Israel Journal of Health Policy Research最新文献

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.

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.