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Grauenfels Cohen G, Cohen MJ, Dveyrin Z, Mor Z, Rorman E, Kaliner E. Serological follow-up after syphilis diagnosis in Israel. Epidemiol Infect 2024; 152:e63. [PMID: 38606644 PMCID: PMC11062779 DOI: 10.1017/s0950268824000566] [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: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024] Open
Abstract
The global incidence of syphilis is increasing. Continuity of care challenges the control of sexually transmitted diseases. In this study, we assessed the follow-up and serological decline differences between community- and hospital-diagnosed patients in Israel. A historical cohort study was conducted using the Israel National Syphilis Center (NSC) repository. Patients with a positive non-specific Venereal Disease Research Laboratory (VDRL) test between 2011 and 2020 were included. Rates of serological follow-up and serological titre decreases were compared between hospital- and community-diagnosed patients. The study included 4,445 patients, 2,596 (58.4%) were diagnosed in community clinics and 1,849 (41.6%) in hospitals. Of community-diagnosed patients, 1,957 (75.4%) performed follow-up testing, compared with 834 (51.2%) hospital-diagnosed patients (p < 0.001). On multivariate analysis, the odds ratio of serology follow-up among community-diagnosed patients was 2.8 (95 per cent confidence interval (95% CI): 2.2-3.5) that of hospital-diagnosed patients. There were 1,397 (71.4%) community-diagnosed patients with serological titre decrease, compared with 626 (74.9%) hospital-diagnosed patients (p = 0.03). On multivariate analysis, this difference diminished. Serological follow-up testing is suboptimal and was performed more often among patients initially diagnosed in the community compared to hospitals. Continuity of care should be improved to promote successful patient care and prevent disease spread.
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Affiliation(s)
| | - Matan J. Cohen
- Faculty of Medicine, Hebrew University, Clalit Health Services, Jerusalem district, Israel
| | - Ze’ev Dveyrin
- National Public Health Laboratory Tel Aviv, Ministry of Health, Tel-Aviv Jaffa, Israel
| | - Zohar Mor
- Central Department of Health, Ministry of Health, Ramla, Israel
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Efrat Rorman
- National Public Health Laboratory Tel Aviv, Ministry of Health, Tel-Aviv Jaffa, Israel
| | - Ehud Kaliner
- Central Department of Health, Ministry of Health, Ramla, Israel
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2
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Bucris E, Indenbaum V, Levin T, Kanaaneh Y, Friedman K, Kushnir T, Sheffer R, Savion M, Salama M, Di-Castro N, Labay K, Butera M, Shihada B, Mor Z, Lustig Y, Zuckerman NS. Rapid molecular epidemiology investigations into two recent measles outbreaks in Israel detected from October 2023 to January 2024. Euro Surveill 2024; 29:2400202. [PMID: 38639095 PMCID: PMC11027474 DOI: 10.2807/1560-7917.es.2024.29.16.2400202] [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: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 04/20/2024] Open
Abstract
Between late 2023 and early 2024, two measles outbreaks occurred in Israel, each caused by importation of measles virus strains of respective B3 and D8 genotypes. In this study, we validate transmission pathways uncovered by epidemiological investigations using a rapid molecular approach, based on complete measles virus genomes. The presented findings support this rapid molecular approach in complementing conventional contact tracing and highlight its potential for informing public health interventions.
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Affiliation(s)
- Efrat Bucris
- These authors contributed equally to the manuscript
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Victoria Indenbaum
- These authors contributed equally to the manuscript
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Tal Levin
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Yara Kanaaneh
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Keren Friedman
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Tatyana Kushnir
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Rivka Sheffer
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Michal Savion
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Matanelle Salama
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Noa Di-Castro
- District Health Office, Ministry of Health, Tiberias, Israel
| | - Kozita Labay
- District Health Office, Ministry of Health, Tiberias, Israel
| | - Maya Butera
- District Health Office, Ministry of Health, Tiberias, Israel
| | - Baraah Shihada
- District Health Office, Ministry of Health, Tiberias, Israel
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Yaniv Lustig
- These authors contributed equally to the manuscript
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
| | - Neta S Zuckerman
- These authors contributed equally to the manuscript
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Ramat-Gan, Israel
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Kaliner E, Bornstein S, Kabha D, Lidji M, Sheffer R, Mor Z. A retrospective cohort analysis of treatment outcomes of patients with tuberculosis who used substances in Tel Aviv, Israel. Alcohol Alcohol 2024; 59:agad073. [PMID: 37961929 DOI: 10.1093/alcalc/agad073] [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: 05/12/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS To outline the demographic, clinical, laboratory characteristics, and treatment outcomes of tuberculosis (TB) patients who used substances. METHODS This retrospective cohort study compared 50 TB patients who used substances with a matched random sample of 100 TB patients who did not use substances between 2007 and 2017. Treatment failure was defined as a sputum smear or culture that tested positive after 5 months of treatment, loss to follow-up, unevaluated patients, or death. RESULTS TB patients who used substances were typically younger, experienced homelessness, smokers, and had fewer chronic diseases than those who did not use substances. They also were hospitalized for longer periods, their treatment durations were longer, had higher rates of multidrug resistant strains, increased rates of treatment failure, and higher mortality. Individuals whose treatment failed predominantly originated from the former Soviet Union, experienced homelessness, and had chronic diseases compared with those whose treatment was successful. In the multivariate analysis, homelessness [odds ratios (OR) = 6.7], chronic diseases (OR = 12.4), and substance use (OR = 4.0) were predictors of treatment failures. CONCLUSIONS TB patients who used substances were more likely to have treatment failure. Targeted interventions, including early diagnosis and enhanced support during treatment, are essential to achieve treatment success in this vulnerable population, in addition to TB-alcohol/drug collaborative activities.
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Affiliation(s)
- Ehud Kaliner
- Central District Department of Health, Ministry of Health, Ramla, Israel
| | - Sandy Bornstein
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Doaa Kabha
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Lidji
- Tel Aviv Tuberculosis Clinic, Association Against Tuberculosis and Lung Diseases, Tel Aviv, Israel
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Zohar Mor
- Central District Department of Health, Ministry of Health, Ramla, Israel
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
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4
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Eisen L, Mor Z, Madar M, Rabinovitch R, Dadon Y, Sheffer R, Kaliner E, Goldstein L. Hepatitis C Virus Elimination Program among Prison Inmates, Israel. Emerg Infect Dis 2023; 29:2358-2361. [PMID: 37877627 PMCID: PMC10617329 DOI: 10.3201/eid2911.230728] [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] [Indexed: 10/26/2023] Open
Abstract
The Israeli Prison Services implemented a hepatitis C virus (HCV) elimination program in 2020. Inmates considered high risk for HCV were offered serology; HCV-seropositive participants were offered HCV RNA testing. Among participants, 7.0% had detectable HCV RNA and were offered antiviral drug therapy. This program reduced HCV burden among incarcerated persons.
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Affiliation(s)
| | | | - Miriam Madar
- Ministry of Health, Tel-Aviv Department of Health, Tel Aviv, Israel (L. Eisen, R. Sheffer)
- Ashkelon Academic College, Ashkelon, Israel (Z. Mor)
- Central Department of Health, Ministry of Health, Ramla, Israel (Z. Mor, E. Kaliner)
- Israel Prison Service, Israel (M. Madar, R. Rabinovitch, L. Goldstein)
- Deputy Director Office, Ministry of Health, Jerusalem, Israel (Y. Dadon)
| | - Ron Rabinovitch
- Ministry of Health, Tel-Aviv Department of Health, Tel Aviv, Israel (L. Eisen, R. Sheffer)
- Ashkelon Academic College, Ashkelon, Israel (Z. Mor)
- Central Department of Health, Ministry of Health, Ramla, Israel (Z. Mor, E. Kaliner)
- Israel Prison Service, Israel (M. Madar, R. Rabinovitch, L. Goldstein)
- Deputy Director Office, Ministry of Health, Jerusalem, Israel (Y. Dadon)
| | - Yuval Dadon
- Ministry of Health, Tel-Aviv Department of Health, Tel Aviv, Israel (L. Eisen, R. Sheffer)
- Ashkelon Academic College, Ashkelon, Israel (Z. Mor)
- Central Department of Health, Ministry of Health, Ramla, Israel (Z. Mor, E. Kaliner)
- Israel Prison Service, Israel (M. Madar, R. Rabinovitch, L. Goldstein)
- Deputy Director Office, Ministry of Health, Jerusalem, Israel (Y. Dadon)
| | - Rivka Sheffer
- Ministry of Health, Tel-Aviv Department of Health, Tel Aviv, Israel (L. Eisen, R. Sheffer)
- Ashkelon Academic College, Ashkelon, Israel (Z. Mor)
- Central Department of Health, Ministry of Health, Ramla, Israel (Z. Mor, E. Kaliner)
- Israel Prison Service, Israel (M. Madar, R. Rabinovitch, L. Goldstein)
- Deputy Director Office, Ministry of Health, Jerusalem, Israel (Y. Dadon)
| | - Ehud Kaliner
- Ministry of Health, Tel-Aviv Department of Health, Tel Aviv, Israel (L. Eisen, R. Sheffer)
- Ashkelon Academic College, Ashkelon, Israel (Z. Mor)
- Central Department of Health, Ministry of Health, Ramla, Israel (Z. Mor, E. Kaliner)
- Israel Prison Service, Israel (M. Madar, R. Rabinovitch, L. Goldstein)
- Deputy Director Office, Ministry of Health, Jerusalem, Israel (Y. Dadon)
| | - Liav Goldstein
- Ministry of Health, Tel-Aviv Department of Health, Tel Aviv, Israel (L. Eisen, R. Sheffer)
- Ashkelon Academic College, Ashkelon, Israel (Z. Mor)
- Central Department of Health, Ministry of Health, Ramla, Israel (Z. Mor, E. Kaliner)
- Israel Prison Service, Israel (M. Madar, R. Rabinovitch, L. Goldstein)
- Deputy Director Office, Ministry of Health, Jerusalem, Israel (Y. Dadon)
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5
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Endevelt R, Tulchinsky TH, Stahl Z, Mor Z, Davidovitch N, Levine H, Troen AM. Challenges and obstacles implementing evidence-based food fortification policy in a high-income country. Front Public Health 2023; 11:1052314. [PMID: 37006576 PMCID: PMC10061091 DOI: 10.3389/fpubh.2023.1052314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
The World Health Organization (WHO) recognizes food fortification as one of the most cost-effective and beneficial public health measures available. Mass fortification policies and regulations can reduce health disparities, including in high-income countries, by improving micronutrient intake among food-insecure or high-risk populations without changing their diet or behavior. While international health organizations have traditionally prioritized technical assistance and grants to medium and low-income countries, it is important to recognize that micronutrient deficiencies may also pose an important yet underappreciated public health problem in many high-income countries. Nevertheless, some high-income countries, including Israel, have been slow to adopt fortification, due to a variety of scientific, technological, regulatory, and political barriers. Overcoming these barriers requires an exchange of knowledge and expertise among the all stakeholders to achieve cooperation and broad public acceptance within countries. Similarly, sharing the experience of countries where the matter is in play may help inform efforts to advance fortification globally. Here we share a perspective on progress and barriers to achieve this goal in Israel, to inform efforts made to avoid the regrettable waste of unrealized human potential from prevalent yet preventable nutrient deficiency conditions, in Israel and beyond.
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Affiliation(s)
- Ronit Endevelt
- The Israel Ministry of Health, Jerusalem, Israel
- School of Public Health, Faculty of Welfare and Health Sciences, Haifa University, Haifa, Israel
| | | | - Ziva Stahl
- The Israel Ministry of Health, Jerusalem, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
- Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Zohar Mor
- The Israel Ministry of Health, Jerusalem, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hagai Levine
- The Hebrew University–Hadassah Medical Center Braun School of Public Health & Community Medicine, The Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Aron M. Troen
- The School of Nutritional Sciences and Institute of Biochemistry Food and Nutrition Science, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Aron M. Troen
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Bashkin O, Otok R, Kapra O, Czabanowska K, Barach P, Baron-Epel O, Dopelt K, Duplaga M, Leighton L, Levine H, MacLeod F, Neumark Y, Paillard-Borg S, Tulchinsky T, Mor Z. Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis. Int J Public Health 2022; 67:1605303. [PMID: 36618436 PMCID: PMC9812945 DOI: 10.3389/ijph.2022.1605303] [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: 08/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,*Correspondence: Osnat Bashkin,
| | - Robert Otok
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Ori Kapra
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Kasia Czabanowska
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA, United States,Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Lore Leighton
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Hagai Levine
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat-Gan, Israel
| | - Fiona MacLeod
- School of Public Health, University College Cork, Cork, Ireland
| | - Yehuda Neumark
- Hadassah Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Zohar Mor
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
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7
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Mor Z, Shachar C, Shai U, Sheffer R. Re-admission after early discharge from involuntary hospitalization of psychiatric patients. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.262] [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
State psychiatrics in Public Health Departments in Israel can involuntary hospitalize patients (IHP) in psychotic status. IHP who are unsatisfied with the involuntary hospitalization can appeal to a Psychiatric Committee (PC) in the institution to ask to shorten their hospitalization. The PC can decide to discharge the patient to ambulatory treatment. This cohort study aimed to assess re-admission of IHP among patients who shortened their involuntary hospitalization in Tel-Aviv.
Methods
IHP whose involuntary hospitalization was shortened by PC (research arm) were compared to IHP patients who completed the entire hospitalization length, as was initially recommended by the psychiatrist (control arm). Re-admission was defined as hospitalization within one year after release by the PC/end of hospitalization.
Results
From 3,160 IHR between 2010 and 2015, 1,338 were re-hospitalized during a year after release, 317 (41.7%) from the research arm and 1,012 (42.6%) from the control arm, p < 0.7. Discharge of IHP by PC during first month of the involuntary hospitalization resulted in a higher re-admission rates than IHR from the control group (58.4% vs. 46.4%, respectively, p < 0.001). Yet, discharge of IHR by the PC after one month of hospitalization (or end of the hospitalization) resulted in lower re-admission rates (14.8% vs. 53.6%, respectively, p < 0.001). Risks factors for re-admission included male gender, Israeli born, single and diagnosis of schizophrenia.
Conclusions
Re-admission rates were higher in IHR who were released by the PC during the first month of hospitalization. The first month is important for mental and therapeutic stabilization of IHP. After 30 days, release of IHP can be re-assessed according to the patients’ situation. Early discharge of males who were diagnosed with schizophrenia should be carefully assessed.
Key messages
• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
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Affiliation(s)
- Z Mor
- Public Health, Ministry of Health , Tel Aviv, Israel
- School of Health Sciences, Ashkelon Academic College , Ashkelon, Israel
| | - C Shachar
- Medical School, Tel Aviv University , Tel Aviv, Israel
| | - U Shai
- Public Health, Ministry of Health , Tel Aviv, Israel
| | - R Sheffer
- Public Health, Ministry of Health , Tel Aviv, Israel
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8
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Mor Z, Davidi N, Alroy Preis S. Civil-military cooperation to contain COVID-19 epidemic in Israel- Lesson learned. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.059] [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
Issue
Public Health Services (PHS) has a major role in controlling COVID-19. As the epidemic propagated, and due to limited resources, PHS in Israel reached it capacity to contain the outbreak. Following a political decision in June 2020, the Home Front Command (HFC) of the Israeli Army was assigned to integrate in operating the National epidemiological efforts, while the PHS remained responsible for policy, setting guidelines and supervision.
Problem
The civilian PHS and the military HFC had to establish cooperation, institute new hierarchical structure and divide the responsibility, despite the differences in organizational cultures, financial and human resources. Additionally, inter and intra organizational interests had to be resolved.
Results
Formal and informal efforts were needed to bridge between the two organizations, while utilizing the comparative advantage of each agency. PHS has experience in controlling outbreaks, well-established intra-organizational communication, high professional identity, commitment and familiarity with different populations in Israel. HFC is a flexible, creative, learning and fast-responding organ, experienced in controlling emergencies and has well-established chains of command. HFC is supported by IT and intelligence officers. Organizational disadvantages had to be resolved. PHS is deficient in resources, has limited capacity in operating staff during irregular hours, and is obliged to share the health leadership and authority with the army. HFC has to confront high rotation of its manpower, difficulty in succumbing to non-military guidelines and regulations and possible mistrust between the army and special populations, such as Arabs or ultra-religious Jews.
Lessons
Civil-military epidemiological cooperation can boost the National response in containing epidemics. Policymakers from each agency should use leadership skills to encourage integration while being sensitive to the needs and expectations of all participants.
Key messages
• Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.
• Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.
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Affiliation(s)
- Z Mor
- Public Health, Ministry of Health , Tel Aviv, Israel
- School of Health Sciences, Ashkelon Academic College , Ashkelon, Israel
| | - N Davidi
- Home Front Defence, Israeli Defence Forces , Ramla, Israel
| | - S Alroy Preis
- Public Health, Ministry of Health , Tel Aviv, Israel
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Bashkin O, Otok R, Leighton L, Czabanowska K, Barach P, Davidovitch N, Dopelt K, Duplaga M, Okenwa Emegwa L, MacLeod F, Neumark Y, Raz MP, Tulchinsky T, Mor Z. Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study. Front Public Health 2022; 10:990353. [PMID: 36117595 PMCID: PMC9479633 DOI: 10.3389/fpubh.2022.990353] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/12/2022] [Indexed: 01/26/2023] Open
Abstract
The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,*Correspondence: Osnat Bashkin
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Lore Leighton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Kasia Czabanowska
- Department of International Health, Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States,College of Population Health, Sigmund Freud University, Vienna, Austria
| | - Nadav Davidovitch
- Faculty of Health Sciences, Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beersheba, Israel,The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat Gan, Israel
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,Faculty of Health Sciences, Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beersheba, Israel
| | - Mariusz Duplaga
- Faculty of Health Sciences, Department of Health Promotion and e-Health, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Leah Okenwa Emegwa
- Department of Health Sciences, The Swedish Red Cross University College (SRCUC), Huddinge, Sweden
| | - Fiona MacLeod
- School of Public Health, University College Cork, Cork, Ireland
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - Maya Peled Raz
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa, Israel
| | | | - Zohar Mor
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
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Vaughan AM, Cenciarelli O, Colombe S, Alves de Sousa L, Fischer N, Gossner CM, Pires J, Scardina G, Aspelund G, Avercenko M, Bengtsson S, Blomquist P, Caraglia A, Chazelle E, Cohen O, Diaz A, Dillon C, Dontsenko I, Kotkavaara K, Fafangel M, Ferraro F, Firth R, Fonager J, Frank C, Carrasco MG, Gkolfinopoulou K, Grenersen MP, Guzmán Herrador BR, Henczkó J, Hoornenborg E, Igoe D, Ilić M, Jansen K, Janță DG, Johansen TB, Kasradze A, Koch A, Kyncl J, Martins JV, McAuley A, Mellou K, Molnár Z, Mor Z, Mossong J, Novacek A, Orlikova H, Pem Novosel I, Rossi MK, Sadkowska-Todys M, Sawyer C, Schmid D, Sîrbu A, Sondén K, Tarantola A, Tavares M, Thordardottir M, Učakar V, Van Ewijk C, Varjas J, Vergison A, Vivancos R, Zakrzewska K, Pebody R, Haussig JM. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill 2022; 27. [PMID: 36082686 PMCID: PMC9461311 DOI: 10.2807/1560-7917.es.2022.27.36.2200620] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.
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Affiliation(s)
- Aisling M Vaughan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Soledad Colombe
- Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Natalie Fischer
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Celine M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jeff Pires
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Giuditta Scardina
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Margarita Avercenko
- Infectious Disease Prevention and Control Unit, Department of Infectious Risks Analysis and Prevention, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sara Bengtsson
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Paula Blomquist
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Anna Caraglia
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Emilie Chazelle
- Santé publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Orna Cohen
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Asuncion Diaz
- National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Christina Dillon
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Irina Dontsenko
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Katja Kotkavaara
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mario Fafangel
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Federica Ferraro
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Jannik Fonager
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Christina Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mireia G Carrasco
- Ministry of Health, Government of Andorra, Andorra la Vella, Andorra
| | - Kassiani Gkolfinopoulou
- Surveillance Coordination Department. Hellenic National Public Health Organization (EODY), Athens, Greece
| | | | - Bernardo R Guzmán Herrador
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Judit Henczkó
- Department of Microbiological Reference Laboratory, National Public Health Center, Budapest, Hungary
| | - Elske Hoornenborg
- Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands
| | - Derval Igoe
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Maja Ilić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Denisa-Georgiana Janță
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | | | - Ana Kasradze
- Head of Public Health Emergency Preparedness and Response Division, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Anders Koch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Andrew McAuley
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, Hellenic National Public Health Organization (EODY), Athens, Greece
| | - Zsuzsanna Molnár
- Department of Communicable Disease Epidemiology and Infection Control, National Public Health Center, Budapest, Hungary
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.,Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Alina Novacek
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Hana Orlikova
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | | | - Maria K Rossi
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | | | - Clare Sawyer
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Anca Sîrbu
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | - Klara Sondén
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Arnaud Tarantola
- Santé publique France Regional Office, Saint-Denis, Île-de-France, France
| | - Margarida Tavares
- National Program for Sexually Transmitted Infections and HIV Infection, Directorate-General of Health, Lisbon, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), and EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Emerging Infectious Diseases Unit, Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marianna Thordardottir
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Veronika Učakar
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Catharina Van Ewijk
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Juta Varjas
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | | | - Roberto Vivancos
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Karolina Zakrzewska
- National Institute of Public Health (NIH) - National Research Institute, Warsaw, Poland
| | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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11
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Tzanani I, Bendayan D, Jaffe A, Mor Z. Tuberculosis Treatment Outcomes of Patients with Diabetes Mellitus. Isr Med Assoc J 2022; 24:503-508. [PMID: 35972007] [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: 06/15/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is one of the risk factors for progression from latent to active tuberculosis. However, the effect of DM on subsequent tuberculosis treatment is still inconclusive. OBJECTIVES To compare tuberculosis treatment outcomes and the rate of drug resistance of tuberculosis patients with or without DM. METHODS This case-control study was conducted between 2005 and 2015 at the only tuberculosis ward in Israel. All 80 tuberculosis patients who had DM and were hospitalized during the study period were included in this study, as were a randomized sample of 213 tuberculosis patients without DM. Demographic, clinical, and laboratory data were collected from patient files in the hospital and clinics after discharge. RESULTS Tuberculosis patients with DM were more often older and more likely to be Israeli citizens with a lower socioeconomic status than patients without DM. No statistically significant differences were found in clinical presentation, radiological findings, and sputum smear tests between the two groups. Culture converting times were prolonged in patients with DM compared to normoglycemic patients. Multidrug drug resistance tuberculosis was more common among normoglycemic tuberculosis patients than tuberculosis patients with DM (9.2% vs. 1.6%, P = 0.12). Treatment success rates were 76.2% and 83.1% for tuberculosis patients with or without DM, respectively (P = 0.18). DM was not statistically significant in the multivariate analysis predicting treatment success, which controlled for age, citizenship, compliance, addictions, and chronic diseases. CONCLUSIONS The presence of DM does not necessarily affect tuberculosis treatment outcomes as long as treatment compliance is optimal.
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Affiliation(s)
- Ido Tzanani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Bendayan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pulmonary Medicine and Tuberculosis, Shmuel Harofe Hospital, Beer Yaakov, Isra
| | - Anat Jaffe
- Endocrinology and Diabetes Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Zohar Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ministry of Health, Tel Aviv, Israel
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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12
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Zucker R, Mor Z, Abudin A, Davis G, Arroyo H, Wagner Kolasko G, Arad D, Shilo G. Party keepers: a significant community-based intervention for harm reduction. Isr J Health Policy Res 2022; 11:26. [PMID: 35659299 PMCID: PMC9165538 DOI: 10.1186/s13584-022-00535-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gay men use recreational drugs more often than heterosexuals—especially at social events. While partying at a venue, partygoers are at risk of drug overdosing, without access to an emergency help. This study evaluates a unique and novel intervention aimed at training men who have sex with men (MSM) and transgender individuals who frequent parties, to provide immediate assistance on-site to partygoers who have overdosed. Methods The Party Keepers (PK) course is a unique 4-h training course that provides the participants with tools to identify, prevent, and treat common medical syndromes that are associated with excessive substance use. Participants were asked to complete a questionnaire on their sociodemographic attributes; their sexual risk behaviour; pre-exposure prophylaxis (PrEP) use and drug-use behaviour before and after the course; and the emergency situations they encountered in party venues after the course. Results Of the 85 participants who completed the training and left valid contact information, 52 (62%) completed the questionnaires. Their average age was 37.0 years, most lived in Tel-Aviv, and were single. Participants reported that, after the course, they reduced their own use of recreational drugs (cocaine, amyl nitrates, alcohol), reduced their sexual risk behaviours, and significantly increased their use of PrEP. Of all the PKs, 63% (N = 32) indicated that they now provided first-aid and other assistance to partygoers at public venues, which enhanced their sense of community responsibility. In the multivariate analysis, a high level of confidence as a PK, and the knowledge gained in the course, predicted the incidence of subsequent assistance to partygoers in emergency situations. Conclusions The PK initiative—a harm-reduction intervention led by peers, aimed at fighting drug overdosing at gay venues—was useful in reducing drug use and sexual risk behaviours among the course participants. Most course participants also responded to drug-related emergency situations at gay parties, as a result. This evaluation of community health intervention within a sexual minority community can help health policy makers design more community based interventions and allocate resources to include community participants in harm-reduction policies.
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Affiliation(s)
- Roy Zucker
- Mount Sinai Hospital, Icahn School of Medicine New York, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.,Magen David Adom Israeli EMS Services, Tel-Aviv, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ben Zvi 12, 78211, Ashkelon, Israel
| | - Anuar Abudin
- Magen David Adom Israeli EMS Services, Tel-Aviv, Israel
| | | | - Hansel Arroyo
- Mount Sinai Hospital, Icahn School of Medicine New York, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | | | - Dan Arad
- Tel Aviv Medical Center Sourasky Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
| | - Guy Shilo
- Bob Shapell School of Social Work, Tel Aviv University, P.O.B 39040, Ramat Aviv, Tel Aviv, Israel.
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13
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Khoury S, Kaplan S, Zaidenstein R, Cohen E, Tischler-Aurkin D, Sheffer R, Mathew L, Mor Z. Adherence to antimalarial chemoprophylaxis among Israeli travelers visiting malaria-endemic areas. Travel Med Infect Dis 2021; 44:102193. [PMID: 34728384 DOI: 10.1016/j.tmaid.2021.102193] [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] [Received: 06/22/2020] [Revised: 07/17/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Travelers are recommended to take antimalarial chemoprophylaxis (AMC) when traveling to endemic areas. METHODS This prospective comparative cohort study included 400 Israeli travelers to malaria-endemic areas, recruited in pre-travel clinics. They were contacted within one month following their return and asked about their actual adherence and the reasons for non-adherence. RESULTS Of 400 travelers with a mean age of 24.6 [SD = 4] years, 201 (50.2%) were men and 328 (82%) were singles. The majority (N = 185, 46.3%) traveled with friends, and the most common travel destination was southeast Asia (N = 267, 66.8%). Most travelers (N = 340, 85%) did not adhere to the AMC. In the multivariate analysis, non-adherence was found to be significantly associated with traveling solo or with friends, traveling to southeast Asia and longer travel duration. The most common reason for non-adherence among travelers was the perception that the risk of contracting malaria is low (N = 251, 73.8%). CONCLUSION In this study, 85% of the Israeli travelers did not adhere to the AMC, especially those traveling solo or with friends, visiting southeast Asia and for a long period. Counselors at the pre-travel clinics should stress the importance of AMC in highly endemic countries and consider alternative treatment strategies, especially in low risk areas or long duration travel, such as short-term schedule or reserve AMC for field trips.
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Affiliation(s)
- Sobhi Khoury
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shiran Kaplan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Zaidenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine Department A, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Mor Travel Clinics, Israel
| | - Erica Cohen
- Mor Travel Clinics, Israel; Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Lewis Mathew
- Mor Travel Clinics, Israel; Izrael Department of Health, Ministry of Health, Afula, Israel
| | - Zohar Mor
- Mor Travel Clinics, Israel; Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel; School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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14
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Kaplan S, Khoury S, Zaidenstein R, Cohen E, Tischler-Aurkin D, Sheffer R, Lewis M, Mor Z. Morbidity among Israeli backpack travelers to tropical areas. Travel Med Infect Dis 2021; 45:102178. [PMID: 34687872 DOI: 10.1016/j.tmaid.2021.102178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/10/2020] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Travelers to tropical areas may be susceptible to illness or injuries. This study aims to assess morbidity among travelers during their travel and compare those who became ill or were injured with those who did not. METHODS This prospective study included 400 travelers who were counselled by a physician in pre-travel clinics in central Israel between 2017 and 2018. Participants were interviewed within a month after their return regarding morbidity during travel, including health problems that started one week following their return. RESULTS Most travelers (N = 320, 80%) reported at least one illness or injury. Illnesses/injuries were more common among females than males (84.9% vs. 75.1%, p = 0.01), travel periods longer than 30 days (87.7% vs. 77.2%, p = 0.03), and travelers accompanied by their friends or solo travelers compared with those who traveled with their family/partner (83.8% and 70.0%, respectively, p = 0.002). The most common complaint was diarrhea (N = 159, 49.6%), followed by high-altitude sickness (N = 118, 36.9%) and fever (N = 100, 31.2%). Altitude sickness symptoms were more common in females than in males (58.9% vs. 41.0%, p = 0.006) and in those who ascended rapidly in comparison to those who ascended gradually (58.7% vs. 44.6%, p = 0.04). Animal injury was reported by 30 (7.5%) participants yet only eight (27.0%) received medical care, seven of whom (23.3%) were vaccinated against rabies. CONCLUSIONS Being a female, traveling with friends or alone and longer travel periods were associated with illness/injury. Practitioners at pre-travel clinics should inform travelers of the possible risks including the potential severe consequences of rabies and altitude sickness.
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Affiliation(s)
- Shiran Kaplan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sobhi Khoury
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Zaidenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine Department A, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Mor Travel Clinics, Israel
| | - Erica Cohen
- Mor Travel Clinics, Israel; Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Matthew Lewis
- Mor Travel Clinics, Israel; Israel District Health Office, Ministry of Health, Israel
| | - Zohar Mor
- Mor Travel Clinics, Israel; Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel; School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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15
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Bashkin O, Dopelt K, Mor Z, Leighton L, Otok R, Duplaga M, MacLeod F, De Nooijer J, Neumark Y, Paillard-Borg S, Tulchinsky T, Zelber-Sagi S, Davidovitch N. The Future Public Health Workforce in a Changing World: A Conceptual Framework for a European-Israeli Knowledge Transfer Project. Int J Environ Res Public Health 2021; 18:9265. [PMID: 34501853 PMCID: PMC8430594 DOI: 10.3390/ijerph18179265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of "Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach"-a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project's work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ben Tzvi 12, Ashkelon 78211, Israel; (K.D.); (Z.M.); (T.T.)
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ben Tzvi 12, Ashkelon 78211, Israel; (K.D.); (Z.M.); (T.T.)
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva 8410501, Israel;
| | - Zohar Mor
- Department of Public Health, Ashkelon Academic College, Ben Tzvi 12, Ashkelon 78211, Israel; (K.D.); (Z.M.); (T.T.)
| | - Lore Leighton
- The Association of Schools of Public Health in the European Region (ASPHER), Avenue de Tervueren 153, 1150 Brussels, Belgium; (L.L.); (R.O.)
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Avenue de Tervueren 153, 1150 Brussels, Belgium; (L.L.); (R.O.)
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, ul. Skawińska 8, 31-066 Kraków, Poland;
| | - Fiona MacLeod
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland;
| | - Jascha De Nooijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem 91120, Israel;
| | - Stephanie Paillard-Borg
- Department of Health Sciences, The Swedish Red Cross University College (SRCUC), P.O. Box 1059, 14121 Huddinge, Sweden;
| | - Theodore Tulchinsky
- Department of Public Health, Ashkelon Academic College, Ben Tzvi 12, Ashkelon 78211, Israel; (K.D.); (Z.M.); (T.T.)
| | - Shira Zelber-Sagi
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa 3498838, Israel;
| | - Nadav Davidovitch
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva 8410501, Israel;
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, P.O. Box 3566, Ramat Gan 5213604, Israel
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16
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Shviro Roseman N, Bilenko N, Sheffer R, Mor Z. Reduction in self-reported influenza-like-illness in school children and household members following influenza vaccine administration - a cohort study, Israel, 2016-7. Isr J Health Policy Res 2021; 10:38. [PMID: 34225814 PMCID: PMC8256775 DOI: 10.1186/s13584-021-00478-6] [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] [Received: 02/15/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Second-grade pupils in Israel have been vaccinated against influenza since the winter of 2016–2017. This study aims to appraise the rate reduction of seasonal influenza vaccine among vaccinated children and their household members, and that of the vaccinated cohort and their household members. Methods This retrospective cohort study was performed in winter 2016–2017 in Tel-Aviv District, Israel and compared second-grade pupils who were vaccinated at school, with third-grade pupils- who were not vaccinated at school. Parents in nine schools were asked to report prior vaccination against influenza and influenza-like illness (ILI) of their children and other household members. Rate reduction was defined as [(ILI among unvaccinated) – (ILI among vaccinated)] / (ILI among vaccinated) (%). Results Of 527 participants, 359 (68.1%) were unvaccinated and 168 (31.9%) vaccinated. Unvaccinated children reported more ILI compared with vaccinated children (19.5% vs. 7.7%), yielding a rate reduction of 60.5%. Unvaccinated children also had a greater number of physicians’ visits and missed school days (35.7% vs. 14.9 and 42.9% vs. 25.6%, respectively). The rate of ILI among household members of unvaccinated children was 34.5%, compared with 25.0% among household members of vaccinated children. The vaccinated cohort (defined as all children in second grade) reported less ILI compared with the unvaccinated cohort (defined as all children in third grade), with a rate reduction of 44.6%. Pupils of the unvaccinated cohort were more likely to miss school days (42.1% vs. 32.0%, respectively), and a higher rate of ILI was reported among household members of the unvaccinated cohort (35.4% vs. 27.3%, respectively). Conclusion Influenza vaccine administered in school setting reduced ILI among the vaccinated cohort and their household members by 60.5 and 27.5%, respectively, compared with the unvaccinated cohort. Expansion of the vaccination program in a school setting increased the public health benefit of influenza vaccines among both school children and their household members.
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Affiliation(s)
- Noa Shviro Roseman
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel. .,School of Public Health, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Natalya Bilenko
- School of Public Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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Salama M, Indenbaum V, Nuss N, Savion M, Mor Z, Amitai Z, Yoabob I, Sheffer R. A Measles Outbreak in the Tel Aviv District, Israel, 2018-2019. Clin Infect Dis 2021; 72:1649-1656. [PMID: 32619227 DOI: 10.1093/cid/ciaa931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/30/2020] [Indexed: 11/14/2022] Open
Abstract
During a national measles outbreak in 2018-2019, the Tel Aviv District suffered a major upsurge of cases, with 413 patients reported. Among them, 100 (24%) were <1 year, 92 (22%) patients were aged 12 months to 4 years, 47 (11%) were 5-18 years, 169 (41%) were 19-60 years, and 5 (1%) patients were older than 61 years (born before 1957). Among all cases, 230 (56%) were part of the Ultra-Orthodox Jewish community, 55 (13%) were among undocumented African immigrants. Despite high vaccination coverage, sustained measles transmission occurred, due in part to importations and numerous exposures in medical settings by a susceptible birth cohort. The Ultra-Orthodox Jewish community was particularly afflicted due to its condense population, high birth rates, and multiple exposures in crowded religious settings. This outbreak demonstrates the necessity of addressing immunity gaps as well optimal healthcare planning in order to prevent future outbreaks.
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Affiliation(s)
- Matanelle Salama
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Vicki Indenbaum
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Naama Nuss
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Michal Savion
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Zohar Mor
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Ziva Amitai
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Irina Yoabob
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Rivka Sheffer
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
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Margineanu I, Mor Z, Garcia D, Gilpin C, Dhawan S, Ritz N, Zenner D. TB and COVID-19 in migrants - the need to focus on both conditions. Int J Tuberc Lung Dis 2021; 25:333-335. [PMID: 33977899 DOI: 10.5588/ijtld.21.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- I Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Rijksuniversiteit Groningen, Groningen, the Netherlands
| | - Z Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel, Ashkelon Academic College, School of Health Sciences, Ashkelon, Israel
| | - D Garcia
- Migrant Clinicians Network, Austin, TX, USA
| | - C Gilpin
- International Organization for Migration, Geneva, Switzerland
| | - S Dhawan
- Partasia Biopharm, New Delhi, India, SHARE INDIA, Delhi, India
| | - N Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, Mycobacterial and Migrant Health Research, University Children´s Hospital Basel, University of Basel, Basel, Switzerland
| | - D Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University of London, London, UK
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Leventer-Roberts M, Sheffer R, Salama M, Nuss N, Rahmani S, Kornriech T, Mor Z. Pediatric measles cases by residence status in Tel Aviv, Israel. Vaccine 2020; 38:5773-5778. [PMID: 32690425 DOI: 10.1016/j.vaccine.2020.07.006] [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: 01/16/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Measles is a vaccine-preventable infectious disease whose outbreaks generally originate from exposure to populations with low vaccination coverage. METHODS This study compared the rates and morbidity of measles cases in the district of Tel-Aviv during two outbreaks (2012 and 2018-2019) by citizenship and geographic location. RESULTS There were 67 pediatric cases reported in 2012 and 222 in 2018-2019. Cases were more likely to have pneumonia in 2012 as compared to in 2018-2019 (58.2% versus 6.3%) and less likely to report a single vaccination dose (9.5% versus 22.8%, respectively). In 2012, the majority of cases were among children without legal residence (CWLR), while in 2018-2019, they were the minority of cases (N = 54, 80.6% versus N = 51, 23.0%, respectively). In both outbreaks, CWLR were more likely to be less than one year old (the recommended age for the first dose of measles vaccination), unvaccinated or with unknown vaccine status, to be treated in a tertiary care center, and to have pneumonia than children with Israeli citizenship (CC). In both outbreaks, CWLR lived in a concentrated neighborhood in Southern Tel Aviv. CONCLUSION While the two measles outbreaks differed in overall morbidity, in both outbreaks CWLR presented with a more severe clinical presentation and were less likely to be vaccinated (in part due to their younger age) than CC. The geographically concentration of CWLR was distinct from that of the CC in both outbreaks. Healthcare professionals should promote vaccination uptake and increase parents' awareness to early signs of the disease.
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Affiliation(s)
- Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Departments of Pediatrics and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Matanelle Salama
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Naama Nuss
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Sarit Rahmani
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Tamar Kornriech
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel; School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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Antebi-Gruszka N, Mor Z, Shilo G. Mental Distress, Well-Being, and Stress-Related Growth following an Anti-LGBQ Hate Crime among LGBQ Young Adults in Israel: The Effect of Familiarity with the Victims and the Mediating Role of Emotional Support. J Homosex 2020; 67:1145-1163. [PMID: 31081482 DOI: 10.1080/00918369.2019.1607682] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Using data from 696 Israeli LGBQ individuals aged 13-30, this study explored the negative (mental distress) and positive changes (well-being and stress-related growth) following the deadliest anti-LGBQ hate crime in Israel to date (the Bar-Noar Massacre), while examining differences in these outcomes between those who did and did not know hate crime victims. Furthermore, the mediating role of emotional support in facilitating better mental health and stress-related growth was tested. Results suggested that compared to those who did not know any victims, those who personally knew the victims sought emotional support from more sources, had higher scores of mental distress, but also of well-being and stress-related growth. Emotional support indeed mediated the relationship between familiarity with hate crime victims and better mental health and higher levels of growth. Increasing access to emotional support may be particularly helpful in addressing the needs of LGBQ young adults following an anti-LGBQ hate crime.
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Affiliation(s)
- Nadav Antebi-Gruszka
- Mental Health Counseling, Department of Psychology, City College of New York, CUNY, New York, New York, USA
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Guy Shilo
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel
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Atias D, Levine H, Elinav H, Haouzi-Bashan M, Lior Y, Mor Z. Community Vs. hospital HIV testing sites in Jerusalem, Israel - who's tested and who's at risk? Isr J Health Policy Res 2020; 9:10. [PMID: 32418539 PMCID: PMC7232836 DOI: 10.1186/s13584-020-00368-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background After decades of constant increase in HIV diagnoses among men who have sex with men (MSM), a gradual decrease has been reported in recent years. Timely detection of HIV leads to early treatment and behavioral changes which decrease further transmissions. This cross-sectional study aimed to assess demographic and behavioral characteristics of individuals who were tested for HIV in Jerusalem, Israel. Methods This study compared individuals who were tested at Hadassah AIDS Center (HAC) with those tested at the Jerusalem Open House (JOH) - an LGBTQ community center. Participants completed anonymous questionnaires regarding their demographic, HIV-testing history, and sexual behaviors. High-risk sexual behavior (HRSB) was defined as a diagnosis of sexually transmitted disease or condomless anal/vaginal sex during the last year. Results Among 863 participants, 104 (12.1%) were tested in HAC and 759 (87.9%) in JOH. Of those, 19 (18.3%) and 227 (29.9%) were HRSB, respectively. Two MSM were tested positive in JOH. JOH received more MSM, HRSB and individuals who were previously tested for HIV, while HAC received more migrants and health-care workers. HRSB-participants were more commonly younger, males, non-Jewish, with lower income, previously tested for HIV, reported more sexual partners, payed for sex or used drugs. Conclusions MSM and HRSB-individuals were more likely to be tested in JOH, while migrants and health-care workers in HAC, possibly due to the geographic location, reputation and specific atmosphere. In order to encourage HIV-tests among HRSB and non-Jews, additional interventions should be employed, including outreach activities, extending opening hours and reducing testing costs should be employed.
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Affiliation(s)
- Dor Atias
- The Hebrew University Hadassah Medical School, Jerusalem, Israel. .,The Jerusalem Open House for Pride and Tolerance, Jerusalem, Israel.
| | - Hagai Levine
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Hila Elinav
- Hadassah AIDS center, department of clinical microbiology and infectious diseases, Hadassah Hebrew University medical center, Jerusalem, Israel
| | - Michele Haouzi-Bashan
- Hadassah AIDS center, department of clinical microbiology and infectious diseases, Hadassah Hebrew University medical center, Jerusalem, Israel
| | - Yotam Lior
- The Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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Shachaf S, Davidovitch N, Halpern P, Mor Z. Utilization profile of emergency department by irregular migrants and hospitalization rates: lessons from a large urban medical center in Tel Aviv, Israel. Int J Equity Health 2020; 19:56. [PMID: 32349751 PMCID: PMC7191790 DOI: 10.1186/s12939-020-1152-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Irregular migrants (IMM) are excluded from the National health insurance in most developed countries and may use the emergency department (ED) as a source for medical care. This study aims to compare the use of ED by IM with that of Israeli citizens (IC) in a large urban hospital in Tel Aviv, including socio-demographic characteristics, hospitalization proportion and medical conditions on admission. Methods This cross-sectional study included all IM and IC patients older than 18 years who attended the ED between 2007 and 2011, and compared their socio-demographic characteristics, the administrative details of the visit and clinical variables upon admission. Hospitalization proportion was calculated by dividing the number of patients who were admitted to the hospital ward by the number of all patients who attended the ED. Results IM who attended the ED were younger compared to IC (mean 39 ± 17 versus 52 ± 22 years, respectively), mostly males (1.4 Male/Female ratio) and mainly originated from developing countries. IM were more commonly self-referred, more likely to attend the ED during evening hours and weekends, complained of occupational injuries and frequented the surgical rather the medical ward of the ED compared with IC. IM stayed at the ED for longer periods than IC, yet the proportion of their hospitalization was lower than that of IC (19.4% versus 23.5%, respectively). Conclusion IM stayed in the ED for longer periods and were less likely to be admitted to the hospital wards, suggesting presentation of non-severe medical conditions or possible barriers in ensuring care continuity in the community following discharge. Minimizing the barriers of IM to primary care in the community can reduce unnecessary referrals to the ED. Additionally, hospitals managements should respond to the high-volume of IM by shifting staff to busy hours and improving the communication with IM.
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Affiliation(s)
- S Shachaf
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel. .,Department of Emergency Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - N Davidovitch
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel
| | - P Halpern
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Mor
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkleon, Israel
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Mor Z, Cadesky A, Halleluyan R, Sheffer R. Attitudes of Israeli medical students towards the medical treatment of uninsured migrants. BMC Med Educ 2020; 20:72. [PMID: 32171315 PMCID: PMC7071779 DOI: 10.1186/s12909-020-1973-4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Undocumented migration to developed countries poses practical concerns, as migrants are not medically insured. This cross-sectional study aims to appraise the attitudes of Israeli medical students towards the uninsured migrant population. METHODS Participants from five medical schools in Israel completed anonymous questionnaires in Hebrew, based on the "Medical Students' Attitudes Toward the Underserved" (MSATU), which assessed students' attitudes regarding the professional responsibility and societal expectations towards the migrants. It also evaluated students' views of the migrants as eligible for expensive medical procedures. RESULTS A total of 891 students completed the survey with a median age of 28 years. The majority were Jews (N = 816, 91.6%) and singles (N = 681, 68.5%). Participants in the pre-clinical years were likely to be female and unmarried compared to those in clinical training. They also demonstrated higher scores on professional responsibilities and societal expectations than students in clinical training, but no significant differences were found in their views on expensive medical services. Students of minorities (non-Jews and migrants) scored higher on professional responsibilities and societal expectations. The scores for professional responsibilities and societal expectations decreased as students progressed in their medical training (Spearman coefficient p = 0.04 and p = 0.01, respectively). This trend was more apparent in males rather than females. CONCLUSION MSATU scores declined as students progressed through medical school, with females maintaining more favorable attitudes than males. Medical schools should attempt to maintain the enthusiasm and idealism that students possess as they enter medical training and provide clinical experience with migrant populations that allows for cross-cultural communication.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.
| | - Adam Cadesky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Halleluyan
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Mor Z, Cohen-Arkin A. [HOMOPHOBIA IN A SCIENTIFIC COVER]. Harefuah 2020; 159:212. [PMID: 32186794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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25
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Abstract
Background Highly active antiretroviral therapy (HAART) has changed life-expectancy and mortality trends among people living with HIV/AIDS (PLWHA) since 1996. This retrospective cohort study aimed to assess the mortality epidemiology of PLWHA in Israel and analyze the causes of death. Methods This cohort study included all adult Israeli-citizens PLWHA between 1985 and 2010 and crossed matched with the Civil Registry to identify those who died. Death certificates were classified into AIDS or non-AIDS deaths related-causes. Standardized mortality-ratio (SMR) represented mortality excess. Results Of all 5140 PLWHA who were followed-up for 36 955 person-years, 1066 (20.7%) died. The ratio of AIDS-related deaths to non-AIDS related deaths reduced from 1.2:1 before 1996 to 0.6:1 after 1997, and case-fatality rates reduced from 12.0 to 0.9%, respectively (P < 0.001). SMR were 3.0 (95% CI: 2.3–3.5) for males and 3.9 (95% CI: 3.3–4.5) for females. Fatality cases were more likely older Israeli-born males, co-infected with tuberculosis, reported before 1996 and acquired HIV by drug-injection or infected-blood products. Deaths of AIDS-related causes were common among Israeli-born gay men, while non-AIDS deaths were common among those reported after 1997 and drug users. Conclusions Death rates declined since HAART introduction. Yet, SMR remained high, and PLWHA infected by drug-use or blood-products have not enjoyed relative longevity.
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Affiliation(s)
- Zohar Mor
- Department of Tuberculosis and AIDS, P.O. Box 1176, Jerusalem 9101002, Israel.,Tel Aviv Department of Health, Ministry of Health, P.O. Box 6120101, Tel Aviv 6473912, Israel.,School of Public Health, Sackler Faculty of Medicine, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, P.O. Box 6120101, Tel Aviv 6473912, Israel
| | - Daniel Chemtob
- Department of Tuberculosis and AIDS, P.O. Box 1176, Jerusalem 9101002, Israel
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Mor Z, Turner D, Livnat Y, Levy I. Recreational drug and excessive alcohol use among HIV-infected men who have sex with men in Central Israel. BMC Public Health 2019; 19:1360. [PMID: 31651293 PMCID: PMC6813972 DOI: 10.1186/s12889-019-7747-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/04/2019] [Indexed: 01/19/2023] Open
Abstract
Background HIV-infected men who have sex with men (MSM) who use recreational drugs (RD) or excessive alcohol (EA) may be involved in risky sexual behaviours, including unprotected anal intercourse (UAI). This study describes the prevalence RD/EA-use among HIV-infected MSM, and compares those who used RD/EA with those who did not. Methods This cross-sectional study included HIV-infected MSM who were recruited in a convenient sample from two AIDS-treatment centres and events for HIV-infected MSM in Israel in 2016. Participants completed anonymous questionnaires including RD/EA-use and their sexual behaviours. RD/EA-use was defined as consumption of any psychoactive stimulants or dissociative anaesthetics, or an uptake of alcohol until drunkenness before or during sex. Results Of all 276 HIV-infected MSM, 202 (73.2%) used RD/EA. Those who used RD/EA were younger, reported earlier sexual debut, had more sexual partners, were more likely to perform UAI with casual partners, more commonly involved in paid sex, used psychiatric medications and more likely to be unsatisfied with their health-status compared to those who did not use RD/EA. HIV-infected MSM who used RD/EA reported a lower CD4-count and higher viral-load than those who did not. In a multivariate analysis, being younger, reported earlier sexual debut and been prescribed psychiatric drugs were associated with RD/EA-use among HIV-infected MSM. Conclusions A large proportion of HIV-infected MSM used RD/EA and also engaged in risky sexual behaviours. A subset of HIV-infected MSM can benefit from mental support during their routine treatment at the AIDS treatment centres and should also receive harm reduction intervention by their providers in order to minimize potential risks pertaining to RD/EA-use.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel. .,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.
| | - Dan Turner
- AIDS Treatment Centre, Sourasky medical Centre, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Livnat
- Israeli AIDS Task Force, Tel Aviv, Israel.,Buchman Faculty of Law, Tel Aviv University, Tel Aviv, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,AIDS and STD Unit, Sheba Medical Centre, Ramat Gan, Israel
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Abstract
The knowledge of sexual practices of heterosexual males (HM) in Israel is limited despite the increase inthe incidence of sexually transmitted diseases (STI). This study assessed sexual practices among Israeli HM and the associations between demographic characteristics and sexual risk behaviors. The Cross-sectional study included a representative sample of 913 Jewish HM aged 18-44, which completed a questionnaire including their demographics, sexual practices, and risky sexual behavior. Of all participants, 66.8% had monogamous sex with their steady partner. These participants were more likely to be older, religious, involved ina limited repertoire of sexual practices, and less likely to engage in risky sexual behavior. Of the participants, 9.6% were in steady relationships but had concomitant sexual casual partner/s. They were more likely to be secular, paid for sex, and had more lifetime sexual partners. Of all the participants, 23.6% were singles and had sex with casual partner/s. They were more likely to be younger and engage in risky sexual behavior. Of all participants, 10.3% were involved in risky sexual behavior. These men were more likely to be singles, pay for sex and have more lifetime sexual partners. We conclude that preventive interventions aimed to prevent STI-infections should target HM who are in singles and those in steady relationships and have concomitant sex partners.
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Affiliation(s)
- Guy Shilo
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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Chemtob D, Mor Z, Harel N, Averick N. HIV infection among men who have sex with men in Israel: a 35-year epidemiological and clinical overview, 1981-2015. BMC Public Health 2019; 19:747. [PMID: 31196014 PMCID: PMC6567630 DOI: 10.1186/s12889-019-7000-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/08/2018] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is the first to describe major epidemiological trends and clinical characteristics among Israeli men who have sex with men (MSM), who are at a higher risk for HIV infection. METHODS This retrospective study includes all individuals reported to the Israeli Ministry of Health with HIV and self-identified as MSM between 1981 and 2015. The incidence rates of HIV infection and AIDS-defining diseases were analyzed and Kaplan-Meier survival estimates were calculated from time of HIV infection notification to AIDS diagnosis and death across three consecutive periods representing antiretroviral treatment availability. RESULTS The trend of increase in HIV incidence is similar to Western Europe, although Israeli rates are lower. Of 2052 HIV/AIDS Israeli MSM diagnosed during the follow-up, 296 (14.6%) developed AIDS. MSM constitute 28.4% of all HIV/AIDS cases and 41.5% of cases among men. Average times from HIV-notification until AIDS diagnosis were 15.5 [14.0-16.9], 16.0 [15.5-16.4], and 6.7 [6.7-6.8] years, within 1981-1996, 1997-2007, and 2008-2015, respectively. The HIV-incidence rate among Israeli MSM slightly declined from 2012, after peaking in 2011 at 6.2 per 100,000. CONCLUSIONS The recent reduction in HIV-incidence and in AIDS diagnoses among Israeli MSM is encouraging. Nevertheless, the disproportionate incidence of HIV among MSM requires sustained efforts to abate further infections.
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Affiliation(s)
- D Chemtob
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel. .,Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Z Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - N Harel
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel
| | - N Averick
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel
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Abstract
Syphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR = 1.8 [1.2-2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR = 2.2 [1.5-8.2]), especially with HIV-infected partner (OR = 3.2 [1.1-7.9]). In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.
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Affiliation(s)
- Amir Polansky
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Itzchak Levy
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,b Infectious Disease Unit , Sheba Medical Center , Ramat Gan , Israel
| | - Zohar Mor
- c Tel Aviv Department of Health , Ministry of Health , Tel Aviv , Israel.,d School of Health Sciences , Ashkelon Academic College , Ashkelon , Israel
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Rich RS, Leventhal A, Sheffer R, Mor Z. Risky sexual behavior and sexually transmitted infections among men who have sex with men and purchase sex attending an Israeli sexually transmitted infection clinic. Int J STD AIDS 2019; 31:236-243. [PMID: 30890117 DOI: 10.1177/0956462419830856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/15/2022]
Abstract
Men who have sex with men (MSM) and purchase sex (MPS) are a sub-group potentially at high risk for acquiring and transmitting sexually transmitted infections (STIs). This is a hard-to-reach population resulting in a scarcity of studies covering the issue. This cross-sectional study aimed to assess the association between purchasing sex and high-risk behaviors related to HIV/STI transmission and appraise the STI prevalence among MSM. All MSM who attended the STI clinic in Tel Aviv between 2003 and 2010 were included. Demographics, behavioral, clinical, and laboratory data were compared between MPS and non-MPS to identify high-risk sexual behaviors and STI prevalence associated with purchasing sex. Of the first visits of 2694 MSM who attended the STI clinic during the study period, 151 (5.6%) paid for sex. MPS were more commonly older and married than non-MPS. MPS were more likely to engage in behaviors associated with high risk for HIV/STI transmission, including infrequent condom use during anal sex, substance use during sex, and selling sex themselves. MPS had a higher STI prevalence than non-MPS, although this was not statistically significant ( p = 0.05). These findings highlight the need to establish culturally tailored interventions for MPS addressing the potential risks associated with purchasing sex.
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Affiliation(s)
- Rivka S Rich
- Ministry of Health, Public Health Services, Jerusalem, Israel.,School of Public Health, Hebrew University, Jerusalem, Israel
| | - Alex Leventhal
- School of Public Health, Hebrew University, Jerusalem, Israel
| | | | - Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.,School of Health Science, Ashkelon Academic College, Ashkelon, Israel
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Salama M, Amitai Z, Lustig Y, Mor Z, Weiberger M, Chowers M, Maayan S, Zimhony O, Ben-Ami R, Chazan B, Zaltzman-Bershadsky N, Cohen R, Tsyba E, Sheffer R, Anis E, Glazer Y, Pessah S, Mendelson E, Leshem E. Outbreak of West Nile Virus disease in Israel (2015): A retrospective analysis of notified cases. Travel Med Infect Dis 2018; 28:41-45. [PMID: 30016649 DOI: 10.1016/j.tmaid.2018.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND West Nile Virus (WNV) is mosquito-borne virus that is endemic in Israel. In 2015, national disease surveillance demonstrated a sharp increase in disease cases, with 149 cases diagnosed. METHODS Clinical data was extracted from the patients' medical files and laboratory analysis on blood, cerebrospinal fluid or urine was carried out. Data on climate was extracted from the Israel Meteorological Service. RESULTS Neuroinvasive disease was reported in 70% of cases and case-fatality rate was 16%. Simultaneously with the outbreak, an intense heat wave and an upsurge in summer temperatures occurred. CONCLUSIONS Clinical data shows substantial morbidity and mortality of WNV disease in Israel. Climatic measures are consistent with previous reports and point to the importance of temperature monitoring and rapid implementation of preventive environmental measures during the summer to reduce potential mosquito breeding sites. WNV disease should be suspected as a cause of fever or neurologic disease in travelers returning from endemic countries.
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Affiliation(s)
- Matanelle Salama
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel.
| | - Ziva Amitai
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | - Zohar Mor
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Miriam Weiberger
- Infectious Disease Unit, Assaf Harofeh Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shlomo Maayan
- Division of Infectious Diseases, Barzilai Medical Center, Israel
| | - Oren Zimhony
- Infectious Diseases, Kaplan Medical Center, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Regev Cohen
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Israel
| | - Evgenia Tsyba
- Division of Infectious Diseases, Barzilai Medical Center, Israel
| | - Rivka Sheffer
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Emilia Anis
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Yael Glazer
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Silvia Pessah
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | - Eyal Leshem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine C', The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Mor Z, Nuss N, Savion M, Nissan I, Lidji M, Maneshcu S, Kaidar-Shwartz H, Amitai Z, Rorman E, Sheffer R. Tuberculosis outbreak in a nursing home involving undocumented migrants and Israeli citizens. Isr J Health Policy Res 2018; 7:36. [PMID: 30007410 PMCID: PMC6046096 DOI: 10.1186/s13584-018-0219-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
ABSTRACK OBJECTIVES: Israel has absorbed > 60,000 migrant from the horn of Africa (MHOA) since 2006. No cross-transmission of Mycobacterium tuberculosis from MOHA to Israeli citizens has yet been reported. This study describes the results of contact investigation and laboratory work-out of a unique mixed cluster which included both MOHA and Israeli citizens. METHODS Description of the results of epidemiological investigation including laboratory confirmation. RESULTS This unique Mycobacterium tuberculosis strain included 29 patients: 26 were MOHA and three citizens who immigrated to Israel from the former Soviet Union. This is the first mixed cluster described in Israel, which has not been represented in the SITVIT international database of genotyping markers. The transmission from non-citizens to citizens occurred in a nursing institution, when MOHA infected three other contacts- two of whom were retarded residents, one of them died. The index case was screened before employment, and was permitted to return to wok although his chest X-ray demonstrated radiological findings compatible with tuberculosis. Epidemiological links were found in other 12 MOHA members of the cluster. CONCLUSION This report describes cross-transmission of Mycobacterium tuberculosis from non-citizens MOHA to Israeli citizens who were residents of a nursing home, which may be the first sign for an epidemiological shift. Although cross-ethnical transmission is still rare in Israel, medical settings should employ efficient infection control measures to protect both patients and staff from Mycobacterium tuberculosis.
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Affiliation(s)
- Z Mor
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - N Nuss
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel.
| | - M Savion
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
| | - I Nissan
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - M Lidji
- Tel Aviv Tuberculosis clinic, Tel Aviv, Israel
| | - S Maneshcu
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
| | - H Kaidar-Shwartz
- National Tuberculosis Reference Laboratory, Ministry of Health, Tel Aviv, Israel
| | - Z Amitai
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
| | - E Rorman
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - R Sheffer
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
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Rich R, Leventhal A, Sheffer R, Mor Z. Heterosexual men who purchase sex and attended an STI clinic in Israel: characteristics and sexual behavior. Isr J Health Policy Res 2018; 7:19. [PMID: 29945677 PMCID: PMC6020288 DOI: 10.1186/s13584-018-0213-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/30/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Commercial sex shares a role in HIV and sexually transmitted infections (STI) transmission. Men who pay for sex (MPS) may transmit HIV/STI to other populations which are low-risk. This study aimed to test our hypothesis that MPS engage in high-risk sexual behaviors associated with HIV/STI transmission more so than non-MPS. Methods This cross-sectional study included heterosexual men who attended an STI clinic between 2003 and 2010. Demographic, clinical, behavioral and laboratory data were compared between MPS and non-MPS to identify factors associated with high-risk sexual behavior and STI-burden. Results Of the first visits of 6156 heterosexual men who attended the STI-clinic during the study period, 1649 (26.7%) were MPS. MPS were more commonly older, married and non-Israeli born compared with non-MPS. MPS were more likely to engage in risk-behaviors associated with HIV/STI-transmission, including a greater number of lifetime sexual partners, substance use and previous STI diagnoses. Determinants associated with STI-diagnoses at the current visit included being non-Israeli born, presenting with STI symptoms, reporting a greater number of lifetime sexual partners and having sexual encounters with non-Israeli individuals. Conclusions Approximately 25% of all men who attended the clinic were MPS. They were more likely to engage in risk-behaviors associated with HIV/STI transmission compared to non-MPS. These findings highlight the need to establish interventions for MPS that both continue to encourage condom use and address the potential perils pertaining to risky sexual behaviors.
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Affiliation(s)
- Rivka Rich
- School of Public Health, Hebrew University, Jerusalem, Israel. .,Ministry of Health, Public Health Services, Jerusalem, Israel.
| | - Alex Leventhal
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Rivka Sheffer
- Ministry of Health, Public Health Services, Jerusalem, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.,School of Public Health, Tel Aviv University, Tel Aviv, Israel
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Abstract
Introduction Israel has absorbed >40,000 Eritrean undocumented migrants since 2007, while the majority live in the southern neighborhoods of Tel-Aviv. As non-citizens and citizens infants in Israel receive free preventive treatment at the mother and child health clinics (MCHC), this study aimed to compare development and growth achievements between children of Eritrean mothers (CE) to children of Israeli mothers (CI), and assess their compliance to routine follow-up and vaccination-timeliness. Methods This cohort study included all Israeli-born CE between 2009 and 2011, compared with a random sample of CI and treated at the same MCHC and followed-up to the age of 30-months. Dependent outcomes included anthropometric measurements, developmental achievements and adherence to immunization schedule. Results Of all 271 CE who were compared with 293 CI, no statistically significant differences were found in birth anthropometric measurements. Yet, CE had increased weight and length than CI after reaching one year of age (p<0.05). CE were more likely to fail in tests assessing fine-motor skills, linguistic and socio-emotional domains than CI, while no statistical difference was found in gross-motor achievements. At the end of follow-up, 203 (74.9%) of the CE and 271 (74.1%) of the CI completed the vaccination schedule, p = 0.9. Conclusion CE had greater anthropometric measurements than CI after one year of age, and showed higher impairments in fine motor, linguistic and socio-emotional domains. Adherence to vaccination was similar. The inequalities in child health should be responded in the MCTC, and Eritrean mothers should be trained with the current recommendations for child well-being.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Anat Amit Aharon
- Sackler Faculty of Medicine, Nursing Department, Tel-Aviv University, Tel Aviv, Israel
- The Department of Public Health, Tel Aviv Municipality, Tel Aviv, Israel
| | | | - Haim Nehama
- The Department of Public Health, Tel Aviv Municipality, Tel Aviv, Israel
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Lönnroth K, Mor Z, Erkens C, Bruchfeld J, Nathavitharana RR, van der Werf MJ, Lange C. Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points. Int J Tuberc Lung Dis 2018; 21:624-637. [PMID: 28482956 DOI: 10.5588/ijtld.16.0845] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
As tuberculosis (TB) rates continue to decline in native populations in most low TB incidence countries, the proportion of TB patients born outside their country of residence ('foreign-born') increases. Some low-incidence countries have experienced a substantial increase in TB rates related to recent increases in the number of asylum seekers and other migrants from TB-endemic countries. However, average TB rates among the foreign-born in low-incidence countries declined moderately in 2009-2015. TB in foreign-born individuals is commonly the result of reactivation of latent infection with Mycobacterium tuberculosis acquired outside the host country. Transmission is generally low in low-incidence countries, and transmission from migrants to the native population is often modest. Variations in levels and trends in TB notifications among the foreign-born are likely explained by differences and fluctuations in the number and profile of migrants, as well as by variations in TB control, health and social policies in the host countries. To optimise TB care and prevention in migrants from endemic to low-incidence countries, we propose a framework for identifying possible TB care and prevention interventions before, during and after migration. Universal access to high-quality care along the entire migration pathway is critical. Screening for active TB and latent tuberculous infection should be tailored to the TB epidemiology, adapted to the needs of specific migrant groups and linked to treatment. Ultimately, the long-term TB elimination goal can be reached only if global health and socio-economic inequalities are dramatically reduced. Low-incidence countries, most of which are among the wealthiest nations, need to contribute through international assistance.
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Affiliation(s)
- K Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Z Mor
- Research Branch, Tel Aviv Department of Health, Tel Aviv, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - J Bruchfeld
- Unit of Infectious Diseases, Department of Medicine Solna, Department of Infectious Diseases Karolinska University Hospital, Stockholm, Sweden
| | - R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, Division of Infectious Diseases and Immunity, Imperial College, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research, Clinical Tuberculosis Center, Borstel, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
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Abstract
BACKGROUND Several studies have suggested that the incidence of tuberculosis (TB) varies with the seasons. OBJECTIVE To determine the seasonality of TB in Israel and to explore possible associations with climatic variables. METHODS Laboratory-confirmed TB cases reported between 2001 and 2011 in individuals resident in Israel for at least 1 year before diagnosis were included in the study. Climatic variables included average temperature and average ultraviolet radiation. The mean serum 25-hydroxyvitamin D level of the population was also recorded. RESULTS Of all 2653 TB cases, incidence peaked during spring (n = 712) and reached its nadir during the fall (n = 577), with a case proportion amplitude (CPA) of 5.1% (P = 0.036). Individuals born in the Horn of Africa exhibited a CPA of 9.5% (P = 0.077). Mean population 25-hydroxyvitamin D level was significantly correlated with the seasonal pattern of the disease. Southern Israel had the highest global radiation and, counter-instinctively, the highest TB incidence. CONCLUSIONS TB exhibited a seasonal tendency in Israel, with the spring peak/fall nadir pattern found elsewhere. Vitamin D is suspected to be an explanatory variable for this seasonal phenomenon. The finding that the highest incidence is in the area receiving the highest global radiation suggests population-related vulnerability to vitamin D deficiency.
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Affiliation(s)
- I Margalit
- The Hebrew University-Hadassah Medical School, Jerusalem
| | - C Block
- The Hebrew University-Hadassah Medical School, Jerusalem, Department of Clinical Microbiology & Infectious Diseases, Hadassah-Hebrew University Medical Centre, Jerusalem
| | - Z Mor
- Ramla Department of Health, Ministry of Health, Ramla, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tairy D, Levy I, Turner D, Livnat Y, Mor Z. Differences in knowledge, attitudes and behaviors of Israeli HIV-uninfected gay men in HIV-discordant vs. concordant steady relationships. AIDS Care 2017; 30:802-806. [PMID: 29254365 DOI: 10.1080/09540121.2017.1417533] [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] [Indexed: 10/18/2022]
Abstract
HIV-discordant gay male couples may play an important role in HIV-transmissions. This cross-sectional study compared the knowledge, attitudes and sexual behaviors of HIV-uninfected gay men, between those in HIV-discordant and those in HIV-concordant steady relationships. Anonymous questionnaires were distributed electronically in designated gay-related internet sites and in AIDS-clinics in 2015. The dependent variable was defined as a steady relationship of an HIV-uninfected man with an HIV-infected partner. Risky sexual behavior was defined as unprotected anal intercourse (UAI) with a sex partner whose HIV-status was either positive or unknown. Of 2,319 responders, 460 (20%) were HIV-uninfected gay men in steady relationships, of whom 72 were in HIV-discordant relationships and 388 were in HIV-concordant relationships. Those in HIV-discordant relationships presented better established knowledge regarding HIV-transmission, more lenient attitudes regarding UAI, and reported being involved in riskier sexual behavior, both within and outside their steady relationship compared to men in HIV-concordant relationships. UAI was performed by 48% of the HIV-discordant couples and was associated with the use of sero-positioning strategy and with achieving undetectable viral-load. These findings reflect the complexity of constant use of condoms during long-term sero-discordant relationships. Targeted interventions for HIV-prevention in HIV-discordant couples should be employed for balancing the partners' desire for intimacy and sexual pleasure in the relationship, while reducing the risk for acquiring HIV. ABBREVIATIONS ART: Antiretroviral therapy; PEP: Post exposure prophylaxis; PrEP: Pre exposure prophylaxis; STI: Sexually transmitted infections; UAI: Unprotected anal intercourse.
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Affiliation(s)
- Daniel Tairy
- a Sackler Medical School , Tel Aviv University , Tel Aviv , Israel
| | - Itzchak Levy
- a Sackler Medical School , Tel Aviv University , Tel Aviv , Israel.,b AIDS Unit and Infectious Disease Unit , Sheba Medical Center , Ramat Gan , Israel
| | - Dan Turner
- a Sackler Medical School , Tel Aviv University , Tel Aviv , Israel.,c The Crusaid Kobler AIDS Center and Infectious Disease Unit , Sourasky Medical Center , Tel Aviv , Israel
| | | | - Zohar Mor
- a Sackler Medical School , Tel Aviv University , Tel Aviv , Israel.,e Tel Aviv Department of Health , Ministry of Health , Tel Aviv , Israel
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Mor Z, Turner D, Livnat Y, Levy I. HIV infected men who have sex with men in Israel: knowledge, attitudes and sexual behavior. BMC Infect Dis 2017; 17:679. [PMID: 29025414 PMCID: PMC5639789 DOI: 10.1186/s12879-017-2782-1] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 10/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-infected (HIVI) men who have sex with men (MSM) may transmit HIV to their sero-discordant sex partner/s. This study assesses the knowledge, attitudes and sex-practices of Israeli HIVI-MSM. METHODS This cross-sectional study compared HIVI-MSM to self-reported HIV-uninfected (HIVU) MSM by using anonymous questionnaires that were distributed in AIDS-treatment centers and gay-related internet-sites in 2015. Unprotected anal intercourse (UAI) in the last 6 months was the outcome variable. RESULTS Of 300 HIVI-MSM and 1299 HIVU-MSM, UAI with sero-discordant/unknown-status partner/s was performed by 12.1% and 17.9%, respectively, p=0.02. UAI with sero-discordant/unknown-status among HIVI-MSM and HIVU-MSM was associated with the type of partnership: 37.7% vs. 52.4% for steady partner/s, 19.0% vs. 39.9% for sex-buddies and 23.5% vs. 24.0% for casual partner/s (p<0.001, p=0.01, p=0.6), respectively. On these occasions, HIVI-MSM were more likely to be receptive during UAI: 92.3%, 87.5% and 83.3% for steady partner/s, sex buddies and casual partner/s, respectively. In cases HIVI-MSM performed UAI, 31.3% expected their partner/s to share responsibility for condom-use vs. 9.7% of HIVU-MSM. HIVI-MSM were involved in risky sexual-behaviors, such as substances-use, earlier sexual debut and sex for money. HIVI-MSM were more likely to disclose their HIV-status with their partner before sex and demonstrated better knowledge about HIV-transmission than HIVU-MSM. CONCLUSION HIVI-MSM performed UAI with sero-discordant/unknown-status partner/s less frequently than HIVU-MSM. Their condom-use practices were associated with the type of partner, and were lower for casual vs. steady partners or sex-buddies. HIVI-MSM tended to use sero-adaptive strategies to reduce the potential risk of HIV-transmission to their sero-discordant/unknown-status partner/s.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, 12 Ha'arba'a St, 6473912, Tel Aviv, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Turner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,AIDS Treatment Center, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Itzchak Levy
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,AIDS Treatment Center, Sheba Medical Center, Ramat Gan, Israel
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Abstract
OBJECTIVES The aim of this systematic review was to assess incidence rates of laboratory-confirmed influenza (LCI) outcomes among infants under 6 months of age. DESIGN Systematic literature search and review of indexed studies in PubMed, EMBASE, the Cochrane Library and CINAHL Plus from inception to 19 April 2017. SETTING Population-based estimates from community or hospital settings. PARTICIPANTS Infants under 6 months of age. PRIMARY AND SECONDARY OUTCOME MEASURES LCI illness in ambulatory care settings, LCI hospitalisation, LCI intensive care unit admission and LCI death. Only studies with population-based incidence data were included. RESULTS We identified 27 primary studies, 11 of which were from the USA, four were from other non-US high-income settings and the remaining were from lower-middle-income or upper-middle-income countries. Most studies (n=23) assessed incidence of LCI hospitalisation, but meta-analysis to pool study-specific rates was not possible due to high statistical and methodological heterogeneity. Among US studies, the reported incidence of LCI hospitalisation ranged from 9.3 to 91.2 per 10 000 infants under 6 months for seasonal influenza, while the only US-based estimate for pandemic H1N1 influenza was 20.2 per 10 000 infants. Reported rates for LCI hospitalisation for seasonal influenza from other countries ranged from 6.2 to 73.0 per 10 000 infants under 6 months, with the exception of one study with an estimated rate of 250 per 10 000 infants. No events were reported in five of the nine studies that evaluated LCI death among infants under 6 months. CONCLUSION Our review of published studies found limited data on LCI outcomes for infants under 6 months, particularly from non-US settings. Globally representative and reliable incidence data are necessary to fully evaluate influenza disease burden and the potential impact of maternal influenza immunisation programme on morbidity and mortality in young infants.
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Affiliation(s)
- Deshayne B Fell
- University of Ottawa and Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Jeanene Johnson
- Independent Epidemiology Consultant, Los Gatos, California, USA
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Katz
- Medical School for International Health and Department of Health Systems Management, Ben Gurion University in the Negev, Beersheba, Israel
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Kathleen M Neuzil
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Justin R Ortiz
- Initiative for Vaccine Research, WHO, Geneva, Switzerland
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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Mor Z, Raveh Y, Lurie I, Leventhal A, Gamzu R, Davidovitch N, Benari O, Grotto I. Medical condition and care of undocumented migrants in ambulatory clinics in Tel Aviv, Israel: assessing unmet needs. BMC Health Serv Res 2017; 17:484. [PMID: 28705192 PMCID: PMC5513046 DOI: 10.1186/s12913-017-2421-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 150,000 undocumented migrants (UM) who are medically uninsured reside in Israel, including ~50,000 originating from the horn of Africa (MHA). Free medical-care is provided by two walk-in clinics in Tel-Aviv. This study aims to compare the medical complaints of UM from different origins, define their community health needs and assess gaps between medical needs and available services. METHODS This cross-sectional study included a random sample of 610 UM aged 18-64 years, who were treated in these community clinics between 2008 and 2011. The study compared UM who had complex medical conditions which necessitated referral to more equipped medical settings with UM having mild/simple medical conditions, who were treated at the clinics. RESULTS MHA were younger, unemployed and more commonly males compared with UM originating from other countries. MHA also had longer referral-delays and visited the clinics less frequently. UM with complex medical conditions were more commonly females, had chronic diseases and demonstrated longer referral-delays than those who had mild/simple medical conditions. The latter more commonly presented with complained of respiratory, muscular and skeletal discomfort. In multivariate analysis, the variables which predicted complex medical conditions included female gender, chronic illnes and self-referral to the clinics. CONCLUSIONS The ambulatory clinics were capable of responding to mild/simple medical conditions. Yet, the health needs of women and migrants suffering from complex medical conditions and chronic diseases necessitated referrals to secondary/tertiary medical settings, while jeopardizing the continuity of care. The health gaps can be addressed by a more holistic social approach, which includes integration of UM in universal health insurance.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health Tel Aviv, 12 Ha'arba'a St, 6473912, Tel Aviv, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yuval Raveh
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ido Lurie
- Physician for Human Right (PHR-I), Tel Aviv, Israel.,Kfar Saba Adult Clinic, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Alex Leventhal
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Roni Gamzu
- Administration Department, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadav Davidovitch
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Orel Benari
- Lev el Lev Clinic, Ministry of Health, Tel Aviv, Israel
| | - Itamar Grotto
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Public Health Services, Ministry of Heath, Jerusalem, Israel
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Chemtob D, Gandacu D, Mor Z, Grotto I, Anis E, Rosenberg E. A national strategic plan for reducing the burden of sexually transmitted infections in Israel by the year 2025. Isr J Health Policy Res 2017; 6:23. [PMID: 28428838 PMCID: PMC5395852 DOI: 10.1186/s13584-017-0141-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 03/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background There is on ongoing debate in the literature regarding the real burden of STIs (sexually transmitted infections) in Western countries and the proper strategies needed to estimate and to prevent them. Our purpose is to present an evidence-based national strategic plan for STI prevention in Israel through assessing the current burden of illness, leading international preventive strategies, and practical policymaking experience. Methods Epidemiologic and health policy data on STIs were analyzed from various sources: a) systematic national surveillance data for the years 2002–2014; b) the international scientific literature (published between 2002–16; keywords: Sexually Transmitted Diseases (STD) (or STI) AND prevention AND intervention AND gonorrhea OR chlamydia OR syphilis; c) internal Ministry of Health (MOH) analyses and reports, and d) expert opinion. Results Incidence rates in Israel of Chlamydia trachomatis (chlamydia), Neisseria gonorrhea (gonorrhea) and Treponema pallidum (syphilis) are lower than in most Western countries. However, rates vary among population subgroups: chlamydia, gonorrhea and syphilis are higher in Jews than in non-Jews, and this gap has increased for chlamydia over the past decade. Primary and secondary syphilis rates have increased among men having sex with men (MSM). It is likely that STIs are under-reported and that incidence is even rising due to migration. A key recommendation is the establishment of an active surveillance system of STIs, utilizing active case finding in high risk populations, along with regular contact with STI clinics run by the four national health management organizations and by the MoH. As with most European countries, the low prevalence of chlamydia and gonorrhea does not justify population-wide screening. Conversely, the increasing incidence of syphilis among MSM should lead to regular screening among this group. Conclusions A national STIs prevention strategy for the year 2025 was presented. Although the current burden of illness is low relatively to other Western countries, this is thought to reflect a certain degree of underreporting. These and other gaps suggest a need for focused epidemiologic and health services research to better characterize health risk behaviors as well as provider practice patterns. Innovative implementation strategies have been described, together with the capacity building components needed for developing specific and implementable policy recommendations for the year 2025.
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Affiliation(s)
- Daniel Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - Dan Gandacu
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Zohar Mor
- Tel Aviv Regional District Health Office, Ministry of Health & School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Grotto
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Emilia Anis
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Elliot Rosenberg
- Department of Occupational Health, Ministry of Health, Jerusalem, Israel
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Zhdanov V, Bilenko N, Mor Z. Risk Factors for Recurrent Tuberculosis among Successfully Treated Patients in Israel, 1999-2011. Isr Med Assoc J 2017; 19:237-241. [PMID: 28480678] [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: 06/07/2023]
Abstract
BACKGROUND Recurrent tuberculosis (TB) is one of the indices used to assess the effectiveness of the Israeli National TB Programs (NTP). OBJECTIVES To estimate the incidence of recurrent TB in Israel and to identify the associated risk factors. METHODS We conducted a retrospective cohort study of all TB patients who were Israeli citizens and diagnosed between 1999 and 2011 with a treatment outcome recorded as "success." We compared those who had recurrent TB with those who did not. In addition, a nested case-control study included all those who had recurrent TB with a random sample from this cohort matched by age, gender, and year of TB diagnosis. RESULTS Of 3515 TB patients diagnosed between 1999 and 2011, 37 (1.05%) had recurrent TB during the follow-up period, with an incidence rate of 1.55 cases per 1000 person-years (PY). Male gender [hazard ratio (HR) 3.2, 95% confidence interval (95%CI) 1.4-7.4], human immunodeficiency virus (HIV) infection (HR 3.9, 95%CI 1.5-10.4), positive sputum culture [odds ratios (OR) 2.7, 95%CI 1.1-6.9], and low adherence to anti-TB treatment (OR 3.2, 95%CI 1.0-10.3) were found to be risk factors for recurrent TB. CONCLUSIONS Male gender, HIV infection, positive sputum culture, and low adherence to anti-TB drugs during the initial TB episode were risk factors for developing recurrent TB.
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Affiliation(s)
- Valeria Zhdanov
- Department of Public Health, Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Natalya Bilenko
- Department of Public Health, Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Ashkelon Department of Health, Ministry of Health, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mor Z, Lidji M, Chemtob D, Cedar N, Grotto I. Erratum to: ‘HIV prevalence in the Israeli tuberculosis cohort, 1999–2011’. BMC Public Health 2016; 16:319. [PMID: 27075758 PMCID: PMC4831161 DOI: 10.1186/s12889-016-2889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shuldiner J, Leventhal A, Chemtob D, Mor Z. Mortality after anti-tuberculosis treatment completion: results of long-term follow-up. Int J Tuberc Lung Dis 2016; 20:43-8. [PMID: 26688527 DOI: 10.5588/ijtld.14.0427] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycobacterium tuberculosis affects the lung parenchyma even after successful treatment. OBJECTIVE To assess long-term mortality in a cohort of individuals who had recovered from tuberculosis (TB), and to compare their mortality rate and causes of death with those of the general population. METHODS This retrospective cohort study of all Israeli citizens who recovered from tuberculosis between 2000 and 2010 included all patient files and death certificates and/or hospitalisation records of deceased individuals. Death rates were computed using standard mortality rates (SMR). Cox proportional hazard regression was conducted to identify risk factors for death, and causes of death were compared with those in the general Israeli population. RESULTS Over 11 years of follow-up, comprising 18,246 person-years, 389 (12.0%) Israeli citizens died after completion of anti-tuberculosis treatment, giving an SMR of 3.7. The SMR was strongly correlated with age, and was highest in males and individuals aged 25-44 years. Compared to the general population, among individuals who recovered from TB there were more deaths due to septicaemia and pneumonia, and fewer deaths due to cerebrovascular diseases, stroke and diabetes (P < 0.05). CONCLUSIONS Individuals who recover from TB are at higher risk of long-term mortality than the general population, and their causes of death are different. Periodical follow-up might be beneficial for individuals to facilitate early diagnosis.
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Affiliation(s)
- J Shuldiner
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem, Israel
| | - A Leventhal
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem, Israel; Department of International Relations, Ministry of Health, Jerusalem, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel; Ramla Department of Health, Ministry of Health, Ramla, Israel
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Mor Z, Davidovich U. Sexual Orientation and Behavior of Adult Jews in Israel and the Association With Risk Behavior. Arch Sex Behav 2016; 45:1563-1571. [PMID: 26754157 DOI: 10.1007/s10508-015-0631-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/22/2015] [Revised: 09/05/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
Estimating the size of key risk groups susceptible to HIV/sexually transmitted diseases (STI) is necessary for establishment of interventions and budget allocation. This study aimed to identify various dimensions of sexual orientation and practices in Israel, and correlate the findings with sexual risk behavior (SRB). It used a random representative sample of the Jewish population aged 18-44 years who completed online questionnaires regarding their self-identified sexual orientation, attraction and practices, and SRB. Concordant heterosexuals were those who self-reported heterosexual identity, were attracted and had sex only with the opposite gender. National estimates regarding prevalence of gay, lesbian, and bisexual men and women were based on the civil census. The sample included 997 men and 1005 women, of whom 11.3 and 15.2 % were attracted to the same-gender, 10.2 and 8.7 % reported lifetime same-gender encounters, while 8.2 and 4.8 % self-identified as gay or bisexual men and lesbian or bisexual women, respectively. The estimated population of self-identified Jewish gay or bisexual men and lesbian or bisexual women aged 18-44 in Israel was 94,176, and 57,671, respectively. SRB was more common among self-identified gays or bisexual men and among discordant heterosexual men and women. Those who reported same-gender sexual practices reported greater SRB than those who only had opposite-gender encounters. Interestingly, SRB among discordant heterosexuals was associated with same-sex behavior rather than attraction. Health practitioners should increase their awareness of sexual diversity among their clientele, and should recognize that risk for HIV/STI may exist among self-identified heterosexuals, who may not disclose their actual sexual attraction or practices.
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Affiliation(s)
- Zohar Mor
- Ramla Department of Health, Ministry of Health, 3 Danny Mass St., 72100, Ramla, Israel.
| | - Udi Davidovich
- Geneeskundige en Gezondheidsdienst, Amsterdam, The Netherlands
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Goldblatt D, Rorman E, Chemtob D, Freidlin PJ, Cedar N, Kaidar-Shwartz H, Dveyrin Z, Mor Z. Molecular epidemiology and mapping of tuberculosis in Israel: do migrants transmit the disease to locals? Int J Tuberc Lung Dis 2016; 18:1085-91. [PMID: 25189557 DOI: 10.5588/ijtld.14.0186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Israel receives migrants from various countries, some of which have high tuberculosis (TB) prevalence. OBJECTIVE To assess the predominant Mycobacterium tuberculosis strains in Israel isolated during 2008-2010 among Israeli-born and migrant patients, and to investigate possible transmission of TB from migrants to the local population. METHODS Molecular characterisation employed 43-spacer spoligotyping and 16-loci mycobacterial interspersed repetitive units-variable number of tandem repeats typing. All patients were classified according to those who were members of a cluster and those who were not. RESULTS Among 684 M. tuberculosis strains isolated from new patients genotyped and assigned to their specific cohort populations during the study period, major spoligotype families were Central Asian (CAS) (n = 140, 20%), Beijing (n = 101, 15%) and T (n = 160, 23%). Most Beijing strains (66%) were isolated from patients from the former Soviet Union (FSU), while CAS strains were mainly (74%) from Ethiopia, Eritrea and Sudan (EES). For the heterogeneous T-clade, patient countries of origin were 38% EES and 33% FSU. CONCLUSIONS Predominant M. tuberculosis genotypes in Israel in 2008-2010 were similar to genotypes endemic to the migrants' countries of origin. Epidemiological investigations did not demonstrate transmission between migrants and Israeli-born patients sharing the same cluster.
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Affiliation(s)
- D Goldblatt
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - E Rorman
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - P J Freidlin
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - N Cedar
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - H Kaidar-Shwartz
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - Z Dveyrin
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
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Mor Z, Davidovich U. Same-sex sexual attraction, behavior, and practices of Jewish men in Israel and the association with HIV prevalence. AIDS Care 2016; 28 Suppl 1:64-7. [PMID: 26883581 PMCID: PMC4828613 DOI: 10.1080/09540121.2016.1146400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/20/2016] [Indexed: 11/02/2022]
Abstract
In order to efficiently direct efforts and resources required for the prevention of HIV and other sexually transmitted infection among men who have sex with men (MSM) in Israel, it is necessary to define their particular behaviors, estimate their size, and asses the HIV-burden. This cross-sectional study included a sub-sample from a random representative National study performed in Israel, which included Jewish males aged 18-44 who completed online anonymous questionnaires regarding their sexual attraction and practices, commercial sex-work, as well as condom and substances' use. Additionally, participants were asked to identify themselves as gay, bisexual, or heterosexual. National estimates regarding prevalence of risk-behaviors and HIV-infection among MSM were based on the Statistical Abstract of Israel and the National HIV Registry, respectively. Of the total sample of 997 men, 11.9% reported lifetime male sex encounters, while 4.5% and 3.7% self-identified as gay or bisexual, respectively. The estimated population of self-identified Jewish gays/bisexuals aged 18-44 in Israel was 94,176, and in Tel-Aviv 33,839. HIV prevalence among MSM was estimated at 0.7% in Israel and 1.0% in Tel-Aviv. MSM were more likely to live in Tel-Aviv, had higher levels of education, and were scored higher on several determinants of sexual risk in comparison to those attracted to women, including early sexual debut, greater number of sexual partners, ever paid/been paid for sex, sexually coerced, and substance use. In conclusion, MSM were involved in greater risk behaviors than those who only had female sex partners. Most MSM were living in Tel-Aviv and their estimated HIV prevalence was 1.0%.
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Affiliation(s)
- Zohar Mor
- Ramla Department of Health, Ministry of Health, Ramla, Israel
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Abstract
OBJECTIVES Arab men who have sex with men (AMSM) are becoming visible in society, and reports of HIV infection and sexually transmitted infections (STIs) are emerging. This study aimed to assess the knowledge of AMSM regarding HIV transmission, their attitudes towards condom use and their sexual practices compared with Jewish MSM (JMSM), and to evaluate AMSM-JMSM friendships and sexual encounters. METHODS Participants in this cross-sectional study completed questionnaires in Arabic or Hebrew. The outcome variable was unprotected anal sex (UAI) in the previous 6 months with a partner(s) whose HIV status was discordant or unknown. AMSM and JMSM indicated if they had friends or sexual encounters from the other ethnic group. RESULTS The questionnaires were completed by 342 (16.2%) AMSM and 1775 (83.8%) JMSM in 2012. AMSM were more likely to be religious, 'closeted' and married than JMSM; their knowledge regarding HIV transmission was inferior and attitudes towards condom use were less favourable. AMSM reported less alcohol and drug use than JMSM, were more likely to be attracted to and have sex with women, and reported a greater number of sexual partners and more UAI. Being AMSM was a predictive variable for UAI in the multivariate model. While 178 AMSM (52.0%) reported that most of their close friends were JMSM, 251 (73.4%) had only/mostly sexual encounters with JMSM. Among JMSM, 41 (2.3%) reported that their close friends were AMSM, and 308 (17.3%) had only/mostly sexual encounters with AMSM. CONCLUSIONS The knowledge of AMSM regarding HIV transmission and their attitudes towards condom use were less favourable than those of JMSM, and they performed more UAI. AMSM may benefit from targeted interventions, including reconciling their same-sex attraction in positive terms. Same-sex attraction and gay identity may provide common ground to strengthen Arab-Jew communication in Israel.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.,Ramla Department of Health, Ministry of Health, Ramla, Israel
| | - E Grayeb
- Bone Marrow Transplantation Department, Hadassah Medical Centre, Jerusalem, Israel.,Al-Qaws for Sexual and Gender Diversity in the Palestinian Society, Jerusalem, Israel
| | - A Beany
- Department of Internal Medicine C, Bnai Zion Medical Centre, Haifa, Israel
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Abstract
Antiretroviral therapy (ART) improved the survival of people living with HIV/AIDS (PLWHA) and decreased HIV-related morbidities. This study assesses the cancer incidence of all adult PLWHA in Israel by transmission routes before and after 1996. This cohort study was based on cross-matching the National HIV/AIDS and Cancer Registries of all HIV/AIDS and cancer cases reported from 1981 to 2010 with the National civil census. PLWHA were followed-up until cancer diagnosis, death, leaving Israel, or 2010, whichever occurred first. Cancer incidence was adjusted for age, and compared with the National incidence. Of all 5,154 PLWHA followed-up for 36,296 person-years, 362 (7.0%) developed cancer (997.4 cases per 100,000 person-years). Higher hazard ratios to develop cancer were demonstrated among older PLWHA, Jewish people, and intravenous drug users. Cancer incidence among PLWHA was higher in the pre-ART period than after 1997 (1,232.0 and 846.7 cases per 100,000 person-years, respectively). The incidence of AIDS-defining cancers was higher than non-AIDS-defining malignancies, and higher in the pre-ART than the post-ART period (777.0 and 467.2 cases per 100,000 person-years, respectively), while the incidence of non-AIDS-defining cancers showed the opposite trend (376.5 and 455.0 cases per 100,000 person-years, respectively). The incidence of AIDS-defining and non-AIDS-defining cancers declined between the pre-ART and the post-ART period by 2.0 to 3.4 times. PLWHA had higher rates of malignancies than the general population. In conclusion, cancer incidence among PLWHA was associated with age, and declined after ART introduction; yet it was higher than that of the general population. PLWHA may benefit from age-related cancer screening, increased adherence to ART, and reduction of environmental oncogenes.
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Affiliation(s)
- Zohar Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
- Ramla Department of Health, Ministry of Health, Ramla, Israel
| | - Micha Barchana
- School of Public Health, Haifa University, Haifa, Israel
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Grossman Z, Avidor B, Mor Z, Chowers M, Levy I, Shahar E, Riesenberg K, Sthoeger Z, Maayan S, Shao W, Lorber M, Olstein-Pops K, Elbirt D, Elinav H, Asher I, Averbuch D, Istomin V, Gottesman BS, Kedem E, Girshengorn S, Kra-Oz Z, Shemer Avni Y, Radian Sade S, Turner D, Maldarelli F. A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity. PLoS One 2015; 10:e0135061. [PMID: 26302493 PMCID: PMC4547742 DOI: 10.1371/journal.pone.0135061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/17/2015] [Indexed: 11/30/2022] Open
Abstract
Background HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the 1980s and 1990s by introductions of subtype C from Ethiopia (predominantly acquired by heterosexual transmission) and subtype A from the former Soviet Union (FSU, most often acquired by intravenous drug use). The epidemic matured over the last 15 years without additional large influx of exogenous infections. Between 2005 and 2013 the number of infected men who have sex with men (MSM) increased 2.9-fold, compared to 1.6-fold and 1.3-fold for intravenous drug users (IVDU) and Ethiopian-origin residents. Understanding contemporary spread is essential for effective public health planning. Methods We analyzed demographic and virologic data from 1,427 HIV-infected individuals diagnosed with HIV-I during 1998–2012. HIV phylogenies were reconstructed with maximum-likelihood and Bayesian methods. Results Subtype-B viruses, but not A or C, demonstrated a striking number of large clusters with common ancestors having posterior probability ≥0.95, including some suggesting presence of transmission networks. Transmitted drug resistance was highest in subtype B (13%). MSM represented a frequent risk factor in cross-ethnic transmission, demonstrated by the presence of Israeli-born with non-B virus infections and FSU immigrants with non-A subtypes. Conclusions Reconstructed phylogenetic trees demonstrated substantial grouping in subtype B, but not in non-MSM subtype-A or in subtype-C, reflecting differences in transmission dynamics linked to HIV transmission categories. Cross-ethnic spread occurred through multiple independent introductions, with MSM playing a prevalent role in the transmission of the virus. Such data provide a baseline to track epidemic trends and will be useful in informing and quantifying efforts to reduce HIV transmission.
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Affiliation(s)
- Zehava Grossman
- School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
- National Cancer Institute, Frederick, MD, United States of America
- * E-mail:
| | - Boaz Avidor
- Crusaid Kobler AIDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Laboratory of Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zohar Mor
- Ramla Department of Health, Ministry of Health, Ramla, Israel
| | | | - Itzchak Levy
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | | | | | | | | | - Wei Shao
- Advanced Biomedical Computing Center, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, United States of America
| | | | | | | | | | | | | | | | | | | | - Shirley Girshengorn
- Crusaid Kobler AIDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Laboratory of Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Dan Turner
- Crusaid Kobler AIDS Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Frank Maldarelli
- National Cancer Institute, Frederick, MD, United States of America
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