Israel Journal of Health Policy Research最新文献

Background: In recent decades, caesarean section (CS) rates have dramatically increased; the reasons for this trend are multifactorial and not fully understood. This continuing trend has raised public health concerns regarding higher maternal and perinatal risks, high costs, healthcare efficiency, and inequality of services. We aimed to characterize and evaluate Israel's CS rate by applying the Robson classification system.

Methods: This was a national retrospective cross-sectional study. Data from 1,061,786 live births were collected from electronic medical records of women admitted for delivery across all Israeli hospitals between 2014 and 2023. The Robson classification system (also known as the Robson ten group classification system; RTGCS), has been used to monitor, assess, and compare CS rates. Data analysis followed WHO's RTGCS manual guidelines. Each birth was classified into one of the Robson groups to assess group size, the CS rate within each group, and the contribution to the overall CS rate.

Results: We found an increasing trend in CS rates, with 19.0% marking the highest rate recorded over the last decade. Group 3 + 4 (multiparous, singleton, cephalic, term pregnancy without previous CS) and 1 (nulliparous, singleton, cephalic, term pregnancy in spontaneous labor) were the most represented (56.1% and 20.7%, respectively). The major contributors to CS included Groups 1, 3 + 4, 5 (multiparous, singleton, cephalic, term pregnancy with a previous CS), 8 (all multiple pregnancies), and 10 (singleton, cephalic, pre-term pregnancy).

Conclusions: Using a population-based dataset that spanned ten years, this study identified subgroups in need of targeted interventions and offered insight into CS rate dynamics. The study underscores the RTGCS's potential to optimize maternity outcomes, shape policy, and inform healthcare practices, making a meaningful contribution to the field. The findings highlight the importance of integrating RTGCS into routine data collection and improving obstetric data quality.

Background: Approximately one in seven 10 to 19-year-olds cope with mental health conditions globally, which amounts to 13% of the overall burden of disease within this specific age demographic, and the prevalence is expected to rise. Neglecting the management of mental health conditions during adolescence has repercussions into adulthood that adversely affect both physical and mental well-being, and constrain opportunities for leading fulfilling lives.

Main body: This integrative article introduces a new empirically-based model entitled "Continuity of Community Reintegration" (the CCR model) that acknowledges the emotional, social, and functional aspects of the personal recovery process of adolescents by considering the essential care providers, i.e., the family, community-based programs, schools, and clinics or hospitals. This model is based on a research project including a scoping review and qualitative data collected from 86 stakeholders involved in Amitim for Youth, the first community-based program for adolescents with mental health conditions in Israel.

Conclusion: The model underscores that continuity of care across all the care providers is essential to optimize the personal recovery of these adolescents while emphasizing their agency, encouraging them to engage actively in decision-making, goal setting, and while guiding them towards reintegration into the community and personal recovery.

Background: Israel relies heavily on foreign-trained physicians, with approximately 58% of all its practicing physicians having received their medical education abroad. The Israeli Ministry of Health (MOH) has estimated a 30% non-return rate (i.e., the proportion of Israeli medical graduates who remain abroad after completing their studies, rather than returning to practice in Israel) among Israeli medical graduates studying abroad. However, this estimate is based on limited data. This study explores the self-reported class non-return rate among Israeli medical graduates from foreign medical schools and examines potential factors influencing their decision to remain abroad.

Methods: This study analyzed data provided by the Israeli MOH regarding Israeli medical graduates who completed their education at foreign medical schools accredited under the Yatziv Reform between 2023 and 2024. The data were collected via a structured online survey developed by the MOH in 2024-2025 and distributed through WhatsApp. Respondents provided self-reported information including: university attended, year of graduation, number of Israeli students in the cohort (hereafter referred to as class size), and the number of Israelis reported to have returned to practice in Israel. The primary outcome was the self-reported non-return rate at the class level.

Results: Among 101 valid responses representing 37 classes and approximately 1,048 Israeli medical graduates across 11 countries, the overall non-return rate was 9.7%, with substantial variation by country, from 0% in Jordan to 40.5% in Italy. Excluding graduates from the Palestinian Authority (PA) increased the rate to 12.1%, though not significantly. A significant negative correlation was found between class size and non-return rate (ρ = - 0.51, p = 0.0011), while higher Human Development Index (HDI) values were associated with both smaller class sizes (ρ = - 0.72, p < 0.001) and higher non-return rates (ρ = 0.53, p = 0.0007). A multiple regression model with class size, HDI, and their interaction explained 31% of the variance in non-return rates (Adj. R² = 0.31; p = 0.002), with all terms significant.

Conclusions: The self-reported non-return rate was lower than expected but varied substantially by country. Class size, HDI, and their interaction were significant predictors of non-return, highlighting the need for targeted return policies and improved data to inform workforce planning.

Background: Despite the global rise in medical cannabis use for health purposes, patients with medical cannabis licenses face significant legal and health risks when traveling abroad. The present study sought to understand how medical cannabis users experience these challenges while traveling abroad.

Methods: We conducted semi-structured interviews with 15 Israeli medical cannabis license holders and collected supplementary data from two of the largest Facebook groups of medical cannabis users in Israel.

Results: Two main themes were identified : (a) vague regulations for medical cannabis users who travel abroad. Patients described international regulations as vague, with authorities failing to treat medical cannabis like other prescription medications for tourists. They criticized the lack of clear, formal information and guidelines; (b) legal, semi-legal, and illegal solutions adopted by medical cannabis users traveling abroad. In response to these challenges, patients have adopted various strategies, such as avoiding travel, selecting cannabis-friendly destinations, planning in advance to obtain cannabis through legal or illegal means, and finding alternative self-medication options.

Conclusion and policy recommendation: The study revealed the need for improving the clarity of international policies to reduce legal and health risks faced by licensed medical cannabis users traveling abroad. We recommend that countries adopt mutual recognition of prescriptions, standardized travel certificates, and improved institutional guidance. The World Health Organization (WHO) should support this effort by issuing non-binding global guidelines and promoting best practices. Grounding these recommendations in access to care and health equity frameworks would ensure fair, safe, and continuous treatment access across borders.

Background:  Similar to countries worldwide, Israel suffers from the effects of a modern lifestyle, with high rates of obesity, lack of healthy nutrition and insufficient physical activity. Global health organizations recommend national systemic programs to address this problem. The Israel National Program for Active and Healthy Living-Efsharibari was launched at the end of 2011 via government resolution, to reduce morbidity and mortality and improve quality of life for the diverse population. It is a collaborative effort of the Ministries of Health, Culture and Sport, and Education.

Methods:  Development and monitoring of a comprehensive set of indicators to assess process, outputs and outcomes in relation to program objectives. Qualitative and quantitative retrospective review of legislation, standards and health-promoting environments. Review of national data and surveys related to key activity domains - policy, supportive environments and social marketing - and a study of related behavioral and morbidity indicators.

Results:  Over a decade, notable changes were observed for indicators in key activity domains, aligning with the programs' initial objectives. Improvements were found for 13 of 18 planned nutrition policies and 7 of 8 physical-activity policies. Changes to the nutritional environment included enhanced nutritional labeling and reductions in the amounts of sodium, sugar and saturated fat in commercial food products. An increase in national and local health promotion infrastructures included adoption of the "healthy city" protocol in 77 local authorities and implementation of the "health-promoting school" plan in 1,698 schools across the country. Behavior and morbidity indicators display mixed findings: reported behaviors in the field of nutrition have improved and physical activity among adults 65 + has increased. However, fewer children, youth, and adults are achieving the global recommended levels of reported physical activity and there are negative trends in breastfeeding behaviors. In terms of morbidity, a decrease in mortality from heart disease and diabetes was found, along with modest fluctuations in obesity trends.

Conclusions:  Consistent and ongoing efforts of the national plan to promote health in all policies, enable healthy choices, and promote systematic change have impacted Israeli society over time. In spite of changes of government and a lack of funds, Efsharibari has allowed for continuous cooperation between policymakers, professionals and additional partners, including during the COVID-19 pandemic. Additional efforts are necessary to reduce health disparities, enhance healthy behaviors and improve morbidity indicators. Amidst ongoing international dialogue to improve and expand health promotion, Israel's practical experience, including both successes and challenges serves to inform the international community.

Background: Hospitalized patients are inherently one of the most vulnerable populations. When the hospital is damaged, this population becomes even more at risk. Violence and natural disasters always have the potential to damage hospitals and other healthcare facilities, creating additional strain on an already catastrophic event. This study presents the preparedness of hospitalized patients during a mass casualty incident in order to understand their perspectives during a time of war in order to prepare, optimize, and to guide policy in order to maintain the highest level of care, efficiency, and safety.

Methods: A descriptive cross-sectional prospective analysis was conducted for patients admitted during an active war.

Results: Data from 103 patients were analyzed. 77% reported mobility limitations that significantly increased compared to their baseline home status. The majority did not know what to do in a disaster, only 20.4% felt able to take care of themselves in an emergency. 61.7% believed it was important to have CPR or stop-the-bleeding training. The major challenges were getting out of bed (56.9%), mobility help (41.2%), pain, and attachment to IVs/drains (both 25.5%). Older patients, non-Jewish individuals, religious patients, and those without an academic degree were all significantly at higher risk for having less knowledge about what to do if there was a mass casualty incident.

Conclusions: There is a clear need to better understand the patient perspective, as reflected in specific points identified in this study, in order to optimize hospital preparedness when the hospital itself is a disaster victim.

Background: The paper examines the experiences of volunteers, residents, and leadership in Tel Aviv Medical Center's (TLVMC) Neurosurgery Department following the October 7th terrorist attacks. It explores how volunteers impacted the department's operations during acute medical staff shortages, a surge in patient needs, and a time of profound national and personal crisis.

Methods: Fifteen semi-structured interviews were conducted with volunteers, residents, and management members in TLVMC's Neurosurgery Department to provide a qualitative analysis of their experiences and insights for future disaster preparedness. The findings are analyzed using three theoretical frameworks: Surge Capacity Framework, Resilience Theory, and Volunteer Process Model.

Results: Participants reflected on the overall impact of volunteers in the department - helping to maintain the service's functionality and operations, filling gaps in staffing, and providing relief and support to staff members - as well as the non-medical contributions such as increasing morale and a sense of solidarity within the community. Volunteers also spoke about the personal impact of this experience, expressing their desire to give back and have a sense of purpose. Participants emphasized the importance of strong leadership, cohesive teams, and the need for pre-disaster planning.

Conclusions: Volunteers provided essential clinical and morale support. They reported meaningful personal experiences and also offered practical recommendations for future disaster volunteering. Embedding community-wide planning and formal volunteer integration can strengthen healthcare system resilience.

Background: Over the past two decades, the increasing frequency of disasters highlights the urgent need for nurses willing to respond to these crises. Although disaster care is part of their professional role, willingness to provide care in such situations is not always guaranteed and may be influenced by various factors. Understanding what shapes their intention to provide care is critical for effective disaster planning. This study investigates the role of empathy in shaping nurses' intention to participate in disaster care, drawing on the Empathy-Altruism Hypothesis. To further contextualize this relationship, elements of the Theory of Planned Behavior-attitude toward the behavior, subjective norms, and perceived behavioral control-were also examined as potential predictors of behavioral intention.

Methods: A cross-sectional and correlational study was carried out among nurses in Greece using a convenience sampling method. Data collection took place from December 2023 to April 2024. Participants completed a questionnaire covering demographics, academic background, experiences with disasters, empathy (assessed using the Jefferson Scale of Empathy), and behavioral intentions related to disaster care. The Behavioral Intention Scale was used to assess the behavioral intention, attitude toward the behavior, subjective norms and perceived behavioral control.

Results: The final sample included 252 nurses. Findings revealed a strong intention to participate in disaster victim care. Empathy levels were moderate to high, with a mean score of 103.56 on a 20-140 scale. Multiple linear regression, using behavioral intention as the dependent variable, revealed a significant positive association between subjective norms and behavioral intention. In contrast, empathy, attitude, and perceived behavioral control were not significantly associated with behavioral intention.

Conclusions: This study provides insights into the factors that influence nurses' intention to provide disaster care, with subjective norms emerging as the strongest predictor. These findings partially support the Theory of Planned Behavior and suggest that social expectations and perceived peer support may be critical in shaping willingness to respond. Although nurses exhibited strong empathy and a high intention to participate in disaster care, empathy did not significantly influence behavioral intention. Further research is needed to explore empathy's potential contribution to motivating nurses to engage in disaster response.

Background: Most older adults prefer to "age in place" within their communities. This preference cannot always be honored and dependent older adults may transfer to a long-term care facility. The Return Home is an Israel Ministry of Health initiated care model designed to prevent or delay a transfer of the dependent older adult to a long-term facility. The intervention team included a physician, nurse, social worker, occupational therapist, physical therapist, and a dietician, all participating in in-home visits. This study's aim was to examine the Return Home model's feasibility to prevent long-term care placement in a complex, dependent geriatric population.

Methods: We analyzed data from the electronic medical record (EMR) of the provider. Participants were recruited by the Israeli Ministry of Health from July 2021 to November 2022 at the time of hospital discharge. Caregiver input was obtained from interviews at the beginning and end of the one-year intervention.

Results: 138 patients were enrolled in the intervention. 86 (62%) completed the intervention in their homes, 39 (28%) died during the intervention, 5 (4%) were transferred to a long-term facility, 8 (6%) were dis-enrolled. Prescription medication usage declined by 0.79 medications per person on average. Forty patients had pressure ulcers at the time of admission; all of these ulcers healed during the program, after an average time of 1.5 months. Caregiver burden measured by the Zarit score, declined from 20.9 to 9.7, t (156) = 11.88, p < 0.001.

Conclusions: The Return Home intervention demonstrated the feasibility of preventing or delaying long-term care placement for a complex, dependent geriatric population. Further evaluation is needed to determine effectiveness and inform broader implementation.

Background: The gradual increase in referrals to the busy Emergency Departments (ED) raises concerns about the potential negative effect on the quality of medical care and patient satisfaction. Urgent Care Center (UCC) provides an alternative to the ED for non-life saving medical conditions. This study aimed to compare the admission rates, reasons for referrals and patient's satisfaction amongst UCCs based on their distance from the nearest ED.

Methods: This cross-sectional study included all medical records of four UCCs between 2017 and 2020. Admission rates, reasons for referrals, and patients' satisfaction were compared between UCCs located near and ED located farther away.

Results: The study included 216,903 patients with an average age of 32.4±24.4 years. Most referrals were independent, with 37.7% occurring on weekends. The average triage time and total time spent in the UCCs were approximately 5.3 minutes and 62.8 minutes, respectively. The proportion of residents visiting UCCs in cities with an ED was 14.4% with a level of satisfaction of 91.5%, compared with UCCs in cities without ED where these figures were 23.7% and 84.4%, respectively. UCCs in northern Israel treated more patients with trauma/injury (33.0%) than UCCs in southern Israel (28.2%).

Conclusions: UCCs in the two locations without an ED received a higher volume of patients, while their satisfaction levels were lower. UCC serves as an alternative to ED for non-lifesaving medical conditions.