The effects of the Friendship Online Intervention Program on physical activity, substance abuse, psychosomatic symptoms, and well-being among at-risk youth.

INTRODUCTION: At-risk youth are those who are currently or potentially exposed to physical, mental, or emotional danger. The Friendship Online Intervention Program (FOIP) was created to encourage physical activity (PA) and reduce risky behavior among vocational secondary-school youth in Israel. We wanted to evaluate the effect of FOIP on PA, substance abuse, and psychological factors, including psychosomatic symptoms and well-being. METHODS: From October 2021 to June 2022, nonrandom sampling was employed to select at-risk youth from vocational secondary schools for participation in the FOIP. Before and after the intervention, questionnaires were administered to the intervention and control groups. The effects of FOIP were evaluated by univariate and multivariable analyses. RESULTS: The intervention (n = 103) and control (n = 77) groups showed similar levels of PA, cigarette smoking, and alcohol consumption at the beginning of the study. At follow-up, the intervention group showed a 57% increase in PA versus no change for the control group and decreased levels of smoking compared to the control group (p < .001). Similarly, in the intervention group, the number of psychosomatic symptoms decreased (effect size = 1.68) and life satisfaction increased (effect size = 0.86). Group assignment (intervention or control group) significantly predicted PA level, cigarette smoking, psychosomatic symptoms, and life satisfaction (adjusted R2 = .46, .20, .08, and .28, respectively) with participants in the intervention group showing more favorable results compared with the control group. CONCLUSIONS: FOIP was effective in increasing PA and decreasing risky behaviors among youth. FOIP may help at-risk youth build resilience and promote their physical and mental health.

Are pregnancy and parity associated with telomere length? A systematic review.

BACKGROUND: Women's reproduction requires increased energy demands, which consequently may lead to cellular damage and aging. Hence, Telomere Length (TL), a biomarker of biological aging and health status may possibly serve as a biomarker of reproductive effort. The aim of this systematic review is to evaluate telomere dynamics throughout pregnancy and the association between parity and TL. METHODS: A systematic search was conducted across seven databases including CINAHL, Cochrane, PsycINFO, Proquest, PubMed; Scopus; and Web of Science, using keywords and MeSH descriptors of parity and TL. Predefined inclusion and exclusion criteria were used to screen abstracts and titles. After the removal of duplicates, 3431 articles were included in the primary screening, narrowed to 194 articles included in the full-text screening. Consensus was reached for the 14 studies that were included in the final review, and the Newcastle-Ottawa scale (NOS) was utilized to assess the quality of the selected studies. A mini meta-analysis utilized JASP 0.17.3 software and included 4 applicable studies, comprising a total of 2564 participants to quantitatively assess the estimated effect size of parity on TL. RESULTS: Of the 11 studies reviewed on parity and TL, four demonstrated a negative correlation; one - a positive correlation and six -found no correlation. Studies demonstrating a negative correlation encompassed rigorous methodological practices possibly suggesting having more children is associated with enhanced telomere attrition. Of the four longitudinal studies assessing telomere dynamics throughout pregnancy, most found no change in TL from early pregnancy to postpartum suggesting pregnancy does not affect TL from early pregnancy to early postpartum. The meta-analysis revealed a negative, yet, non-significant effect, of the estimated effect size of parity on TL(ES = -0.009, p = 0.126, CI -0.021, 0.03). CONCLUSIONS: Studies assessing pregnancy, parity and TL yielded mixed results, most likely due to the different research methods utilized in each study. Improvements in study design to better understand the short-term effects of pregnancy on TL and the effect of parity on TL over time, include precise definitions of parity, comparisons of different age groups, inclusion of reproductive lifespan and statistically adjusting for potential confounders in the parity and TL relationship.

Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system.

During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination.The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines.Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (ß = -0.52), which, in turn, was negatively associated with stress (ß = -0.10). Furthermore, discrimination was positively associated with perceived threat (ß = 0.21), which, in turn, was positively associated with stress (ß = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.

Between-country analysis of implementing an obesity prevention intervention using RE-AIM: HENRY in Israel and UK.

Health Exercise Nutrition for the Really Young (HENRY) is a UK community-based early childhood obesity prevention intervention that was adopted and implemented in Israel between 2013 and 2018. The aim of this study was to explore the implementation process in Israel and compare it with that of the 'parent' programme in the UK, in order to throw light on the challenges of introducing complex interventions into different countries and cultures. Published reports from HENRY and Haifa University's evaluation of the Israeli implementation were reviewed and comparisons between the UK and Israel were carried out utilizing the RE-AIM framework. In both countries, the intention was to implement in lower SES communities. When comparing the individual items, Reach and Effectiveness, we found a difference in the Reach although Effectiveness was similar: Reach was proportionally lower in Israel, but parent and professional changes in behaviour were positive in both countries. For the organizational items Adoption, Implementation and Maintenance, we found large differences between the countries. Major challenges identified in Israel included: failing to take adequate account when planning and implementing the intervention of the different ways social and health services are organized and how local authorities are structured and provide services. In addition, differences in culture beyond language and professional variations were challenges, when trying to transfer the intervention with high fidelity from the UK to Israel. Lessons learnt may benefit others in attempting cross-country implementation of complex interventions.

[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.

Do Israeli health promoting schools contribute to students' healthy eating and physical activity habits?

The Israeli Health Promoting School Network (HPSN) is actively committed to enhancing a healthy lifestyle for the entire school population. This study aimed to explore the contribution of school participation in the HPSN and students' individual characteristics to healthy eating and physical activity habits among Israeli school children aged 10-12 years. A cross-sectional survey was conducted among 4166 students in grades 4-6 from 28 schools. The schools were selected from a sample of HPSN affiliated and non-HPSN schools. The contribution of individual characteristics (grade, gender and subjective self-reported health education activities at school) and school characteristics (school type, population group, deprivation score) to healthy eating and physical activity habits was analyzed using multi-level hierarchical models. Multi-level analysis indicated that student's individual characteristic was significantly associated with healthy eating and physical activity habits. The subjective self-reported health education received at school was statistically significant factor associated with students' health behaviors. The school's affiliation with the HPSN was not associated with higher healthy eating and physical activity scores after adjusting for individual factors. These findings suggest that Israeli HPSN schools do not contribute to children's health behaviors more than other schools. Therefore, health promoting activities in HPSN schools need to be improved to justify their recognition as members of the HPS network and to fulfill their mission.

A cross sectional survey assessing knowledge, attitudes and behaviors regarding brucellosis among Arab Israelis.

BACKGROUND: Brucellosis is a contagious zoonotic disease transferred from sick animals to humans and endemic in the Middle East and other countries. Humans mainly acquire the disease by consuming non-pasteurized dairy products from infected animals. This study assesses the rates of non-pasteurized dairy product consumption, knowledge and attitudes regarding brucellosis among Israeli Arabs, in towns with and without reported cases of brucellosis. The aim is to assess if there is an association between knowledge, attitudes and consumption of non-pasteurized dairy products and if encountering the disease in the community is associated with consumption, attitudes and knowledge. METHODS: A cross sectional telephone survey of 306 respondents from five Arab towns in the northern part of Israel, three towns with and two without reported cases of the disease during 2014. The questionnaire included questions regarding knowledge and attitudes related to brucellosis and patterns of production, purchase and consumption of dairy products from non-regulated sources, mainly semi-hard low value white cheese. RESULTS: Nearly 41% of respondents reported consuming cheese from non-regulated sources and 16.1% of respondents reported purchasing milk from non-regulated sources. Favorable attitudes towards factors enhancing transmission of brucellosis were associated with purchasing and consuming milk or homemade white cheese from non-regulated sources in multivariable logistic regression models (odds ratio- 2.21 and 2.66 respectively, confidence intervals between 1.7 and 3.9). However, knowledge about the disease was not associated with these behaviors. In towns with previous reported cases of the disease the purchasing and consumption of non-regulated cheeses was higher than in towns without reported cases and the opposite for non-regulated milk consumption. CONCLUSIONS: The purchase and consumption of cheese from non-regulated sources is very common in specific communities among Israeli Arabs. Attitudes are a significant factor associated with the risky behavior, such as consuming milk and cheese from non-regulated sources. However, knowledge and previous reported cases of the disease in the community do not prevent most risky behaviors. Interventions should not focus only on dissemination of information.

Cross-Cultural Validity in Self-Reported Alcohol Use.

BACKGROUND AND AIM: Little evidence is available on whether respondents from divergent sociocultural populations report alcohol consumption in systematically similar ways. Therefore, this study examined whether the validity of self-reported alcohol use differed between Arab and Jewish Israeli pub patrons. METHODS: The analytical sample consisted of 227 Arab and 900 Jewish Israeli pub patrons who were approached as they left pubs and asked to record their Breath Alcohol Content (BrAC) value and complete a questionnaire that probed into their alcohol use. Validity of self-reported alcohol use across the 2 groups was examined by testing the discrepancy in concordance between the self-reported number of drinks and BrAC scores through simple Pearson correlations and by performing a multi-group measurement invariance (MI) comparison. RESULTS: The Pearson correlation between the self-reported number of drinks and BrAC by the ethno-cultural group was almost identical across groups (Jews: r = 0.47, p < 0.01, df = 898; Arabs: r = 0.42, p < 0.01, df = 225). MI test results further confirmed that the factor loadings of the 2 drinking measures are similar across the 2 ethno-cultural groups. CONCLUSIONS: Self-reported alcohol consumption gives cross-culturally valid and acceptable estimates of alcohol consumption in this sample of Israeli Arabs and Jews.

Alcohol-Impaired Driving: The Influence of Adverse Rearing Environments, Alcohol, Cannabis Use, and the Moderating Role of Anxiety.

BACKGROUND: The rate of alcohol-impaired driving (AID) increases during the college years and students who have reported adverse rearing environments appear to be at increased risk for the development of alcohol and drug use behaviors. Alcohol and cannabis are the most commonly used drugs by college students, and these substances are particularly predictive of substance-impaired driving. OBJECTIVES: The present study aimed to investigate whether adverse rearing environment experiences and level of alcohol and cannabis use are related to the frequency of alcohol-impaired driving and whether anxiety might buffer or accelerate this effect. METHODS: Data regarding adversity, drug use, anxiety, and AID were obtained from 1,265 students annually, from first to final year of college, over four waves (Mean Age at wave 1 = 18.5 years). RESULTS: Structural equation modeling supported associations among childhood adversity, alcohol, cannabis, and anxiety symptoms. A significant mediation effect was found such that adversity was predictive of AID via alcohol use and cannabis use. Among men, anxiety symptoms accelerated the path from increased cannabis use and decelerated the path from increased alcohol use to AID frequency. Conclusions/Importance: Childhood adversity is a developmental risk precursor to drug use and AID, whereas anxiety might serve a risk or protective factor to AID, contingent on the drug used.

Examining differences in drinking patterns among Jewish and Arab university students in Israel.

OBJECTIVES: Worldwide there is a dearth of studies examining drinking patterns in Arabs and how these compare to other populations. The few studies that exist have suggested distinct drinking patterns in Arabs, with not only high rates of abstinence but also high rates of heavy drinking among current drinkers. No studies have yet examined potential socio-cognitive mechanisms that may contribute to this distinct drinking pattern. Israel represents a unique and valuable resource for studying Arab population drinking patterns because Israeli Arabs are nonimmigrants living in areas where exposure to Western lifestyles, including alcohol consumption, is prevalent. The current study was set out to examine differences in alcohol consumption in a convenience sample of 1310 Jewish and Arab students from Israeli universities and colleges and to explore alcohol expectancies as potential mediators of ethno-religious differences. DESIGN: Logistic regressions were used to produce odds ratios and 95% confidence intervals to test differences between Jewish and Arab students on binary outcomes (lifetime, last month, and heavy drinking). Mediation of ethno-religious differences by alcohol expectancies was tested with bootstrapping procedures. RESULTS: Results show that while Israeli Arab students tend to be more likely to abstain from alcohol than Israeli Jewish students, among current drinkers, Israeli Arab students are at a particular high risk of heavy drinking. Results also show that this is partly mediated by the expectancy that alcohol only influences the drinker at high levels of intake. CONCLUSION: The current study confirms distinct Arab drinking patterns found in previous studies. The present study is the first demonstration that drinking expectations mediate ethno-religious differences in heavy drinking among Israeli Arabs and Jews. This work contributes to the understanding of ethno-religious group differences in harmful drinking, potentially informing future etiologic research and public health interventions aimed at reducing alcohol-related harm.

Alcohol consumption among Arabs in Israel: a qualitative study.

BACKGROUND: The Israeli society is a unique setting in which the Arabs are exposed to western alcohol consumption norms while living in Arab communities where alcohol consumption is not accepted. OBJECTIVES: To characterize Arab Muslim, Druze and Christian alcohol consumption behaviors and contingencies while being exposed to western style alcohol consumption. METHODS: This study was a phenomenological qualitative study interviewing six focus groups and 13 individual Arab Muslims, Christians and Druze. Themes and categories were identified using qualitative methodology analysis. RESULTS: Two concurrent contingencies exist for Arab Muslim men: on the one hand they describe pressure to drink because of social norms, and on the other hand they are reprehended for drinking, because of the religious interdiction. Therefore, they hide their drinking in secluded places. In addition, participants reported more heavy drinking among Muslim Men. Arab Christians reported drinking openly especially among men. Women do not drink and are looked down upon if they drink. Drinking may be viewed as a stage in life that a Muslim boy or young man goes through, he is expected to grow out of this stage and stop drinking while becoming religious. Conclusions/importance: Due to Muslim laws prohibiting alcohol consumption, alcohol consumption is not high, however it does exist especially among young men and when they drink they tend to drink heavily, more than the Arab Christians. Therefore, there is a need for interventions targeting younger Muslim men, to establish moderate drinking behaviors, if they chose to drink.

The Effect of the Mamanet Cachibol League on Psychosomatic Symptoms, Healthy Eating, and Social Support Among Arab Women: A Mixed-Methods Study.

BACKGROUND: The Mamanet Cachibol League (MCL), a community-based model developed in Israel, promotes physical activity and amateur team sports among women. Women in the Arab society have traditionally played few sports, especially team sports. AIMS: The study aimed to assess the differences in health indicators and well-being, including psychosomatic symptoms, self-reported health, healthy eating habits, and social support, by comparing Arab women MCL participants and nonparticipants and examines benefits and motivations of community-based team sports for participants. METHODS: An explanatory sequential mixed-methods approach included a cross-sectional study with intervention and control groups of Israeli Arab women aged 25-59 years. Two-way analyses of covariance and multiple regression models evaluated demographics, well-being, healthy eating, and social support. Quality in-depth interviews with 30 MCL participants further explained the quantitative findings. RESULTS: MCL participants reported higher self-assessed health (P < .001) and decreased psychosomatic symptoms (P < .001) than nonparticipants. Healthier eating and well-being were also linked to MCL participation. The women sense of belonging improved social interactions, personal and professional happiness, and group dedication. MCL attendees felt empowered because the group advocated equality and valued women. Women said their involvement helped their families. CONCLUSIONS: Findings on the MCL community-based model suggest that team sports may serve as an effective tool for promoting health and well-being of Arab women and foster positive community relationships. The sense of belonging and personal empowerment derived from being part of a sports team may also contribute to positive mental health outcomes.

Low Response to the COVID-19 Vaccine Among the Arab Population in Israel: Is It a Cultural Background, or a Systemic Failure, or Maybe Both?

INTRODUCTION: A low response to COVID-19 vaccination was observed among the Arab population in Israel. Efforts to improve this achieved moderate results. OBJECTIVES: The aim of this study was to examine the extent to which demographic and cultural factors, the media, trust, perceptions, and government policies influence the willingness of Arabs to be vaccinated against COVID-19. METHODS: A cross-sectional survey was conducted among Israeli Arabs (558 respondents). The questionnaire was distributed through social networks between January 16 and 26, 2021. The t-tests, Chi-square tests, Z tests, which were used to evaluate the significance of variables, and Pearson correlations calculated for the study variables were used for statistical analysis. Hierarchical logistic regression was calculated to assess the extent of background influence on the odds for vaccination, and mediation was examined using the Process procedure. RESULTS: Moderate means were found for attitudes towards vaccination, vulnerability, vaccine effectiveness, and pandemic fatigue. A lower score was found for accessibility to medical services, social norms, and emotional barriers. Trust was highest in health-related authorities, whereas trust in government and the media was the lowest. Higher pandemic fatigue was associated with lower trust and lower odds for vaccination. DISCUSSION: Lack of awareness of the specific needs of the Arab minority in Israel, lack of vaccination campaigns in Arabic language, long neglect of Arabs in the Israeli health system, mistrust of governmental authorities by the Arabs, and low socioeconomic background of Israeli Arabs might have led to lower trust levels and incompliance with governmental policies among Arabs. Addressing these issues may benefit the entire population. The authors believe that "A chain (in population health) is only as strong as its weakest link."

Compliance with Ministry of Health Regulations among Israeli Nurses during the COVID-19 Pandemic: The Mediating Role of Risk Perception.

The COVID-19 pandemic has created a sustained state of emergency, causing uncertainty and risk taking. Israeli nurses were required to follow new regulations and safety measures issued by the Israeli Ministry of Health (MOH). This study aimed to examine nurses' compliance with MOH regulations and its association with their risk and threat perceptions and their positive and negative emotions. A cross-sectional online survey was conducted among 346 Israeli nurses. The study model was examined with path analysis. Most nurses reported complying with MOH regulations either fully (49%) or very often (30%). Negative emotions were positively associated with perceptions of both threat and risk, yet only risk perception was positively associated with nurses' compliance. A significant mediated relationship was found between negative emotions and nurses' compliance, with the possible mediator being risk perception. Hence, higher negative emotions were associated with a greater risk perception, which was associated with higher compliance. Health systems leaders must strategize to deal with the wave-like character of the pandemic. Solutions to nursing teams' negative emotions must be provided to keep the balance between feelings of complacency and a situation of high-level, intense negative feelings, which might lead to abstention, burnout, or emotional injury.

Working Status of First-Time Postpartum Mothers and Telomere Length-A 1-Year Prospective Study.

OBJECTIVE: Transitioning to motherhood can create work family conflicts affecting mothers' health. Although employment is generally associated with longer telomeres, this may diminish during the early years of child-rearing. This study aimed to assess the impact of work reentry on telomere length (TL) among first-time mothers. METHODS: In this 1-year prospective study, a total of 103 first-time postpartum mothers participated from two medical institutions in Northern Israel; they completed validated questionnaires, reported their current working status, and provided dried blood spots measuring TL. RESULTS: We found that working status significantly predicted change in TL and was negatively correlated with change in TL over time (ß = -0.245; 95% confidence interval, -0.169, -0.018; P = 0.016). CONCLUSIONS: Identifying ideal timing of work reentry is recommended for first-time postpartum mother's optimal health and TL.

Factors Associated with Decisions of Arab Minority Parents in Israel to Vaccinate Their Children against COVID-19.

The Arab ethnic community in Israel is characterized by low social economic status and is at risk due to the typically crowded households. Understanding parents' level of awareness is important to avoid new outbreaks. OBJECTIVES: This study seeks to identify predicting factors associated with perceived susceptibility to COVID-19, and barriers to COVID-19 vaccination. MATERIALS AND METHODS: A survey was conducted through social media, using snowball sampling via social networks. Additionally, t-tests, Chi-square tests, and Z tests were used to evaluate differences between independent proportions. Pearson correlations were calculated for the study variables. Multiple logistic regression examined the extent to which the background variables were related to the intention to vaccinate the child. RESULTS: A total of 2843 Arab parents participated in the study. Older parents, higher socioeconomic status, higher trust in the authorities, vaccinated parents, and low psychological and physical barriers were positively correlated with willingness to vaccinate children. Pandemic fatigue was associated with less positive attitudes and reduced perceived effectiveness toward vaccination. CONCLUSION: Addressing minorities' poor standards of living and physical and psychological barriers posed by the authorities to minorities' access to vaccination may increase compliance with COVID-19 vaccination and protect the health of the entire population.

The Mediating Role of the Perceived COVID-19 Vaccine Benefits: Examining Israeli Parents' Perceptions Regarding Their Adolescents' Vaccination.

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents' willingness to vaccinate their adolescents and their point of view regarding adolescents' involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16-18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents' involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents' involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents' COVID-19 perceived threat and adolescent vaccination, as well as between parents' trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents' vaccination adherence. Considering the importance of adolescents' involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns.

During the first lockdown in Israel, citizens were instructed to visit community clinics only for urgent cases. However, they were not informed that emergency departments (EDs) were safe. Reports from the National Ambulance Services showed a 22% increase in at-home deaths during the lockdown. Perhaps, the reason is because some critically ill patients postponed referrals and came "at the last minute". After the first lockdown, the Ministry of Health (MOH) declared that hospital EDs were safe. The objective of the study was to examine the rates of admission from EDs to hospital wards, and non-COVID-19 in-hospital deaths during the first lockdown in Israel, compared with the second and third lockdowns. From the business intelligence software of the Rambam Medical Center in Israel, we collected data about the rates of admission to the ED, the non-COVID-19 in-hospital deaths during the three lockdowns, during the same periods in the previous three years, and the main five causes of non-COVID-19 deaths. Data comparison was done using multiple chi-square tests. ED admission numbers were significantly higher during the first lockdown than during the second (χ2 (1, n = 36,245) = 24.774, p = 0.00001) and third lockdowns (χ2 (1, n = 36,547) = 8.7808, p = 0.0030). We found a significantly higher number of non-COVID-19 in-hospital deaths vs. discharges during the first lockdown than in the second and third lockdowns (χ2 (2, n = 26,268) = 7.794, p = 0.0203) The number of deaths due to respiratory diseases was significantly higher during the first lockdown than in the second lockdown (χ2 (1, n = 572) = 8.8185, p = 0.0029) and in the third lockdown (χ2 (1, n = 624) = 9.0381, p = 0.0026), and deaths from infectious diseases were higher during the first lockdown than during both the second and third lockdowns (χ2 (1, n = 566) = 5.9479, p = 0.0147, and χ2 (1, n = 624) = 9.5978, p = 0.0019), respectively. The onset of CVA and CVD are abrupt, while respiratory and infectious diseases may have an insidious pattern; this may have led patients to postpone referrals to hospitals to the "last minute" during the first lockdown, perhaps due to fears of contracting COVID-19, and as a result of vague instructions. Citizens and policymakers must be made aware of this point during future pandemics.

Physicians' Compliance with COVID-19 Regulations: The Role of Emotions and Trust.

(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians' decision making and preventive behavior during the COVID-19 pandemic in Israel. (2) Methods: An online survey was conducted among 187 Israeli physicians in April and May 2020 during the COVID-19 pandemic. The questionnaire included the levels of physicians' perceived threat and perceived risk during the epidemic, trust in the health system, emotions, and the degree of compliance with hygiene rules and mandated behaviors. (3) Results: Most physicians reported complying with the rules of hygiene at work (73%) and full compliance with Ministry of Health guidelines (61%). The findings show that higher levels of trust, positive emotions, and threat and risk perceptions were associated with a higher degree of compliance with Ministry of Health guidelines and more careful decision making among physicians. (4) Conclusions: Levels of trust in the health system and positive emotions among healthcare staff during the pandemic are related to careful adherence to guidelines. Taking steps to maintain physical and mental health among healthcare staff is important for their functioning and for maintaining public health.

A health promotion perspective for the control and prevention of Brucellosis (Brucella melitensis); Israel as a case study.

BACKGROUND: Brucellosis (Brucella melitensis) is endemic in many countries around the world, therefore, identifying what is required to control and prevent the disease is essential. The health promotion concept and five areas of action, presented in the Ottawa Charter (1986) may help understand how to go forward in the prevention of the disease. Israel serves as a case study. AIM: To identify barriers to the control and prevention of brucellosis (Brucella melitensis) in Israel by analyzing trends in incidence in conjunction with interventions implemented over the last seven decades, applying the health promotion areas of action. METHODS: 1. A document review approach was adopted to develop a list of interventions implemented in Israel to prevent and control brucellosis and identify barriers to implementation. These were analysed using the health promotion areas of action. 2. Data from the mandatory reporting of infectious diseases in Israel regarding brucellosis in humans between 1951 and 2021 are presented and analyzed in conjunction with the interventions implemented. RESULTS: A large range of interventions were implemented following outbreaks of the disease. These interventions followed the health promotion areas of action, including mainly: policy, education and environment and brought about a decrease in the disease among both animals and humans. However, major interventions were discontinued after a few years. In addition, we identified some areas of action that could be much improved on. The interventions, in many cases were not simultaneously implemented or coordinated, decreasing the chances of them having the expected long term impact. CONCLUSIONS: Control and prevention of the disease in Israel is partial. Areas of action that could be improved include enforcement of regulations, strengthening community action and improving personal skills. Simultaneous and continuous implementation of the interventions may achieve the goals of sustained prevention and control. There seems to be a lack of a long-term strategy and an integrated holistic intervention approach that may contribute to the control and prevention of the disease.