Smoking and other correlates of health care services utilization among mandatory military recruits in Israel.

INTRODUCTION: Data on utilization of ambulatory care and the impact of lifestyle on health among young adults are scarce. Israeli mandatory military service provides a unique opportunity to investigate these topics. Study objective was to analyze the utilization of health care services (HCS) during the first year of military service, and its associations with health behavior at recruitment, in order to plan health services, health classification, and health promotion activities. METHODS: We conducted a retrospective cohort study among a representative sample of 5,751 mandatory new recruits between January 1, 2004, and December 31, 2008. Data were collected from the Israeli Defense Force computerized medical and administrative records and from an ongoing health survey among military recruits. RESULTS: During their first year of service, recruits had, on average, more than 7 visits to the primary care clinic, more than 10 dispensed nonchronic medications, and more than 5 days of sick leave. Female sex (OR = 1.27; 1.06-1.51) and current cigarette smoking (OR = 1.57; 1.34-1.84) were significantly associated with increased use of HCS, after controlling for possible confounders. CONCLUSIONS: Our findings indicate high utilization of HCS during the first year of military service and highlight the potential effect of cigarette smoking as a risk factor for increased morbidity among apparently healthy young adults. These findings support adding smoking status to fitness assessments and could aid health promotion efforts to reduce smoking rates among adolescents.

[The military role in a flu pandemic].

Pandemic influenza is a major challenge to emergency preparedness agencies and health systems throughout the world. It requires preparation for a situation of widespread morbidity due to flu and its complications which will lead to a huge burden on the health system in the community and in hospitals, and work absenteeism, also among health care personnel. This may require major involvement of the army in both preparedness and measures to be taken to tackle such an event. This article reviews the different roles armies could take in such a crisis, and presents the Israeli test case. Defense systems are characterized by a number of attributes that may be major advantages during pandemic influenza: crisis management capacities, ability to deal with varied tasks in sub-optimal conditions, logistic resources (fuel, food and water), widespread deployment in the country and sometimes in the world, and the ability to activate people in risky situations, even against their will. The army roles during pandemic outbreaks could include: taking national and regional command of the event, assigning workforce for essential civilian missions, use of logistic and military resources, maintaining public order and implementing public health measures such as isolation and quarantine. In addition, the army must continue its primary role of maintaining the security and guarding the borders of the state, especially in times of global geopolitical changes due to pandemic. Since March 2009, the influenza A/H1N1 2009 virus spread throughout the world, leading the WHO to declare a state of pandemic influenza. According to Israeli preparedness plans, the management of the event was supposed to pass to the defense system. However, due to the moderate severity of the illness, it was decided to leave the management of the event to the health system. In view of the necessity of maintaining military combat capabilities, and the possibility of outbreaks in combat units, which actually occurred, the Israel Defense Forces (IDF) policy for the pandemic was stricter than the policy of the Ministry of Health. Defense systems in Israel and the world should prepare, the sooner the better, for the possibility of a worse pandemic, in which the army may take a major role, especially since regular life in the country, in such a case, would be disturbed.

Seroprevalence of measles, mumps and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel.

Evidence-based vaccination policy is important for the global and local efforts of achieving control over measles. In 2007, the first Israeli birth cohort to be twice vaccinated during childhood with Measles-Mumps-Rubella vaccine reached adulthood. In parallel, Israel experienced its largest measles outbreak since 1994. We aimed to assess the seroprevalence of measles IgG antibodies and concordance with rubella and mumps seroprevalence among young Israeli adults born 1988-9 in comparison to previous birth cohorts, in order to inform evidence based prevention policy. We conducted a seroprevalence study of IgG antibodies among 439 Israeli adults born in 1988-9, based on a representative sample of sera collected at age 18-19 upon recruitment to mandatory military service in 2007. In total, 85.7% were seropositive for measles as compared with 95.6% in the 1996 recruitment (P < 0.001). The absolute decline was significant both for males (8.8%, P = 0.001) and females (12.1%, P < 0.001). There were no significant differences in seropositivity by gender, years of education, country of birth or smoking status. Rubella seropositivity among measles seropositives was 90.4%, significantly (P < 0.001) higher than 72.1% among measles seronegatives. Mumps seropositivity among measles seropositives was 87.0%, significantly (P < 0.001) higher than 62.3% among measles seronegatives. Results were similar for Israeli-born only. Our findings indicate that measles seroprevalence decreased after the last change in vaccination policy and reach sub-optimal level. Until global eradication is reached, a proactive vaccination program to supplement routine childhood vaccination program should be considered in Israel and in other countries.

Diminishing gender differences in condom use among a national sample of young Israeli men and women between 1993 and 2005.

BACKGROUND: Studies related to condom use among young adults consistently point to substantial gender disparities, although the use has generally increased. This study examined trends in condom use between 1993 and 2005 among 13,988 Israelis aged 18-25 years and the associated sociodemographic factors. METHODS: An HIV/AIDS Knowledge, Attitudes, and Practice survey was self-administered to dischargees from Israel's compulsory military service. Multivariate logistic regression models were used to assess trends in condom use and the association over time of sociodemographic factors and sexual behaviors with consistent condom use. RESULTS: During the 13-year period, consistent condom use increased among men (from 35% to 58%) and women (from 17% to 54%), almost eliminating the gender difference. Among both genders, consistent condom use was associated with being single, being older at the time of sexual debut, and being religious, and was inversely associated with age and education; however, gender differences were found in the strength of the associations over time. CONCLUSIONS: The excess risk of exposure of young women to lack of condom use has minimized, an unusual situation on international comparison, although population risk for HIV and sexually transmitted infections exists in Israel. Further understanding of factors influencing the decreasing gender differences is required to reorient and tailor HIV/AIDS interventions to most effectively reach young adults of both sexes.

Rubella seroprevalence in the first birth cohort reaching fertility age after 20 years of two dose universal vaccination policy in Israel.

BACKGROUND: A national program of a 2-dose universal childhood MMR vaccination policy has been in effect in Israel since 1988. As the 1988 birth cohort reached fertility age, questions regarding immunity against rubella were raised. OBJECTIVE: To assess the seroprevalence of rubella IgG antibodies among young Israeli adults born after 1987 in comparison to previous birth cohorts, in order to determine evidence based policy for prevention of rubella and congenital rubella syndrome. METHODS: We conducted a seroprevalence study of rubella IgG antibodies among 416 Israeli adults (42.5% females) born in 1988-1989, based on a representative sample of sera collected at age 18-19 upon recruitment to mandatory military service in 2007. RESULTS: In total, 87.7% were seropositive (>15 IU/ml) as compared with 84.8% in the 1999 recruitment (P=0.26) and 93.4% in 1987 (P=0.004). Yet there was a difference by gender. The proportion of seropositives among female young adults (92.7%) was significantly lower as compared to those measured in the 1999 (99.2%, P=0.001) and 1987 (99.0%, P=0.006) recruitments. The proportion of seropositives among males (84.1%) was significantly higher as compared to those measured in 1999 (73.0%, P<0.001) but similar to those of 1987 (88.8%, P=0.13). Females born in the FSU were found to be high risk groups as 11.5% were seronegative. CONCLUSIONS: Our findings indicate that despite a successful program of congenital rubella syndrome prevention in Israel, there is a decline in seroprevalence among female young adults, especially immigrants from the FSU. A proactive catch-up program for females, especially for those of higher risk for susceptibility should be considered in Israel and in other countries.

Seroepidemiology of Epstein-Barr virus and cytomegalovirus among Israeli male young adults.

PURPOSE: To assess the seroprevalence and seroconversion of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) Immunoglobulin G (IgG) antibodies and identify associated socioeconomic and smoking variables among male young adults in Israel, to explore health disparities and aid prevention efforts. METHODS: A population-based seroprevalence study of EBV and CMV IgG antibodies in a systematic sample of Israeli males upon recruitment to mandatory military service during 1994-2004. Associations between socioeconomic and smoking variables and the seroprevalence of EBV/CMV were evaluated, controlling for possible confounders. A subset of seronegative subjects was assessed for seroconversion upon discharge from military service. RESULTS: Overall seroprevalence rates were 87% for EBV and 59% for CMV. An association between the seroprevalence of EBV and CMV was observed. Seroconversion was 56% for EBV as compared with 31% for CMV. Lower paternal education was found to be associated with both EBV and CMV seroprevalence. Lower socioeconomic status, North African origin, and urban residence were found to be associated with CMV seropositivity, as was smoking for EBV seropositivity. CONCLUSIONS: Socioeconomic disparities exist in the seroprevalence rates of CMV and EBV among Israeli male young adults. The results of the study could aid public health efforts and determine target populations when a vaccine becomes available.

Sub-optimal prevalence of mumps antibodies in a population based study of young adults in Israel after 20 years of two dose universal vaccination policy.

BACKGROUND: A recent mumps outbreak in Israel despite an ongoing national program of a 2-dose universal childhood vaccination policy since 1988, raised questions regarding population immunity among young adults. OBJECTIVE: To assess the seroprevalence of mumps antibodies among young Israeli adults born after 1987 in order to determine evidence based vaccination policy. METHODS: We conducted a seroprevalence study of mumps IgG antibodies among 441 Israeli adults born in 1988-9, based on a representative sample of sera collected upon recruitment to mandatory military service in 2007. RESULTS: The overall seroprevalence of IgG antibody to mumps virus among 1988-9 born was 83.7%, 82.1% among males and 85.7% among females. Seroprevalence among 2007 recruits was similar to 1999 recruits (83.3%, P=0.89) and significantly lower than 1987 recruits (94.1%, P<0.0001). The absolute decrease between 2007 and 1987 for males was 13.1% (P<0.0001) and for females 7.0% (P=0.02). Seroprevalence was not significantly higher among native Israelis (84.9%) than among young adults born in the Commonwealth of Independent States (81.1%, P=0.46) and significantly higher compared to young adults born in Western Europe or North America (68.2%, P=0.045). CONCLUSIONS: Our findings indicate sub-optimal population seroprevalence despite a 2-dose universal childhood vaccination policy. This study allows better understanding of current mumps outbreaks in Israel and elsewhere following periods of low circulation of wild virus. These findings support mumps vaccination, even for populations and individuals that received two doses during childhood, as means for outbreak containment among young adults, especially in crowded settings, and serve as a reminder to the need for dynamic vaccination policy, supported by health promotion activities.

Infection control in field hospitals after a natural disaster: lessons learned after the 2010 earthquake in Haiti.

After the January 12, 2010, earthquake in Haiti, Project Medishare and the University of Miami organized, built, and staffed a 200-bed field hospital (the University of Miami Hospital in Haiti [UMHH]) on the outskirts of Port-au-Prince. We describe the operational challenges of providing a safe environment at the UMHH. Furthermore, we compared how these issues were addressed at this ad hoc hospital with how they were addressed at the field hospital of the Israel Defense Force, a fully deployable hospital with an organization fine-tuned as a result of prior disaster situations, also in Haiti.

Declining population immunity to mumps among Israeli military recruits.

Population-based seroepidemologic data on mumps have not been available in Israel since 1987, and the effects of mass immigration from the Commonwealth of Independent States during the 1990s have not been investigated. We conducted a seroprevalence study of mumps antibodies among 353 Israeli military recruits aged 18-19, based on a representative sample of sera collected in 1999. The overall seroprevalence rate was 83.3%, which was significantly lower than that measured in 1987 (94.1%, P<0.001). Foreign-born subjects had substantially lower seroporevalence rates than their native Israeli counterparts (68.5% versus 86.1%, P<0.001). Recent seroprevalence levels are below those required for herd immunity, and most likely contributed to an outbreak of mumps observed among young adults in Israel in 2005. Immigration appears to be a contributing factor to the decrease in population seroprevalence over time.

Declining seroprevalence of rubella antibodies among young Israeli adults: a 12-year comparison.

BACKGROUND: In March 2000, the Israel Defense Force (IDF) experienced an outbreak of rubella. No population-based rubella seroepidemiologic data were available for the 13-year period preceding the epidemic. METHODS: We conducted a population-based seroprevalence study of rubella antibodies among 289 IDF recruits drafted in 1999. RESULTS: We found that 69.2% of males and 90.8% of females in service were seropositive at recruitment in 1999, immediately before the outbreak. These rates were significantly lower than those last measured in 1987 (88% among males and 98.1% among females). CONCLUSIONS: Our findings indicate that this rubella outbreak among young adults was facilitated by a decrease in immunity to levels below those required for herd immunity, at which epidemic virus transmission was no longer blocked. This is most likely due to widespread pediatric vaccination coverage with incomplete catch-up immunization among adolescents and young adults. These findings serve as a reminder that changes to childhood vaccination programs may affect the epidemiology of disease among older segments of the population several years after the change is implemented.