Impact of Remote Medical Devices on Utilization of Medical Services in Pediatric Patients with Upper Respiratory Infections: A Retrospective Study.

Background: Remote mobile examination devices in telemedicine are a new technology in healthcare. Objective: To assess the utilization of visits using remote medical devices. Methods: A retrospective analysis of follow-up visits, referrals, laboratory testing and antibiotic prescriptions of 470,845 children's video visits with and without remote medical examination device and in-clinic visits. Results: Rates of follow-up visits, referrals and laboratory tests were higher in video visits compared to visit with medical device (OR of 1.27, 1.08, 1.93 respectfully). For in-clinic visits, rates of follow-up were lower but higher for referrals to subspecialists and laboratory test referrals when compared to telemedicine. Antibiotic prescriptions were provided at a lower rate in video visits compared to visits with a medical device (OR = 0.48) and in-clinic visits. Conclusions: Incorporating a remote medical device may reduce follow up visits, referrals and laboratory tests compared to a video visit without a device. The prevalence of antibiotic prescriptions did not escalate in telemedicine consultations.

Are pregnancy and parity associated with telomere length? A systematic review.

BACKGROUND: Women's reproduction requires increased energy demands, which consequently may lead to cellular damage and aging. Hence, Telomere Length (TL), a biomarker of biological aging and health status may possibly serve as a biomarker of reproductive effort. The aim of this systematic review is to evaluate telomere dynamics throughout pregnancy and the association between parity and TL. METHODS: A systematic search was conducted across seven databases including CINAHL, Cochrane, PsycINFO, Proquest, PubMed; Scopus; and Web of Science, using keywords and MeSH descriptors of parity and TL. Predefined inclusion and exclusion criteria were used to screen abstracts and titles. After the removal of duplicates, 3431 articles were included in the primary screening, narrowed to 194 articles included in the full-text screening. Consensus was reached for the 14 studies that were included in the final review, and the Newcastle-Ottawa scale (NOS) was utilized to assess the quality of the selected studies. A mini meta-analysis utilized JASP 0.17.3 software and included 4 applicable studies, comprising a total of 2564 participants to quantitatively assess the estimated effect size of parity on TL. RESULTS: Of the 11 studies reviewed on parity and TL, four demonstrated a negative correlation; one - a positive correlation and six -found no correlation. Studies demonstrating a negative correlation encompassed rigorous methodological practices possibly suggesting having more children is associated with enhanced telomere attrition. Of the four longitudinal studies assessing telomere dynamics throughout pregnancy, most found no change in TL from early pregnancy to postpartum suggesting pregnancy does not affect TL from early pregnancy to early postpartum. The meta-analysis revealed a negative, yet, non-significant effect, of the estimated effect size of parity on TL(ES = -0.009, p = 0.126, CI -0.021, 0.03). CONCLUSIONS: Studies assessing pregnancy, parity and TL yielded mixed results, most likely due to the different research methods utilized in each study. Improvements in study design to better understand the short-term effects of pregnancy on TL and the effect of parity on TL over time, include precise definitions of parity, comparisons of different age groups, inclusion of reproductive lifespan and statistically adjusting for potential confounders in the parity and TL relationship.

Working Status of First-Time Postpartum Mothers and Telomere Length-A 1-Year Prospective Study.

OBJECTIVE: Transitioning to motherhood can create work family conflicts affecting mothers' health. Although employment is generally associated with longer telomeres, this may diminish during the early years of child-rearing. This study aimed to assess the impact of work reentry on telomere length (TL) among first-time mothers. METHODS: In this 1-year prospective study, a total of 103 first-time postpartum mothers participated from two medical institutions in Northern Israel; they completed validated questionnaires, reported their current working status, and provided dried blood spots measuring TL. RESULTS: We found that working status significantly predicted change in TL and was negatively correlated with change in TL over time (ß = -0.245; 95% confidence interval, -0.169, -0.018; P = 0.016). CONCLUSIONS: Identifying ideal timing of work reentry is recommended for first-time postpartum mother's optimal health and TL.

Prevalence, diagnosis and treatment of ADHD in Arab and Jewish children in Israel, where are the gaps?

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting children and causing significant impairment. It is not clear to what extent ADHD differs between population groups. This study aims to assess prevalence, diagnosis and treatment of ADHD among Arab and Jewish children of primary school age in Israel. METHODS: Cross-sectional survey, including 517 parents of children ages 7-10 (225 Jewish and 292 Arab) and 60 homeroom teachers of the corresponding children. Both parents and homeroom teachers completed the ADHD Rating Scale-V-RV. ADHD was defined according to DSM-5 ADHD criteria by both parents and teachers, or clinical diagnosis. In addition, parents reported ADHD medication and adherence to medication. RESULTS: Prevalence of ADHD was similar for both groups. Yet, seeking diagnosis was lower among Arab Muslim children (9.2%) compared to Jewish children (17.8%). Arab Muslim children received significantly less medication compared to Jewish children. Parental decision to seek diagnosis was associated with education (OR = 6.14, CI 1.74-21.71), not ethnicity. Ethnicity predicted parents' decisions to pharmacologically treat their children with ADHD (OR = 7.61, CI 1.14-50.86) and adherence to medication (OR = 10.19, CI 1.18-88.01). CONCLUSION: Education is critical in the help-seeking process, affecting the rate of ADHD diagnosis. Pharmacological treatment and adherence are correlated with ethnicity. Parents with limited education and minorities should be targeted for interventions to increase awareness regarding ADHD and treatment.

Applying the Socioecological Model to Map Factors Associated with Military Physical Activity Adherence.

Physical activity (PA) within the military can have large effects on the soldier's health, productivity, and ability to meet tasks. This study aims to identify the factors associated with PA adherence during military service, applying the socioecological model, which classifies the factors influencing health behaviors into individual, social, and environmental levels. This cross-sectional survey was carried out among 500 soldiers aged 18 to 49 years in the Israeli Defense Forces. Statistical analysis to assess associations between PA and individual, social, and environmental factors included correlations, variance analyses, and multivariable linear regression. PA rates were higher among men soldiers in combat positions. Individual level factors, such as intention to perform PA (ß = 0.42, p < 0.001), and self-efficacy regarding PA (ß = 0.20, p < 0.001) were associated with PA among men and women. However, social norms were associated with PA only among men (ß = 0.24, p < 0.001). The physical environment was not associated with PA adherence (ß = -0.04, p = 0.210). Conclusions: Developing interventions on the individual level for all military personnel and interventions on the social level, mainly for men, could help increase levels of PA in the military.

Shared Decision Making and Trust Matter: Patient's Use of Video Consultations and a Remote Medical Device in Primary Care.

Background: There is growing interest in the incorporation of video consultations in primary care. Remote medical devices used for remote physical examinations are a new complementary addition to these consultations and may increase their effectiveness. This study examines a social behavioral-technological model by the factors predicting the acceptance of video consultation with or without a technological medical device, their perceived ease of use (PEU), and their perceived usefulness (PU), as well as social behavioral factors: trust and shared decision making. Methods: We conducted an online survey among patients who had visited a physician during 2021 and had the option to receive video consultations with or without remote medical devices. Structural equation modeling was applied to assess the proposed model of predicting the extent of future telemedicine use. Results: Among the 1,198 patient responders, the intention to use telemedicine video consultation had a significant positive association with trust, shared decision making, PEU, and PU and with high socioeconomic constructs. The intention to use telemedicine video consultation with a medical device had a significant positive association with shared decision making, PEU, and PU. The statistical results suggest a good fit with the proposed models. Conclusions: The proposed social behavioral-technological model demonstrated that to successfully adopt video consultations and new remote medical devices in primary care, there is a need for trust and shared decision making to be established in patient-physician relationships.

Neighborhood violence and health: the mediating role of loneliness among two ethnic groups in Israel.

Neighborhood violence is associated with poor health, but the mechanisms explaining this association are still unknown. This study seeks to examine the role of loneliness as a mediator of the association between neighborhood violence and health among two ethnic groups (Arabs and Jews) in Israel. A representative survey was conducted among adult residents (1903 Arabs and 2726 Jews) of four Israeli towns: two Arab towns, one Jewish town and one mixed town. A stratified sample of households by residential area, age and sex, was selected in each town. Mediation models were tested using Hayes' PROCESS procedure. Traffic violations, juvenile delinquency and vandalism were reported by more than 50% of Arab residents, relative to about 25-30% of Jewish residents. Loneliness mediated the association between neighborhood violence and health, with a full serial mediation for mental health and a partial serial mediation for physical health. Findings indicate that Arab towns are characterized by severe neighborhood violence. The association between neighborhood violence and physical health was fully dependent on the mediators among both ethnic groups. Future studies should use prospective designs with objective measures of health and violence to validate our cross-sectional findings.

Patterns of Active Travel and Physical Activity among Adolescents in Israel.

Active travel (AT) is a core physical activity (PA) indicator for children and youth; contributing to health and wellbeing, at both the individual and societal levels. This analysis explores patterns of adolescent active school travel (AST) and cycling and associations with different PA measures. Secondary analysis of the cross-sectional 2018-2019 Health Behaviour in School Age Children study in Israel included an extended PA module with walking, cycling and e-cycling modes. The nationally representative sample includes students in grades 6-12 (n = 4407). Analysis of weighted data included descriptive analyses, inferential statistics, and regression analyses. AST was reported by 61.9% of adolescents; 39.3% reported 20 min or more daily AST; 27.1% reported habitual cycling (HC) and 17.4% reported habitual e-cycling (HEC). There are mixed results for socio-economic status and environment. AST and HC were associated with less sedentary hours daily (odds ratio [OR] = 1.190 and 1.397, respectively); HC was associated with positive sports self-rating (OR = 2.394). Stepwise regression analysis found that lower AST duration, time in minutes, was associated with watching television with the family. Promotion of adolescent AT may be associated with increased PA and joint parent-adolescent AT, and was utilized across different socio-demographic groups in Israel.

"It's a kind of freedom": adolescents and parents speak about motivations for active travel and COVID-19.

PURPOSE: Active travel (AT) incorporates physical activity into daily living, critical for healthy adolescent development. We explore adolescent and parent attitudes and behaviours related to motivations for adolescent AT and effects of the COVID-19 pandemic. METHODS: We conducted semi-structured Zoom interviews with 25 adolescent-parent dyads in communities across Israel during early stages of the COVID-19 pandemic. Thematic content analysis was used to develop categories and themes. RESULTS: We identified key themes related to adolescent AT: Fostering independence enables adolescent AT; Pampering and safety concerns inhibit adolescent AT; Family and community norms influence adolescent travel modes; Personal enjoyment and positive attitudes facilitate AT; Peers and social networks promote adolescent AT and PA; Built environment and transport options influence AT choices. Interestingly, adolescents indicate AT is an opportunity for peer-to-peer communication without screen distraction, yet they use social media to promote AT and PA. CONCLUSIONS: The findings point to the influence of positive parent perceptions, active and supportive family and community norms on adolescent AT. Peer norms and social networks as well as features of the built environment also have the potential to influence AT. The COVID-19 pandemic encouraged use of AT and provided a setting for positive AT experiences.

A health promotion perspective for the control and prevention of Brucellosis (Brucella melitensis); Israel as a case study.

BACKGROUND: Brucellosis (Brucella melitensis) is endemic in many countries around the world, therefore, identifying what is required to control and prevent the disease is essential. The health promotion concept and five areas of action, presented in the Ottawa Charter (1986) may help understand how to go forward in the prevention of the disease. Israel serves as a case study. AIM: To identify barriers to the control and prevention of brucellosis (Brucella melitensis) in Israel by analyzing trends in incidence in conjunction with interventions implemented over the last seven decades, applying the health promotion areas of action. METHODS: 1. A document review approach was adopted to develop a list of interventions implemented in Israel to prevent and control brucellosis and identify barriers to implementation. These were analysed using the health promotion areas of action. 2. Data from the mandatory reporting of infectious diseases in Israel regarding brucellosis in humans between 1951 and 2021 are presented and analyzed in conjunction with the interventions implemented. RESULTS: A large range of interventions were implemented following outbreaks of the disease. These interventions followed the health promotion areas of action, including mainly: policy, education and environment and brought about a decrease in the disease among both animals and humans. However, major interventions were discontinued after a few years. In addition, we identified some areas of action that could be much improved on. The interventions, in many cases were not simultaneously implemented or coordinated, decreasing the chances of them having the expected long term impact. CONCLUSIONS: Control and prevention of the disease in Israel is partial. Areas of action that could be improved include enforcement of regulations, strengthening community action and improving personal skills. Simultaneous and continuous implementation of the interventions may achieve the goals of sustained prevention and control. There seems to be a lack of a long-term strategy and an integrated holistic intervention approach that may contribute to the control and prevention of the disease.

Associations of accelerometer measured school- and non-school based physical activity and sedentary time with body mass index: IPEN Adolescent study.

BACKGROUND: This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex. METHODS: Cross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11-19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models. RESULTS: Adolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found. CONCLUSIONS: This multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures.

Social Capital as a Mediator and Moderator in the Association between Loneliness and Health, Israel as a Case Study.

Loneliness has been associated with poor health. Social capital (SC) could possibly prevent the ill effects of loneliness. The study aims to assess the association of loneliness with physical and mental health in four different communities in Israel and study the impact of structural and cognitive SC on that association. A cross-sectional face-to-face survey with 4620 adults in four towns was conducted. The questionnaire included self-rated health (SRH), mental health (MH), loneliness, cognitive and structural SC and socioeconomic characteristics. Logistic regression analysis and mediation and moderation effects were calculated. Loneliness was associated with worse SRH (OR = 0.4-0.5) and worse MH (OR = 2.0-10). Both SC variables were associated with health. However, towns differ in these associations. Structural SC serves as a significant mediator between loneliness and SRH in all towns and is a mediator between loneliness and MH in two towns. Cognitive social capital was a moderator between loneliness and MH in two towns. This study suggests that increasing SC could possibly compensate for loneliness and buffer its effect on health. The study reinforces the need for the performance of separate health profiles to assess possible interventions for each community, as not always can we generalize these results to all communities.

"My problem is that I live next door to my mother-in-law": Arab women's postpartum experiences with positive and negative social interactions and the impact on their well-being: A qualitative study.

Social support is commonly associated with women's postpartum health. Yet such support can also have unintended effects and trigger negative reactions. This study provides a qualitative examination of the positive and negative social interactions described by Arab postpartum women. Participants were Arab women recruited at Mother and Child Healthcare Clinics (MCHC). Inclusion criteria were married women over the age of 18 with a healthy newborn who described both positive and negative social experiences. Exclusion criteria were signs of postpartum depression. Data were gathered using semi-structured in-depth interviews that were audio-recorded and transcribed verbatim. Themes and categories were extracted based on interpretative phenomenological analysis. The impact of lived experiences on the well-being of postpartum women was explored. Data analysis revealed three main themes: (1) Support from the family and community: positive impact on the mother; (2) Negative social interactions as invasion of mother's personal space; (3) Impact of negative social interactions on mother's relationship with her family. A deeper understanding of the social environment of these women and the factors that affect their well-being during the critical postpartum period can help MCHC staff offer culturally appropriate support and relevant interventions.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region.

BACKGROUND: The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region. METHODS: Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use. RESULTS: In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour. CONCLUSION: We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

Predictors of maternal self-efficacy and the mediating role of postpartum fatigue for Jewish and Arab women in Northern Israel.

OBJECTIVE: The study aims to investigate positive and negative social interactions as predictors of maternal self-efficacy and to examine the mediating role of postpartum fatigue. DESIGN: Participants included 450 Arab and Jewish mothers of healthy one-month-old infants who visited 14 well-baby care clinics located in northern Israel. The study used a prospective longitudinal cohort design. Participants completed the first questionnaire and agreed to a follow-up phone interview three months later. Both ethnic groups had a response rate of 90% for the follow-up interview. The questionnaire included six scales that measured socioeconomic status and demographics, obstetric characteristics, social networks and support, negative social interactions, fatigue and maternal self-efficacy (MSE). The phone interview was a shorter version of the written questionnaire focusing on MSE and fatigue. Maternal self-efficacy four month after birth was examined with social support, negative interactions and fatigue, using multiple linear regressions within each ethnic group. FINDINGS: In both groups, negative social interactions decreased perceptions of maternal self-efficacy. Women who reported higher social support after birth experienced a greater sense of maternal self-efficacy four months after birth, though the association was stronger among Jewish women. Post-partum fatigue affects Arab and Jewish mothers differently. Among Arab mothers, fatigue at one month mediates MSE as well as the relationship between social support and negative interactions at four months. Among Jewish mothers, these factors are directly related to MSE, with no mediation effect. IMPLICATIONS FOR PRACTICE: The correlations found between social interactions, fatigue and maternal self-efficacy can be useful in providing appropriate care that includes information and parental support. Health professionals working with postpartum women must assess degree of postpartum fatigue and negative postpartum social interactions as well as social support during the postpartum period.

Evaluation of an intervention to reduce child injury in Bedouin communities in Southern Israel.

BACKGROUND: Child injury is particularly prevalent in low socioeconomic populations and minorities. In Israel, Bedouin children exhibit high rates of injuries and death. A multifaceted community intervention to reduce injury in children in and around the home was run in nine Bedouin communities in Southern Israel during 2014-2018. The aim of the study was to evaluate the effect of the intervention on injuries among children aged 0-4 by comparing emergency room (ER) visits and hospitalisations before and after the intervention. METHODS: Child injury data (ages 0-4, 5-17) for 2013-2018 were obtained from Soroka Medical Center, including ER visits and hospitalisations. Further data on reason for hospitalisation and injury severity score (ISS) were obtained from the National Centre for Trauma Research for 2011-2018. Reach was assessed by calculating the per cent of participants from the total relevant population in each town. Poisson regression was used to assess change over time, from preintervention (2013) to postintervention (2018). RESULTS: A high proportion of educational institutions took part in the intervention, and around 20% of relevant households received a home visit (n=6334). There was a significant reduction in ER visits (7.6%) in children aged 0-4 in 2018 compared with 2013. Hospitalisations did not decrease significantly, although the number of admissions for burns and falls was reduced significantly at follow-up. CONCLUSIONS: This multifaceted intervention programme resulted in reduced injury in children aged 0-4 years in the Bedouin community. The use of simultaneous multiple intervention methods was effective in increasing child safety.

Between-country analysis of implementing an obesity prevention intervention using RE-AIM: HENRY in Israel and UK.

Health Exercise Nutrition for the Really Young (HENRY) is a UK community-based early childhood obesity prevention intervention that was adopted and implemented in Israel between 2013 and 2018. The aim of this study was to explore the implementation process in Israel and compare it with that of the 'parent' programme in the UK, in order to throw light on the challenges of introducing complex interventions into different countries and cultures. Published reports from HENRY and Haifa University's evaluation of the Israeli implementation were reviewed and comparisons between the UK and Israel were carried out utilizing the RE-AIM framework. In both countries, the intention was to implement in lower SES communities. When comparing the individual items, Reach and Effectiveness, we found a difference in the Reach although Effectiveness was similar: Reach was proportionally lower in Israel, but parent and professional changes in behaviour were positive in both countries. For the organizational items Adoption, Implementation and Maintenance, we found large differences between the countries. Major challenges identified in Israel included: failing to take adequate account when planning and implementing the intervention of the different ways social and health services are organized and how local authorities are structured and provide services. In addition, differences in culture beyond language and professional variations were challenges, when trying to transfer the intervention with high fidelity from the UK to Israel. Lessons learnt may benefit others in attempting cross-country implementation of complex interventions.

Design and implementation of a multifaceted injury prevention intervention in Bedouin children in southern Israel.

BACKGROUND: Child injury is prevalent in the Bedouin community of southern Israel, with higher injury rates compared with the general population. Bedouin children aged 0-4 were twice as likely as children from other population groups to suffer any injury, and for example, incidence of burns in Bedouin children was 0.91/1000 children, compared with 0.46/1000 in Jewish children. METHODS: A multifaceted injury prevention intervention was developed based on best practice methods, culturally adapted and implemented in nine Bedouin towns in collaboration with local authorities. Intervention elements included a youth leadership scheme, workshops for mothers in maternal child health centres, home safety visits, a preschool intervention and a media campaign. Outcome assessment of change following home visits was conducted. Process evaluation included a survey of mothers and focus groups with youth participants. RESULTS: High participation was demonstrated indicating acceptability of the programme. Assessment of home visits showed an improvement in the level of household safety between first and second visits, as measured by a checklist. Youth participants expressed satisfaction in the programme, which gave them confidence and practical tools. CONCLUSION: A multifaceted intervention programme was conducted in the Bedouin community in southern Israel and found to be acceptable, with high participation levels. Collaboration between national and local authorities improved implementation, and multiple programmes in different settings enabled broad exposure to the programme.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis.

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.