Israel Journal of Health Policy Research最新文献

Background: Nurses play a vital role in disaster response during emergencies. Nevertheless, limited attention has been paid to factors that influence nurses' responses and challenges in prehospital settings. These issues became evident during the October 7, 2023, terror attack on Israel, when nurses heroically provided medical treatment, but there was no organized nurse-led initiative to provide emergency care in a prehospital setting.

Aims: (1) To examine the factors associated with nurses' intentions to provide prehospital emergency reponse during disasters; and (2) To understand multilevel determinantsof nurses' prehospital emergency response to inform health policy recommendations.

Methods: This study employed an explanatory sequential mixed-methods design. Between February and December 2024, a self-reporting questionnaire was distributed to Israeli nurses (n = 315), followed by a qualitative phase involving an open-ended questionnaire completed by 20 healthcare professionals involved in medical care during the attack or in senior emergency preparedness roles. Descriptive and inferential statistics and qualitative content analysis were employed. We applied the socioecological framework to organize the results from both phases.

Results: High personal resilience, readiness and self-efficacy, along with positive attitudes, low hesitancy, and residence in a rural-type settlement significantly predicted nurses' intention to provide prehospital emergency care. Qualitative analysis revealed four key themes related to nurses' prehospital roles: (1) individual barriers and facilitators, (2) interprofessional relationships and teamwork, (3) nurses' roles within the community, and (4) organizational and policy challenges. Findings from both phases were synthesized using the socioecological framework for analysing prehospital nursing care during emergencies.

Conclusion: Nurses' prehospital emergency response intentions are shaped by personal, professional, and policy-level factors. Beyond education, targeted health policies must clearly define nurses' roles, strengthen interprofessional collaboration, and integrate nursing into disaster preparedness frameworks to improve system resilience and patient outcomes, particularly in the face of escalating environmental crises globally.

Background: Accessibility and availability are critical components of quality healthcare, particularly for dialysis patients requiring tri-weekly treatments. Inconveniently placed or oversubscribed dialysis centers contribute to widening healthcare disparities. This study aims to enhance equity in dialysis care by utilizing Geographic Information Systems (GIS) to optimize facility placement through data-driven decision-making.

Methods: This cross-sectional study analyzed national data from 5,961 hemodialysis patients across 76 dialysis centers in Israel. Geographic accessibility was assessed using GIS to measure travel distances between patients' residences and their treating dialysis centers. For utilization rate, active hemodialysis patient count was compared to estimated maximum capacity for each center. Statistical comparisons across districts were conducted using chi-square, ANOVA, or Kruskal-Wallis tests, with Bonferroni corrections. Findings were visualized using ArcGIS software.

Results: The median travel distance to dialysis centers varied significantly by district (p < 0.001), with the longest distance in the North district (10.9 km) and the shortest in the South district (3.4 km). The mean utilization rate was 73.3%, with the highest in the North district (82.5%) and the lowest in the Jerusalem district (64.3%). No significant differences in utilization rates were found between districts (p = 0.38.

Conclusions: To our knowledge, this is the first study to apply GIS to national patient-based data for assessing dialysis center accessibility and utilization. Our findings demonstrate how GIS integration with national registries can inform equitable healthcare planning and facility allocation. This approach offers policymakers a scalable, technology-driven strategy to optimize resource distribution, correct healthcare inequities, and improve accessibility for dialysis patients.

In their previously published article in the Israel Journal of Health Policy Research, Rose and colleagues describe and advocate for greater use of implementation science in Israel. As a discipline, implementation science seeks to traverse the last steps in bringing new science from research to clinical practice, which are often the most difficult of the entire process. Implementation science in general faces substantial challenges, including the extraordinary heterogeneity of the dissemination process, and the obstacles represented by established practices, singular preferences, and questions about generalizability. In our view, implementation science complements classic epidemiology as part of a continuum of population health research that warrants greater attention and funding. For now, however, implementation science will need to show that it can consistently achieve sizable, durable, and widespread results if it is to traverse its own last mile and establish itself as a successful and permanent component of biomedicine in Israel.

On October 7th, 2023, a deadly attack was launched on southern Israel from the Gaza Strip followed by major clashes along the Israel-Lebanon border. In the following days, approximately 2.5% of the Israeli population was evacuated from their homes, many of whom were directly affected by the violence Many evacuees were housed in Eilat, a small geographically peripheral city known for its holiday atmosphere in the southernmost part of Israel. The horrors of the terror attacks and the war, the unprecedented number of evacuees, and the highly limited mental health resources available in this remote city have combined to create an overwhelming demand for mental health services, which required the deployment of special measures. In this report from the field, we discuss our experiences in sending the first organized, organic teams to provide primary mental health support to the evacuees, with the supervision of Shalvata Mental Health Center, located over 300 km away from Eilat. Our experience highlights the need for proper preparation, planning, and practice for large-scale mental health support intervention in mass evacuation events and points to several successful and suboptimal practices for future deployment.

Background: One of the primary challenges faced by survivors of sexual abuse and assault is the fragmented nature of care. This begins immediately after the assault and continues throughout their recovery journey. To address this, specialized sexual assault referral centers (SARC) were established in Israel, providing comprehensive medical, legal, and emotional support. This study examines the association between these centers and survivors' consent to forensic examination and filing of police complaints.

Methods: This retrospective cohort study analyzed data from 616 cases of sexual abuse and assault reported at the SARC at Bnai Zion Medical Center between January 2016 and May 2022. Data included demographic information, assault characteristics, treatment details, and survivors' consent to forensic examination and police complaint filing.

Results: Four distinct profiles of sexual assault survivors were identified. The first profile included survivors who consented to both forensic examination and police complaints. This group was characterized by shorter intervals between the assault and arrival at the center, being accompanied by friends or family, more often agreeing to receive medication and experiencing more incidents involving more than one attacker. The second profile included survivors who consented to forensic examination only, and it consisted mainly of young women who arrived unaccompanied, later after the assault, expressed more willingness to receive medications and often involved single perpetrator assaults with alcohol use. The third profile involved survivors who filed only a police complaint and were characterized by lower rates of alcohol use during the assault and less frequent receipt of medication. The fourth profile comprised survivors who refused both forensic examination and police complaint, primarily young females who arrived unaccompanied and often reported experiencing forced vaginal or anal penetration. Key predictors of group membership included time since the assault, biological sex, assault type, alcohol use, medication, presence of an informal escort, and multiple perpetrators.

Conclusions: The study underscores the importance of a victim-centered, trauma-informed approach to care, highlighting the need for tailored interventions to address the specific needs and barriers of each survivor profile. The findings suggest that timely access to medical care and supportive services is significantly associated with survivors' decisions to consent to forensic examinations and file police complaints.

Background: In Israel, the absence of national growth charts leads to the use of CDC or WHO growth charts to assess pediatric growth indices. This population-based cross-sectional study compared BMI z-scores and weight classifications using CDC and WHO charts in children insured by Clalit Health Services (CHS).

Methods: The study analyzed the CHS electronic database for patients aged 2-18 years with at least one recorded BMI measurement from January 2017 to December 2023. Exclusion criteria included improbable BMI measurements (> 60 kg/m² or < 10 kg/m²). Demographic data, height, and weight were collected, and BMI z-scores were calculated using both CDC and WHO growth charts. Results were stratified by sex and age groups (2-5 years and > 5-18 years).

Results: The cohort included 1,475,543 children: 488,008 aged 2-5 years (52% male) and 987,535 aged > 5-18 years (51% male). In the younger group, the median CDC BMI z-scores were below 0 (< 50th percentile), while the median WHO BMI z-scores were above 0 for both sexes, with significant differences between methods (P < 0.001). BMI z-scores were lower in males than in females across both methods (P < 0.001). In the older group, for both methods, the median BMI z-scores were above 0. WHO z-scores had higher medians in males compared to CDC z-scores (P < 0.001), while in females, z-scores were similar between methods (P = 0.210). CDC showed lower median z-scores for males compared to females (P < 0.001), whereas WHO results were comparable between sexes (P = 0.337). There were significant discrepancies in weight classification, particularly in the 2-5 age group. Overweight rates were over 4% higher using CDC charts compared to WHO (P < 0.001), with minimal agreement (Kappa = 0.06 for males, 0.01 for females). In the older group, WHO classified 4% more children as overweight than CDC (P < 0.001), with moderate agreement in males (Kappa = 0.74) and strong agreement in females (Kappa = 0.81).

Conclusions: The study underscores the risk of misclassifying childhood overweight and obesity depending on the growth standard used, particularly in younger children. Policymakers should carefully choose appropriate standards and consider developing national growth charts tailored to the local pediatric population, while allocate resources for early interventions addressing both undernutrition and overnutrition.

Background: New vaccines and monoclonal antibody (mAb) against respiratory syncytial virus (RSV) were recently approved for adults and infants, respectively. However, their inclusion in national vaccination programs has been slow. Accurate assessment of RSV disease burden among all ages is essential for the global introduction of these agents.

Methods: We evaluated all-ages burden of RSV hospitalizations, from 2020 to 2024, based on data collected by a new national laboratory-based hospital surveillance system. RSV-positive respiratory samples from patients hospitalized in general hospitals nationwide were reported. Data were analyzed by RSV circulation periods and age-group to determine hospitalization rates and 30-day mortality (30-DM) rates. We compared the laboratory-confirmed hospitalization rates with rates previously calculated based on ICD-9 codes.

Results: RSV-confirmed hospitalizations were reported for all age-groups. The highest RSV hospitalization rates were found among patients < 1 year old. Patients ≥ 60 years old had the highest RSV hospitalization rates among ≥ 5 years old patients, and their 30-DM rates reached 14.7%, exceeding those of influenza. During the COVID-19 pandemic, lower rates of RSV-confirmed hospitalizations were reported among ≥ 60 years old patients, probably due to higher adherence to social distancing measures. We found higher numbers and rates of laboratory-confirmed hospitalizations among all age-groups ≥ 1 year old, than those previously reported by our group, based on ICD-9 codes.

Conclusions: Laboratory-confirmation of RSV is paramount for optimal assessment of RSV hospitalization burden, particularly beyond infancy, and for the global adoption of newly developed vaccines and mAb.