Environmental, Social, and Governance Implementation in Healthcare Organizations: A Case Study of Assuta Medical Centers.

BACKGROUND: Environmental, social, and governance (ESG) is a form of international private business self-regulation that aims to contribute to society from a philanthropic, activist, or charitable nature by engaging in or supporting volunteering or ethically oriented practices. The major benefit of ESG is having the organization's workers recruited for the goal of making the world a better place. There is a growing understanding regarding the extent of the environmental impacts of health services. Therefore, the interest in measuring and reporting the sustainability of health system performance is becoming crucial. As population aging and growth in healthcare demand are two of the main challenges of the current and mainly future health services, performance, and quality measurement as well as sustainability metrices are relevant more than ever. OBJECTIVES: To review the ESG activities at Assuta Medical Centers (AMC) that helped the organization earn the Maala Index Platinum + grade in 2021. METHODS: We reviewed the ESG elements that were implemented at AMC. RESULTS: AMC entered an ESG process in November 2019 and earned Platinum and Platinum+ grades from the Maala Index in 2020 and 2021, respectively. AMC won the Workforce Diversity prize for having many employees over 60 years of age. AMC activities are detailed as a case study for other health organizations in Israel and worldwide. CONCLUSIONS: A big leading health organization can spearhead sustainable development goals model in Israel and worldwide.

Less Is More (Healthy): Overuse of Healthcare Services.

BACKGROUND: Overuse of healthcare services is a common phenomenon defined as: "a healthcare service that is provided under circumstances in which its potential for harm exceeds the possible benefit." It is expressed in the gap between desired services and available ones and is accompanied by high financial and human life costs. One-fifth to one-third of patients receives unnecessary, ineffective, or potentially harmful treatments or services. One of the greatest challenges to understanding overuse is the lack of definition for appropriate use. Apart from the physical and mental damage caused by overuse or improper use of medical services, this phenomenon has many implications, such as increasing waiting times for services, creating long queues, and incurring considerable financial costs as over 10% of hospital expenses are used to correct medical errors or preventable infections. Government intervention through economic arrangements such as deductibles and pre-authorization of services by the insurer are partially effective in reducing the overuse of health services. Additional solutions include ensuring safety and quality of care as well as shared decision-making.

[Efficacy comparison between Chinese medicine's labor inducement methods and conventional methods customary in hospitals].

INTRODUCTION: According to Chinese medicine, a correct balance of Qi (energy) and quantity of blood are vital in order to commence labor and continue the childbirth process. Correspondingly, there are two main reasons for a delayed or difficult childbirth: lack of Qi and blood or stagnation of Qi and blood. AIM: Efficacy comparison of Chinese medicine's inducement methods to conventional methods and to the combination of both. METHODS: Retrospective study with 80 women participating aged 22-40, who required labor inducement. The study group consisted of 50 women who received Chinese medicine's inducement treatment (Shiatsu and/or Acupuncture) prior to and/or during hospitalization. The control group consisted of 30 women who received customary hospital labor inducement methods. All the women received the questionnaires between one month to 10 years after childbirth. RESULTS: Significant correlation was found between Chinese medicine inducement methods (Shiatsu/Acupuncture) and reduction of additional interventions throughout the birth process, when these were given during hospitalization (x2=47.29, d.f.=21, p=0.001). Correlation close to significant was found when inducement was given prior to hospitalization, especially when labor was induced by Shiatsu (x2=16.8, d.f.=9, p=0.052). An outstanding difference was found in shortening the birth process time (MS=0.45, F(6,72)=2.505, p=0.029) when combining Chinese medicine and conventional inducement methods (medicinal/mechanical). CONCLUSIONS: Study results show that Chinese medicine inducement methods, whether or not combined with conventional methods, are an important and effective tool in their ability to reduce the extent of intervention throughout the birth process and also in reducing delivery completion interventions. SUMMARY: Significant difference was found in shortening labor process when inducement treatment combined both Chinese medicine and conventional methods, in comparison to conventional inducement alone {medicinal/mechanical). This is an important result considering the high availability and low cost of Chinese treatment, and especially because it is a non-harmful method of inducement.

Zoonotic disease in a peripheral population: persistence and transmission of Leishmania major in a putative sink-source system in the Negev Highlands, Israel.

Populations at the edge of their geographic distributions are referred to as peripheral populations. Very little attention has been given to this topic in the context of persistence of infectious disease in natural populations. In this study, we examined this question using zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major in the Negev Desert of Israel as a model system. Here, we suggest that the regional persistence of Phlebotomus papatasi populations and L. major transmission in the Sede Boqer region could be explained through processes akin to sink-source and/or mainland-island metapopulation dynamics. Given its potentially enzootically superior ecological conditions, we hypothesize that the Zin Valley ecotope constitutes the "mainland" or the "source" patch for the Sede Boqer area where L. major transmission is persistent and resistant to local extinctions (die-outs) whereas the local sand fly populations on the Zin Plateau ("island patch" or "sink patch") are more prone to local extinctions. Between 2007 and 2008, we trapped sand flies and sand rats in the two areas and compared sand fly abundance and L. major infection prevalence in both. In both 2007 and 2008, sand fly abundance was high and continuous in the Zin Wadi but low and discontinuous in the Zin Plateau. Infection prevalence of sand rats was significantly higher in the Wadi (13%) compared with the Zin Plateau (3%). Minimum infection rate in sand flies did not differ significantly between the two areas. Overall, our results are consistent with the premise that the Zin Valley population is relatively robust in terms of L. major transmission, whereas transmission is potentially more tenuous in the plateau. Understanding the biotic and abiotic processes enabling the persistence of L. major and other vector-borne diseases in peripheral disease foci is important for predicting the effect of anthropogenic land use and climate change.