Attitudes and Knowledge of Medical Students in South of Israel Toward Medical Cannabis.

BACKGROUND: Public and medical interest in the use of cannabis has increased in Israel and the world over recent years. STUDY QUESTION: The aim of the study was to assess the attitudes of medical students from the Faculty of Health Sciences of Ben-Gurion University of the Negev on the use of medical cannabis. STUDY DESIGN: This is a cross-sectional study using a self-administered questionnaire completed by medical students from Ben-Gurion University of the Negev, Beer-Sheva, Israel. MEASURES AND OUTCOMES: Attitudes and knowledge toward the use of medical cannabis were evaluated. RESULTS: A total of 243 medical students participated in the study. Of these, 111 (46.1%) were from preclinical years. The mean age was 27.31 ± 3.07, and 138 (57.3%) were female students. Most students (N = 193, 79.4%) agreed to a great degree or to a very great degree that there was a role for cannabis for medical purposes. Most students thought that medical cannabis should be recommended for use by pain specialists (N = 231, 95.1%), by oncologists (N = 208, 85.6%), and by psychiatrists (N = 192, 79%). A little more than half of the participants (N = 127, 52.5%) would agree to be licensed, as future physicians, to prescribe medical cannabis. A logistic regression analysis found that the students strongly agreed with legalization of medical cannabis and students who strongly agreed that medical cannabis should be in the health basket predicted a very strong agreement about its use (OR = 2.623, P ≤ 0.002, and OR = 3.285, P ≤ 0.001, respectively). CONCLUSIONS: Most medical students support the use of medical cannabis for medical purposes and are in favor of its legalization. As physicians of the future, it is important to assess the attitudes of medical students on medical cannabis.

Ethnicity Affects A1C Levels in Patients With Diagnosed Type 2 Diabetes in Southern Israel.

Purpose: To assess whether ethnicity affects the association between A1C and fasting glucose in people with type 2 diabetes. Methods: This investigation was an epidemiological, cross-sectional study based on computerized medical records of the Southern District of Clalit Health Services. The study population comprised patients ≥40 years of age with type 2 diabetes who underwent blood tests between 8 August 2015 and 20 July 2020. A normal-error multiple linear regression model was used to assess differences in associations among ethnic groups (i.e., Arabs, Ethiopian Jews, and non-Ethiopian Jews) and A1C. Results: A total of 59,432 patients with type 2 diabetes were included in the study. Of these, 1,804 were Jews of Ethiopian origin, 49,296 were non-Ethiopian Jews, and 8,332 were Arabs. Compared with non-Ethiopian Jews, A1C levels were increased by 0.1% (1 mmol/mol) among Ethiopian Jews and by 0.3% (3 mmol/mol) among Arabs. Ethnicity was a strong predictor of A1C, explaining 0.6% of its variance. An A1C level of 7% (53 mmol/mol) correlated with fasting glucose levels of 141, 136, and 126 mg/dL in non-Ethiopian Jews, Ethiopian Jews, and Arabs, respectively. Conclusion: Ethnic differences in A1C should be considered by clinicians, researchers, and policymakers.

Adolescent Obesity and Type Two Diabetes in Young Adults in the Minority Muslim Bedouin Population in Southern Israel.

Minority populations suffer from adolescent obesity at increasing rates and develop diabetes type 2 at a younger age. To assess the prevalence of adolescent obesity in the minority Bedouin population of Israel and its association with obesity and diabetes type 2 during young adulthood. A retrospective cohort study, based on computerized medical records. The study cohort was comprised of Bedouin adolescents, born in 1988-1990, who had BMI measurements at ages 14-19 years in their medical records (N = 3310). The prevalence of obesity was 17.3% in middle adolescence, and 9.6% in late adolescence. The ORs for obesity in young adulthood were 30.1 (95% CI 19.1-49.3) and 40.9 (95% CI 25.7-69.1) for the middle and late adolescent groups, respectively. The incidence of diabetes type 2 per 105 person-years was 494.88 (95% CI 263.55-846.27) vs. 23.06 (95% CI 4.76-67.40) and 446.93 (95% CI 223.11-79 9.68) vs. 113.13 (95% CI 74.55-164.59) among adolescents with and without obesity in the middle and late adolescence groups, respectively. Interventions are needed to reduce the prevalence of adolescent obesity in the vulnerable Muslim Bedouin population in southern Israel.

Cultural Aspects of Health care for Ethiopian Jewish Immigrants in Israel: A Literature Review.

The unique health-related traditions, perceptions, and communication patterns of Ethiopian immigrants are challenging to Israeli healthcare providers who are trained in western medicine. The aim of this review was to conduct a survey of traditions, beliefs, and symptom reporting by Ethiopian immigrants and culturally oriented interventions to improve the care of Ethiopian immigrants. We used the keywords "Ethiopian immigrants Israel" and "Ethiopian Jews." Of 418 articles initially retrieved, 35 satisfied the inclusion and exclusion criteria. We described health-related traditions and their possible complications. Possession syndrome was frequently misdiagnosed as a neurological or psychiatric disorder. The medical staff was unfamiliar with these health and illness beliefs, somatization patterns, and the communication style of Ethiopian immigrants. There were successful interventions that involved liaisons from the Ethiopian community and community-based educational activities. Medical professionals working with African immigrants worldwide can use the Israeli experience to develop effective, culturally oriented interventions to optimize the health care for these immigrants.

The Attitudes and Beliefs of Family Physicians Regarding the Use of Medical Cannabis, Knowledge of Side Effects, and Barriers to Use: A Comparison Between Residents and Specialists.

BACKGROUND: Israel has a regulated system with clearly defined indications for treatment with medical cannabis. STUDY QUESTION: The main question was whether family physicians in southern Israel face barriers/knowledge gaps in prescribing cannabis for medical indications. The secondary question was whether there was a difference between residents and specialists in family medicine. STUDY DESIGN: A questionnaire-based cross-sectional study. MEASURES AND OUTCOMES: Attitudes of the participating physicians on the use of medical cannabis; comparison of attitudes of specialists in family medicine and residents on the use of medical cannabis. RESULTS: One hundred and fifty-two family physicians participated in the study including 48 residents. More than 78% supported the use of medical cannabis and about 63% supported it's legalization. About 84% of the physicians believed that medical cannabis helped cancer patients and 82% believed it helped in the chronic pain. Only 28.3% believed that family physicians should recommend the use of medical cannabis. The physicians were well aware of the psychiatric (82%) and the neurological (78%) adverse effects of medical cannabis. Most (68%) were not willing to prescribe medical cannabis. No socio-demographic characteristic was associated with willingness to prescribe cannabis. About 95% of the physicians believed that the main barrier to recommending treatment was its potential for abuse, 66% percent-the danger that it would leak to the general public. About 60% of the specialists were not prepared to undergoing training in the prescription of medical cannabis compared with 31% of the residents ( P = 0.004). CONCLUSIONS: Family physicians are concerned about recommending medical cannabis. It is encouraging that residents are motivated to undergo training to prescribe medical cannabis. There remain medical indications and adverse effects that family physicians are less aware of. Further studies should focus on effective ways to improve the level of physicians' knowledge on the issue.

Medical screening tests and vaccination among hospital-based physicians in Israel.

BACKGROUND: Very few studies have evaluated physician participation in screening tests and vaccinations. The aim was to evaluate attitudes and actual practice of screening tests and vaccinations among hospital-based physicians and to identify factors that predict actual performance. METHODS: A cross-sectional study including 220 physicians in various specializations. The study was conducted between January 1, 2017 and December 10, 2017. The statistical analysis was performed during October, 2020 and completed in October 25, 2020. RESULTS: The vast majority of physicians (94%) believed in the importance of screening tests for physicians, but less than half actually underwent the tests themselves. A high percentage of physicians measured their BMI (84.5%) and had a serum lipid profile test (67.7%) and complete blood counts (75%) over the previous five years, but less than a third of female physicians over 50 years of age had a mammogram and only 8% of the physicians over 50 had a fecal occult blood test. A high percentage of physicians were vaccinated for Hepatitis A and B, chickenpox and measles (66-96% for the various vaccinations), but only 41% had an influenza vaccination in the previous year. In a multivariate logistic regression model, physicians who believed that hospital physicians bore a responsibility for recommending screening tests to their patients were more likely to have their BMI and their blood pressure checked (OR = 2.234, P = 0.007). They were more likely to undergo laboratory testing (OR = 4.082, P < 0.0001) and tended to get vaccinated more (OR = 1.907, P = 0.051). CONCLUSION: The rate of screening tests and vaccinations among hospital-based physicians is sub-optimal and very low for fecal occult blood testing and mammograms. Structured programs are required to implement screening tests and vaccinations among physicians.

Scientific Drawing as a Potential Treatment Modality for Patients with Anorexia Nervosa.

BACKGROUND: Anorexia nervosa (AN) is a severe psychiatric disease that is refractory to treatment. To date, there is no effective pharmacological therapy and existing psychotherapy treatment is only partially effective. In neuropsychological terms, AN is characterized by cognitive inflexibility and an overly detailed processing style. Creating artwork and drawing requires integrative thinking that encompasses the big picture. OBJECTIVES: To describe preliminary observations of drawing treatment modality based on precise scientific drawing. METHODS: The artwork method is based on the classic work by squares and on additional techniques from scientific drawing. The method was developed and implemented in a sheltered home for patients with eating disorders in Parma, Italy. Five patients, four women and one man, agreed to participate in a 10-session workshop as a part of multidisciplinary intervention. The ages of participants were 17-28 years and all had presented with AN for several years. RESULTS: Using the method of copying drawings on squares made it possible to identify features that were common to all the patients, such as focusing on the external form of the drawing rather than on the internal details, exerting strong pressure on the pencil without consideration of the need for future corrections, drawing distorted perceptions of curves, and the adding of significant volume. CONCLUSIONS: Precise scientific drawing could be a useful instrument in the understanding and correction of a patient's distorted world and self-perspective. More evidence could be provided by further studies with a larger sample and a control group.

Melatonin and the health of menopausal women: A systematic review.

Melatonin is involved in multiple changes that characterize the aging and can potentially be a safe and effective treatment for menopausal women. The aim of this study was to carry out a systematic review of the medical literature on the health benefits of oral melatonin administration on menopausal women. The electronic databases PubMed, Scopus, and Web of Science were searched systematically on interventional studies that evaluated the association between oral melatonin administration and the health of menopausal women. Risk for bias was assessed for randomized, controlled studies by the RoB v.2 tool and for non-randomized trials by the ROBINS-I tool. Twenty-four studies on melatonin treatment in various aspects of women's health were included in the final systematic review. The studies included 1,173 participants. No evidence was found for an independent effect of melatonin on hemodynamic measures or markers of glucose metabolism. There is some evidence that very low-density lipoprotein and triglycerides levels increase during melatonin administration. There is a fair amount of evidence that melatonin treatment has a favorable effect on bone density and BMI. Melatonin treatment improves EEG patterns and subjective sleep quality in postmenopausal women with preexisting sleep impairment. In a dose of 3 mg and above, melatonin improves climacteric symptoms in one or more domains. The vast majority of the studies had a low risk for bias. In light of multiple health benefits and an excellent safety profile, melatonin administration should be considered in menopausal women.

The prevalence, reasons and attitudes for the practice of informal medicine.

BACKGROUND: Informal medicine, entailing undocumented medical advice, has been described in diverse medical disciplines and geographical regions. We assessed the current prevalence and characteristics of informal medical consulting, the reasons physicians provide it, and their attitudes toward it. METHODS: We conducted a survey among family physicians in Israel, a country with a national health insurance system. A questionnaire was emailed to all primary care physicians in the two largest HMOs in southern Israel. Fifteen questions addressed the prevalence, practice and attitudes to informal medical consulting. Ten questions assessed demographics and professional experience. RESULTS: Of 143 respondents (mean age 41 years), 55% were women. Ninety-five percent of the respondents reported requesting informal medical consulting from other physicians. Fifty-four percent reported often providing informal consulting to family and friends; and an additional 27% reported doing so under exceptional circumstances. The main reasons given for informal consulting requests were availability and accessibility (81% of respondents), and not financial savings. Only 17.5% stated being in favor of informal consulting for family and friends. Only 11% expressed feeling satisfaction after providing such consultation; 49% expressed discomfort. Sixty-six percent thought a position paper on informal consulting to family and friends is needed. CONCLUSIONS: Our survey of primary care physicians shows very frequent informal medical consulting, despite high dissatisfaction with such, and an interest in receiving guidelines on this practice.

Manifestations of verbal and physical violence towards doctors: a comparison between hospital and community doctors.

BACKGROUND: Healthcare workers, in the hospital and in community clinics, are frequently exposed to verbal and physical abuse that can lead to frustration and despair. This study's objectives were to evaluate trends in violence towards hospital and community doctors in the Negev region of Israel and to compare them to the results of a previous 2005 study. METHODS: A convenience sample of doctors in the hospital and in the community completed anonymous questionnaires on previous exposure to work place violence and their attitudes to it. The data were collected in 2017. RESULTS: One hundred forty-five doctors participated in the study, of who 63 were hospital doctors and 82 were community doctors. Fifty nine percent of the doctors reported that they experienced at least one incident of verbal abuse over the previous year and 9% were exposed to physical abuse, compared to 56 and 9%, respectively, in the previous study. More hospital doctors (58.7%) were exposed to verbal abuse on the part of family members than community doctors (35.8%) (P = 0.007). The most common reason for a violent outbreak was long waiting times, followed by dissatisfaction with treatment, both consistent with the findings in the previous study. Seventy one percent said that violence was a major problem for doctors. The majority (73.9%) had not participated in a workshop or other training for preventing workplace violence or coping with it, an improvement over the 83% who reported not receiving any training in the previous study. CONCLUSIONS: Workplace violence is a major issue, which affects hospital and community physicians alike. There is a rise in the number of doctors who have undergone training in this area, although the majority have yet to receive formal training.

Caution is Needed in Interpreting Hemoglobin A1c Levels in the Muslim Bedouin Population of Southern Israel.

BACKGROUND: The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.

Developing a Comprehensive Geriatric Genogram Assessment Tool.

BACKGROUND: The use of graphic depictions (pictorials) to represent medical conditions is an accepted method that can complement standard methodology of comprehensive geriatric assessment. OBJECTIVES: To use the clinical pathway method to develop a comprehensive geriatric genogram assessment tool (CGGAT), which could supplement the written summary letter and recommendations. METHODS: We used the critical paths method to develop a tool to facilitate implementation of the comprehensive geriatric assessment recommendations. A multidisciplinary group of clinicians used the critical pathways method to develop a CGGAT. RESULTS: We used the CGGAT to depict the physical and functional status of patients and to complement the textual historical information, family dynamics, and current patient issues. CGGAT is a simple instrument that provides a visual structure and it can facilitate the sharing of information among team members, encourage interdisciplinary dialogue, enhance understanding and adherence on the part of patients and professionals, and reduce the burden on the clinicians who conduct the initial comprehensive geriatric assessment. CONCLUSIONS: We showed the benefits and obstacles related to the adaptation of this new tool and provide recommendations for further development.

Urinary incontinence among Muslim women in Israel: risk factors and help-seeking behavior.

INTRODUCTION AND HYPOTHESIS: The prevalence of urinary incontinence (UI) varies among women in different cultures. Muslim women with UI have complex issues related to the need for cleaning (ablution) before prayer. The aim was to assess the prevalence of UI, factors associated with it, its effect on quality of life, and help-seeking behavior among Muslim women. METHODS: This was a cross-sectional study. Self-administered questionnaires completed by women 18-75 years of age who visited the primary care clinic between 21 June 2015 and 9 October 2015 and additional data collected from their medical records. RESULTS: A total of 492 women (mean age 31.8 ± 9.5 years) participated in the study. Of these, 43% suffered from UI and 19% from severe to very severe UI. The mean score for interference in daily life (0-10) was 6.3 ± 3.7. Sixty percent of women with UI had stress incontinence, 23% urge incontinence, and 9% mixed incontinence. Only 10% had consulted previously with their physician regarding UI. Increased BMI (OR = 1.048, 95% CI 1.009-1.089) and polygamy (OR = 1.943, 95% CI 1.007-3.749) were associated with severe to very severe UI. Age, parity, and more severe degrees of UI were associated with help-seeking behavior (OR = 1.065 95% CI 1.008-1.125, OR = 0.763 95% CI 0.624-0.934, OR = 4.073 95% CI 1.410-11.765 respectively). CONCLUSIONS: Urinary incontinence is very common among Muslim women in primary care in southern Israel and significantly impairs their quality of life. Only a small percentage consults with their physician.

A Descriptive Analysis of Changes in Selected Drug Groups Available to Primary Care Physicians in Israel From 2000 to 2013.

Several medical and economic factors affect the process of development and introduction of new drugs and the disappearance of various medical agents from the drug market. There are no data in the existing literature on quantitative and qualitative changes in the drug market. We assessed changes in the drug market in Israel over 14 years, focusing on drug groups that, in our subjective opinion, are mainly used in primary care medicine: pain medications, lipid lowering agents, drugs for diabetes, and antihypertensives. We assessed volume of drugs and changes and trends in terms of therapeutic efficacy and safety in selected drugs in each of the groups over the study time period. We used the Medic Compendium for the analyses. Medic contains a listing of drugs that are approved and available for use in Israel. It is updated every 2 months. In 2000, there were 253 available drugs in the study groups that contained 124 active agents. In contrast, in 2013, there were 278 available drugs that contained 130 active agents. Over the study years, there was an increase in the number of drugs that are effective, "user friendly," and have a high safety profile. Our study provides the first data on quantitative and qualitative changes that have taken place in selected groups of drugs. Although the availability of the drugs in different countries is determined by multiple factors, we assumed that there are other countries with a similar situation in terms of their drug markets.

Health Related Absenteeism of Family Physicians in the Negev Region of Israel: A Cross-Sectional Study.

Physicians tend to treat their own illnesses differently than the general population, sometimes continuing to come to work when ill. To assess whether family physicians continue to work when ill. A cross-sectional study with a convenience sample. A self-administered, anonymous questionnaire, that included socio-demographic data, questions relating to illness, and reasons for work absenteeism, was completed by family physicians in the Negev region of Israel. 107 physicians participated in the study including 46 women (43 %). The mean age was 45.1 ± 11.4. Forty physicians (37.4 %) said they come to work with an acute illness, 47 (43.9 %) answered that they do so some of the time, and 19 (17.8 %) said that they did not come to work ill. On a scale from 1 to 10 the mean score for the question as to whether physicians are liable to infect their patients was 7.4, with a higher score meaning more likely to infect. Older physicians were more likely to say that the decision to stay away from work was related to the lack of available physicians (P = 0.002), while board certified physicians were more likely than residents to stay away from work due to an acute illness (P = 0.023). Family physicians in the Negev sometimes work when they are ill. This finding has positive sides related to dedication to patients and the work place, but one cannot ignore the fact that patients may be infected by their physicians. Behavioral guidelines, including social, legal, and ethical aspects, should be formulated on this issue.

Female Physicians and the Work-Family Conflict.

There has been a dramatic increase in the number of female physicians in all fields and specializations of medicine, but this increase has not resulted in a redistribution of domestic tasks and responsibilities. Reviewing the literature of the last two decades (April 1994 to April 2014) on how female physicians cope with the challenge of balancing their family and professional lives for the duration of their professional careers revealed that they suffer from the work-family conflict more than other professionals and that it has a more negative effect on women than on men. Women physicians consider work-family balance significantly when making career choices. These considerations affect their career success, their productivity as faculty members, their marital life, and parenthood. Having a supportive spouse at home and a facilitating mentor at work are important for a positive work-family balance among female physicians. Special career-supporting measures, such as flexible work schedules and expanded support for childcare over the course of work and when taking part in academic activities, are critical for female physicians.

Anemia among Muslim Bedouin and Jewish women of childbearing age in Southern Israel.

There are inequalities in health indicators among different ethnic groups living in the same region and receiving the same medical services. Anemia is a global problem. Although the prevalence of anemia is not high in Israel, differences among ethnic groups have not been studied. Our objective was to assess anemia among Bedouin and Jewish women of childbearing age in southern Israel. A retrospective observational study was conducted based on data from computerized medical records. Seven thousand eight hundred seventy-one women in the study clinics underwent complete blood counts and had blood hemoglobin levels of 11 g/dl or below. The Jewish patients were older (31.7 vs. 29.7 years, P < 0.001), practiced birth control more (24.2 vs. 9.9 %, P < 0.001), and adhered to it more (81.1 vs. 61.9 %, P < 0.001). Bedouin women had more children (3.7 vs. 1.9, P < 0.001), and more Bedouin women were pregnant during the study period (49.3 vs. 35.0 %, P < 0.001). The most prevalent types of anemia were iron deficiency and anemia of chronic disease. Two types of anemia were proportionally higher among Jewish women, anemia of chronic disease (18.1 vs. 9.7 %, P < 0.001) and folic acid deficiency (3.3 vs. 2.2 %, P > 0.001). The adherence rates for treatment were very low. Three factors associated with severe anemia (hemoglobin below 8 g/dl) were being Bedouin (odds ratio (OR) = 1.295, P < 0.001), use of birth control (OR = 0.419, P < 0.001), and pregnancy (OR = 0.447, P < 0.001). Being a Bedouin woman is a risk factor for severe anemia, and adherence to treatment for anemia is very low in both groups. These findings should be addressed in a national program to reduce health inequalities.