Barriers and Enablers to Implementing a Smoke-free Home and Car During Pregnancy: A Qualitative Study Among Expectant Israeli Fathers.

INTRODUCTION: Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. This study aims to identify barriers and facilitators for implementing a smoke-free home and car among expectant Israeli fathers. AIMS AND METHODS: Twenty-four qualitative semistructured telephone interviews were audio-recorded, transcribed, and analyzed according to a reflexive and collaborative thematic approach. Inclusion criteria were being male, Hebrew speaker, age ≥18 years, smoking at least one cigarette a day, and living with their nonsmoking pregnant spouse. The Capability, Opportunity and Motivation for Behavior (COM-B) model was used as a theoretical model for analysis. RESULTS: Participants reported feeling a strong responsibility for their pregnant spouse's comfort and health, stating that they are doing the best they can to reduce their spouse's secondhand smoke exposure (Motivation). Participants had a low level of knowledge about specific secondhand smoke health consequences, effective strategies to reduce secondhand smoke exposure, with incorrect perceptions about what constitutes exposure (Capability). Couple relationships were not affected by the husband's smoking habits, and participants expressed mutual consideration and understanding (Opportunity). Participants also expressed positive attitudes regarding smoke-free home and car implementation but emphasized that any changes have to be their own decision (Motivation). CONCLUSIONS: The present study identified principal Capability, Opportunity and Motivation barriers and facilitators that influence Israeli expectant fathers' decision to implement a smoke-free home and car. Those findings will inform the development of a digital behavioral intervention targeting expectant fathers to reduce prenatal secondhand smoke exposure. IMPLICATIONS: Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. Interventions among expectant fathers that focus on creating a smoke-free home and car may be effective because pregnancy has been identified as a "window of opportunity" that generates a strong motivation and creates a sense of urgency to change smoking behavior, while being considered more achievable than smoking cessation. Interventions might be effective if they focus on strengthening the parental responsibility among expectant fathers and emphasize the benefits of a smoke-free home and car, while maintaining male autonomy and increasing skills to effectively implement a smoke-free home and car.

Women's attitudes towards disclosure of genetic information in pregnancy with varying levels of penetrance.

BACKGROUND: Chromosomal-microarray-analysis (CMA) may reveal susceptibility-loci (SL) of varied penetrance for autism-spectrum-disorder (ASD) and other neurodevelopmental conditions. Attitudes of women/parents to disclosure of SL during pregnancy are understudied. METHODS: A multiple-choice questionnaire was distributed to postpartum women. Data were collected on women's interest to receive prenatal genetic information with various levels of penetrance. RESULTS: Women's (n = 941) disclosure choices were dependent on the magnitude of risk: approximately 70% supported disclosure of either full or 40% penetrance, 53% supported disclosure at a 20% risk threshold, and 40% supported disclosure at 10% or less. Although most women supported, rejected or were indecisive about disclosure consistently across all risk levels, nearly one-quarter (24%) varied their responses based on penetrance, and this was associated with religiosity, education, parity and concern about fetal health (p-values <0.04). Among those who varied their choices, the risk threshold was lower among secular women (20%) than among ultraorthodox women (40%). In a multivariable analysis, ultraorthodox women were much less likely to vary their choices on ASD disclosure compared with secular women (aOR = 0.37, p < 0.001). CONCLUSION: Women's attitudes toward disclosure are influenced by the level of risk and their individual characteristics. We therefore encourage engaging women/couples in disclosure decisions regarding uncertain and probabilistic results from prenatal genomic tests.

Changes in Smoking Behavior, Stress, and Sleep Duration Among Israeli Hospital Workers During the COVID-19 Pandemic: A Cross-sectional Study.

INTRODUCTION: Being on the COVID-19 frontline could negatively impact healthcare workers mental health. AIMS AND METHODS: We examined smoking behavior changes and the association with changes in stress levels and sleeping patterns among hospital workers during the pandemic. An online survey was conducted among employees of a large tertiary medical center in Israel. Data collected included sociodemographic characteristics, smoking status, changes in smoking behavior (for smokers only), stress levels, and sleeping duration during the pandemic, perceptions of risk for COVID-19 infection and disease severity, presence of a chronic illness, COVID-19 exposure and infection status, and involvement in treating COVID-19 patients. Multinominal logistic regression modeling assessed the effects of covariates on smoking behavior change. RESULTS: Overall, 920 healthcare workers participated. More than half (59%) reported an increase in stress and 28% reported changes in sleep duration. Thirty-five percent of current smokers (n = 132), reported smoking more. Increased stress was associated with an increase in smoking (odds ratio [OR] = 3.45, 95% confidence interval [CI] 1.2-9.4, p = .016), and an increase in sleeping hours was significantly associated with a decrease in smoking (OR = 6.42, 95% CI 1.2-32, p = .02). Among smokers who reported perceived levels of stress to be the same or slightly higher than prepandemic, a strong inverse association was observed between sleep and smoking. CONCLUSIONS: The mental health consequences of the pandemic, specifically for health workers, could lead to negative changes in smoking behaviors. Together with offering stress-management skills and coping strategies, mental health support should target smoking behaviors and sleep disturbances. IMPLICATIONS: A high proportion of healthcare employees working in a large tertiary medical center in Israel reported increased stress levels during the COVID-19 pandemic. Among smokers, increased stress levels were associated with increased smoking, suggesting that smoking may be a coping mechanism for COVID-19-related stress. Offering stress-management skills and coping strategies can mitigate the negative impact on health workers' smoking behavior, and reduce stress-related increases in smoking behavior.

Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991-2016.

BACKGROUND: Members of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010. METHODS: The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991-2016 (at least once in 2010-2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991-2000, Period2: 2001-2009, Period3: 2010-2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days. RESULTS: The proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001). CONCLUSIONS: The findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.

Ethnic inequalities in community rehabilitation use and psychiatric hospitalizations among people with chronic psychotic disorder.

PURPOSE: Community rehabilitation is crucial for the long-term treatment of people with chronic psychotic disorder. Ethnic minorities are less likely to seek care and have accessible treatment. This study examines whether the use of rehabilitation services and the relationship between rehabilitation and number of hospitalization days differ between Arabs and Jews. METHODS: Data from the Israel National Psychiatric Case Register on 18,684 adults with schizophrenia/schizoaffective disorders hospitalized in 1963-2016 were merged with data from the national Mental Rehabilitation Register. Associations between the use of rehabilitation services and demographic and clinical characteristics were assessed through logistic regression modeling. Associations between ethnicity and duration of rehabilitation (housing or vocational) and annual hospitalization days during Period1: 2001-2009 and Period2: 2010-2016 were analyzed using ANOVA. RESULTS: Among Jewish patients (N = 2556), 37% and 57% used rehabilitation services during Period1 and Period2, respectively, compared with 18% and 40% among Arab patients (N = 15,145) (p < 0.0001). The use of rehabilitation services was significantly higher among Jews (adjusted OR = 2.26, 95% CI 2.07-2.47). Average duration of housing and vocational rehabilitation services did not differ between Arab and Jewish patients. In both groups, duration of rehabilitation was inversely associated with annual hospitalization days. CONCLUSIONS: The ethnic disparity in the use of rehabilitation services has narrowed over time, yet remains. Although fewer Arab patients use rehabilitation, Jewish and Arab benefit similarly from the services with regard to reduced hospitalization days. To further close the ethnic gap, greater efforts must be made to expand the availability of culturally appropriate rehabilitation services for the Arab minority.

Comparison of Smoking Cessation Program Registration, Participation, Smoking Cessation Medication Utilization, and Abstinence Rates Between Smokers With and Without Schizophrenia, Schizo-affective Disorder, or Bipolar Disorder.

INTRODUCTION: People with serious mental illness (SMI) are three times more likely to smoke and be heavy smokers than smokers without SMI. Counseling combined with smoking cessation medication (SCM) is the recommended treatment. However, until 2017, SCM prescription for SMI smokers was discouraged (FDA black box warning). This study compared use of smoking cessation programs (SCP) and SCM between smokers with and without SMI. AIMS AND METHODS: Data regarding SCP and SCM use were extracted from the database of a large HMO that offers free Group and telephone SCP. SCP registration, participation, completion, and abstinence rates between July 2013 and December 2019 were compared between smokers with and without SMI, controlling for demographic and health variables. RESULTS: 48 000 smokers registered for a SCP during the study period. Smokers with SMI were 1.8 times more likely to register for a SCP than smokers without SMI. Smokers without SMI were, however, 1.2 times more likely to start the SCP, 1.5 times more likely to complete the SCP, and 1.6 times more likely to have quit by the end of the program. The strongest factors predicting abstinence were SCP completion and SCM use. Smokers with SMI were less likely to purchase SCM, although their purchase rate increased after the black box warning was lifted. CONCLUSIONS: Smoking cessation programs and SCM use should be encouraged in the SMI population. Providing support during the quit attempt and adapting SCP to the needs of smokers with SMI, combined with SCM prescription promotion, should improve abstinence. IMPLICATIONS: Smokers with serious mental illness (SMI) were more likely to seek professional help to quit smoking than non-SMI smokers, with over 30% achieving abstinence, discrediting healthcare professional beliefs that SMI smokers don't want to and cannot quit. Smoking cessation program (SCP) completion and smoking cessation medication (SCM) utilization were the strongest predictors of abstinence. SMI smokers were more likely to drop out of SCPs and less likely to use SCMs. Providing support during the quit attempt and adapting SCPs to the needs of smokers with SMI, combined with SCM prescription promotion, should improve abstinence.

Postpartum women's attitudes to disclosure of adult-onset conditions in pregnancy.

BACKGROUND: Advanced prenatal genomic technologies can identify risks for adult-onset (AO) conditions in the fetus, challenging the traditional purpose of prenatal testing. Professional guidelines commonly support disclosure of high-penetrance AO actionable conditions, yet attitudes of women/parents to these findings and factors affecting their attitudes are understudied. METHODS: We explored 941 (77% response rate) postpartum women's attitudes towards receiving prenatal genetic information, and associations of sociodemographic, medical and psychological characteristics with their choices, focusing on AO conditions. RESULTS: Women largely support the disclosure of actionable AO findings (58.4%), in line with professional guidelines. A third of the women also supported the disclosure of non-actionable AO conditions. Stronger religious observance (p < 0.001) and higher psychological distress (p = 0.024) were associated with decreased interest in receiving actionable AO conditions, whereas higher concern for fetal health yielded increased interest (p = 0.032). Attitudes towards disclosure were strongly associated with women's perceived benefit of such information for their own, partner's, and future child's health. Termination of pregnancy based on such information received very little support. CONCLUSION: In-light of the demonstrated understanding of nuanced genetic information and the observed diversity in attitudes, a culturally competent opt-in/out policy could be considered. If full-disclosure is practiced, support should be provided to those expressing higher levels of distress.

The Impact of Smoking Cessation on Hospitalization and Psychiatric Medication Utilization among People with Serious Mental Illness.

Background: Despite the high prevalence of smoking amongst people with serious mental illness (SMI), referral rates to smoking cessation programs (SCPs) are low. Mental health workers reticence to refer to SCPs has been attributed, in part, to their belief that quitting will have a deleterious effect on their patients' mental health status. Objectives: This study's objective was to determine if participating in a smoking cessation program had an adverse effect on mental health status among people with SMI, measured here by a change in hospitalization occurrence or psychiatric medication utilization. People with SMI who had participated in at least one SCP session in a large health maintenance organization (n = 403) were compared to an age-gender-diagnosis matched sample of SMI smokers (1,209) who had never participated. Results: No change in psychiatric hospitalization occurrence pre- versus post-SCP participation was found among participants (Pre:7.2% vs. Post:5.2, p = 0.2) or nonparticipants (Pre:7.0% vs. Post:6.0%, p = 0.2). Mean defined daily dose (DDD) for anti-psychotic, mood stabilizer, anti-depressant and anxiolytic medications also did not change over time for participants and nonparticipants. However, participants who did not complete the SCP and didn't quit had a 0.35 higher mean DDD for anti-psychotic medications compared with participants who had completed the SCP or quit, and with nonparticipants (p = 0.006), and were the only group to exhibit an increase in mean antipsychotic DDD over time (Pre:1.42, Post:1.63). SCP participation was not associated with hospitalization occurrence or psychiatric medication utilization. Conclusions/Importance: Smoking cessation should be encouraged, with close monitoring during the quit process.

Why Switch? - Motivations for Self-Substitution of Illegal Drugs.

BACKGROUND: Self-substitution is the conscious switch from one drug to another for reasons such as price, availability, desired effect, or perceived benefit of the substitute drug. Purpose/Objectives: This study aimed to describe drug use patterns and motivations associated with substitution. We examined correlates of lifetime substitution among individuals with substance use disorder. Methods: A cross-sectional study of 771 treatment-enrolled individuals. We used self-report for determining the lifetime prevalence, correlates, and motivations for substitution. Results: Of the 771 respondents, 570 (73.9%) reported ever substituting their preferred substance. The main incentives for substitution were availability (23.7%) and curiosity (20.2%). Among heroin or cannabis preferers, improved effects or less adverse effects of the substitute drug, self-medication, and managing withdrawal symptoms were significant substitution incentives. Increased odds for substitution were observed for past 12 months use of cannabis (OR = 1.51, CI = 1.06-4.52), prescription opioids (OR = 2.86, CI = 1.81-4.52), novel psychoactive substances (OR = 2.68, CI = 1.64-4.36), and repeated admission (OR = 1.50, CI = 1.05-2.14). Older age at onset-of-use was negatively associated with substitution (OR = 0.95, CI = 0.93-0.98). Conclusions: Self-substitution of one substance for another is a highly prevalent behavior among treatment-enrolled patients with substance use disorder. Clinicians caring for substance use disorder patients should be aware of substitution patterns involving the use of highly potent substances, which constitutes a risk to patients. Results underscore the benefit of substitution patterns analyses, as they reveal important information on the characteristics of persons who use drugs and their motivations.

Comparison of Perceptions and Smoking Cessation Experiences Between Smokers With and Without Serious Mental Illness in a Large Health Maintenance Organization.

OBJECTIVE: Smoking prevalence is threefold higher among people with serious mental illness (PWSMI) than in the general population, yet smoking cessation rates for PWSMI are lower. Numerous reasons have been posited as to why tobacco use is higher and abstinence rates are lower among PWSMI. This study explores smoking cessation perceptions and experiences among PWSMI and people without serious mental illness (SMI). METHODS: Participants in this cross-sectional study were recruited from among members of a large health maintenance organization (HMO) in Israel who had registered for or commenced a smoking cessation program in 2015 through 2017. The sample comprised 208 PWSMI and a matched sample of people without SMI (N = 428). Telephone surveys were used to collect information about smoking status and smoking/cessation history, use of smoking cessation programs and aids (prescription medications, nicotine replacement therapy, electronic cigarettes), motivation and intention to quit, self-efficacy (to quit), smoking cessation outcome expectancies, physician support to quit, barriers and facilitators for those who had not quit, and reinforcements/challenges for those who had quit. RESULTS: Of those without SMI, 27% quit smoking compared to 20% of PWSMI (p = .051). Irrespective of mental health status, the most significant predictor of abstinence was the use of smoking cessation prescription medications. Family physicians were significantly less likely to inquire about motivation to quit, refer to smoking cessation programs, or prescribe smoking cessation medications for PWSMI than for people without SMI. Beyond these factors, no differences were noted between respondents with and without SMI regarding motivation to quit, intention to quit, and abstinence self-efficacy. PWSMI who had not quit were more likely to be concerned about how quitting might affect their functioning and how they would pass the time without cigarettes. CONCLUSIONS: PWSMI have similar levels of motivation and intention to quit smoking as those without SMI. However, they are disadvantaged by the reduced support received from their family physicians and lower cessation medication usage. Efforts to promote the implementation of smoking cessation treatment guidelines will help promote smoking abstinence among PWSMI.

[WEARING A MASK IS A PERSONAL PROTECTION AGAINST SARS-COV-2 INFECTION EVEN IN A VACCINATION-ON-BOARDING COUNTRY].

INTRODUCTION: Even with the advent of the COVID-19 vaccine, masks and social distancing are recommended as a precautionary measure to suppress SARS-CoV-2 infection and disease. In Israel, as in many other countries, despite official regulations and widespread availability and accessibility to affordable effective masks, the use of face masks is not consistent or universal. Physicians and other medical and health professionals have a vital role to play in communicating to the public about the importance of masking and encouraging people to wear face masks correctly and consistently. This review underscores the importance of masking as a protective public health mitigation measure. It describes types of face masks mainly used by the public and their effectiveness. It emphasizes the importance of identifying and addressing barriers (e.g., physical, social, economic) to encourage widespread and sustained appropriate use of masks. The article also proposes strategies to enhance masking, such as changing social norms through targeted local interventions and governmental control of mask quality and price.

Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges.

Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries. Nevertheless, life expectancy has remained lower among Israeli Arabs than Israeli Jews, and this gap has recently widened. Age-adjusted mortality as a result of heart disease, stroke, or diabetes remains higher in Arabs, whereas age-adjusted incidence and mortality of cancer were higher among Jews. The prevalence of obesity and low physical activity in Israel is considerably higher among Arabs than Jews. Smoking prevalence is highest for Arab men and lowest for Arab women. Health inequalities are also evident by the indicators of socioeconomic position and in subpopulations, such as immigrants from the former Soviet Union, ultra-Orthodox Jews, and Bedouin Arabs. Despite universal health coverage and substantial improvements in the overall health of the Israeli population, substantial inequalities in NCDs persist. These differences might be explained, at least in part, by gaps in social determinants of health. The Ministry of Health has developed comprehensive programmes to reduce these inequalities between the major population groups. Sustained coordinated multisectoral efforts are needed to achieve a greater impact and to address other social inequalities.

Alcohol abuse in developed and developing countries in the World Mental Health Surveys: Socially defined consequences or psychiatric disorder?

BACKGROUND: Previous single country research has raised concerns that: (1) the DSM-IV diagnosis of alcohol abuse (AA) is met primarily through the hazardous use criterion related to drinking and driving and (2) that the hazardous use and social consequences AA criteria primarily reflect varying socioeconomic and cultural factors rather than psychiatric disorder. METHODS: Using representative cross-national data from the 21 countries in the World Mental Health surveys, adults meeting DSM-IV lifetime criteria for AA but not dependence from 10 developed (n=46,071) and 11 developing (n=49,761) countries were assessed as meeting AA with the hazardous use or the social consequences criteria. RESULTS: Between 29.3% (developed) and 16.2% (developing) of respondents with AA met only the hazardous use criterion. AA cases with and without hazardous use were similar in age-of-onset, course, predictors, and psychopathological consequences in both developed and developing countries. DISCUSSION AND CONCLUSIONS: Despite some associations of the AA criteria with socioeconomic factors, the hazardous use and social consequences criteria were significantly associated with psychiatric predictors and sequelae. The findings indicate that these criteria reflect psychiatric disorder and are appropriate for inclusion as DSM-5 Alcohol Use Disorder criteria. SCIENTIFIC SIGNIFICANCE: These findings support a psychiatric rather than a sociocultural view of the hazardous use and social consequences symptoms and provide evidence that they are appropriate diagnostic criteria cross-nationally with utility in a wide range of socioeconomic environments. This suggests consideration for their adoption by ICD-11. Further research is needed on the implications of these results for prevention and treatment.

Online health information seeking among Jewish and Arab adolescents in Israel: results from a national school survey.

This study examined patterns and determinants of seeking online health information among a nationally representative sample of 7,028 Jewish and Arab 7th- through 12th-grade students in 158 schools in Israel. Nearly all respondents (98.7%) reported Internet access, and 52.1% reported having sought online health information in the past year. Arab students (63%) were more likely than Jewish students (48%) to seek online health information. Population-group and sex differences in health topics sought online were identified, although fitness/exercise was most common across groups. Multivariate regression models revealed that having sought health information from other sources was the strongest independent correlate of online health information-seeking among Jews (adjusted odds ratio = 8.93, 95% CI [7.70, 10.36]) and Arabs (adjusted odds ratio = 9.77, 95% CI [7.27, 13.13]). Other factors associated with seeking online health information common to both groups were level of trust in online health information, Internet skill level, having discussed health/medical issues with a health care provider in the past year, and school performance. The most common reasons for not seeking online health information were a preference to receive information from a health professional and lack of interest in health/medical issues. The closing of the digital divide between Jews and Arabs represents a move toward equality. Identifying and addressing factors underpinning online health information-seeking behaviors is essential to improve the health status of Israeli youth and reduce health disparities.

Schizophrenia or schizoaffective disorder? A 50-year assessment of diagnostic stability based on a national case registry.

BACKGROUND: Schizoaffective disorder (SAD) remains a controversial diagnosis in terms of necessity and reliability. OBJECTIVES: We assessed diagnostic patterns of SAD and schizophrenia (SZ) among hospitalized psychiatric patients over a fifty-year period. METHOD: Data from the Israeli National Psychiatric Registry on 16,341 adults diagnosed with SZ or SAD, hospitalized at least twice in 1963-2017, were analyzed. Stability between most-frequent, first and last diagnosis, and diagnostic-constancy (the same diagnosis in >75 % of a person's hospitalizations) were calculated. Three groups were compared: People with both SAD and SZ diagnoses over the years (SZ-SAD), and people with only one of these diagnoses (SZ-only; SAD-only). The incidence of SAD and SZ before and after DSM-5 publication was compared. RESULTS: Reliability between last and first diagnosis was 60 % for SAD and 94 % for SZ. Agreement between first and most-frequent diagnosis was 86 % for SAD and 92 % for SZ. Diagnostic shifts differ between persons with SAD and with SZ. Diagnostic-constancy was observed for 50 % of SAD-only patients. In the SZ-SAD group, 9 % had a constant SAD diagnosis. Compared to the other groups, the SZ-SAD group exhibited a higher substance use prevalence, younger age at first-hospitalization, and more hospitalizations/person (p < 0.0001). The incidence of a first-hospitalization SAD diagnosis increased by 2.2 % in the 4-years after vs. prior to DSM-5. CONCLUSIONS: A SAD diagnosis is less stable than SZ. The incidence of a SAD diagnosis increased after DSM-5, despite stricter diagnostic criteria. The SZ-SAD group exhibited the poorest outcomes. SAD may evolve over time necessitating periodic re-evaluation.

Patterns of adult tobacco use in Uzbekistan.

BACKGROUND: Little is known about the prevalence of tobacco use in Uzbekistan, a country targeted intensively by the international tobacco industry. METHODS: A national household survey elicited information about cigarette smoking and nasway use (a form of smokeless tobacco). RESULTS: Prevalence of past-month smoking and nasway use among men (N=1795) was 19.6% and 22.3%, respectively, and 1.6% and 0.5% among women (N=1831). Among men, smoking was independently associated with Uzbek ethnicity, urban residence, age and occupation; nasway use was associated with rural residence, age, being married and occupation. CONCLUSIONS: The smoking rate in Uzbekistan remains low relative to neighbouring countries, perhaps due to widespread use of cheaper nasway. These findings establish a baseline for future surveys and highlight the importance of smokeless tobacco in assessing overall consumption.

A pilot training program for a motivational enhancement approach to hepatitis C virus treatment among individuals in Israeli methadone treatment centers.

Although hepatitis C virus (HCV) can be cleared, very few infected persons complete the treatment, resulting in disease progression and transmission. Motivational interventions effectively address health and substance-use-related conditions in many cultures. The research team piloted an HCV treatment motivational enhancement training and supervision for four counselors treating four patients in one (of 11) large methadone programs in Israel between 2007 and 2008. The counselors received a 3-day training followed by seven supervision sessions. Training included cultural and language adaptation from the original United States version to practice in Israel. Feasibility was assessed and demonstrated through training field notes and questionnaire feedback, review of taped intervention sessions for counselor proficiency and patient engagement, and patient completion of intervention sessions and piloted measures. While positive feasibility outcomes were noted, future studies should employ larger numbers of counselors and patients to assess the effectiveness of motivational enhancement in promoting HCV treatment in methadone patients.

Adherence to smoking cessation guidelines (5As) by psychiatrists and primary care physicians for persons with serious mental illness.

1) Compare the 5A (Ask-Advise-Assess-Assist-Arrange) practice rates between psychiatrists and primary care physicians (PCPs) regarding smoking cessation for PWSMI. 2) Compare the 5A practice rates reported by physicians with rates reported by PWSMI. 3) Identify which specialty is perceived as primarily responsible for smoking cessation promotion for PWSMI.Telephone surveys were carried out in a large health maintenance organization (HMO) among all psychiatrists, a random sample of PCPs, and HMO members with serious mental illness who had registered/participated in a smoking cessation program. Physicians were asked how frequently they carried out each 5A practice, along with questions regarding role responsibility and interaction between the two clinical specialties. PWSMI were asked to report about each 5A practice by both PCP and treating psychiatrist.Ask-Advise-Assess rates were higher than Assist-Arrange rates for both specialties. 83% of PCPs had satisfactory 5A practice scores compared to 46% of psychiatrists (X2=23.9, p < 0.001). With the exception of Ask rates, physician rates for each 5A component were higher than those reported by PWSMI. PCPs were more likely to see smoking cessation promotion as their responsibility and did not always confer with the psychiatrist regarding referral and SCM prescription.Interventions focusing on promoting Assist-Arrange practices and better integration between the specialties are required.

A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals.

Healthcare-acquired infections (HAI) pose vast health and economic burdens. Proper hand-hygiene is effective for reducing healthcare-acquired infections (HAI) incidence, yet staff compliance is generally low. This study assessed the feasibility, acceptability and preliminary effect of employing medical clowns to enhance hand-hygiene among physicians and nurses. Staff perception of the intervention and its impact on hand-hygiene was assessed via self-report questionnaires. Nearly 1,500 hand-hygiene compliance observations were conducted in accordance with WHO guidelines before, during and after the intervention. In each of three hospitals in Israel, two departments were selected-one in which medical clowns routinely operate and one clown-naive department. Professional medical clowns acted as hand-hygiene promoters employing humorous tactics to encourage hand-sanitizing based on the WHO "5 Moments" model. The clown appeared in each department seven times during the 2-week intervention phase. Pre-intervention hand-hygiene compliance ranged from just over 50% to 80% across hospitals and departments. Overall, about 70% of nurses (N = 132) and 80% of physicians (N = 49) felt the intervention improved personal and departmental hand-hygiene, with large inter-department variation. Pre- to post-intervention hand-hygiene compliance increased by 4% -25% (3.5-14.8 percentage points) in four departments, three of which had low baseline compliance levels. Results of this feasibility study suggest that employing medical clowns as hand-hygiene promoters as a novel approach toward HAI prevention is feasible and welcome by hospital staff.