[THE IMPACT OF ARTIFICIAL INTELLIGENCE AND BIG DATA ON HEALTHCARE].

INTRODUCTION: The fourth industrial revolution has led to a paradigm shift in the world of data; this paper reviews the implications on the medical and health services. These changes include: -The transition to big data: New layers of information such as longitudinal data, OMICS, information from social networks and the internet will be added to the conventional sources of information: anamnesis, physical examination, lab results etc. and will assist in medical decisions. -The transition to medical prediction: The information will allow not only diagnosing the current medical situation, but will also enable predicting the patient's risk level for developing certain diseases in the future. -The transition to artificial intelligence systems: This will enable analysis and generate insights into the vast amount of available information. -The decline in data production and data analysis costs: Much of the information will be collected by the patient himself and derived from his wearable devices. Information that was previously costly and exclusively owned by health officials, will be owned by others including the patient himself. These changes pose risks alongside the opportunities. The pace and quality of incorporating all this data depends on two opposing forces: technological innovation on the one hand, and system barriers on the other. Barriers include objections from users, budgetary constraints, patient privacy and regulatory barriers. The healthcare system must prepare wisely, but quickly, for the dramatic changes.

[THE PARADIGM SHIFT IN MEDICINE FOLLOWING THE 4TH INDUSTRIAL REVOLUTION].

INTRODUCTION: A tremendous paradigm shift is occurring in the field of medicine. This is because the forward momentum in the evolving sphere of digital medicine has opened up new worlds of discovery that all fuse together to form a tsunami of innovation, along with sociological and social changes. The exponential rate of technological change creates profound sociological changes and these dynamics affect the medical field. This paper reviews some dimensions of this paradigm shift, such as the transition from illness to a focus on wellness; the shift from slow medicine into exponential medicine; personalized medicine to digital medicine, and more. Each paradigm shift creates challenges for health professionals, regulators, the public and the industry. The bottom line is that medicine is shifting from hospital back to the home. Physicians, health care organizations, the Ministry of Health, insurance companies and the industry need to prepare for this change - each in their respective areas of expertise. Careful strategic thinking is required, not only to adjust to the change but also to promote it in a patient-centered manner. The role of the medical doctor, the utilization of exponential technologies and finding new uses for existing hospital infrastructures are only secondary challenges with the primary consideration being improving people's health and decreasing medical costs. The best minds and talents should be involved in preparing for this shift and in planning "home hospitalizations" supported by technologies that will give the new patient - consumer exactly what they want and need.

Safe communities for children: insight from a pilot program for preventing unintentional injuries.

This study presents insights in safety promotion of community-based intervention programs, in preventing unintentional injury among children. We modeled and used an evaluation tool to estimate the effectiveness of a community-based injury prevention program. The intervention program consisted of a five-year multidisciplinary, multi-strategic childhood safety promotion and injury prevention protocol. The purpose of the program was to set up safety awareness in ten low-income communities in Israel. This study describes the process, impact and outcome of the intervention program and includes the difficulties faced during the evaluation process, documenting the insights gained from this pilot program. The findings suggest that evaluating the program was a positive and important undertaking. Evaluating the success of the outcome in the earlier program, however, did not confirm its effectiveness. It appears there were hindrances to the progress and implementation of the program. This study gave insights into these obstacles and how we should correct them.

[Emergency Department (ED) administrative data--what can we learn from this data about pediatric injury? Is there a need for a designated injury surveillance system?].

BACKGROUND: Data on injury characteristics can help direct prevention activities. AIMS: To explore the potential use of Emergency Department (ED) data as a source of information regarding child injury in Israel. To examine the need for a designated injury surveillance system in Israel. METHODS: Data on ED visits by children (0-17 years] between the years 2005-2007, for reasons other than illness were extracted from the administrative data system of a pediatric hospital in Israel. Data was analyzed using SPSS. RESULTS: The study included 36,603 children, 62% males. Mean age was 7 (s.d. 5) years. Hospitalization was the outcome for 2333 children (6.5%). The reason for the visit was "other accident" for half of the patients: 15,652 kids (43%) due to falls and 2111 children (6%) were involved in road crashes. Patient complaints included 636 children (2%) that had swallowed an object, 113 of them (18%) were hospitalized. Bruises were the most frequent complaint. Half of the children complained of bruises, 10,277 were bruised as a result of a fall, 1,473 (7.5% of bruised population) were bruised as a result of a road accident. Cuts were the second most frequent complaint (8,773 children, 24%) with only 2% hospitalized. One half of the patients with cuts were aged 0-4 years. Only 231 kids had suffered poisoning, of them, 193 children (84%) infants and toddlers below the age of 4 years and 16% were hospitalized. CONCLUSION: Findings suggest that administrative data can be used to observe pediatric injury patterns. Several new data fields in the existing system could fill information gaps on the external cause of injury. Making this data available to injury prevention professionals should be considered a priority.

[The rationale for promotion of bicycle helmet legislation for children up to 18 years].

BACKGROUND: Each year, many children suffer from injuries caused by bicycles, scooters, skateboards, and roller skates accidents. Head injury is the most common cause of death and serious disability in bicycle-related crashes. In various studies the use of bicycle helmets has been proven to be the most effective measure in preventing head injury: the use of bicycle helmets reduced the risk of head and brain injury by 85-88%. Legislation that mandates the use of helmets has been shown to effectively increase helmet use and, therefore, significantly decrease head injuries among riders. COST-BENEFIT: Legislation requiring helmets will save $44.2 million (direct benefit) to society over a 5-year period, and save approximately 57 lives, 2,544 hospitalizations, and 13,355 emergency room visits. BICYCLE-RELATED DEATHS AND INJURIES IN ISRAEL: Data from trauma registry of 10 hospitals of the Israeli Center for Trauma and Emergency Medicine research indicate that 649 children ages 17 years and under were injured in a bicycle-related accidents (58-serious, 77-medium injury). Bicycle-related injuries accounted for approximately 33% of motor vehicle accidents among children ages 17 years and under. LEGISLATION: Many countries have legislation requiring helmets for riders. In Israel, there is no law requiring helmets. On a telephone survey, conducted by 'Beterem', a high support rate for a law requiring bicycle helmets (89%) was found among parents to children up to 15 years of age. Based on the evidence of the effectiveness of helmets as a means for reducing head injuries in cyclists, and the importance of a law to this effect, the medical community in Israel should act to promote the legislation requiring helmets for children on bicycles, scooters, skateboards, roller skates, and rollerblades.

Epidemiology of pediatric bite/sting injuries. One-year study of a pediatric emergency department in Israel.

Animal bite/sting injuries are a known source of morbidity with a significantly higher incidence among children who are most often bitten in the face, head, and neck. The objective of this study was to provide a better understanding of bite/sting injuries treated at the pediatric emergency department in order to guide preventive efforts. The sociodemographic, epidemiological, and clinical data on all bite/sting injuries treated in one representative pediatric emergency department in Israel over a 1-year period were retrieved and analyzed. Two hundred of the 9,309 pediatric trauma cases treated in the emergency department were bite/sting injuries (2.1%). Non-Jewish patients were under-represented in this subgroup. The majority of patients were males (61.5%). Age distribution from 0-12 years was fairly even, except for an unexplained peak at 8 years. Dogs inflicted 56%, cats 11%, and hornets 9.5% of the injuries. Limbs were affected in 64% and the head and neck in 27%. Specialists, mostly plastic surgeons, were consulted in 42 cases (21%). The incidence rate for hospitalization (7%) was similar to that seen in other types of injuries. Children with scorpion or hornet stings and young age were more likely to be hospitalized. Preventive and educational aspects are discussed.

Parental knowledge on car safety for children: an Israeli survey.

The objective of this study was to assess the level of parental car safety knowledge and actual behavior regarding their children under the age of 15 years. This study forms part of the National Center for Child Safety and Health in Israel (Beterem) program to examine awareness on child safety. Seven hundred and five Jewish families with at least one child at home younger than 15 years (a total of 1,345 children) were used as a randomized sample of the Jewish population. A telephone survey was conducted by professional interviewers using a questionnaire developed by injury prevention specialists consisting of seven knowledge questions and a diagram that described the usual seating positions and restraining method of the family members in the family car. Concerning knowledge about injury prevention, the rate of incorrect answers was high, 64% in regard to the proper car seats for age and 84% in regard to the age for booster seats. Sixty five percent of parents did not know what a booster seat was and 54% did not know that the proper place for children was in the back seat. The average of incorrect answers was 4.86 out of 7 (SD=1.45) correlated with low socioeconomic status. Concerning care safety behavior 60% percent of babies and 38% of toddlers were not restrained properly. This study should alert planners and policy makers to the need of implementation of educational prevention programs for the Israeli public of parents concerning car safety for children in order to reduce childhood injury.

Childhood injury prevention: intervention in the Bedouin city of Rahat.

For several years, the National Center for Children's Health and Safety (Beterem) has worked on many levels to promote safety and prevent injury of the children in Israel. As part of intervention programs in 20 communities around Israel, this paper describes a 1-year, multidisciplinary, multistrategic childhood safety promotion and injury prevention project. The project took place in the Bedouin city of Rahat in the Southern part of Israel, the Negev, conducted by a local safety coordinator. This specific intervention study took place from March 2003 to March 2004. The main goal was to identify hazards and dangerous obstacles in public places in Rahat, then remove or repair the obstacles found, in order to secure a safe public environment for children. "Obstacle" was defined as any barrier that could endanger the safety of a child. Ten examples are used to illustrate this applied research project, and 80% of the problems were solved within the project period (time to solve between 1 week to 3 months, depending on various factors). We recommend the involvement of a safety coordinator from the community to focus on safety hazards for children, the use of a documentation diary to log the time frame, and also the use of pictures to illustrate the hazards and the changes, or to use as arguments in the lobbying process.

Recent trends in adolescent asthma.

Asthma is a disability that can affect the quality of life of the adolescent going through a period with difficulty and often rebellion, but gentle care from the primary physician will guide the adolescent through this period. A worldwide increase in childhood asthma has been observed and recent data from the National Health Interview Survey-2003 in the United States showed an overall 12.5% of children under age 18 years, who ever had asthma diagnosed. This short communication reviews the recent U.S. findings with research on adolescent asthma in Israel, where a study from year 2000 found a higher percentage of ever had diagnosed asthma (13.7%).

Child injury in Israel: emergency room visits to a children's medical center.

The object of this study was to provide data for policy making and prevention program planning in Israel. The study examined all visits to the Department of Emergency Medicine at the Schneider Children's Medical Center in 1996 (41,279 visits in total). Approximately 22.6% of the emergency room patients were admitted following injury. Most (97%) were unintentional injury. Approximately 42% of the patients were less than 4 years old and about 20% were 2 years old. In all age groups, the rate of boys was double. Approximately 92% were Jews. Despite this low rate of non-Jewish patients, however, they constituted 20% of later hospitalizations. The main injuries recorded were bruises and wounds from blunt objects, falls, motor vehicle-related accidents, and sport injuries. The most commonly injured body parts were the head and upper and lower limbs. In 82%, medical treatment was reported and 7% were hospitalized. In examining injuries over the year, there were no significant differences between the different months, but there were clusters of injuries around various holidays--bicycle and skateboard accidents at Rosh Hashanah, Yom Kippur, and Succoth; pedestrian accidents around Lag BaOmer; burns on Purim, Hannukkah, and Passover; and accidental poisoning around Passover. The findings gave an indication of the nature of the injured population groups. These data could be useful for prevention strategy, both on the level of physical injury as well as on the level of the times of the year, when the risk was higher. The data collected very strongly raise the urgent need for establishing a national surveillance system, which would allow tracking injury-related data with respect to young people throughout the country.

Burn injuries and adolescents in Israel.

Burn injury is a public health concern often associated with individual pain, emotional stress, prolonged hospitalizations, permanent disfigurement and family stress. In this paper we studied the avaliable data on burn injury among adolescents in Israel through a Medline search and found three relevant studies with data on this population. The incidence rate of burn injury was 0.46 per 1,000 children aged 5-14 years for Jews and 0.91 for Bedouin. Most of the burn injury in this age group was caused by hot liquids, followed by fire and chemical burns for both Jews and Bedouin, but electical burns occurred more often in Bedouins. Mortality was very low for the adolescent group. Prevention programs in schools since the 1980s have been found effective, but the public health focus should now be geared towards groups at risk.

Youth injury in Israel: an appeal for change.

Unintentional injury in children and adolescents have raised public health concerns in recent years, because it is the leading cause of death, a physical burden for the injured person, an emotional and social burden for the families together with an economic burden for society. The National Center for Children's Safety and Health in Israel was established in 1995 at the Schneider Children's Medical Center in order to focus on prevention of childhood and adolescent injury and safety. Over these years data has been collected from the Central Bureau of Statistics, the Ministry of Health, the National Trauma Register, Police and the National Poison Center in order to look for trends and develop strategies for intervention. These efforts, together with the active prevention programs that have been established, resulted in a national report (1) presented to the Minister of Health and other policy makers in 2003. The current situation of youth injuries in Israel, which over the years have not shown any improvement, necessitates a new agenda with a focus on prevention and collaboration between various ministries and agencies in order to implement it. The report alone cannot have an impact upon youth safety, but we hope that it will provide an impetus for developing youth safety strategies and programs based on data. We also believe there is a need for long-term monitoring and follow-up of youth injury trends in Israel.

[Childhood injuries in Israel: status and prevention strategies].

BACKGROUND: In Israel, as in other developed countries, injuries are a leading cause of death and disabilities among children and youth between 1-19 years of age and the leading cause for Potential Years of Life Lost up to 65 years of age. In 1997, 225 children died as a result of accidental injuries, compared to 151 cases of death due to other internal causes. The most prevalent cause of death being motor vehicle accidents, rating 3:100,000: drowning--1:100,000 and falls, burns, suffocation and poisonings--less than 1:100,000 each. Mortality rates are just the tip of the iceberg, the most extreme outcome of an injury. Hospitalization rates and emergency room visits are higher. Injury was the cause for one out of 3 children to visit the emergency department. Hence, in 2001, there were 187,531 visits due to trauma, an annual rate of 712:10,000. The hospitalization rate due to injuries was 67:10,000 and the mortality rate was 8:100,000. Injuries in the community: Data concerning injuries in the community are relatively rare since no surveillance system exist. In their article "Childhood injuries in northern Israel--prevalence and risk factors", Miron at al. describe the prevalence, demographic variables and risk factors of injuries in the community of northern Israel. The article contributes to our knowledge of accidental injuries at the level of the primary care physician in the community. The findings indicate that falls and blows are the most common causes for mild injuries that usually occur in the home and backyard, and Arab children are at special risk for injuries, in general, and falls, in particular. These findings are consistent with existing data. Prevention is the way: 71-95% of all injuries can be prevented by simple means. This has been proven in many countries that managed to reduce mortality from accidental injuries by 10-20%. In the U.S.A., for example, the percentage was reduced to about 35% in a decade. In Sweden, 3 decades of constant preventive efforts combined with close monitoring of the data have proven effective in reducing rate of mortality due to accidental injuries in children by 80%. The strategies which have proven to be effective are education and publicity, safer products and surroundings, promoting public policy, enforcement, data collection, research and evaluation and empowerment. A combination of strategies is most effective. National Vision: Despite the dismal picture, accidental injuries in children can be prevented and are not inevitable. It is wise to look at injuries as a heterogeneous group of illnesses, with different etiology, risk groups, and 'preventive treatments'--a group of diseases which are all preventable. It is very important that a national strategy for child safety be established accompanied by an adequate budget. Above all, it requires a lot of faith and commitment for the only vision: making the world a safer place for children.