of belonging, promotes setting and realization of goals, provides meaning, and maintains motivation.

Conclusions: The results provide insights into the management of nursing education during prolonged emergencies and health policy implications. Although focused on a war scenario, the findings have broader implications and offer strategies applicable to more general crises.

Background: Compassionate use programs allow patients with life-threating and serious conditions to access investigational therapies when standard treatments are inadequate. This study aims to analyze the trends and outcomes of the compassionate use of medicinal products in Israel.

Methods: Data from the Israeli Ministry of Health's compassionate use database (2020-2024) were anonymized and analyzed. Duplicates were removed, and a pivot table was used to assess factors such as active ingredients, indications, treatment counts, and patient demographics. Results were presented as counts and percentages, with treatments over 0.5% of the total classified as common. Statistical analyses included Student's t-test and chi-squared test for subgroup differences (p < 0.05 significant). Commonly used medicinal products were cross-referenced with the MOH drug database for registration and reimbursement status.

Results: A total of 3,284 compassionate treatments were administered, employing 596 distinct medicinal products to address 1,361 conditions in 2020-2024. Temporal analysis identified a peak in 2020, which accounted for 24% of total treatments, followed by a decrease thereafter. Patient age stratification indicated that those aged 65 to 80 received the highest treatment proportion (26%), while the 45 to 65 age group accounted for 19%. Treatments were mainly concentrated in large central hospitals (77%) and the central district (49%), with the southern district showing the least usage. The authorization process was primarily for the continuation of study drug in 63% of cases. Additionally, Belantamab mafodotin and Trametinib were the most frequently utilized medicinal products, accounting for 9% and 8.6% of treatments, respectively. Disease category analysis revealed that relapsed refractory multiple myeloma, central nervous system tumors, and inflammatory bowel disease were among the top conditions treated, varying by age group. Notably, 60% of the most common technologies (13 out of 22) were subsequently included into the national health basket, typically following an extended period of compassionate use that exceeded two years.

Conclusion: The study suggests that Israel's compassionate use programs have accelerated early access to novel therapies for complex conditions and provided a bridge to the inclusion of novel medicinal products in the national health basket. Nonetheless, the study identifies a concerning downward trend in utilization alongside potential access disparities, thereby underscoring the necessity for further targeted investigations.