Israel Journal of Health Policy Research最新文献

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.

Poverty, conflict and war are the most prominent reasons for food insecurity worldwide including for the population of Gaza since October 7, 2023. It has been shown that at least during the seven-month period between January and July, 2024, an adequate supply of food was delivered to Gaza. However, a distinction must be made between food availability (entering Gaza), and food accessibility (food supply actually reached at the household level). The latter was apparently controlled by Hamas; and there are no reliable data available on the actual distribution of food. A prerequisite for achieving a better "day after" for the population of Gaza depends on achieving a permanent end to the hostilities between Hamas and other Gazan militants with Israel. That must be a top priority for policymakers. Nonetheless, understanding the elements involved in the planning for a successful "day after" can begin now. We know that most of the population needs housing, as well as sufficient, adequate and accessible food, water, energy sources, adequate health services for acute and chronic medical and surgical conditions, mental health, and preventive care. In this article, we focus on planning for food and nutrition security for the "day after," a process that will require actions along the six dimensions of food security- availability, accessibility, utilization, stability, sustainability, and agency. We outline these dimensions and their necessary components.

Background: Efficient hospital-to-home transitions for older adults and their informal caregivers are hampered by current fragmented care systems, resulting in communication and coordination lapses when people move between hospital-to-home settings. Such fragmentation often leads to suboptimal hand-overs of information and care, medication errors, and overlooked follow-up appointments, which, in turn, contribute to adverse health outcomes for the elderly population. This study aims to answer the question: "What policy interventions can improve the transitions from hospital to home for older adults and their informal caregivers" Thus the study focuses on delineating policy recommendations at the micro, meso, and macro levels to facilitate smoother and more beneficial hospital-to-home transitions for older adults and their informal caregivers.

Methods: As part of the European Union Transitional Care Program (TRANS-SENIOR), this qualitative descriptive study leverages a multiple perspectives approach through in-depth interviews with older adults and informal caregivers. The goal is to pinpoint critical intervention zones of policy recommendations based on a holistic understanding of older adult and caregiver recommendations for improving hospital-to-home transitions.

Results: Findings show strategies that strengthen patient and caregiver engagement on the micro level. These include implementing personalized care plans and improving communication channels between healthcare providers and their recipients. The meso level targets healthcare organizations and systems, promoting the adoption of streamlined care coordination, enhanced discharge planning, and bolstered support services for caregivers. Such interventions are designed to smooth the transition process, ensuring that care continues seamlessly from hospital to home. At the macro level, our findings urge policy reforms to address broader systemic issues, such as the allocation of resources, the introduction of funding mechanisms, and the expansion of healthcare workforce capacity. These policy recommendations aim to create an enabling environment for effective care transitions, addressing underlying challenges that impede seamless care transitions.

Conclusion: This paper presents a set of policy recommendations for policymakers, healthcare professionals, and stakeholders. These recommendations aim to tackle the multifaceted challenges associated with hospital-to-home transitions to enhance care experience and outcomes for older adults and their caregivers by addressing individual, organizational, and systemic issues.

Background: Enhancing security and dependability of health systems necessitates resource allocation, a well-defined infrastructure, and a steadfast commitment to ensuring its safety and stability over time. This study aimed to assess changes in patient safety culture over time (2014-2022) within a network of private hospitals in Brazil and to examine its association with the hospital accreditation process. The study utilized the Hospital Survey on Patient Safety Culture (HSOPSC) to measure healthcare professionals' perceptions of patient safety culture.

Methods: The HSOPSC questionnaire was distributed to 71 hospitals between 2014 and 2022 with 259,268 responders. Hospitals were classified as accredited (AH) or non-accredited (NAH). A linear mixed-effects regression model was used to analyze the trend of dimension scores over time, accounting for both fixed and random effects to accommodate within-hospital correlations and variations across time points.

Results: Out of 12 dimensions analysed, 11 significantly improved, and one ("frequency of reported events") remained unchanged over time (p = 0.84). Two dimensions had < 50% positive responses: "communication openness" (47.13% [38.19-58.73]) and "nonpunitive response to errors" (41.24% [34.13-51.98]). Safety culture improved among AH across all, but "frequency of reported events" (p = 0.12), dimensions. Among NAH, "frequency of reported events" decreased over time (p = 0.008) while other dimensions remained unchanged.

Conclusion: Our results suggest an improvement in patient safety culture within this network of private hospitals in Brazil from 2014 to 2022. While accreditation appears to be associated with fostering a culture of safety over time, our study does not establish a causal relationship. Additionally, non-accredited hospitals tended to report fewer adverse events, which may indicate underreporting and missed opportunities for healthcare system improvement through adverse event analysis.

Minority populations in many countries, including Israel and the US, experience significant health disparities compared to the majority population. A health workforce that reflects the characteristics of the population including race/ethnicity, language and socioeconomic backgrounds, can help address these disparities. Over the years, Isreal and the US have implemented a variety of programs and policies to promote greater representation of minority populations in medicine and other health professions. This paper compares some of the efforts and outcomes in the 2 countries to support a more diverse health workforce. While progress has been made in both countries, they now face significant challenges which are likely to put recent progress at risk.