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Khayat A, Levine H, Berg CJ, Shauly-Aharonov M, Manor O, Abroms L, Romm KF, Wysota CN, Bar-Zeev Y. IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis. Tob Control 2024; 33:e3-e10. [PMID: 36368887 PMCID: PMC10172385 DOI: 10.1136/tc-2022-057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements. METHODS Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported. RESULTS The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend. CONCLUSIONS IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michal Shauly-Aharonov
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Beyar R, Blazer S, Breuer E, Carmi R, Ciechanover A, Clarfield AM, Glick S, Magen D, Manor O, Paltiel O, Skorecki K. Moral clarity at WHO needs to be clearer. Lancet 2024; 403:905. [PMID: 38373434 DOI: 10.1016/s0140-6736(24)00065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Rafael Beyar
- Rambam Health Care Campus, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Rivka Carmi
- Israeli Academy for Science in Medicine, Ramat Gan, Israel
| | | | | | - Shimon Glick
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Daniella Magen
- Rambam Health Care Campus, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Orly Manor
- Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Karl Skorecki
- Rambam Health Care Campus, Haifa, Israel; Bar-Ilan University, Ramat-Gan, Israel
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Revel-Vilk S, Shalev V, Gill A, Paltiel O, Manor O, Tenenbaum A, Azani L, Chodick G. Assessing the diagnostic utility of the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system using real-world data. Orphanet J Rare Dis 2024; 19:71. [PMID: 38365689 PMCID: PMC10873939 DOI: 10.1186/s13023-024-03042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Gaucher disease (GD) is a rare autosomal recessive condition associated with clinical features such as splenomegaly, hepatomegaly, anemia, thrombocytopenia, and bone abnormalities. Three clinical forms of GD have been defined based on the absence (type 1, GD1) or presence (types 2 and 3) of neurological signs. Early diagnosis can reduce the likelihood of severe, often irreversible complications. The aim of this study was to validate the ability of factors from the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system to discriminate between patients with GD1 and controls using real-world data from electronic patient medical records from Maccabi Healthcare Services, Israel's second-largest state-mandated healthcare provider. METHODS We applied the GED-C scoring system to 265 confirmed cases of GD and 3445 non-GD controls matched for year of birth, sex, and socioeconomic status identified from 1998 to 2022. The analyses were based on two databases: (1) all available data and (2) all data except free-text notes. Features from the GED-C scoring system applicable to GD1 were extracted for each individual. Patients and controls were compared for the proportion of the specific features and overall GED-C scores. Decision tree and random forest models were trained to identify the main features distinguishing GD from non-GD controls. RESULTS The GED-C scoring distinguished individuals with GD from controls using both databases. Decision tree models for the databases showed good accuracy (0.96 [95% CI 0.95-0.97] for Database 1; 0.95 [95% CI 0.94-0.96] for Database 2), high specificity (0.99 [95% CI 0.99-1]) for Database 1; 1.0 [95% CI 0.99-1] for Database 2), but relatively low sensitivity (0.53 [95% CI 0.46-0.59] for Database 1; 0.32 [95% CI 0.25-0.38]) for Database 2). The clinical features of splenomegaly, thrombocytopenia (< 50 × 109/L), and hyperferritinemia (300-1000 ng/mL) were found to be the three most accurate classifiers of GD in both databases. CONCLUSION In this analysis of real-world patient data, certain individual features of the GED-C score discriminate more successfully between patients with GD and controls than the overall score. An enhanced diagnostic model may lead to earlier, reliable diagnoses of Gaucher disease, aiming to minimize the severe complications associated with this disease.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel.
| | - Varda Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aidan Gill
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Ora Paltiel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
- Department of Hematology , Hadassah Medical Organization, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | | | - Liat Azani
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv, Israel
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Shapiro I, Youssim I, Paltiel O, Calderon-Margalit R, Manor O, Friedlander Y, Hochner H. Perinatal exposures and adolescence overweight: The role of shared maternal-offspring pathways. Atherosclerosis 2024; 389:117438. [PMID: 38241794 PMCID: PMC10872218 DOI: 10.1016/j.atherosclerosis.2023.117438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND AIMS Early life exposures affect offspring health across the life-course. We aimed to examine whether prevalent perinatal exposures and obstetric complications are independently associated with offspring overweight in adolescence. We then assessed whether shared maternal-offspring pathways drive the association of perinatal exposures with offspring overweight. METHODS Using data from the Jerusalem Perinatal Study birth cohort, two perinatal scores were constructed: obstetric complications (OC) and prevalent perinatal exposures (PPE) scores. PPE score, generated by principal component analysis, included three primary components. Logistic regressions were used to assess associations of scores with offspring overweight, with and without adjustment for maternal life-course survival. RESULTS OC and PPE scores were independently associated with offspring overweight (OROC = 1.15, 95%CI:1.07,1.25; ORPPE1- SEP and lifestyle = 0.85, 95%CI:0.79,0.91; ORPPE2- Maternal body size = 1.20, 95%CI: 1.13,1.28; ORPPE3-Fetal growth = 1.18, 95%CI:1.11,1.26). Maternal survival was associated with offspring overweight (OR = 1.38, 95%CI:1.08,1.76), yet introducing PPE score to the same model attenuated this association (OR = 1.16, 95%CI:0.90, 1.49). When OC score and maternal survival were included in the same model, their associations with offspring overweight remained unchanged. CONCLUSIONS Mother-offspring shared factors, captured by maternal life-course survival, underlie the effect of prevalent perinatal exposures on offspring overweight. However, the effect of obstetric complications was independent, highlighting the contribution of additional pathways.
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Affiliation(s)
- Ilona Shapiro
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel.
| | - Iaroslav Youssim
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | - Hagit Hochner
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
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Barasche-Berdah D, Ein-Mor E, Calderon-Margalit R, Rose AJ, Krieger M, Brammli-Greenberg S, Ben-Yehuda A, Manor O, Cohen AD, Bar-Ratson E, Bareket R, Matz E, Paltiel O. Nationwide Evaluation of Quality of Care Indicators for Individuals with Severe Mental Illness and Diabetes Mellitus, Following Israel's Mental Health Reform. Community Ment Health J 2024; 60:354-365. [PMID: 37697183 DOI: 10.1007/s10597-023-01178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
Diabetes Mellitus (DM) is more common among individuals with severe mental illness (SMI). We aimed to assess quality-of-care-indicators in individuals with SMI following the 2015 Israel's Mental-Health-reform. We analyzed yearly changes in 2015-2019 of quality-of-care-measures and intermediate-DM-outcomes, with adjustment for gender, age-group, and socioeconomic status (SES) and compared individuals with SMI to the general adult population. Adults with SMI had higher prevalences of DM (odds ratio (OR) = 1.64; 95% confidence intervals (CI): 1.61-1.67) and obesity (OR = 2.11; 95% CI: 2.08-2.13), compared to the general population. DM prevalence, DM control, and obesity rates increased over the years in this population. In 2019, HbA1c testing was marginally lower (OR = 0.88; 95% CI: 0.83-0.94) and uncontrolled DM (HbA1c > 9%) slightly more common among patients with SMI (OR = 1.22; 95% CI: 1.14-1.30), control worsened by decreasing SES. After adjustment, uncontrolled DM (adj. OR = 1.02; 95% CI: 0.96-1.09) was not associated with SMI. Cardio-metabolic morbidity among patients with SMI may be related to high prevalences of obesity and DM rather than poor DM control. Effective screening for metabolic diseases in this population and social reforms are required.
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Affiliation(s)
- Deborah Barasche-Berdah
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel.
| | - Eliana Ein-Mor
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Michal Krieger
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arye Ben-Yehuda
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arnon D Cohen
- Clalit Health Services, 101 Arlozorov St., POB 16250, 62098, Tel Aviv, Israel
| | | | - Ronen Bareket
- Meuhedet Health Fund, 124 Ibn Gvirol St, 62038, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Matz
- Leumit Health Fund, 23 Sprinzak St, 64738, Tel Aviv, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Abdel-Rahman N, Manor O, Elran E, Siscovick D, Calderon-Margalit R. Implications of Patient-Reported Outcome Measures among patients with recently diagnosed type 2 diabetes. Isr J Health Policy Res 2024; 13:6. [PMID: 38297393 PMCID: PMC10829200 DOI: 10.1186/s13584-024-00592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND For the past two decades, the assessment of the quality of diabetes care has mostly relied on clinical quality indicators. These have not included Patient-Reported Outcome Measures (PROMs) which provide information on outcomes deemed valuable by patients. We aimed to examine the potential utility of PROMs in type 2 diabetes care and to study the association of PROMs with patients' characteristics and clinical quality indicators. METHODS A cross-sectional survey of recently (≤ 4 years) diagnosed patients with type 2 diabetes (n = 392) in the setting of a large health plan. PROMs were based on two well-validated questionnaires, the Problem Areas in Diabetes (PAID) one-page questionnaire that measures diabetes-related distress, and the ten item PROMIS-10 global health questionnaire that measures general health. Additional items were added following a previous qualitative study among Israeli patients with diabetes. The survey was carried out using phone interviews, and data collected were linked to the electronic medical records. Multivariable regression models were used to assess the associations of socio-demographic variables and clinical quality indicators with the PROMs. RESULTS About a fifth of participants (22%) had high diabetes-related distress (PAID score ≥ 40), a third reported that they did not feel confident in self-management of diabetes and about a third reported having sexual dysfunction. Women, younger patients, and those with a low education level (≤ 12 years) reported worse general health, were more likely to experience high diabetes-related distress, and to have low confidence in diabetes self-management. Interestingly, performance of all seven diabetes quality indicators was associated with worse general health and high diabetes-related distress. Of note, levels of glycated hemoglobin, LDL-cholesterol, or blood pressure were not associated with PROMs. CONCLUSIONS PROMs provide important information on patient self-reported health status and are likely to reflect aspects of the quality of care that are not otherwise available to clinicians. Thus, the use of PROMs has the potential to expand the evaluation of diabetes care and promote patient-centered care. We recommend that policy-makers in the Ministry of Health and health maintenance organizations implement PROMs for assessing and improving the care for patients with type 2 diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel.
| | - Orly Manor
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel
| | - Einat Elran
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel
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Revel-Vilk S, Zimran A, Istaiti M, Azani L, Shalev V, Chodick G, Manor O, Paltiel O. Cancer Risk in Patients with Gaucher Disease Using Real-World Data. J Clin Med 2023; 12:7707. [PMID: 38137776 PMCID: PMC10744109 DOI: 10.3390/jcm12247707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The association between GD and cancer has been uncertain due to ascertainment bias in previously published studies. We analyzed cancer incidence using the Maccabi Healthcare Service (MHS) electronic health records among 264 patients with GD compared to 3440 matched controls. We ascertained cancers diagnosed before and after the index date (i.e., the first documentation of GD in cases and the corresponding date for controls). Before the index date, cancers were diagnosed in 18 individuals, with 11 (4.2%) in the GD group and 7 (0.2%) in the control group. After the index date, cancers were diagnosed in 57 individuals, with 20 (7.9%) in the GD group and 37 (1.1%) in the control group, with a median follow-up of almost 13 years in both groups. The most common cancers diagnosed in GD were non-melanoma skin cancer (NMSC) and hematological malignancies, with a clustering of diagnoses around the time of GD diagnosis. The incidence of cancers (excluding MNSC) was 4.1 (95% CI 2.2-7.1) and 0.7 (95% CI 0.4-0.9) per 1000 patient-years in the GD and control groups, respectively, with an incidence rate ratio of 6.37 (95% CI 3-12.7). Patients with GD underwent more cancer screening tests than their counterparts in the control group. While our study revealed an increased occurrence of cancers in patients with GD, this finding might be partly attributed to the more rigorous surveillance procedures employed in this patient population.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (A.Z.); (M.I.)
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel;
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Ari Zimran
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (A.Z.); (M.I.)
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel;
| | - Majdolen Istaiti
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (A.Z.); (M.I.)
| | - Liat Azani
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv 6772168, Israel
| | - Varda Shalev
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (G.C.)
| | - Gabriel Chodick
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (G.C.)
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Ora Paltiel
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel;
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel;
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Reychav I, Yaakobi A, McHaney R, Tal Y, Manor O. Identification of behavioural changes in reporting adverse events early during COVID-19: An ambulatory care perspective in Israel. Int J Health Plann Manage 2023; 38:1314-1329. [PMID: 37194151 DOI: 10.1002/hpm.3654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/04/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
This study examined adverse event reporting centred on three significant dates in the months before the pandemic arrived in Israel. On these dates, broad media coverage exposed citizens and health care providers with indications about the forthcoming pandemic. The current study tracked whether parameters related to reporting adverse medical events provided early indications that a large crisis was unfolding. The method for analysing the data was based on a statistical test called Regression Discontinuity Design, which helped identify parameters related to medical reporting patterns which significantly changed. The examination indicated nurses' reports were unique in relation to others and indicated three phases: (1) upon declaration of the upcoming pandemic, there was a rise in reporting; (2) when the disease was named, there was moderation and maintenance in a steady quantity of reports, and finally, (3) when the first case arrived in Israel, a slight decrease in reporting began. Nurses' behaviours manifested as changes in reporting patterns. In this process of increase, moderation and decrease, it can be concluded that these are three stages that may characterise the beginning of a large event. The research method presented reinforces the need for forming tools by which significant events such as the COVID-19 pandemic can be identified quickly, and aid in proper planning of resources, optimise staffing and maximise utilization of the health systems.
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Affiliation(s)
- Iris Reychav
- Industrial Engineering and Management Department, Ariel University, Ariel, Israel
| | - Alon Yaakobi
- Industrial Engineering and Management Department, Ariel University, Ariel, Israel
| | - Roger McHaney
- Daniel D. Burke Chair for Exceptional Faculty, Professor and University Distinguished Teaching Scholar, Management Information Systems, Kansas State University, Manhattan, Kansas, USA
| | - Yossi Tal
- Risk Management and Patient Safety Advisor, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Orly Manor
- Deputy of Risk Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
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Ginzburg A, Barasche-Berdah D, Manor O, Levine-Schnur R, Paltiel O, Levine H. Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices. Isr J Health Policy Res 2023; 12:5. [PMID: 36717901 PMCID: PMC9885622 DOI: 10.1186/s13584-022-00549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/02/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making. METHODS PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed. RESULTS Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location. CONCLUSIONS Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.
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Affiliation(s)
- Amit Ginzburg
- grid.17788.310000 0001 2221 2926Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Deborah Barasche-Berdah
- grid.17788.310000 0001 2221 2926Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orly Manor
- grid.17788.310000 0001 2221 2926Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Levine-Schnur
- grid.21166.320000 0004 0604 8611Harry Radzyner Law School, Reichman University, Herzliya, Israel
| | - Ora Paltiel
- grid.17788.310000 0001 2221 2926Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- grid.17788.310000 0001 2221 2926Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Rasooly A, Pan Y, Tang Z, Jiangjiang H, Ellen ME, Manor O, Hu S, Davidovitch N. Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China. Int J Health Policy Manag 2022; 11:3019-3031. [PMID: 35942954 PMCID: PMC10105207 DOI: 10.34172/ijhpm.2022.6372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Quality measurements in primary healthcare (PHC) have become an essential component for improving diabetes outcomes in many high-income countries. However, little is known about their implementation within the Chinese health-system context and how they are perceived by patients, physicians, and policy-makers. We examined stakeholders' perceptions of quality and performance measurements for primary diabetes care in Shanghai, China, and analyzed facilitators and barriers to implementation. METHODS In-depth interviews with 26 key stakeholders were conducted from 2018 to 2019. Participants were sampled from two hospitals, four community healthcare centers (CHCs), and four institutes involved in regulating CHCs. The Consolidated Framework for Implementation Research (CFIR) guided data analysis. RESULTS Existing quality measurements were uniformly implemented via a top-down process, with daily monitoring of family doctors' work and pay-for-performance incentives. Barriers included excluding frontline clinicians from indicator planning, a lack of transparent reporting, and a rigid organizational culture with limited bottom-up feedback. Findings under the CFIR construct "organizational incentives" suggested that current pay-for-performance incentives function as a "double-edged sword," increasing family doctors' motivation to excel while creating pressures to "game the system" among some physicians. When considering the CFIR construct "reflecting and evaluating," policy-makers perceived the online evaluation application - which provides daily reports on family doctors' work - to be an essential tool for improving quality; however, this information was not visible to patients. Findings included under the "network and communication" construct showed that specialists support the work of family doctors by providing training and patient consultations in CHCs. CONCLUSION The quality of healthcare could be considerably enhanced by involving patients and physicians in decisions on quality measurement. Strengthening hospital-community partnerships can improve the quality of primary care in hospital-centric systems. The case of Shanghai provides compelling policy lessons for other health systems faced with the challenge of improving PHC.
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Affiliation(s)
- Alon Rasooly
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yancen Pan
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Zhenqing Tang
- Shanghai Health Development Research Center, Shanghai, China
| | - He Jiangjiang
- Shanghai Health Development Research Center, Shanghai, China
| | - Moriah E. Ellen
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel. 5 School of Public Health, Fudan University, Shanghai, China
| | - Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
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11
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Abdel-Rahman N, Manor O, Valinsky L, Mosenzon O, Calderon-Margalit R, Roberman S. What is important for people with type 2 diabetes? A focus group study to identify relevant aspects for Patient-Reported Outcome Measures in diabetes care. PLoS One 2022; 17:e0277424. [PMCID: PMC9662717 DOI: 10.1371/journal.pone.0277424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background
Patient-Reported Outcome Measures (PROMs) aim to evaluate the quality of care based on the perspectives of patients rather than clinical indicators. Qualitative research is needed to identify these perspectives in people with type 2 diabetes.
Objective
To identify, for the first time in Israel, aspects valuable for people with type 2 diabetes that can be relevant for PROMs in diabetes care.
Methods
A qualitative study included three focus groups totalling 19 people with type 2 diabetes. Inclusion criteria were: (1)type 2 diabetes, (2)diabetes duration of at least six months, and (3)adults aged 45–80 years. Purposive sampling enabled recruitment of heterogeneous participants. Also, two experts’ panels with healthcare providers involved in diabetes care (n = 23) were conducted to provide triangulation of information (more testimony about what is valuable for people with type 2 diabetes). Discussions were recorded, transcribed and thematically analysed.
Results
Four domains were deemed valuable for people with type 2 diabetes: (1)challenges of living with diabetes, including reduced physical function, healthy lifestyle struggles, sexual dysfunction, and financial burden, (2)mental health issues, including depression, distress, anxiety, frustration, and loneliness, (3)self-management ability, including management of lifestyle modifications and treatment, knowledge about the disease and treatment, and (4)patient-clinician relationships, including the devotion of clinicians, trust in clinicians and treatment, shared decision-making, and multidisciplinary care under one roof. Experts favour using PROMs in diabetes routine care and even acknowledged their necessity to improve the treatment process. However, only some of the domains raised by people with type 2 diabetes were identified by the experts.
Conclusions
There are content gaps between perspectives of people with type 2 diabetes and their healthcare providers. PROMs are essential in addressing issues largely not addressed in routine diabetes care. We recommend that researchers and healthcare providers, who intend to utilize PROMs for diabetes care, consider the aforementioned domains.
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Affiliation(s)
- Nura Abdel-Rahman
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
| | | | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
- * E-mail:
| | - Sveta Roberman
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
- Gordon Academic College of Education, Haifa, Israel
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12
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Abdel-Rahman N, Calderon-Margalit R, Cohen A, Elran E, Golan Cohen A, Krieger M, Paltiel O, Valinsky L, Ben-Yehuda A, Manor O. Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population-Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes. J Am Heart Assoc 2022; 11:e025603. [PMID: 36129044 DOI: 10.1161/jaha.122.025603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006-2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011-2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose-response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49-1.72) and 1.23 (95% CI, 1.14-1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50-1.69) for cardiac outcomes. Conclusions Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ronit Calderon-Margalit
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | | | - Michal Krieger
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ora Paltiel
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | - Orly Manor
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
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13
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Velosa M, Hochner H, Yerushalmi B, Harel S, Friss C, Calderon-Margalit R, Paltiel O, Manor O, Balicer RD, Greenfeld S, Kariv R, Ledderman N, Matz E, Peter I, Friedlander Y, Turner D. Pre- and Perinatal Factors Predicting Inflammatory Bowel Disease: A Population-Based Study with Fifty Years of Follow-Up. J Crohns Colitis 2022; 16:1397-1404. [PMID: 35299254 DOI: 10.1093/ecco-jcc/jjac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pre- and perinatal events may be associated with an increased risk of inflammatory bowel disease [IBD]. We aimed to investigate the role of pre- and perinatal factors as potential risk factors for the development of IBD in a population with a follow-up of 50 years. METHODS We conducted a nested case-control study, reporting IBD incidence among individuals born in 1964-76, for whom pre- and perinatal exposures were reported as part of the Jerusalem Perinatal Study [JPS], by linking them to the database of the epidemiology group of the Israeli IBD Research Nucleus [epi-IIRN], including all IBD patients in Israel since 2005 and their matched controls. RESULTS We identified 2789 individuals within the epi-IIRN cohort who were also included in the JPS cohort [n = 90 079]: 746 IBD patients (405 with Crohn's disease [CD] and 341 with ulcerative colitis [UC]) and 2043 non-IBD controls. Those with a 'Non-western' family origin had decreased odds of developing CD and UC. High socioeconomic status was associated with CD but not UC. Low birth weight [≤2500 g] occurred less frequently in IBD cases compared to controls, especially in UC patients, showing a protective effect. Being the first born was associated with CD, and having older siblings lowered the odds of developing CD, decreasing 7% with each additional sibling. Smoking and breastfeeding data were available for a subset of individuals, but neither was associated with IBD development. CONCLUSION This population-based study identifies several pre- and perinatal variables as predictors of IBD development. This information may be helpful to facilitate implementation of early diagnosis interventions and family follow-up protocols.
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Affiliation(s)
- Monica Velosa
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Baruch Yerushalmi
- Department of Gastroenterology and Hepatology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sasha Harel
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
| | - Chagit Friss
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
| | | | - Ora Paltiel
- Hadassah, Hebrew University Braun School of Public Health, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran D Balicer
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | | | | | | | - Eran Matz
- Leumit Health Services, Tel Aviv, Israel
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yechiel Friedlander
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Turner
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
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Ben Mordechay E, Sinai T, Berman T, Dichtiar R, Keinan-Boker L, Tarchitzky J, Maor Y, Mordehay V, Manor O, Chefetz B. Wastewater-derived organic contaminants in fresh produce: Dietary exposure and human health concerns. Water Res 2022; 223:118986. [PMID: 35988339 DOI: 10.1016/j.watres.2022.118986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Irrigation with reclaimed wastewater is a growing practice aimed at conserving freshwater sources, especially in arid and semiarid regions. Despite the apparent advantages to water management, the practice of irrigation with reclaimed wastewater exposes the agroenvironment to contaminants of emerging concern (CECs). In this report, we estimated the unintentional dietary exposure of the Israeli population (2808 participants) to CECs from consumption of produce irrigated with reclaimed wastewater using detailed dietary data obtained from a National Health and Nutrition Survey (Rav Mabat adults; 2014-2016). Human health risk analyses were conducted based on acceptable daily intake (ADI) and threshold of toxicological concern (TTC) approaches. The highest unintentional exposure to wastewater-borne CECs was found to occur through the consumption of leafy vegetables. All analyzed CECs exhibited hazard quotients <1 for the mean- and high-exposure scenarios, indicating no human health concerns. However, for the extreme exposure scenario, the anticonvulsant agents lamotrigine and carbamazepine, and the carbamazepine metabolite epoxide-carbamazepine exhibited the highest exposure levels of 29,100, 27,200, and 19,500 ng/person (70 kg) per day, respectively. These exposure levels exceeded the TTC of lamotrigine and the metabolite epoxide-carbamazepine, and the ADI of carbamazepine, resulting in hazard quotients of 2.8, 1.1, and 1.9, respectively. According to the extreme estimated scenario, consumption of produce irrigated with reclaimed wastewater (leafy vegetables in particular) may pose a threat to human health. Minimizing irrigation of leafy vegetables using reclaimed wastewater and/or improving the quality of the reclaimed wastewater using an advanced treatment would significantly reduce human dietary exposure to CECs.
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Affiliation(s)
- Evyatar Ben Mordechay
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel; Phytor Lab for Drug Development, Hadassah Medical Center Hebrew University Biotechnology Park (JBP), Ein Kerem Campus, Jerusalem 91120, Israel
| | - Tali Sinai
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel; Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Tamar Berman
- Department of Environmental Health, Ministry of Health, Jerusalem, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - Jorge Tarchitzky
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel
| | - Yehoshua Maor
- Phytor Lab for Drug Development, Hadassah Medical Center Hebrew University Biotechnology Park (JBP), Ein Kerem Campus, Jerusalem 91120, Israel
| | - Vered Mordehay
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel
| | - Orly Manor
- School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Benny Chefetz
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 7610001, Israel.
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Skorecki K, Beyar R, Carmi R, Clarfield AM, Glick S, Manor O, Reis S. WHO's Palestinian statistics: what's Israel got to do with it? Lancet 2022; 400:659-660. [PMID: 35988574 DOI: 10.1016/s0140-6736(22)01583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Karl Skorecki
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rafi Beyar
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel
| | - Rivka Carmi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel 8410501; Israel National Academy for Science in Medicine, Jerusalem, Israel
| | - A Mark Clarfield
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel 8410501; Centre for Global Health, Beer-sheva, Israel; McGill University, Montreal, QC, Canada.
| | - Shimon Glick
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel 8410501
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Shmuel Reis
- Digital Technologies in HealthCare Program, Holon Institute of Technology, Holon, Israel
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16
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Dattner I, Gal R, Goldberg Y, Goldshtein I, Huppert A, Kenett RS, Manor O, Pfeffermann D, Schechtman E, di Serio C, Steinberg DM. The role of statisticians in the response to COVID-19 in Israel: a holistic point of view. Isr J Health Policy Res 2022; 11:22. [PMID: 35443682 PMCID: PMC9019798 DOI: 10.1186/s13584-022-00531-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic cast a dramatic spotlight on the use of data as a fundamental component of good decision-making. Evaluating and comparing alternative policies required information on concurrent infection rates and insightful analysis to project them into the future. Statisticians in Israel were involved in these processes early in the pandemic in some silos as an ad-hoc unorganized effort. Informal discussions within the statistical community culminated in a roundtable, organized by three past presidents of the Israel Statistical Association, and hosted by the Samuel Neaman Institute in April 2021. The meeting was designed to provide a forum for exchange of views on the profession's role during the COVID-19 pandemic, and more generally, on its influence in promoting evidence-based public policy. This paper builds on the insights and discussions that emerged during the roundtable meeting and presents a general framework, with recommendations, for involving statisticians and statistics in decision-making.
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Affiliation(s)
| | - Reuven Gal
- Samuel Neaman Institute, Technion, Haifa, Israel
| | | | | | | | - Ron S Kenett
- Samuel Neaman Institute, Technion, Haifa, Israel.,KPA Group, Ra'anana, Israel.,University of Turin, Turin, Italy
| | | | - Danny Pfeffermann
- Hebrew University, Jerusalem, Israel.,Israel Central Bureau of Statistics, Jerusalem, Israel.,University of Southampton, Southampton, UK
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Schejter E, Manor O, Broda A, Tal Y. [RISK MANAGEMENT IN COMMUNITY GYNECOLOGY: "CLAIM MANAGEMENT VERSUS RISK MANAGEMENT"]. Harefuah 2022; 161:251-254. [PMID: 35466611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The goal of the study is to analyze the gynecological system in Maccabi HMO in the aspect of risk management and to define points for improving patient safety and minimalization of the risk of lawsuits. Maccabi's risk management system aims to improve the safety of treatment, which is based on independent gynecologists in private clinics (662 doctors), 20 women's health centers and 4 emergency centers in gynecology which provide solutions to urgent cases beyond working hours in community medicine. The service provides an answer to about 870,000 women with about 940,000 annual visits. Characteristics of events in gynecology at Maccabi: events related to pregnancy - 41%, to gynecologist 40%, laboratory 11% and doctor-patient interaction: 8% Event distribution by claim or claim potential: pregnancy 70%, gynecology 30%; in cases of pregnancy - 60% of claims are related to malformations. In the field of obstetrics: in 74% of cases there was a risk factor that could be detected during pregnancy. In pregnancy-related claims reveal that in most cases there are missing or structural defects or a genetic defect that was not diagnosed; in most cases of not finding a structural defect (64%) there was a maternal factor or other suspicious factor during pregnancy follow-up, that would contribute to an early diagnosis. In most cases of non-detection of a genetic defect (92%), some suspicious factor (maternal, familial or findings during pregnancy) could have been defined, which might have contributed to the diagnosis. In gynecological events occurring: about 17% were connected to PAP smears and 13% to intrauterine devices. There is a need for an organizational culture that will encourage reporting: direct reporting to the risk management department, reporting to field risk management referrals and reporting by entities not directly involved.
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Affiliation(s)
| | | | | | - Yosef Tal
- Risk Management Department, Maccabi HMO
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18
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Youssim I, Israel S, Shapiro I, Calderon-Margalit R, Manor O, Paltiel O, Friedlander Y, Hochner H. Independent associations of inter-spousal gaps in age and education with long-term mortality and cancer survival: the Jerusalem Perinatal Study 1964 – 2016. Ann Epidemiol 2022; 70:32-36. [DOI: 10.1016/j.annepidem.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
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19
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Zhu L, Reychav I, McHaney R, Broda A, Tal Y, Manor O. Extension to 'combined SNA and LDA methods to understand adverse medical events': Doctor and nurse perspectives. Int J Risk Saf Med 2021; 31:221-246. [PMID: 32538872 DOI: 10.3233/jrs-190031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients' daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA). METHODS The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.
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Affiliation(s)
- Lin Zhu
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Iris Reychav
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Roger McHaney
- Daniel D. Burke Chair for Exceptional Faculty, Management Information Systems, Kansas State University, Manhattan, KS, USA
| | - Arik Broda
- Risk Management Department, Maccabi Healthcare Services, Israel
| | - Yossi Tal
- Risk Management Department, Maccabi Healthcare Services, Israel
| | - Orly Manor
- Risk Management Department, Maccabi Healthcare Services, Israel
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20
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Besor O, Paltiel O, Manor O, Donchin M, Rauch O, Kaufman-Shriqui V. Associations between density and quality of health promotion programmes and built environment features across Jerusalem. Eur J Public Health 2021; 31:1190-1196. [PMID: 34568902 DOI: 10.1093/eurpub/ckab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health promotion programmes (HPPs) have the potential to influence individual health, depending on their quality and characteristics. Little is known about how they interact with built environment features and neighbourhood demographics in cities with substantial health disparities. METHODS Using the European Quality Instrument for Health Promotion (EQUIHP), we assessed the quality of HPPs, operating between 2016 and 2017, among adults aged 18-75 in Jerusalem. Areas were characterized by ethnicity and area socioeconomic level. Health information (body mass index, physical activity level) was obtained from the city profile survey. Geospatial information on the location and length of walking paths and bicycle lanes was obtained. Spearman correlations were used to assess associations among variables. RESULTS Ninety-three HPPs operating in 349 locations in Jerusalem were identified. Programmes were unevenly distributed across urban planning areas (UPAs), with the highest density observed in the southwest, areas populated mainly by non-orthodox Jewish residents. However, the best performing HPPs based on EQUIHP score were in the north and east UPAs, inhabited primarily by Arab residents. At a neighbourhood level, characteristics of the built environment positively correlated with higher total EQUIHP scores: the ratio between walking lane length to the neighbourhood's population size (r = 0.413, P < 0.001) and length of bicycle lane per population (r = 0.309, P = 0.5). Median EQUIHP score negatively correlated with the number of programmes per neighbourhood size (m2) (r = -0.327, P = 0.006) and neighbourhood average socioeconomic status (SES; r = -0.266, P = 0.027). CONCLUSIONS Our findings suggest that higher quality HPPs were preferentially located in areas of lower SES and served minority populations in Jerusalem.
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Affiliation(s)
- Omri Besor
- Department of Nutrition Sciences, Braun School of Public Health & Community Medicine, The Hebrew University-Hadassah, Jerusalem, Israel
| | - Ora Paltiel
- Department of Nutrition Sciences, Braun School of Public Health & Community Medicine, The Hebrew University-Hadassah, Jerusalem, Israel
| | - Orly Manor
- Department of Nutrition Sciences, Braun School of Public Health & Community Medicine, The Hebrew University-Hadassah, Jerusalem, Israel
| | - Milka Donchin
- Department of Nutrition Sciences, Braun School of Public Health & Community Medicine, The Hebrew University-Hadassah, Jerusalem, Israel
| | - Orly Rauch
- Department of Nutrition Sciences, Braun School of Public Health & Community Medicine, The Hebrew University-Hadassah, Jerusalem, Israel
| | - Vered Kaufman-Shriqui
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel.,Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, Toronto, Canada
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21
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Weisband YL, Torres L, Paltiel O, Sagy YW, Calderon-Margalit R, Manor O. Socioeconomic Disparity Trends in Cancer Screening Among Women After Introduction of National Quality Indicators. Ann Fam Med 2021; 19:396-404. [PMID: 34546946 PMCID: PMC8437575 DOI: 10.1370/afm.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care-based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data. RESULTS In 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening. CONCLUSIONS We found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel's quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.
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Affiliation(s)
| | - Luz Torres
- Research Department, Cardioinfantil Foundation-Cardiology Institute, Bogotá, Colombia
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Yael Wolff Sagy
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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22
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Paltiel O, Hochner H, Chinitz D, Clarfield AM, Gileles-Hillel A, Lahad A, Manor O, Nir-Paz R, Paltiel A, Stein-Zamir C, Yazhemsky E, Calderon-Margalit R. Academic activism on behalf of children during the COVID-19 pandemic in Israel; beyond public health advocacy. Isr J Health Policy Res 2021; 10:48. [PMID: 34407864 PMCID: PMC8371603 DOI: 10.1186/s13584-021-00485-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022] Open
Abstract
Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC’s activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society’s vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - David Chinitz
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - A Mark Clarfield
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and Sleep Unit, Department of Pediatrics, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amnon Lahad
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Clalit Health Services, Jerusalem District, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ari Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chen Stein-Zamir
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ekaterina Yazhemsky
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,School of Business Administration, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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23
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Youssim I, Gorfine M, Calderon-Margalit R, Manor O, Paltiel O, Siscovick DS, Friedlander Y, Hochner H. Holocaust Experience and Mortality Patterns: 4-Decade Follow-up in a Population-Based Cohort. Am J Epidemiol 2021; 190:1541-1549. [PMID: 33564866 DOI: 10.1093/aje/kwab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 02/01/2023] Open
Abstract
Research on mortality associated with exposure to the Holocaust is relevant for a better understanding of the effects of genocides on survivors. To our knowledge, previous studies have not investigated the long-term cause-specific mortality of Holocaust survivors. We compared mortality rates among Israelis born in European countries controlled by the Nazis during World War II with those among Israelis of European descent who did not have this exposure. Records of 22,671 people (45% women; 5,042 survivors) from the population-based Jerusalem Perinatal Study (1964-1976) were linked to the Israeli Population Registry, which was updated through 2016. Cox models were used for analysis, with 2-sided tests of statistical significance. Risk of all-cause mortality was higher among exposed women (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.05, 1.27) than in unexposed women. No association was found between Holocaust exposure and male all-cause mortality. In both sexes, survivors had higher cancer-specific mortality (HR = 1.17 (95% CI: 1.01, 1.35) in women and HR = 1.14 (95% CI: 1.01, 1.28) in men). Exposed men also had excess mortality due to coronary heart disease (HR = 1.39, 95% CI: 1.09, 1.77) and lower mortality from other known causes combined (HR = 0.86, 95% CI: 0.75, 0.99). In summary, experiencing the Holocaust was associated with excess all-cause and cancer-specific mortality in women and cancer- and coronary heart disease-specific mortality in men.
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24
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Besor O, Manor O, Paltiel O, Donchin M, Rauch O, Kaufman-Shriqui V. A city-wide health promotion programme evaluation using EQUIHP: Jerusalem Community-Academic Partnership (J-CAP). Eur J Public Health 2021; 30:455-461. [PMID: 31539039 DOI: 10.1093/eurpub/ckz154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While health promotion initiatives are common, too little is known about their quality, impact and sustainability. Fragmentation between sectors exists and programme evaluation initiatives lack consistency, making comparison of outcomes challenging. METHODS We used a 'snowball' methodology to detect health promotion programmes (HPPs) in the Municipality of Jerusalem, excluding those in schools. The European Quality Instrument for Health Promotion (EQUIHP) was adapted and used to examine programme quality. The tool was pre-tested among stakeholders, and translated into Hebrew and Arabic between March and December 2017. Trained research assistants collected information on four domains using in-person interviews: (i) compliance with international principles of HPPs, (ii) development and implementation, (iii) project management and (iv) sustainability of programmes. RESULTS Overall, 93 programmes, including 33 670 participants, were ascertained and evaluated. The majority of HPPs (54.8%) addressed nutrition and physical activity, with 58.1% targeting the non-orthodox Jewish population and 68.8% aimed at both sexes. Cronbach's alpha scores were 0.968 for the entire EQUIHP tool and 0.802, 0.959, 0.918 and 0.718 for the subdomains of Framework, Project Development, Project Management and Sustainability, respectively. Median domain scores were 0.83, 0.61, 0.76 and 0.75. Median score of the entire tool was 0.67. HPPs operated by the Municipality scored lower than those of non-governmental organizations and health providers/organizations in every domain except for Project Management. CONCLUSION A systematic city-wide evaluation of HPPs is feasible and uncovers strengths and weaknesses, including sustainability and variability by programme provider. Academic-community partnerships may assist planning and improving HPPs in the city.
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Affiliation(s)
- Omri Besor
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Milka Donchin
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Orly Rauch
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Vered Kaufman-Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel.,Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, Toronto, Canada
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25
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Savitsky B, Manor O, Lawrence G, Friedlander Y, Siscovick DS, Hochner H. Environmental mismatch and obesity in humans: The Jerusalem Perinatal Family Follow-Up Study. Int J Obes (Lond) 2021; 45:1404-1417. [PMID: 33762678 DOI: 10.1038/s41366-021-00802-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND According to the hypothesis of Gluckman and Hanson, mismatch between the developmental and postdevelopmental environments may lead to detrimental health impacts such as obesity. While several animal studies support the mismatch theory, there is a scarcity of evidence from human-based studies. OBJECTIVES Our study aims to examine whether a mismatch between the developmental and young-adult environments affect obesity in young adults of the Jerusalem Perinatal Family Follow-Up Study. METHODS Data from The Jerusalem Perinatal Family Follow-Up Study birth cohort was used to characterize early and late environments using offspring and parental sociodemographic and lifestyle information at birth, age 32 (n = 1140) and 42 (n = 404). Scores characterizing the early and late environments were constructed using factor analysis. To assess associations of mismatch with obesity, regression models were fitted using the first factor of each environment and adiposity measures at age 32 and 42. RESULTS Having a stable non-beneficial environment at birth and young-adulthood was most strongly associated with increased adiposity, while a stable beneficial environment was most favorable. The transition from a beneficial environment at birth to a less beneficial environment at young-adulthood was associated with higher obesity measures, including higher BMI (β = 0.979; 95% CI: 0.029, 1.929), waist circumference (β = 2.729; 95% CI: 0.317, 5.140) and waist-hip ratio (β = 0.017; 95% CI: 0.004, 0.029) compared with those experiencing a beneficial environment at both time points. Transition from a less beneficial environment at birth to a beneficial environment at adulthood was also associated with higher obesity measurements (BMI -β = 1.116; 95% CI: 0.085, 2.148; waist circumference -β = 2.736; 95% CI: 0.215, 5.256). CONCLUSIONS This study provides some support for the mismatch hypothesis. While there is indication that an accumulation of the effects of the non-beneficial environment has the strongest detrimental impact on obesity outcomes, our results also indicate that a mismatch between the developmental and later environments may result in maladaptation of the individual leading to obesity.
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Affiliation(s)
- B Savitsky
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel. .,Ashkelon Academic College, School of Health Sciences, Ashkelon, Israel.
| | - O Manor
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - G Lawrence
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Y Friedlander
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | | | - H Hochner
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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26
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Podell R, Kaufman-Shriqui V, Sagy YW, Manor O, Ben-Yehuda A. Correction to: The quality of primary care provided to the elderly in Israel. Isr J Health Policy Res 2021; 10:22. [PMID: 33691779 PMCID: PMC7948336 DOI: 10.1186/s13584-021-00457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Rachel Podell
- Program team of the National Program for Quality Indicators in Community Healthcare in Israel, Hebrew University, POB 12272, 92210, Jerusalem, Israel.,Braun School of Public Health, Hebrew University, POB 12272, 92210, Jerusalem, Israel
| | - Vered Kaufman-Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Yael Wolff Sagy
- Program directorate of the National Program for Quality Indicators in Community Healthcare in Israel, Hebrew University, POB 12272, 92210, Jerusalem, Israel. .,Braun School of Public Health, Hebrew University, POB 12272, 92210, Jerusalem, Israel.
| | - Orly Manor
- Program directorate of the National Program for Quality Indicators in Community Healthcare in Israel, Hebrew University, POB 12272, 92210, Jerusalem, Israel.,Braun School of Public Health, Hebrew University, POB 12272, 92210, Jerusalem, Israel
| | - Arie Ben-Yehuda
- Program directorate of the National Program for Quality Indicators in Community Healthcare in Israel, Hadassah Medical Center, POB 12000, 92210, Jerusalem, Israel
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27
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Clarfield AM, Skorecki K, Manor O, Glick S. A COVID-19 jab in the right direction. Lancet 2021; 397:667-668. [PMID: 33549171 DOI: 10.1016/s0140-6736(21)00310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Affiliation(s)
- A Mark Clarfield
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410101, Israel.
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Shimon Glick
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410101, Israel
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28
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Dior UP, Karavani G, Bursztyn M, Paltiel O, Calderon-Margalit R, Friedlander Y, Youssim I, Manor O, Hochner H. Birth Weight and Maternal Body Size as Determinants of Blood Pressure at Age 17: Results from the Jerusalem Perinatal Study Cohort. Matern Child Health J 2020; 25:162-171. [PMID: 33247825 DOI: 10.1007/s10995-020-03096-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of birth weight (BW) and maternal pre-pregnancy BMI (mBMI) on blood pressure (BP) in adolescence. METHODS A Population-based cohort of 11,729 births in Jerusalem during 1974-1976, with archival data on maternal and birth characteristics was performed. Measurements at age 17 were assessed and linear regression models were used to evaluate the associations of birth characteristics with BP outcomes. RESULTS BW was inversely associated with both systolic (SBP) and diastolic (DBP) BP at age 17 (SBP: B = - 0.829, p = 0.002; DBP: B = - 0.397, p = 0.033). The interaction term between BW and weight at age 17 was significant for DBP (p = 0.017) and pulse pressure (p = 0.005). mBMI yielded significant positive associations with BP, independent of BW. CONCLUSIONS FOR PRACTICE Our findings indicate that there are at least two distinct pathways linking early life characteristics with subsequent BP: Intrauterine growth, as reflected by BW and other genetic or environmental factors, reflected by mBMI and maternal education, contribute to offspring adolescent BP. These results warrant replication in other birth cohorts and underline the need to explore specific mechanisms that account for these associations.
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Affiliation(s)
- Uri P Dior
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel. .,Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Michael Bursztyn
- Hypertension Unit, Department of Medicine, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yechiel Friedlander
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Iaroslav Youssim
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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29
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Loewenberg Weisband Y, Kaufman-Shriqui V, Wolff Sagy Y, Krieger M, Abu Ahmad W, Manor O. Area-level socioeconomic disparity trends in nutritional status among 5-6-year-old children in Israel. Arch Dis Child 2020; 105:1049-1054. [PMID: 32376694 DOI: 10.1136/archdischild-2019-318595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/17/2020] [Accepted: 04/12/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to assess area-level socioeconomic position (SEP) disparities in nutritional status, to determine whether disparities differed by sex and to assess whether nutritional status and disparities changed over time. DESIGN We used repeated cross-sectional data from a national programme that evaluates the quality of healthcare in Israel to assess children's nutritional status. SETTING The study included all Israeli residents aged 7 years during 2014-2018 (n=699 255). METHODS SEP was measured based on the Central Bureau of Statistics' statistical areas, and grouped into categories, ranging from 1 (lowest) to 10 (highest). We used multivariable multinomial regression to assess the association between SEP and nutritional status and between year and nutritional status. We included interactions between year and SEP to assess whether disparities changed over time. RESULTS Children in SEP 1, comprised entirely of children from the Bedouin population from Southern Israel, had drastically higher odds of thinness compared with those in the highest SEP (Girls: OR 5.02, 99% CI 2.23 to 11.30; Boys: OR 2.03, 99% CI 1.19 to 3.48). Odds of obesity were highest in lower-middle SEPs (ORSEP 5 vs 10 1.84, 99% CI 1.34 to 2.54). Prevalence of overweight and obesity decreased between 2014 and 2018, normal weight increased and thinness did not change. SEP disparities in thinness decreased over time in boys but showed a reverse trend for girls. No substantial improvement was seen in SEP disparities for other weight categories. CONCLUSIONS Our study demonstrates the need to consider initiatives to combat the considerable SEP disparities in both thinness and obesity.
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Affiliation(s)
- Yiska Loewenberg Weisband
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Ein Karem, Israel
| | | | - Yael Wolff Sagy
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Ein Karem, Israel
| | - Michal Krieger
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Ein Karem, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Ein Karem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Ein Karem, Israel
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30
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Schapira M, Manor O, Golan N, Kalo D, Mordehay V, Kirshenbaum N, Goldsmith R, Chefetz B, Paltiel O. Involuntary human exposure to carbamazepine: A cross-sectional study of correlates across the lifespan and dietary spectrum. Environ Int 2020; 143:105951. [PMID: 32683210 DOI: 10.1016/j.envint.2020.105951] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
Treated wastewater (TWW) is increasingly used for agricultural irrigation, especially in arid and semi-arid regions. Carbamazepine is among the most frequently detected pharmaceuticals in TWW. Moreover, its uptake and accumulation have been demonstrated in crops irrigated with TWW. A previous controlled trial found that urine concentrations of carbamazepine were higher in healthy volunteers consuming TWW-irrigated produce as compared to freshwater-irrigated produce. The aim of the current study was to assess whether carbamazepine is quantifiable in urine of Israelis consuming their usual diets and whether concentrations vary according to age, personal characteristics and diet. In this cross-sectional study, we recruited 245 volunteers, including a reference group of omnivorous healthy adults aged 18-66; pregnant women; children aged 3-6 years; adults aged >75 years; and vegetarians/vegans. Participants provided spot urine samples and reported 24-hour and "usual" dietary consumption. Urinary carbamazepine levels were compared according to group, personal characteristics, health behaviors, and reported diet. Carbamazepine was detectable (≥1.66 ng/L) in urine of 84%, 76%, 75.5%, 66%, and 19.6% of the reference group, vegetarians, older adults, pregnant women, and children, respectively. Quantifiable concentrations (≥5.0 ng/L) of carbamazepine were found in 58%, 46%, 36.7%, 14%, and 0% of these groups, respectively (p = 0.001 for comparison of proportions across groups). In adults, higher carbamazepine concentrations were significantly associated (p < 0.05) with self-defined vegetarianism, usual consumption of dairy products and at least five vegetables/day, and no meat or fish consumption in the past 24-hours. This study demonstrates that people living in a water-scarce region with widespread TWW irrigation, are unknowingly exposed to carbamazepine. Individuals adhering to recommended guidelines for daily fresh produce consumption may be at higher risk of exposure to TWW-derived contaminants of emerging concern.
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Affiliation(s)
- Michael Schapira
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 9112001, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 9112001, Israel
| | - Naama Golan
- Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel
| | - Dorit Kalo
- Department of Animal Sciences, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot 7610001, Israel
| | - Vered Mordehay
- Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel
| | - Noam Kirshenbaum
- Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel
| | - Rebecca Goldsmith
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 9112001, Israel; Public Health Services, Israel Ministry of Health, Jerusalem, Israel
| | - Benny Chefetz
- Department of Soil and Water Sciences, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel.
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 9112001, Israel.
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31
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Besor O, Manor O, Paltiel O, Dunchin M, Rauch O, Lahad A, Kaufman-Shriqui V. Quality of health promotion programs is associated with built environment features in Jerusalem. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Neighbourhood built environment and infrastructure influence health status. Greater walkability, green spaces and healthy food accessibility can enhance healthy lifestyles. While health promotion programs (HPPs) have been shown to improve population's health, little is known about the reciprocal influences between the built environment and quality and distribution of HPPs across a city.
Methods
HPPs operating in Jerusalem focusing on healthy diet and physical activities were located and evaluated for quality using the European Quality Instrument for Health Promotion (EQUIHP) in 2017. HPPs location, intervention type and characteristics of the target population were documented. Using Geographic Information System (GIS), we combined infrastructure data from the Jerusalem Municipality and socioeconomic score (1 lowest - 10 highest) from Israel's Central Bureau of Statistics. Associations between distribution and quality of HPPs and the built environment at the neighbourhood (n = 115) level and municipal planning area level (7 areas) were assessed.
Results
Overall 93 HPPs operating in 349 locations and serving 582,500 adult residents, were identified in Jerusalem. Higher HPP quality, at the municipal planning area, was associated with higher density of HPPs, longer bike or walking lanes and fewer food stores. Positive significant (p < 0.05) correlations, at a neighbourhood level, were found between neighbourhood EQUIHP median scores and HPPs targeting women (0.262), participants < 60 years old (0.324) and the Arab ethnicity (0.473). Linear regression showed a significant (p = 0.01) decrease of 0.015 in median EQUIHP score at a neighbourhood level for each increase in socioeconomic status score (p = 0.036).
Conclusions
A comprehensive evaluation of HPP quality, spatial and sociodemographic information demonstrates an association of HPP access and quality with the built environment. Fortunately, in Jerusalem high quality programs are designed for populations at need.
Key messages
In Jerusalem, the quality of health promotion programs measured by the EQUIHP score, was positively associated with infrastructure features promoting physical activity and lower neighbourhood SES. In Jerusalem, higher quality of health promotion programs focusing in nutrition and physical activity were designed for populations at need.
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Affiliation(s)
- O Besor
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - O Paltiel
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - M Dunchin
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - O Rauch
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - A Lahad
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
- Jerusalem District, Clalit Health Services, Jerusalem, Israel
| | - V Kaufman-Shriqui
- Department of Nutrition Sciences, School of Health Sciences, Ariel university, Ariel, Israel
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Manor O, Skorecki K, Clarfield AM. Palestinian and Israeli health professionals, let us work together! The Lancet Global Health 2020; 8:e1129-e1130. [PMID: 32827476 PMCID: PMC7438043 DOI: 10.1016/s2214-109x(20)30324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem 91120, Israel.
| | - Karl Skorecki
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - A Mark Clarfield
- Department of Geriatrics, Ben-Gurion University of the Negev, Beersheba, Israel; Department of Geriatrics, McGill University, Montreal, QC, Canada
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Loewenberg Weisband Y, Krieger M, Calderon-Margalit R, Manor O. Trends and socioeconomic disparities in diabetes prevalence and quality of care among Israeli children; 2011-2018. Isr J Health Policy Res 2020; 9:41. [PMID: 32819418 PMCID: PMC7439517 DOI: 10.1186/s13584-020-00399-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/07/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Despite Israel's universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time. METHODS We used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel's four health maintenance organizations. The study population included all Israeli children aged 2-17 years in 2011-2018 (2018: N = 2,404,856). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). We used logistic regression to assess the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1c > 9%), and assessed whether these changed over time. RESULTS Diabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67-3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40-0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18-0.34). Disparities were especially apparent among children aged 2-9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018. CONCLUSIONS While poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
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Affiliation(s)
- Yiska Loewenberg Weisband
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel.
| | - Michal Krieger
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
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Weisband YL, Manor O, Friedlander Y, Hochner H, Paltiel O, Calderon-Margalit R. Interpregnancy and interbirth intervals and all-cause, cardiovascular-related and cancer-related maternal mortality: findings from a large population-based cohort study. J Epidemiol Community Health 2020; 74:957-963. [PMID: 32655002 DOI: 10.1136/jech-2020-214242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Scarce research is available regarding the association between interbirth intervals (IBI) and long-term maternal health outcomes, particularly cardiovascular disease (CVD) mortality. We aimed to assess whether IBIs were associated with all-cause, CVD-related and cancer-related mortality. METHODS We conducted a cohort study in the setting of the Jerusalem Perinatal Study. Women with at least two consecutive singleton live births in 1964-1976 (N=18 294) were followed through 2016. IBIs were calculated as the interval between women's first and second cohort birth. We estimated associations between IBIs and mortality using Cox's proportional hazards models, adjusting for age, parity, maternal education, maternal origin and paternal socioeconomic status. Date of last menstrual period was available for a subset of women. We assessed the interpregnancy interval (IPI) for these women and compared the models using IPI and IBI. RESULTS During 868 079 years of follow up (median follow-up: 49.0 years), 3337 women died. Women with IBIs <15 months had higher all-cause mortality rates (HR 1.18; 95% CI 1.05 to 1.33) compared to women with 33-month to 68-month IBIs (reference category). IBI and CVD mortality appeared to have a J-shaped association; IBIs of <15, 15-20, 21-2626-2632, 33-68 and ≥69 months had HRs of 1.44, 1.40, 1.33, 1.14, 1.00 and 1.30, respectively. No substantial association was found with cancer mortality. Models using IPIs and those using IBI were similar. CONCLUSION Our results support the WHO recommendations for IPIs of ≥24 months and add additional evidence regarding long-term CVD mortality.
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Affiliation(s)
- Yiska Loewenberg Weisband
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Yechiel Friedlander
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.,Hadassah Medical Organization, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.,Hadassah Medical Organization, Jerusalem, Israel
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Paltiel O, Keidar Tirosh A, Paz Stostky O, Calderon-Margalit R, Cohen AD, Elran E, Valinsky L, Matz E, Krieger M, Yehuda AB, Jaffe DH, Manor O. Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records. J Med Screen 2020; 28:25-33. [PMID: 32356670 DOI: 10.1177/0969141320919152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess time trends in colorectal cancer screening uptake, time-to-colonoscopy completion following a positive fecal occult blood test and associated patient factors, and the extent and predictors of longitudinal screening adherence in Israel. SETTING Nation-wide population-based study using data collected from four health maintenance organizations for the Quality Indicators in Community Healthcare Program. METHODS Screening uptake for the eligible population (aged 50-74) was recorded 2003-2018 using aggregate data. For a subcohort (2008-2012, N = 1,342,617), time-to-colonoscopy following a positive fecal occult blood test and longitudinal adherence to screening guidelines were measured using individual-level data, and associated factors assessed in multivariate models. RESULTS The annual proportion screened rose for both sexes from 11 to 65%, increasing five-fold for age group 60-74 and >six-fold for 50-59 year olds, respectively. From 2008 to 2012, 67,314 adults had a positive fecal occult blood test, of whom 71% eventually performed a colonoscopy after a median interval of 122 (95% confidence interval 110.2-113.7) days. Factors associated with time-to-colonoscopy included age, socioeconomic status, and comorbidities. Only 25.5% of the population demonstrated full longitudinal screening adherence, mainly attributable to colonoscopy in the past 10 years rather than annual fecal occult blood test performance (83% versus 17%, respectively). Smoking, diabetes, lower socioeconomic status, cardiovascular disease, and hypertension were associated with decreased adherence. Performance of other cancer screening tests and frequent primary care visits were strongly associated with adherence. CONCLUSIONS Despite substantial improvement in colorectal cancer screening uptake on a population level, individual-level data uncovered gaps in colonoscopy completion after a positive fecal occult blood test and in longitudinal adherence to screening, which should be addressed using focused interventions.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Aravah Keidar Tirosh
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Orit Paz Stostky
- Pharmacy Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Einat Elran
- Quality Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liora Valinsky
- Quality Department, Meuhedet Health Care, Tel Aviv, Israel
| | - Eran Matz
- Community Health Services, Leumit Health Services, Tel Aviv, Israel
| | - Michal Krieger
- Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Arye Ben Yehuda
- Quality Indicators in Community Healthcare Program, Jerusalem, Israel.,Department of Internal Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Dena H Jaffe
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
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Abstract
OBJECTIVE To compare primary medical adverse event keywords from reporters (e.g. physicians and nurses) and harm level perspectives to explore the underlying behaviors of medical adverse events using social network analysis (SNA) and latent Dirichlet allocation (LDA) leading to process improvements. DESIGN Used SNA methods to explore primary keywords used to describe the medical adverse events reported by physicians and nurses. Used LDA methods to investigate topics used for various harm levels. Combined the SNA and LDA methods to discover common shared topic keywords to better understand underlying behaviors of physicians and nurses in different harm level medical adverse events. SETTING Maccabi Healthcare Community is the second largest healthcare organization in Israel. DATA 17,868 medical adverse event data records collected between 2000 and 2017. METHODS Big data analysis techniques using social network analysis (SNA) and latent Dirichlet allocation (LDA). RESULTS Shared topic keywords used by both physicians and nurses were determined. The study revealed that communication, information transfer, and inattentiveness were the most common problems reported in the medical adverse events data. CONCLUSIONS Communication and inattentiveness were the most common problems reported in medical adverse events regardless of healthcare professional reporting or harm levels. Findings suggested that an information-sharing and feedback mechanism should be implemented to eliminate preventable medical adverse events. Healthcare institutions managers and government officials should take targeted actions to decrease these preventable medical adverse events through quality improvement efforts.
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Affiliation(s)
- Lin Zhu
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Iris Reychav
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Roger McHaney
- Daniel D. Burke Chair for Exceptional Faculty, Professor and University Distinguished Teaching Scholar, Management Information Systems, Kansas State University, Manhattan, KS, USA
| | - Aric Broda
- Head of Risk Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yossi Tal
- Risk Management and Patient Safety Advisor, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Orly Manor
- Deputy of Risk Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
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Dumont S, Cullati S, Manor O, Courvoisier DS, Bouchardy C, Merat R, Guessous I. Skin cancer screening in Switzerland: Cross-sectional trends (1997-2012) in socioeconomic inequalities. Prev Med 2019; 129:105829. [PMID: 31476336 DOI: 10.1016/j.ypmed.2019.105829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Skin cancer is one of the most common malignancies. Despite controversy over its efficacy, skin cancer screening has become widespread although socioeconomic screening inequalities have been documented. Switzerland has the highest rate of melanoma in Europe but Swiss trends in skin cancer screening and social disparities have not been investigated. This study aims to evaluate trends in skin cancer screening and its association with socioeconomic indicators in Switzerland between 1997 and 2012. METHOD We used data from four waves (from 1997 to 2012) of the population-based Swiss Health Interview Survey. Multivariable Poisson regressions with robust variance were used to estimate weighted prevalence ratio (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status and use of healthcare. RESULTS This study included 60,764 participants with a mean age of 49.1 years (standard deviation (SD) 17.2) and 53.6% of women. Between 1997 and 2012, the weighted prevalence of ever life-time skin examination and skin examination in the current year increased by 38.2% and 35.3% respectively (p-value <0.001). Participants with a lower education level, lower income and living in non-metropolitan areas were less often screened than their counterparts. Educational differences in ever life-time skin examination increased over time (p-value for trend = 0.036). CONCLUSION While skin cancer screening prevalence in Switzerland increased from 1997 to 2012, most social inequalities persisted over time and educational inequalities increased. Dermatologists should be alerted that populations with lower education should be given special attention.
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Affiliation(s)
- Shireen Dumont
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Switzerland.
| | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Switzerland; Department of Readaptation and Geriatrics, University of Geneva, Switzerland; Division of Quality of Care, Geneva University Hospitals, Switzerland
| | - Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Israel
| | - Delphine S Courvoisier
- Department of Readaptation and Geriatrics, University of Geneva, Switzerland; Division of Quality of Care, Geneva University Hospitals, Switzerland
| | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | - Rastine Merat
- Division of Dermatology and Venereology, Geneva University Hospitals, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Switzerland
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Sagy YW, Krieger M, Horwitz E, Paltiel O, Ravel-Vilk S, Ben-Yehuda A, Manor O, Calderon-Margalit R. Diabetes care in individuals with severe mental Illnesses in Israel. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiovascular disease and risk factors are more common in people with severe mental illness (SMI; schizophrenia, schizoaffective disorders, and bi-polar disorders). For instance, diabetes mellitus (DM) prevalence was reported to be 2-3 times higher, with higher incidence and severity of complications. In 2015, following a reform in mental health services in Israel, services were transferred to the responsibility of the health plans, allowing a comprehensive healthcare. We aimed to compare quality of care indicators and intermediate DM outcomes in individuals with SMI compared to the general population.
Methods
The Israel national program for quality indicators in community healthcare obtains data from electronic medical records from the four health plans, covering the entire civilian population. In 2017, n = 74,226 individuals aged ≥18 years had a registered diagnosis of SMI (prevalence 1.37%). DM prevalence, hemoglobin A1c (HbA1c) testing yearly, and DM control in individuals with SMI were compared with the general population.
Results
DM prevalence in adults with SMI in 2017 was 14.3%, compared with 9.7% among all Israeli adults (RR of 1.5). rates of HbA1c testing and control (HbA1c<7-8%, depending on age and duration of disease) were similar among DM patients with SMI and the general population (testing: 90.1% and 90.9%; Control: 70.8% and 69.7%, SMI and general population, respectively); Similarly, uncontrolled DM (HbA1c>9%) was observed in 10.8% of individuals with SMI and in 10.0% of the general population.
Conclusions
Along with the expected excess of DM prevalence in individuals with SMI, quality of care DM indicators rates were alike among those with SMI as in the general population, suggesting non-inferior quality of care. This is consistent with results reported by the British national diabetes audit for England and Wales. However, our results are limited by a possible under-registration or diagnosis of SMI in the Israeli population.
Key messages
Higher diabetes mellitus prevalence is observed in individuals with severe mental illness. Hemoglobin A1c testing and diabetes mellitus control rates are alike in individuals with severe mental illness compared with the general population, suggesting non-inferior quality of care.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare-Zedek, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Wolff Sagy Y, Krieger M, Horwitz E, Ben-Yehuda A, Paltiel O, Ravel-Vilk S, Manor O, Calderon-Margalit R. Diabetes in Israel- do all patients receive equal care? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators.
Methods
The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged >18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses.
Results
DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c<7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level.
Conclusions
These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP.
Key messages
Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Weisband YL, Calderon-Margalit R, Wolff-Sagy Y, Krieger M, Abu-Ahmed W, Ben-Yehuda A, Horwitz E, Manor O. Socioeconomic disparities in diabetes prevalence and quality of care among Israeli children. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess trends in these over time.
Methods
Repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare that receives data based on electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2-19 years in 2011-2017 (for 2017: N = 2,364,374, including 2,914 with diabetes). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). Using logistic regression, we assessed the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1C> 9%), and assessed whether these changed over time. Models were adjusted for age, and sex.
Results
Diabetes prevalence increased with age and SEP. SEP was positively associated with visiting a specialized diabetes clinic (OR SEP 4 vs. 1 2.53, 95% CI 1.72 - 3.70). Odds of HbA1C testing and odds of poor glycemic control were negatively associated with SEP (OR SEP 4 vs. 1: 0.54, 95% CI 0.40 - 0.72 and OR SEP 4 vs. 1: 0.25, 95% CI 0.18 - 0.34 respectively). Disparities were especially apparent among children aged 2-9 (4.6% poor glycemic control in SEP 4 vs. 40.8% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.8% in 2017.
Conclusions
While poor glycemic control rates among children have improved, significant socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
Key messages
Major socioeconomic inequalities in the control of diabetes among children in Israel remain despite universal health care coverage. The rate of uncontrolled diabetes among Israeli children has improved over time.
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Affiliation(s)
- Y Loewenberg Weisband
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Y Wolff-Sagy
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - M Krieger
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - W Abu-Ahmed
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - A Ben-Yehuda
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - E Horwitz
- Pharmacy Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Niv Y, Chorev N, Tal Y, Manor O, Broda A, Peer T, Mamadov M. [CULTURE OF SAFETY IN THE HOSPITAL]. Harefuah 2019; 158:520-522. [PMID: 31407541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The acute care hospital, with its hospitalization departments, diagnostic centers, outpatient clinics, operation rooms and intensive care units, is a very complex industry with the goal of taking care of patients in every stage of their disease, starting with prevention and continuing with diagnosis and treatment. Diagnosis and treatment processes have many stages; most of them depend on high technology and advanced science. Studies in the USA demonstrated 98,000 to 241,000 cases of mortality due to medical errors and complications, third place after mortality due to cardiac diseases and cancer. The quality of treatment is obviously important. The more effective the drug, the higher the influence on disease activity and the better the recovery. Drug safety is not always appreciated and taken into account. The medical team is requested to notify on every mistake, adverse event and sentinel event on the one hand and "nearly missed" cases on the other hand. The reports are very important for system learning. We believe that by changing the system we can prevent many kinds of human errors. We believe that "to err is human", we are not looking for "blame or shame", but want to prevent the next potential mistake. According to the hospital vision, working plans and projects, an annual risk-management plan is needed. This plan has 3 parts: retrospective, prospective and continuing claims and complains assessment. A good annual, comprehensive risk-management plan will protect the patients and lead to a decrease in morbidity and mortality.
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Affiliation(s)
- Yaron Niv
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
| | - Nechama Chorev
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
| | - Yosi Tal
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
| | - Orly Manor
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
| | - Arik Broda
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
| | - Talma Peer
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
| | - Margarita Mamadov
- The Israeli Society for Patient Safety and Risk Management in Medicine (ISRM), Department of Risk Management, Rabin Medical Center and Clalit Health Services, Tel Aviv University, Department of Risk Management Maccabi Health Services, Department of Risk Management, Leumit Health Services
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Krieger M, Abu Ahmad W, Wolff-Sagy Y, Horwitz E, Ben-Yehuda A, Paltiel O, Manor O, Calderon-Margalit R. [ANTIBIOTIC USE IN COMMUNITY HEALTHCARE IN ISRAEL AS REFLECTED IN THE NATIONAL PROGRAM FOR QUALITY INDICATORS]. Harefuah 2019; 158:299-304. [PMID: 31104389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS We sought to evaluate the extent of overall and second-line systemic antibiotic use in the Israeli community, to compare them to international data and to monitor temporal trends. BACKGROUND Antibiotic overuse is prevalent and has grave implications, primarily the emergence of resistant pathogens - an urgent public health concern worldwide. METHODS The Israel National Program for Quality Indicators in Community Healthcare (QICH) obtains data from electronic medical records from the 4 health-plans, covering the entire civilian population. We assessed 2 quality indicators, compatible with those of the OECD: 1. Overall volume of antibiotics for systemic use dispensed. 2. Volume of second-line antibiotics as a proportion of all systemic antibiotics. Analysis was stratified by gender, age and socio-economic position (SEP). RESULTS The volume of systemic antibiotics dispensed in 2016 was 20.76 DDD/1000 person/day, with second-line antibiotics comprising 22.0% of the total. These values have been stable since 2014, and are higher compared with the OECD averages (20.61 DDD/1000 person/day, and 17.02% in 2015). Both overall volume and the proportion of second-line antibiotics rose with age and were higher among women especially in the 20-40 years age bracket (overall volume of 23.98 DDD/1000 person/day, proportion of second-line antibiotics of 23.98% VS 17.41 and 19.17% in men). Higher overall use was observed among patients of low SEP. CONCLUSIONS The observed volume of systemic antibiotics and the proportion of second-line antibiotics dispensed in the Israeli community were stable and high. Higher use was observed among older individuals, women and patients of low SEP. Our results call for the implementation of a national-level, community-based antibiotic stewardship program. QICH might serve to monitor such a program.
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Affiliation(s)
- Michal Krieger
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Yael Wolff-Sagy
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Ehud Horwitz
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
- Pharmacy Division, Hadassah Medical Center, Hebrew University
| | - Arie Ben-Yehuda
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- Department of Internal Medicine, Hadassah Medical Center, Hebrew University
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Orly Manor
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
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Cullati S, von Arx M, Courvoisier DS, Sandoval JL, Manor O, Burton-Jeangros C, Bouchardy C, Guessous I. Organised population-based programmes and change in socioeconomic inequalities in mammography screening: A 1992-2012 nationwide quasi-experimental study. Prev Med 2018; 116:19-26. [PMID: 30145347 DOI: 10.1016/j.ypmed.2018.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/25/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022]
Abstract
Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992-2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992-1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002-2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.
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Affiliation(s)
- Stéphane Cullati
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland; Institute of Demography and Socioeconomics, University of Geneva, Switzerland.
| | - Martina von Arx
- Institute of Demography and Socioeconomics, University of Geneva, Switzerland
| | - Delphine S Courvoisier
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
| | - José Luis Sandoval
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
| | - Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Israel
| | - Claudine Burton-Jeangros
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Institute of Demography and Socioeconomics, University of Geneva, Switzerland
| | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
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Podell R, Shriqui VK, Sagy YW, Manor O, Ben-Yehuda A. The quality of primary care provided to the elderly in Israel. Isr J Health Policy Res 2018; 7:21. [PMID: 29860940 PMCID: PMC5985580 DOI: 10.1186/s13584-018-0214-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In view of increasing global and local trends in population ageing and the high healthcare utilization rates among the elderly, this study assesses the quality of primary care provided to the elderly population in Israel. It examines changes in quality over time, how quality varies across sub-groups of the elderly, and how quality in Israel compares with other countries. Data originate from the National Program for Quality Indicators in Community Healthcare (QICH), which operates in full collaboration with Israel's four HMOs. METHODS The study population included all elderly Israeli residents aged 65 years or older during 2002-2015 (N = 879,671 residents in 2015). Seven elderly-specific quality indicators from within the QICH framework were included: influenza and pneumococcal vaccinations, benzodiazepine overuse, long-acting benzodiazepine use, body weight documentation, weight loss and underweight. In addition, two non-age specific quality indicators relating to diabetes mellitus were included: the rate of HbA1C documentation and uncontrolled diabetes. Data were collected from patient electronic medical records (EMR) in accordance with each HMO, and aggregated by three variables: gender, age, and socio-economic position (SEP). RESULTS During the measurement period, vaccination rates significantly increased (Influenza: from 42.0% in 2002 to 63.2% in 2015; and pneumococcal vaccination: from 25.8% in 2005 to 77.0% in 2015). Body weight documentation (in 65-74 year old persons) increased from only 16.3% in 2003 to 80.9% in 2015. The rate of underweight (BMI < 23 kg/m2) and significant weight-loss (10% or more of their body weight) was only measured in 2015. The overall rate of benzodiazepine overuse remained steady from 2011 to 2015 at around 5%, while the rate of long-acting benzodiazepine use decreased from 3.8% in 2011 to 2.4% in 2015. The rate of HbA1c documentation for elderly diabetics was higher than for non-elderly diabetics in 2015 (92.2% vs 87.9%). The rate of uncontrolled diabetes was lower for the elderly than the non-elderly population in 2015 (6.9% vs. 15.7%). Gender disparities were observed across all measures, after age stratification, with worse indicator rates among females compared to males. SEP-disparities were not consistent across measures. In all indicators except benzodiazepine overuse, Israel showed a higher quality of care for the elderly in comparison with the international healthcare community. CONCLUSIONS Overall, the quality of care received by elderly Israelis has improved substantially since measurements first began; yet, females receive lower quality care than males. Monitoring results of primary care quality indicators can contribute to population's successful aging; both chronic conditions at earlier ages (e.g. diabetes), and short-term hazardous conditions such as the use of potentially harmful medications and weight loss should be evaluated.
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Affiliation(s)
- Rachel Podell
- Program team of the National Program for Quality Indicators in Community Healthcare in Israel, Hebrew University, POB 12272, 92210 Jerusalem, Israel
- Braun School of Public Health, Hebrew University, POB 12272, 92210 Jerusalem, Israel
| | - Vered Kaufman Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Yael Wolff Sagy
- Program directorate of the National Program for Quality Indicators in Community Healthcare in Israel, Hebrew University, POB 12272, 92210 Jerusalem, Israel
- Braun School of Public Health, Hebrew University, POB 12272, 92210 Jerusalem, Israel
| | - Orly Manor
- Program directorate of the National Program for Quality Indicators in Community Healthcare in Israel, Hebrew University, POB 12272, 92210 Jerusalem, Israel
- Braun School of Public Health, Hebrew University, POB 12272, 92210 Jerusalem, Israel
| | - Arie Ben-Yehuda
- Program directorate of the National Program for Quality Indicators in Community Healthcare in Israel, Hadassah Medical Center, POB 12000, 92210 Jerusalem, Israel
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Affiliation(s)
- A Mark Clarfield
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
| | - Fuad Basis
- Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Avi Israeli
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Shifra Shvarts
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
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Calderon-Margalit R, Cohen-Dadi M, Opas D, Jaffe DH, Levine J, Ben-Yehuda A, Paltiel O, Manor O. Trends in the performance of quality indicators for diabetes care in the community and in diabetes-related health status: an Israeli ecological study. Isr J Health Policy Res 2018; 7:10. [PMID: 29343291 PMCID: PMC5773014 DOI: 10.1186/s13584-018-0206-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Israel is one of the few countries that have a national program for quality assessment of community healthcare. We aimed to evaluate whether improved performance in diabetes care was associated with improved health of diabetic patients on a national level. METHODS We conducted a nationwide ecological study estimating improvements in diabetes-related quality indicators and health outcomes. We estimated both correlations between composite measures of diabetes-related quality indicators and selected outcomes, and assessed through a joinpoint analysis whether trends in selected outcomes changed 4 years after the inception of the national program. RESULTS Between 2002 and 2010, the prevalence of diabetes in Israeli adults increased from 4.8% to 7.4%. During these years, an improvement was noticed in most quality indicators (from 53% to 75% for the composite score). Declines were noted in rates of blindness, diabetes-related end-stage kidney disease, lower limbs amputations and diabetes-related mortality. Significant accelerations in decline were noted for amputations in men and diabetes-related mortality in both Arab men and women 4 years after the inception of the national program. CONCLUSION This study suggests that Israel's national program for quality indicators in diabetes care in the community has probably had a significant impact on the health status of the whole population and may have contributed to narrowing gaps in life expectancy between Israeli Jews and Arabs. Future studies based on individual-level data are needed to confirm these results.
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Affiliation(s)
- Ronit Calderon-Margalit
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel.
| | - Michal Cohen-Dadi
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel
| | - Dana Opas
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel
| | - Dena H Jaffe
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel
| | - Jacob Levine
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel
| | | | - Ora Paltiel
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel
| | - Orly Manor
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, 9112102, Jerusalem, Israel
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Daoud N, Soskolne V, Mindell JS, Roth MA, Manor O. Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment. Int J Public Health 2017; 63:313-323. [PMID: 29273838 DOI: 10.1007/s00038-017-1065-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/26/2017] [Accepted: 12/14/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews. METHODS We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004-2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087). RESULTS Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57-2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53-0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%. CONCLUSIONS Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Varda Soskolne
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | | | - Marilyn A Roth
- Research Department of Epidemiology and Public Health, UCL, London, UK
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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Lawrence GM, Friedlander Y, Calderon-Margalit R, Enquobahrie DA, Huang JY, Tracy RP, Manor O, Siscovick DS, Hochner H. Associations of social environment, socioeconomic position and social mobility with immune response in young adults: the Jerusalem Perinatal Family Follow-Up Study. BMJ Open 2017; 7:e016949. [PMID: 29273651 PMCID: PMC5778288 DOI: 10.1136/bmjopen-2017-016949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Immune response to cytomegalovirus (CMV) impacts adult chronic disease. This study investigates associations of childhood and adulthood social environment, socioeconomic position (SEP) and social mobility with CMV response in young adults. DESIGN Historical prospective study design. SETTING Subcohort of all 17 003 births to residents of Jerusalem between 1974 and 1976. PARTICIPANTS Participants included 1319 young adults born in Jerusalem with extensive archival and follow-up data, including childhood and adulthood SEP-related factors and anti-CMV IgG titre levels and seroprevalence measured at age 32. MAIN EXPOSURE AND OUTCOME MEASURES Principal component analysis was used to transform correlated social environment and SEP-related variables at two time points (childhood and adulthood) into two major scores reflecting household (eg, number of siblings/children, religiosity) and socioeconomic (eg, occupation, education) components. Based on these components, social mobility variables were created. Linear and Poisson regression models were used to investigate associations of components and mobility with anti-CMV IgG titre level and seroprevalence, adjusted for confounders. RESULTS Lower levels of household and socioeconomic components in either childhood or adulthood were associated with higher anti-CMV IgG titre level and seropositivity at age 32. Compared with individuals with stable favourable components, anti-CMV IgG titre level and risk for seropositivity were higher in stable unfavourable household and socioeconomic components (household: β=3.23, P<0.001; relative risk (RR)=1.21, P<0.001; socioeconomic: β=2.20, P=0.001; RR=1.14, P=0.01), downward household mobility (β=4.32, P<0.001; RR=1.26, P<0.001) and upward socioeconomic mobility (β=1.37, P=0.04; RR=1.19, P<0.001). Among seropositive individuals, associations between household components and mobility with anti-CMV IgG titre level were maintained and associations between socioeconomic components and mobility with anti-CMV IgG titre level were attenuated. CONCLUSIONS Our study provides evidence that accumulating low SEP from childhood through adulthood and social mobility may compromise immune response in young adulthood.
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Affiliation(s)
- Gabriella M Lawrence
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yehiel Friedlander
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | | | - Daniel A Enquobahrie
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jonathan Yinhao Huang
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Russell P Tracy
- Departments of Pathology and Biochemistry, University of Vermont, Burlington, Vermont, USA
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - David S Siscovick
- Institute for Urban Health, New York Academy of Medicine, New York City, New York, USA
| | - Hagit Hochner
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Krieger M, Kaufman-Shriqui V, Horoviz E, Wolff-Sagy Y, Paltiel O, Manor O. Overall and second-line antibiotic use in the community in Israel - a call for action. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Krieger
- National Program for Quality Indicators in Community Healthcare, The Hebrew University- Hadassah, Jerusalem, Israel
| | - V Kaufman-Shriqui
- National Program for Quality Indicators in Community Healthcare, The Hebrew University- Hadassah, Ariel, Israel
| | - E Horoviz
- National Program for Quality Indicators in Community Healthcare, The Hebrew University- Hadassah, Jerusalem, Israel
| | - Y Wolff-Sagy
- National Program for Quality Indicators in Community Healthcare, The Hebrew University- Hadassah, Jerusalem, Israel
| | - O Paltiel
- National Program for Quality Indicators in Community Healthcare, The Hebrew University- Hadassah, Jerusalem, Israel
| | - O Manor
- National Program for Quality Indicators in Community Healthcare, The Hebrew University- Hadassah, Jerusalem, Israel
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50
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Sagy YW, Kaufman-Shriqui V, Manor O, Ben-Yehuda A. Israel’s elderly population quality of care: overview of community health indicators. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Wolff Sagy
- National Program For Quality Indicators In Community Healthcare, Jerusalem, Israel
| | - V Kaufman-Shriqui
- National Program For Quality Indicators In Community Healthcare, Ariel, Israel
| | - O Manor
- National Program For Quality Indicators In Community Healthcare, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program For Quality Indicators In Community Healthcare, Jerusalem, Israel
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