RESUMEN
BACKGROUND: On 7 October 2023, Hamas lunched a massive terror attack against Israel. The first weeks after were characterized with great uncertainty, insecurity, and fear. OBJECTIVES: To evaluate the effect of the first 2 months of the Iron Swords war on obstetrical emergency attendance and the corresponding perinatal outcomes. METHODS: We conducted a single center retrospective cohort study of all singleton births between 7 October and 7 December 2023. Prenatal emergency labor ward admission numbers and obstetric outcomes during the first 2 months of the war were compared to the combined corresponding periods for the years 2018-2022. RESULTS: During the initial 2 months of the conflict 1379 births were documented. The control group consisted of 7304 deliveries between 2018 and 2022. There was a decrease in daily emergency admissions to the labor ward during the first 5 weeks of the conflict compared to the corresponding periods in the preceding years (51.8 ± 15.0 vs. 57.0 ± 13.0, P = 0.0458). A notable increase in stillbirth rates was observed in the study group compared to the control group (5/1379 [0.36%] vs. 7/7304 [0.1%]; P = 0.014). Both groups exhibited similar gestational ages at birth, rates of preterm and post-term delivery, neonatal birthweights, mode of delivery, and induction of labor rates. CONCLUSIONS: In the initial weeks following Hamas's attack on Israel, there was a notable decrease in admissions to the prenatal emergency labor ward. This decline coincided with an increase in the rate of stillbirths among a population not directly involved in the conflict.
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Resultado del Embarazo , Humanos , Israel/epidemiología , Embarazo , Femenino , Estudios Retrospectivos , Resultado del Embarazo/epidemiología , Adulto , Recién Nacido , Mortinato/epidemiología , Terrorismo/estadística & datos numéricos , Edad Gestacional , Parto Obstétrico/estadística & datos numéricos , Parto Obstétrico/métodosRESUMEN
BACKGROUND: Heart failure (HF) is an emerging pandemic associated with increased mortality, recurrent hospitalizations, and reduced quality of life. Guideline-directed medical therapy has been shown to improve outcomes, particularly in patients with HF with reduced ejection fraction (HFrEF). The main goal of HF clinics is optimizing medical therapy. OBJECTIVES: To assess the impact of our HF clinic on medical therapy and clinical outcomes. METHODS: We obtained demographic, echocardiographic, and clinical data of patients listed in our HF clinic during a 4-year period. Medical therapy was evaluated based on patient reports and documented data. Recurrent admissions for HF were documented. RESULTS: A total of 317 patients (74.1% male, median age 66 years, IQR 55-74) were listed in the clinic with a total of 1140 visits. Of these patients, 62.5% had HFrEF, 20.5% presented with mildly reduced ejection fraction, and 17% showed preserved ejection fraction at the time of the first visit. The use of sodium glucose co-transporter 2 inhibitors and mineralocorticoid receptor antagonists was optimized in 92% and 91% of the patients, respectively. In the subgroup of patients with HFrEF, the use of angiotensin-receptor antagonist/neprilysin inhibitor increased from 22.6% to 87.9% (P < 0.001) and SGLT2 inhibitor use increased from 49.2% to 92% (P < 0.001). During the follow-up period (2.2 years, IQR 1.1-3.1), 203 patients (64%) were readmitted to the hospital for HF at least once. The rate of readmissions decreased over time. CONCLUSIONS: An HF clinic plays an important role in optimizing medical therapy and reducing readmissions.
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Insuficiencia Cardíaca , Antagonistas de Receptores de Mineralocorticoides , Volumen Sistólico , Humanos , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Anciano , Volumen Sistólico/fisiología , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Hospitalización/estadística & datos numéricos , Resultado del Tratamiento , Antagonistas de Receptores de Angiotensina/uso terapéutico , Ecocardiografía/métodos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Israel/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Instituciones de Atención Ambulatoria/estadística & datos numéricosRESUMEN
BACKGROUND: Hemodialysis requires reliable, recurrent access to the circulatory system. Central venous tunneled dialysis catheters (TDC) are frequently used for patients receiving hemodialysis as a bridge to permanent vascular access or as a final option. TDC are prone to complications such as infection and dysfunction. OBJECTIVES: To assess the prevalence and predictors of TDC dysfunction in a cohort of chronic hemodialysis patients. METHODS: This single-center, retrospective study was based on data from an electronic database of chronic hemodialysis patients during 5 years of follow-up. RESULTS: A total of 625 TDC were inserted in 361 patients, of which 234 (37.4%) were replaced due to dysfunction. The main insertion site was the right internal jugular vein. Diabetes mellitus was an important predictor of TDC dysfunction and was significantly correlated with TDC extraction. Chronic anticoagulation and antiplatelet treatment did not affect the rate of TDC dysfunction or replacement. CONCLUSIONS: TDC use for chronic dialysis patients is increasing and dysfunction is a major problem. In our study, we highlighted the high prevalence of TDC dysfunction and the need for further research to improve hemodialysis access as well as TDC patency and function.
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Cateterismo Venoso Central , Catéteres de Permanencia , Diálisis Renal , Humanos , Diálisis Renal/métodos , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Prevalencia , Persona de Mediana Edad , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Catéteres de Permanencia/efectos adversos , Anciano , Venas Yugulares , Catéteres Venosos Centrales/efectos adversos , Falla de Equipo/estadística & datos numéricos , Factores de Riesgo , Fallo Renal Crónico/terapia , Fallo Renal Crónico/epidemiología , Israel/epidemiología , Estudios de SeguimientoRESUMEN
AIMS: The COVID-19 pandemic has long-lasting deleterious effects on many aspects of the survivors' life. However, the correlations between the severity of COVID-19 infection and rehabilitation outcomes are still unknown. METHODS: Sixty-one post-acute COVID-19 patients underwent a customized rehabilitation program in a rehabilitation daycare facility. The severity of the COVID-19 infection was measured according to the WHO clinical progression scale (CPS). Motor, cognitive, psychological and functional variables were measured using standard and specified scales; 19 out of 61 patients underwent nerve conduction studies. RESULTS: The mean age of participants was 54 years (range 18-84 years), 66% were males, 65% had severe disease according to CPS. The mean length of acute hospitalization was 5.6 ± 4.2 weeks, mean rehabilitation time and mean follow up time was 3.2 ± 2.1 months and 7.2 ± 3.2 months, respectively. A significant improvement was found in activities of daily living (ADL) functions as well as in hand motor strength and walking endurance. A significant correlation was found between higher CPS, prolonged acute hospitalization and ventilation and lower admission functional independence measure (FIM), however no correlation was found between the parameters of acute diseases and FIM at discharge. Moreover, lower CPS was correlated with higher anxiety, depression and lower executive functions score. There was correlation between electrophysiological findings of the median and the peroneal nerves and the motor FIM at discharge. CONCLUSIONS: A customized rehabilitation program can overcome initial motor, mental and cognitive impairments and significantly improves the motor function of covid-19 recovered patients. The results of this study highlight the importance of monitoring and treating the emotional status, particularly anxiety, of COVID-19 patients. Nerve conduction measurements in COVID-19 patients are important in order to evaluate prognosis and improvement in rehabilitation outcomes.
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Actividades Cotidianas , COVID-19 , SARS-CoV-2 , Humanos , COVID-19/rehabilitación , COVID-19/epidemiología , Persona de Mediana Edad , Masculino , Femenino , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Adolescente , Israel/epidemiología , Índice de Severidad de la EnfermedadRESUMEN
Molluscum contagiosum (MC) is a common skin infection affecting children globally, including in Israel, which has a diverse population comprising mainly Jews (73.2%) and Arabs (21.1%). Despite documented disparities in various diseases between these groups, research on differences in dermatological care is scarce. This study aimed to investigate MC as a potential differentiator between Arab and Jewish children. A retrospective analysis of MC cases among children (0-18 years) from 2013 to 2022 was performed at Soroka University Medical Center, a tertiary hospital serving over a million patients. 615 patients participated in our study, with 95.2% Jewish and 4.8% Arab. Both groups showed similar characteristics in lesion quantity (P = 0.535), diameter (P = 0.341), inflammation markers, and lesion location. Additionally, management, treatment response, and outcomes were found to be similar between the two groups. In conclusion, the Arab representation in the study was disproportionately low compared to their population in the area. While Jewish patients may rely more on medical specialists, we believe Arabs may prefer self-management practices, such as the use of traditional medicine, possibly hindering effective physician-led care. Understanding such disparities could improve dermatological care by tailoring approaches to diverse populations.
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Árabes , Judíos , Molusco Contagioso , Humanos , Niño , Molusco Contagioso/epidemiología , Molusco Contagioso/terapia , Israel/epidemiología , Masculino , Femenino , Preescolar , Lactante , Árabes/estadística & datos numéricos , Adolescente , Estudios Retrospectivos , Judíos/estadística & datos numéricos , Recién Nacido , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnologíaRESUMEN
Evidence on unnecessary antibiotic use in children with acute viral gastroenteritis (AGE) is scarce. We characterized the extent and correlates of antibiotic use among children hospitalized with viral AGE. A single-center study enrolled children aged 0-59 months hospitalized for AGE between 2008 and 2015 in Israel. Information was collected on laboratory tests, diagnoses, antibiotic treatment, and rotavirus vaccination. Stool samples were tested for rotavirus antigen, GII-norovirus, and stool cultures were performed for bacterial enteropathogens. Data from 2240 children were analyzed. Rotavirus vaccine was given to 79% of eligible children. Rotavirus test was performed on 1419 (63.3%) children. Before the introduction of universal rotavirus vaccination (2008-2010), rotavirus positivity in stool samples was 37.0%, which declined to 17.3% during the universal vaccination years (2011-2015). Overall, 1395 participants had viral AGE. Of those, 253 (18.1% [95% CI 16.1-20.2]) had unnecessary antibiotic treatment, mostly penicillin 46.6%, ceftriaxone 34.0% and azithromycin 21.7%. A multivariable analysis showed an inverse association between rotavirus vaccination and unnecessary antibiotic treatment (odds ratio = 0.53 [95% CI 0.31-0.91]), while positive associations were found with performing chest-X-ray test (3.00 [1.73-5.23]), blood (3.29 [95% CI 1.85-5.86]) and urine cultures (7.12 [3.77-13.43]), levels of C-reactive protein (1.02 [1.01-1.02]) and leukocytes (1.05 [1.01-1.09]). The results were consistent in an analysis of children with laboratory-confirmed rotavirus or norovirus AGE, or after excluding children with CRP > 50 mg/L. In conclusion, antibiotic prescription was common among hospitalized children with viral AGE, which was inversely related to rotavirus vaccination, possibly due to less severe illness in the vaccinated children.
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Antibacterianos , Gastroenteritis , Hospitalización , Infecciones por Rotavirus , Vacunas contra Rotavirus , Humanos , Gastroenteritis/virología , Gastroenteritis/prevención & control , Gastroenteritis/tratamiento farmacológico , Lactante , Vacunas contra Rotavirus/administración & dosificación , Vacunas contra Rotavirus/inmunología , Preescolar , Masculino , Femenino , Antibacterianos/uso terapéutico , Infecciones por Rotavirus/prevención & control , Hospitalización/estadística & datos numéricos , Israel/epidemiología , Recién Nacido , Heces/virología , Heces/microbiología , Rotavirus/inmunología , Rotavirus/aislamiento & purificación , Vacunación/estadística & datos numéricos , Norovirus/inmunologíaRESUMEN
Biofilm formation and toxin production are some of the virulence factors of Clostridioides difficile (C. difficile), which causes hospital-acquired C. difficile infection (HA-CDI). This work investigated the prevalence and distribution of different strains recovered from HA-CDI patients hospitalized in 4 medical centres across Israel, and characterized strains' virulence factors and antibiotic susceptibility. One-hundred and eighty-eight faecal samples were collected. C. difficile 's toxins were detected by the CerTest Clostridium difficile GDH + Toxin A + B combo card test kit. Toxin loci PaLoc and PaCdt were detected by whole-genome sequencing (WGS). Multi-locus sequence typing (MLST) was performed to classify strains. Biofilm production was assessed by crystal violet. Antibiotic susceptibility was determined using Etest. Fidaxomicin susceptibility was tested via agar dilution. Sequence type (ST) 42 was the most (13.8%) common strain. All strains harboured the 2 toxins genes; 6.9% had the binary toxin. Most isolates were susceptible to metronidazole (98.9%) and vancomycin (99.5%). Eleven (5.85%) isolates were fidaxomicin-resistant. Biofilm production capacity was associated with ST (p < 0.001). In conclusion, a broad variety of C. difficile strains circulate in Israel's medical centres. Further studies are needed to explore the differences and their contribution to HA-CDI epidemiology.
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Antibacterianos , Biopelículas , Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Pruebas de Sensibilidad Microbiana , Factores de Virulencia , Clostridioides difficile/genética , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Clostridioides difficile/patogenicidad , Humanos , Israel/epidemiología , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/epidemiología , Antibacterianos/farmacología , Factores de Virulencia/genética , Masculino , Femenino , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Anciano , Persona de Mediana Edad , Tipificación de Secuencias Multilocus , Adulto , Anciano de 80 o más Años , Secuenciación Completa del Genoma , Heces/microbiologíaRESUMEN
The deleterious health effects of prolonged sitting and physical inactivity are well-established, yet these behaviors are pervasive in modern culture. To inform interventions aimed at reducing sedentary behavior and increasing lifestyle activity, this study examined psychological and behavioral economic factors that may be associated with these behaviors. This cross-sectional study was conducted among 4072 adults in Israel. Participants completed a survey pertaining to lifestyle behaviors and economic preferences using an online platform in September 2020. The psychological and behavioral economic factors of interest were patience, self-control, risk-taking, grit, and general self-efficacy. Sedentary behavior and lifestyle activity (e.g., time spent moving about) was assessed using the Rapid Assessment Disuse Index (RADI) tool (higher score indicative of more sitting and less activity). Multivariable linear and logistic regression analyses examined the association between psychological and behavioral economic factors and RADI score. Among 4072 participants, those who were impatient (vs. patient, ß: -1.13; 95% CI: -1.89, -0.38) had higher grit (ß: -1.25, 95% CI: -1.73, -0.77), and those who were more risk-seeking (ß: -0.23; 95% CI: -0.33, -0.13) had lower RADI scores (i.e., less sedentary, more active). Significant associations for grit and risk-taking were also observed when the RADI score was dichotomized, such that individuals who had higher grit or were more risk-seeking were more likely to be non-sedentary/active. No significant associations were observed for self-control or general self-efficacy. Higher grit and more risk-seeking were associated with a decreased propensity for sedentary behaviors and inactivity; these factors may provide targets for interventions aimed at reducing sedentary behavior and increasing lifestyle activity.
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COVID-19 , Conducta Sedentaria , Humanos , Masculino , Femenino , COVID-19/psicología , Estudios Transversales , Adulto , Persona de Mediana Edad , Israel/epidemiología , Ejercicio Físico/psicología , Anciano , SARS-CoV-2 , Autoeficacia , Economía del Comportamiento , Adulto Joven , Encuestas y Cuestionarios , Asunción de RiesgosRESUMEN
BACKGROUND: The prevalence of vitamin D deficiency has been a growing concern in recent years. Vitamin D is important in many of the body's physiological systems, such as the musculoskeletal, cardiovascular and immune functions. A deficiency of vitamin D in athletes may negatively impact both muscle functions and recovery and, thus, affect performance and increase the risk of injury. Many studies assessed the prevalence of vitamin D deficiency in athletes; however, as of today, there are no official recommendations/protocols for screening vitamin D levels in athletes, and only a few studies were performed in male and female elite athletes (i.e., Olympic level), in different sport disciplines. METHOD: We investigated the prevalence of vitamin D deficiency among athletes entering the Israeli Olympic team. A total of 761 samples of Vitamin D(OH)25 from 334 athletes were analyzed. For this analysis, we used the first test the athlete had performed when joining the Olympic team. The prevalence of vitamin D deficiency (<50 nmol/L, as defined by the Endocrine Society Committee) was investigated according to gender, types of sports and outdoor vs. indoor sports through the different seasons of the Israeli Olympic team athletes. RESULT: Twenty-five athletes (7.5%) were diagnosed with vitamin D deficiency. One hundred and thirty-one athletes (39.2%) had insufficient levels of vitamin D (50-75 nmol/L). The highest incidence of vitamin D deficiency was found amongst gymnastics and combat sport athletes. A significant difference was also found in vitamin D concentration between seasons. Vitamin D average concentration in the winter was 74.1 nmol/L compared to 86.4 nmol/L in the Summer (p < 0.0005). CONCLUSIONS: Due to the importance of vitamin D to athletic performance and the high prevalence of deficiency and insufficiency, we suggest careful and frequent monitoring of groups at risk, including elite athletes, especially in susceptible sports and during the winter. Future studies are necessary to investigate the effectiveness of Vitamin D supplementation in athletes with low baseline vitamin D levels.
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Atletas , Deficiencia de Vitamina D , Vitamina D , Humanos , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/sangre , Israel/epidemiología , Masculino , Femenino , Vitamina D/sangre , Atletas/estadística & datos numéricos , Prevalencia , Adulto , Adulto Joven , Estaciones del Año , DeportesRESUMEN
BACKGROUND: Radon is a radioactive gas and a major risk factor for lung cancer (LC). METHODS: We investigated the dose-response relationship between radon and LC risk in the International Lung Cancer Consortium with 8927 cases and 5562 controls from Europe, North America, and Israel, conducted between 1992 and 2016. Spatial indoor radon exposure in the residential area (sIR) obtained from national surveys was linked to the participants' residential geolocation. Parametric linear and spline functions were fitted within a logistic regression framework. RESULTS: We observed a non-linear spatial-dose response relationship for sIR < 200 Bq/m3. The lowest risk was observed for areas of mean exposure of 58 Bq/m3 (95% CI: 56.1-59.2 Bq/m3). The relative risk of lung cancer increased to the same degree in areas averaging 25 Bq/m3 (OR = 1.31, 95% CI: 1.01-1.59) as in areas with a mean of 100 Bq/m3 (OR = 1.34, 95% CI: 1.20-1.45). The strongest association was observed for small cell lung cancer and the weakest for squamous cell carcinoma. A stronger association was also observed in men, but only at higher exposure levels. The non-linear association is primarily observed among the younger population (age < 69 years), but not in the older population, which can potentially represent different biological radiation responses. CONCLUSIONS: The sIR is useful as proxy of individual radon exposure in epidemiological studies on lung cancer. The usual assumption of a linear, no-threshold dose-response relationship, as can be made for individual radon exposures, may not be optimal for sIR values of less than 200 Bq/m3.
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Contaminación del Aire Interior , Neoplasias Pulmonares , Radón , Humanos , Radón/efectos adversos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Masculino , Femenino , Contaminación del Aire Interior/efectos adversos , Contaminación del Aire Interior/análisis , Persona de Mediana Edad , Anciano , Estudios de Casos y Controles , Contaminantes Radiactivos del Aire/efectos adversos , Contaminantes Radiactivos del Aire/análisis , Neoplasias Inducidas por Radiación/epidemiología , Neoplasias Inducidas por Radiación/etiología , Factores de Riesgo , Europa (Continente)/epidemiología , Israel/epidemiología , Adulto , Relación Dosis-Respuesta en la Radiación , América del Norte/epidemiologíaRESUMEN
With about 1200 individuals murdered, the massacre of October 7th was one of the deadliest terrorist attacks in modern history. The mental health consequences of terrorist attacks have been documented. However, little is known of the impact of the potentially morally injurious experience (PMIE) of betrayal--in which individuals feel betrayed by leaders they once trusted--on levels of psychological burden in the aftermath of such an attack. In this national prospective cohort study, we examined to what extent the PMIE of betrayal exacerbates the risk for posttraumatic stress disorder (PTSD) and depression in the wake of the October 7th terrorist attack. A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 (M = 41.01, SD = 13.72) completed validated self-report questionnaires assessing PTSD, depression, and PMIE-betrayal at two timepoints: T1, in August 2023 (6-7 weeks before the attack) and T2, in November 2023 (5-6 weeks after the attack). In two hierarchical logistic regressions, we found that experience of PMIE-betrayal predicted diagnoses of both PTSD (OR 1.92, 95% CI 1.26-2.92) and depression (OR 2.03, 95% CI 1.37-3.01) at T2, beyond probable PTSD/depression at T1 and demographic and trauma-related variables. Moreover, in two repeated-measure analyses predicting PTSD/depression symptoms, we found significant interactions between PTSD/depression trajectories and PMIE-betrayal, meaning that the increase of PTSD/depression symptoms was significantly higher among participants experiencing betrayal in the context of the attack. Our study highlights the impact of PMIE of betrayal on the dramatic increase in psychopathology following the October 7th terror attack on Israel's population. Clinicians treating individuals coping with PTSD and depression should attend to their patients' possible exposure to betrayal following the attack. Moreover, national leaders and policymakers should take significant steps to repair the public's betrayal experience.
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Depresión , Trastornos por Estrés Postraumático , Terrorismo , Humanos , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/epidemiología , Femenino , Masculino , Adulto , Terrorismo/psicología , Persona de Mediana Edad , Depresión/psicología , Depresión/etiología , Depresión/epidemiología , Anciano , Israel/epidemiología , Estudios Prospectivos , Adolescente , Anciano de 80 o más Años , Adulto Joven , Encuestas y Cuestionarios , Judíos/psicologíaRESUMEN
INTRODUCTION: The Soroka University Medical Center has treated thousands of wounded civilians and soldiers since the outbreak of the "Swords of Iron" war. The mental health division in Soroka treated many patients suffering from acute and multisystemic injuries, during hospitalization in the intensive care units and other departments. Data on the uniqueness of the mental health interventions in these situations is scarce. In this article we will explain the characteristics of the mental health interventions in three representative cases emphasizing principles for a short and focused intervention, aiming to reduce the risk of developing post-traumatic syndrome or other stress related disorders.
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Hospitalización , Personal Militar , Trastornos por Estrés Postraumático , Centros de Atención Terciaria , Humanos , Trastornos por Estrés Postraumático/terapia , Masculino , Adulto , Hospitalización/estadística & datos numéricos , Israel/epidemiología , Heridas y Lesiones/terapia , Servicios de Salud Mental/organización & administraciónRESUMEN
The study examined risk factors for sensitivity to terror threats among descendants of Holocaust survivors (Holocaust G1) during a significant rise in terrorist attacks in Israel. We examined the association of the number of familial Holocaust G1, trauma exposure, probable posttraumatic stress disorder (PTSD), anxiety symptoms, and Holocaust centrality with terror threat salience (TTS) in children and grandchildren of Holocaust G1 (Holocaust G2; G3). A web-based national sample included 297 Holocaust G2 (Mage=62.95, SD=10.25), 224 comparison G2 (Mage=61.79, SD=10.13), 379 Holocaust G3 (Mage=34.02, SD=8.65) and 171 comparison G3 (Mage=33.55, SD=8.26). Participants completed questionnaires on background characteristics, Holocaust background, trauma exposure, probable PTSD, anxiety symptoms, Holocaust centrality, and TTS. Findings showed that Holocaust G2 and G3 reported higher Holocaust centrality and TTS relative to comparisons, and Holocaust G3 reported higher levels of anxiety than comparison G3. The number of Holocaust G1, background characteristics, Holocaust centrality, and anxiety symptoms were associated with TTS in G2 and G3. Probable PTSD and trauma exposure were also associated with TTS in G2 and G3, respectively. Results highlight Holocaust centrality and anxiety among the factors associated with an increased preoccupation with terror threats in Holocaust descendants. Practitioners should implement interventions focusing on these factors, particularly at times of increased terrorism.
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Ansiedad , Holocausto , Trastornos por Estrés Postraumático , Sobrevivientes , Terrorismo , Humanos , Holocausto/psicología , Masculino , Femenino , Sobrevivientes/psicología , Sobrevivientes/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Israel/epidemiología , Ansiedad/epidemiología , Ansiedad/psicología , Factores de Riesgo , Persona de Mediana Edad , Adulto , Anciano , Terrorismo/psicología , Terrorismo/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Cats are now recognized as competent hosts for Leishmania infantum and a blood source for sand fly vectors. Although canine leishmaniosis (CanL) is endemic in Mediterranean Basin countries, large-scale epidemiological studies are lacking for feline leishmaniosis (FeL). This study aimed to assess the prevalence of L. infantum infections, associated risk factors, clinical signs, and clinicopathological abnormalities in domestic cat populations from six Mediterranean Basin countries. METHODS: From 2019 to 2022, blood and serum samples of cats (n = 2067) living in Italy (n = 300), Greece (n = 297), Portugal (n = 295), France (n = 231), Israel (n = 313), and Spain (n = 631) were collected along with animal data (i.e., age, sex, breed, housing conditions, and geographical origin), clinical signs, and laboratory blood test parameters. Cats were grouped according to their age as kittens (up to 1 year), young (older than 1 and younger than 7 years), mature (between 7 and 10 years), and senior (older than 10 years). Serum samples were tested for L. infantum by immunofluorescence antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA), and blood samples of seropositive cats were tested for L. infantum kinetoplast deoxyribonucleic acid (kDNA). Viral infection by feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) was molecularly addressed in all cats enrolled. Statistical analysis was performed to evaluate the association between the risk of L. infantum infection and independent variables, and among co-infection of L. infantum with FIV and/or FeLV, clinical signs, and clinicopathological abnormalities. RESULTS: Overall, 17.3% (358/2067) of cats scored positive for L. infantum by serological tests. Specifically, 24.7% were from Portugal, 23.2% from Greece, 16.6% from Israel, 15% from Spain, 13.3% from France, and 12.6% from Italy. Leishmania infantum DNA was detected in 15 seropositive animals. Housing condition and FIV infection proved to be risk factors for FeL. Leishmania seropositivity was significantly associated with weight loss, lymphadenomegaly, gingivostomatitis, and oral ulcers, as well as with reduced albumin and albumin/globulin ratio, increased total globulins and total proteins, leukocytosis, and thrombocytosis. CONCLUSIONS: This study provides, for the first time, a large-scale epidemiological survey on FeL and its clinical presentation, revealing that L. infantum circulates among domestic cats, especially shelter/free-roaming and FIV-infected animals, living in CanL endemic countries of the Mediterranean Basin.
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Enfermedades de los Gatos , Leishmania infantum , Leishmaniasis Visceral , Animales , Gatos , Enfermedades de los Gatos/epidemiología , Enfermedades de los Gatos/parasitología , Enfermedades de los Gatos/virología , Leishmania infantum/aislamiento & purificación , Leishmania infantum/genética , Masculino , Femenino , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/veterinaria , Leishmaniasis Visceral/parasitología , Región Mediterránea/epidemiología , Factores de Riesgo , Prevalencia , España/epidemiología , Grecia/epidemiología , Portugal/epidemiología , Anticuerpos Antiprotozoarios/sangre , Virus de la Leucemia Felina/aislamiento & purificación , Virus de la Leucemia Felina/genética , Francia/epidemiología , Italia/epidemiología , Leishmaniasis/epidemiología , Leishmaniasis/veterinaria , Virus de la Inmunodeficiencia Felina/aislamiento & purificación , Israel/epidemiologíaRESUMEN
Breastfeeding is associated with medical and developmental benefits. This study aimed to assess associations between nutritional patterns in the first year of life and the likelihood of autism spectrum disorder (ASD). 270 children diagnosed with ASD (cases) and 500 neurotypical children (controls) matched to cases by sex, ethnicity, and birth date (± 3 months) were included in this retrospective case-control study. Both groups were ascertained from children born between 2014 and 2017 whose development/nutrition were monitored at mother-child health clinics in southern Israel. Conditional logistic regression was used to determine the independent association of nutritional patterns with ASD while adjusting for socio-demographic and clinical characteristics. Both exclusive and partial breastfeeding modes were associated with decreased odds of ASD diagnosis (aOR = 0.221, 95%CI = 0.136-0.360; aOR = 0.494, 95%CI = 0.328-0.743, respectively). A breastfeeding duration of >12 months was associated with lower ASD odds (aOR = 0.418, 95%CI = 0.204-0.855), while the introduction of solids after 6 months of age was associated with higher ASD odds than the introduction of solids at 6 months (aOR = 2.455, 95%CI = 1.116-4.201). These findings suggest that a longer period of exclusive breastfeeding is associated with a subsequent reduced likelihood of ASD diagnosis, thus reiterating the importance of proper post-natal nutrition for infant neurodevelopment.
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Trastorno del Espectro Autista , Lactancia Materna , Humanos , Lactancia Materna/estadística & datos numéricos , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/diagnóstico , Femenino , Masculino , Lactante , Estudios Retrospectivos , Estudios de Casos y Controles , Israel/epidemiología , Preescolar , Recién NacidoRESUMEN
BackgroundA new respiratory virus surveillance platform, based on nationwide hospital laboratory data, was established in Israel during the COVID-19 pandemic.AimWe aimed to evaluate the performance of this platform with respect to the detection of influenza and respiratory syncytial virus (RSV) from week 36 in 2020 to week 15 in 2023, and how it fits with the World Health Organization (WHO) mosaic surveillance framework.MethodsData of respiratory samples from hospitalised patients sent for laboratory confirmation of influenza virus or RSV from 25 general hospital laboratories nationwide were collected. We analysed the weekly number and percentage of samples positive for influenza virus or RSV vis-à-vis SARS-CoV-2 activity and compared data from the new surveillance platform with existing surveillance platforms. Using data in the new surveillance platform, we analysed early stages of a 2021 out-of-season RSV outbreak and evaluated the capabilities of the new surveillance system with respect to objectives and domains of the WHO mosaic framework.ResultsThe new hospital-laboratory surveillance platform captured the activity of influenza virus and RSV, provided crucial data when outpatient sentinel surveillance was not operational and supported an out-of-season RSV outbreak investigation. The new surveillance platform fulfilled important objectives in all three domains of the mosaic framework and could serve for gathering additional information to fulfil more domain objectives.ConclusionThe new hospital laboratory surveillance platform provided essential data during the COVID-19 pandemic and beyond, fulfilled important domain objectives of the mosaic framework and could be adapted for the surveillance of other viruses.
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COVID-19 , Gripe Humana , Pandemias , Infecciones por Virus Sincitial Respiratorio , SARS-CoV-2 , Organización Mundial de la Salud , Humanos , COVID-19/epidemiología , Israel/epidemiología , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/diagnóstico , Vigilancia de Guardia , Laboratorios de Hospital/estadística & datos numéricos , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Vigilancia de la Población/métodosRESUMEN
BackgroundShigella is a leading cause of moderate-to-severe diarrhoea worldwide and diarrhoeal deaths in children in low- and-middle-income countries.AimWe investigated trends and characteristics of shigellosis and antimicrobial resistance of Shigella sonnei in Israel.MethodsWe analysed data generated by the Sentinel Laboratory-Based Surveillance Network for Enteric Pathogens that systematically collects data on detection of Shigella at sentinel laboratories, along with the characterisation of the isolates at the Shigella National Reference Laboratory. Trends in the shigellosis incidence were assessed using Joinpoint regression and interrupted time-series analyses.ResultsThe average incidence of culture-confirmed shigellosis in Israel declined from 114 per 100,000 population (95% confidence interval (CI): 112-115) 1998-2004 to 80 per 100,000 population (95% CI: 79-82) 2005-2011. This rate remained stable 2012-2019, being 18-32 times higher than that reported from the United States or European high-income countries. After decreasing to its lowest values during the COVID-19 pandemic years (19/100,000 in 2020 and 5/100,000 in 2021), the incidence of culture-confirmed shigellosis increased to 39 per 100,000 population in 2022. Shigella sonnei is the most common serogroup, responsible for a cyclic occurrence of propagated epidemics, and the proportion of Shigella flexneri has decreased. Simultaneous resistance of S. sonnei to ceftriaxone, ampicillin and sulphamethoxazole-trimethoprim increased from 8.5% (34/402) in 2020 to 92.0% (801/876) in 2022.ConclusionsThese findings reinforce the need for continuous laboratory-based surveillance and inform the primary and secondary prevention strategies for shigellosis in Israel and other endemic high-income countries or communities.
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Antibacterianos , Disentería Bacilar , Vigilancia de Guardia , Shigella sonnei , Humanos , Disentería Bacilar/epidemiología , Disentería Bacilar/microbiología , Disentería Bacilar/diagnóstico , Israel/epidemiología , Niño , Preescolar , Incidencia , Adolescente , Lactante , Masculino , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Femenino , Shigella sonnei/aislamiento & purificación , Shigella sonnei/efectos de los fármacos , Adulto , Persona de Mediana Edad , Adulto Joven , COVID-19/epidemiología , SARS-CoV-2 , Pruebas de Sensibilidad Microbiana , Anciano , Diarrea/epidemiología , Diarrea/microbiología , Recién Nacido , Farmacorresistencia BacterianaRESUMEN
BackgroundHealthcare personnel (HCP) are at high risk for respiratory infections through occupational exposure to respiratory viruses.AimWe used data from a prospective influenza vaccine effectiveness study in HCP to quantify the incidence of acute respiratory infections (ARI) and their associated presenteeism and absenteeism.MethodsAt the start and end of each season, HCP at two Israeli hospitals provided serum to screen for antibodies to influenza virus using the haemagglutination inhibition assay. During the season, active monitoring for the development of ARI symptoms was conducted twice a week by RT-PCR testing of nasal swabs for influenza and respiratory syncytial virus (RSV). Workplace presenteeism and absenteeism were documented. We calculated incidences of influenza- and RSV-associated ARI and applied sampling weights to make estimates representative of the source population.ResultsThe median age of 2,505 participating HCP was 41 years, and 70% were female. Incidence was 9.1 per 100 person-seasons (95%â¯CI:â¯5.8-14.2) for RT-PCR-confirmed influenza and 2.5 per 100 person-seasons (95%â¯CI:â¯0.9-7.1) for RSV illness. Each season, 18-23% of unvaccinated and influenza-negative HCP seroconverted. The incidence of seroconversion or RT-PCR-confirmed influenza was 27.5 per 100 person-seasons (95%â¯CI:â¯17.8-42.5). Work during illness occurred in 92% (95%â¯CI:â¯91-93) of ARI episodes, absence from work in 38% (95%â¯CI:â¯36-40).ConclusionInfluenza virus and RSV infections and associated presenteeism and absenteeism were common among HCP. Improving vaccination uptake among HCP, infection control, and encouraging sick HCP to stay home are important strategies to reduce ARI incidence and decrease the risk of in-hospital transmission.
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Absentismo , Personal de Salud , Gripe Humana , Presentismo , Infecciones por Virus Sincitial Respiratorio , Estaciones del Año , Humanos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/virología , Gripe Humana/epidemiología , Gripe Humana/virología , Gripe Humana/diagnóstico , Gripe Humana/prevención & control , Femenino , Incidencia , Masculino , Personal de Salud/estadística & datos numéricos , Israel/epidemiología , Adulto , Presentismo/estadística & datos numéricos , Persona de Mediana Edad , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/inmunología , Virus Sincitiales Respiratorios/aislamiento & purificación , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Virus Sincitial Respiratorio Humano/genética , Exposición Profesional/estadística & datos numéricos , Pruebas de Inhibición de HemaglutinaciónRESUMEN
BACKGROUND: The COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19. METHODS: A multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed. RESULTS: Four hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05-1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts. CONCLUSION: In conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.
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COVID-19 , Inseguridad Alimentaria , Refugiados , Humanos , Israel/epidemiología , Refugiados/estadística & datos numéricos , Refugiados/psicología , Femenino , Adulto , Masculino , COVID-19/epidemiología , Encuestas y Cuestionarios , Poblaciones Vulnerables/estadística & datos numéricos , Poblaciones Vulnerables/psicología , Abastecimiento de Alimentos/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Persona de Mediana Edad , Grupos FocalesRESUMEN
BACKGROUND: Over the past 20 years, Jewish and Bedouin civilians in southern Israel have faced the ongoing threat of missile attacks from Gaza, with possible mental health consequences. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) among Jewish and Bedouin adult civilians in southern Israel in a period with few missile attacks from Gaza, and no military operations. METHODS: The study population included 389 participants (246 Jews, 143 Bedouins) living within 40 km/25 mi from Gaza for at least 2 years and interviewed between January and March 2023 (before the ongoing war that started on October 7th, 2023). The PTSD Checklist (PCL-5) was used, with a score of 33 as a cutoff point for the presence of PTSD. RESULTS: Compared to Jews, a significantly lower proportion of Bedouins reported accessibility to bomb shelters and siren warning systems. Overall, 20.3% of the respondents exhibited PTSD. Multivariate analysis revealed that after adjustment for demographic and household characteristics, Bedouins had a six-fold significantly higher probability of PTSD in comparison to Jews (OR 5.6, 95%CI 2.8-10.8). Compared to participants with high socioeconomic status (SES), participants with low SES had a six-fold significantly higher probability of PTSD (OR 6.0, 95%CI 2.2-16.5). Participants who did not have an alarm system had more than two-fold odds for PTSD (OR 2.3, 95%CI 1.1-5.5). Being single, living in urban areas, or having a disability significantly increased the probability of PTSD. CONCLUSIONS: The findings of this study demonstrate a significantly higher prevalence of PTSD among the Bedouin population of Southern Israel. Several sociodemographic characteristics were associated with the increased prevalence of PTSD, the most prominent of which was low SES. Healthcare professionals and authorities should be proactive in screening for PTSD, and provide tailored treatment and support, taking into account ethnical and cultural background. Authorities should address the disparity in bomb shelter access and siren warning coverage between Bedouin and Jewish communities.