Israel Journal of Health Policy Research最新文献

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.

Background: Pregnant women commonly sustain injuries following traffic collisions, falls, and intentional incidents such as domestic violence. Injuries sustained by pregnant women can lead to placental abruption, pelvic fracture, preterm delivery as well as maternal and fetal mortality. The aim of this study was to compare injury and hospitalization characteristics among hospitalized pregnant and nonpregnant women. For pregnant women, gestational age was analyzed according to injury severity and hospitalization characteristics.

Methods: The Israel National Trauma Registry was the data source for this retrospective study. Demographic, injury and hospitalization characteristics were collected and analyzed for pregnant and nonpregnant women hospitalized between Jan 1, 2012 and December 31, 2021. Among pregnant females, gestational age was identified. Categorical variables were compared using the Chi-square Test and Fisher's Exact Test.

Results: A total of 33,377 women, aged 18-45 years, were hospitalized due to trauma-related injury; 14,606 (43.8%) were pregnant, and 18,771 (56.2%) were not pregnant. Among the pregnant women, 91.7% had an Injury Severity Score (ISS) of 1, and 75.9% were hospitalized for a single day. In comparison, 31% of the nonpregnant women had an ISS of 1 (P < 0.0001), and 32% were hospitalized for one day. Traffic accidents contributed to 51.8% of hospitalizations among pregnant women, compared with 42.8% among nonpregnant women. While falls were more prevalent among pregnant women, a greater proportion of nonpregnant women were hospitalized with intentional injuries. Among pregnant women, injuries during the third trimester are most common. However, those hospitalized during the first trimester suffered from more severe injuries than injuries during the second and third trimesters did. Compared with nonpregnant women, pregnant women are more likely to sustain minor injuries, have shorter hospitalization stays, have fewer surgical interventions and have fewer admissions to intensive care units (ICUs).

Conclusions: This study provides important data for medical personnel and policymakers regarding trauma-related injuries among pregnant women. The results highlight the need to reassess observation and treatment protocols to balance appropriate maternal and fetal care while minimizing unnecessary hospitalizations. Collaboration among policymakers, obstetricians, and neonatal specialists is essential to refining evidence-based protocols that improve outcomes for pregnant trauma patients and their fetuses.