Digital recording and documentation of endoscopic procedures: physicians' practice and perspectives.

BACKGROUND: In recent years, it has become increasingly prevalent internationally to record and archive digital recordings of endoscopic procedures. This emerging documentation tool raises weighty educational, ethical and legal issues - which are viewed as both deterrents and incentives to its adoption. We conducted a survey study aimed at evaluating the use of DRD in endoscopic procedures, to examine physicians' support of this practice and to map the considerations weighed by physicians when deciding whether or not to support a more extensive use of DRD. METHODS: Israeli physicians from specialties that employ endoscopic technics were surveyed anonymously for demographic background, existence and use of recording equipment, existence of institutional guidelines regarding DRD, and self-ranking (on a scale from 1 to 7) of personal attitudes regarding DRD. RESULTS: 322 physicians were surveyed. 84% reported performing routine endoscopic procedures, 78% had the required equipment for digital recording, and 64% of them stated that they never or only rarely actually recorded the procedure. General surgeons had the second highest rate of DRD equipment (96.5%) but the lowest rates of DRD practice (17.5%). The average ranking of support of DRD by all participants was 5.07 ± 1.9, indicating a moderately high level of support. Significant positive correlation exists between actual DRD rates and average support of DRD (p < 0.001). Based on mediation models, for all specialties and with no exceptions, having routine recording guidelines and positive support of DRD were found to increase the probability of actual recording. Being a surgeon or an urologist negatively correlated with support of DRD, and decreased actual recording rates. The argument "Recording might cause more lawsuits" was ranked significantly higher than all other arguments against DRD (p < 0.001), and "Recording could aid teaching of interns" was ranked higher than all other arguments in favor of DRD (p < 0.001). CONCLUSIONS: While DRD facilities and equipment are fairly widespread in Israel, the actual recording rate is generally low and varies among specialties. Having institutional guidelines requiring routine recording and a positive personal support of DRD correlated with actual DRD rates, with general surgeons being markedly less supportive of DRD and having the lowest actual recording rates. Physicians in all specialties were very much concerned about DRD's potential to enhance lawsuits, and this greatly influenced their use of DRD. These findings should be addressed by educational efforts, centering on professionals from reluctant specialties, as well as by the issuing of both professional and institutional guidelines endorsing DRD as well as requiring it where applicable.

War and Well-Being: The Association between Forgiveness, Social Support, Posttraumatic Stress Disorder, and Well-Being during and after War.

Exposure to war can lead to numerous traumatic experiences affecting the daily lives and personal well-being of the civilian population. However, no research to date has examined the associations between postwar well-being and posttraumatic stress disorder (PTSD) symptoms, tendency to forgive, and social support during and following war. Authors examined a sample of 160 Israeli civilians who were exposed to rocket and missile fire during the 2014 Gaza War. Time 1 (Tl) started approximately one week after the beginning of the war and ended four weeks later following the first 72-hour ceasefire declaration by the United Nations. Respondents were re-approached by personal e-mail approximately one month after T1. A structural equation model design showed that higher postwar tendency to forgive, and social support, are associated with higher postwar well-being. It is notable that higher social support during the war had a negative effect on postwar well-being. In addition, higher posttraumatic symptoms and well-being during the war had a positive effect on higher postwar well-being. The study findings reinforce the importance of personal variables in postwar well-being. However, increased awareness of both social support and PTSD symptoms as "double-edged sword" resources is advisable, considering the different effects of social support and PTSD symptoms on well-being both during and after the war.

Illuminating a Risk for Breast Cancer: A Preliminary Ecological Study on the Association Between Streetlight and Breast Cancer.

Artificial light at night (ALAN) for elongating photophase is a new source of pollution. We examined the association between measured ALAN levels and breast cancer (BC) standard morbidity ratio (SMR) at a statistical area (SA) level in an urban environment. Sample size consisted of 266 new BC cases ages 35-74. Light measurements (lux) were performed in 11 SAs. A new calculated variable of morbidity per SA size (SMR35-74/km2) was correlated with the light variables per road length, using Pearson correlations (P < .05, 1-tailed). Looking for a light threshold, we correlated percentage of light points above SA light intensity median with SMR35-74/km2. SMR35-74/km2 was significantly and positively strongly correlated with mean, median, and standard-deviation (SD) light intensity per road length (r = .79, P < .01, R2 = .63; r = .77, P < .01, R2 = .59; and r = .79, P < .01, R2 = .63). Light threshold results demonstrate a marginally significant positive moderate correlation between percentage of points above 16.3 lux and SMR35-74/km2 (r = .48, P < .07; R2 = .23). In situ results support the hypothesis that outdoor ALAN illumination is associated with a higher BC-SMR in a specific area and age group. Moreover, we suggest an outdoor light threshold of approximately 16 lux as the minimal intensity to affect melatonin levels and BC morbidity. To the best of our knowledge, our attempt is the first to use this method and show such association between streetlight intensity and BC morbidity and therefore should be further developed.

Light and the City: Breast Cancer Risk Factors Differ Between Urban and Rural Women in Israel.

Women are exposed to indoor and outdoor artificial light at night (ALAN) in urban and rural environments. Excessive exposure to hazardous ALAN containing short wavelength light may suppress pineal melatonin production and lead to an increased breast cancer (BC) risk. Our objective was to address the differences in BC risks related to light exposure in urban and rural communities. We examined indoor and outdoor light habits of BC patients and controls that had lived in urban and rural areas in a 5-year period, 10 to 15 years before the time of the study. Individual data, night time sleeping habits and individual exposure to ALAN habits were collected using a questionnaire. A total of 252 women (110 BC patients and 142 controls) participated in this study. The sample was divided to subgroups according to dwelling area and disease status. Age matching was completed between all subgroups. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for urban and rural women separately, using binary logistic regression. OR results of urban population (92 BC patients and 72 control) revealed that BC risk increases with daily use of cellphone (OR = 2.13, 95% CI = 1.01-4.49, P < .05) and residence near strong ALAN sources (OR = 1.51, 95% CI = 0.99-2.30, P < .06). Nevertheless, BC risk decreases if a woman was born in Israel (OR = 0.44, 95% CI = 0.21-0.93, P < .03), longer sleep duration (OR = 0.75, 95% CI = 0.53-1.05, P < .1), and reading with bed light illumination before retiring to sleep (OR = 0.77, 95% CI = 0.61-0.96, P < .02). Furthermore, in the rural population (18 BC patients and 66 control) BC risk increases with the number of years past since the last menstruation (OR = 1.12, 95% CI = 1.03-1.22, P < .01). However, BC risk decreases with longer sleep duration (OR = 0.53, 95% CI = 0.24-1.14, P < .1), reading with room light illumination before retiring to sleep (OR = 0.55, 95% CI = 0.29-1.06, P < .07), and sleeping with closed shutters during the night (OR = 0.66, 95% CI = 0.41-1.04, P < .08). These data support the idea that indoor and outdoor nighttime light exposures differ between urban and rural women. Therefore, we suggest that women can influence BC risk and incidence by applying protective personal lighting habits. Further studies with larger sample sizes are needed to strengthen the results.

Can Avoiding Light at Night Reduce the Risk of Breast Cancer?

Excessive exposure to artificial light at night (ALAN) suppresses nocturnal melatonin (MLT) production in the pineal gland and is, therefore, associated with an increased risk of breast cancer (BC). We examined indoor and outdoor light habits of 278 women, BC patients (n = 93), and controls (n = 185; 2010-2014). Cases and controls were age and residential area matched. Data regarding behavior in the sleeping habitat in a 5-year period, 10 to 15 years prior to disease diagnosis, were collected using a questionnaire. Sleep quality, bedtime, sleep duration, TV watching habits, presleeping reading habits, subjective illumination intensity, and type of illumination were collected. Binary logistic regression models were used to calculate odds ratios with 95% confidence intervals (ORs with 95% CIs) for BC patients in relation to those habits. OR results revealed that women who had slept longer (controls), 10 to 15 years before the time of the study, in a period of 5 years, had a significant (OR = 0.74; 95% CI = 0.57-0.97; P < .03) reduced BC risk. Likewise, women who had been moderately exposed to ALAN as a result of reading using bed light (reading lamp) illumination and women who had slept with closed shutters reduced their BC risk: OR = 0.81, 95% CI = 0.67-0.97, P < .02, and OR = 0.82, 95% CI = 0.68-0.99, P < .04, respectively. However, women who had been exposed to ALAN as a result of living near strong illumination sources were at a significantly higher BC risk (OR = 1.52; 95% CI = 1.10-2.12; P < .01). These data support the hypothesis that diminishing nighttime light exposure will diminish BC risk and incidence. This hypothesis needs to be tested directly using available testing strategies and technologies that continuously measure an individual's light exposure, its timing, and sleep length longitudinally and feed this information back to the individual, so that BC risk can be distinguished prospectively.

Risk factors for DSM-5 posttraumatic stress symptoms (PTSS) among Israeli civilians during the 2014 Israel-Hamas war.

In light of current modifications in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for posttraumatic stress disorder (PTSD), this study aimed to revalidate well-known PTSD risk factors related to terrorism and war in Israel, namely, proximity to the Gaza Strip, dissociative symptoms, acute stress disorder (ASD) symptoms, and social support. One hundred and sixty Israeli civilians were assessed during the 2014 Israel-Hamas war at 2 time points: 1 week after the beginning of the operation (t1) and 1 month after initial evaluation (t2), using the DSM-5 PTSD Symptom Levels Scale (PSLS; Gil, Weinberg, Or-Chen, & Harel, 2015). A paired t test analysis showed significant reduction in the respondents' posttraumatic stress symptoms (PTSS) 1 month after the initial assessment point. A structural equation model (SEM) showed that higher ASD symptoms at t1 and higher dissociative symptoms at t2 increased the risk for PTSS at t2. Conversely, higher peritraumatic dissociation at t1 decreased the risk for PTSS at t2. Proximity to the Gaza Strip, and social support, failed to demonstrate significant association with PTSS at t2. DSM-5 PTSS 1 month after prolonged traumatic exposure are strongly associated with high ASD symptoms at 1 week as a risk factor; high levels of peritraumatic dissociation at 1 week as a protective factor; and high levels of dissociative symptoms at 1 month as a risk factor. Theoretically and clinically the findings of the study further suggest that ongoing massive terrorism and war cannot be viewed or treated as identical to other traumas.

Risk factors for DSM 5 PTSD symptoms in Israeli civilians during the Gaza war.

BACKGROUND: In light of the current modifications presented in the diagnostic criteria of posttraumatic stress disorder (PTSD) in the DSM 5, this study aimed at revalidating well-known PTSD risk factors, including gender, peritraumatic dissociation, social support, level of threat, and trait tendency for forgiveness. METHOD: Five hundred and one Israeli civilians were assessed during real-time exposure to missile and rocket fire at the eruption of the Gaza war. Assessments took place approximately one to 2 weeks after the beginning of this military operation, relying on web administration of the study, which allowed simultaneous data collection from respondents in the three regions in Israel that were under attack. RESULTS: A structural equation model design revealed that higher levels of forgiveness toward situations were associated with fewer PTSD symptoms, whereas peritraumatic dissociation and high levels of objective and subjective threat were positively associated with PTSD symptoms. Additionally, females were at higher risk for PTSD symptoms than males. CONCLUSIONS: The findings of this study provide further evidence for the importance of directing preventive attention to those vulnerable to the development of elevated levels of PTSD symptoms. Theoretical and clinical implications of the findings are discussed.

Prediction of perineal trauma during childbirth by assessment of striae gravidarum score.

OBJECTIVE: To explore the association between striae gravidarum (SG) and the risk for perineal trauma (PT) in childbirth. DESIGN: A cross-sectional study. SETTING: Maternity ward in 5 university medical centers. PARTICIPANTS: Three hundred and eighty-five women (28.9+/-5.3 years old) who delivered vaginally. METHODS: Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between PT as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) obtained at the abdomen, hips, buttocks, and breast. RESULTS: Significantly higher TSS scores were found in women with PT compared with women without PT (3.60+/-0.39 vs. 2.31+/-0.23, p=.003). Specifically, striae scores at the breast and hips were significantly higher among women who had PT. Logistic regression analysis revealed that TSS (OR=0.079; 95% CI 1.012, 1.151; p=.021), as well as a rise in body mass index (BMI) during pregnancy (OR=1.025; 95% CI 1.001, 1.049; p=.043) are significant predictors of PT. CONCLUSIONS: This study demonstrates a significant relation between SG and PT. The findings suggest that SG assessment may be used in the clinical setting by midwives and nurses as a simple and noninvasive tool to better define women at risk for PT.

Osmoregulatory traits of broad-toothed field mouse (Apodemus mystacinus) populations from different habitats.

One mechanism for physiological adjustment of small mammals to different habitats and different seasons is by seasonal acclimatization of their osmoregulatory system. We examined the abilities of broad-toothed field mice (Apodemus mystacinus) from different ecosystems ('sub-alpine' and 'Mediterranean') to cope with salinity stress under short day (SD) and long day (LD) photoperiod regimes. We compared urine volume, osmolarity, urea and electrolyte (sodium, potassium and chloride) concentrations. Significant differences were noted in the abilities of mice from the two ecosystems to deal with salinity load; in particular sub-alpine mice produced less concentrated urine than Mediterranean mice with SD- sub-alpine mice seeming to produce particularly dilute urine. Urea concentration generally decreased with increasing salinity, whereas sodium and potassium levels increased, however SD- sub-alpine mice behaved differently and appeared not to be able to excrete electrolytes as effectively as the other groups of mice. Differences observed provide an insight into the kinds of variability that are present within populations inhabiting different ecosystems, thus how populations may be able to respond to potential changes in their environment. Physiological data pertaining to adaptation to increased xeric conditions, as modelled by A. mystacinus, provides valuable information as to how other species may cope with potential climatic challenges.

Managing terror: differences between Jews and Arabs in Israel.

Using telephone surveys, we examined exposure to terror, coping, and mental health response in randomly selected Jewish-Israelis (n = 100) and Arab-Israelis (n = 100) living in five Israeli cities affected by terrorism. Jewish-Israelis and Arab-Israelis were randomly selected for study participation and completed telephone surveys in May 2002, following an extended string of terror attacks and hostilities. Although terrorism is designed to target Jewish-Israelis, the rates of exposure were similar in the two groups. Arab-Israelis reported using a wider array of coping strategies, yet also endorsed more frequent PTSD and more severe depression symptoms than Jewish-Israelis. We examined a variety of demographic, ethnic, and religious predictors of different coping styles and found varying results. For example, acceptance coping was best predicted by Arab-Israeli ethnicity, being female, greater religiosity, and lower education. Predictors of mental health response to terror were also examined, with Arab-Israeli ethnicity, being female, adaptation coping and collaborative coping best predicting PTSD and depression symptoms. Arab-Israelis may not have the same access to overarching sources of patriotic support that are readily available to their Jewish compatriots, and civilian and economic inequity experienced by the Arab minority may add to a sense of diminished resources. Our findings justify outreach efforts to overlooked minorities at risk for posttraumatic distress. Women seem to be at particular risk for the development of mental health symptoms following terrorism, which should also be noted for outreach purposes.