Prevalence, diagnosis and treatment of ADHD in Arab and Jewish children in Israel, where are the gaps?

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting children and causing significant impairment. It is not clear to what extent ADHD differs between population groups. This study aims to assess prevalence, diagnosis and treatment of ADHD among Arab and Jewish children of primary school age in Israel. METHODS: Cross-sectional survey, including 517 parents of children ages 7-10 (225 Jewish and 292 Arab) and 60 homeroom teachers of the corresponding children. Both parents and homeroom teachers completed the ADHD Rating Scale-V-RV. ADHD was defined according to DSM-5 ADHD criteria by both parents and teachers, or clinical diagnosis. In addition, parents reported ADHD medication and adherence to medication. RESULTS: Prevalence of ADHD was similar for both groups. Yet, seeking diagnosis was lower among Arab Muslim children (9.2%) compared to Jewish children (17.8%). Arab Muslim children received significantly less medication compared to Jewish children. Parental decision to seek diagnosis was associated with education (OR = 6.14, CI 1.74-21.71), not ethnicity. Ethnicity predicted parents' decisions to pharmacologically treat their children with ADHD (OR = 7.61, CI 1.14-50.86) and adherence to medication (OR = 10.19, CI 1.18-88.01). CONCLUSION: Education is critical in the help-seeking process, affecting the rate of ADHD diagnosis. Pharmacological treatment and adherence are correlated with ethnicity. Parents with limited education and minorities should be targeted for interventions to increase awareness regarding ADHD and treatment.

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.

Neighborhood violence and health: the mediating role of loneliness among two ethnic groups in Israel.

Neighborhood violence is associated with poor health, but the mechanisms explaining this association are still unknown. This study seeks to examine the role of loneliness as a mediator of the association between neighborhood violence and health among two ethnic groups (Arabs and Jews) in Israel. A representative survey was conducted among adult residents (1903 Arabs and 2726 Jews) of four Israeli towns: two Arab towns, one Jewish town and one mixed town. A stratified sample of households by residential area, age and sex, was selected in each town. Mediation models were tested using Hayes' PROCESS procedure. Traffic violations, juvenile delinquency and vandalism were reported by more than 50% of Arab residents, relative to about 25-30% of Jewish residents. Loneliness mediated the association between neighborhood violence and health, with a full serial mediation for mental health and a partial serial mediation for physical health. Findings indicate that Arab towns are characterized by severe neighborhood violence. The association between neighborhood violence and physical health was fully dependent on the mediators among both ethnic groups. Future studies should use prospective designs with objective measures of health and violence to validate our cross-sectional findings.

Shared Decision Making and Trust Matter: Patient's Use of Video Consultations and a Remote Medical Device in Primary Care.

Background: There is growing interest in the incorporation of video consultations in primary care. Remote medical devices used for remote physical examinations are a new complementary addition to these consultations and may increase their effectiveness. This study examines a social behavioral-technological model by the factors predicting the acceptance of video consultation with or without a technological medical device, their perceived ease of use (PEU), and their perceived usefulness (PU), as well as social behavioral factors: trust and shared decision making. Methods: We conducted an online survey among patients who had visited a physician during 2021 and had the option to receive video consultations with or without remote medical devices. Structural equation modeling was applied to assess the proposed model of predicting the extent of future telemedicine use. Results: Among the 1,198 patient responders, the intention to use telemedicine video consultation had a significant positive association with trust, shared decision making, PEU, and PU and with high socioeconomic constructs. The intention to use telemedicine video consultation with a medical device had a significant positive association with shared decision making, PEU, and PU. The statistical results suggest a good fit with the proposed models. Conclusions: The proposed social behavioral-technological model demonstrated that to successfully adopt video consultations and new remote medical devices in primary care, there is a need for trust and shared decision making to be established in patient-physician relationships.

Associations of accelerometer measured school- and non-school based physical activity and sedentary time with body mass index: IPEN Adolescent study.

BACKGROUND: This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex. METHODS: Cross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11-19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models. RESULTS: Adolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found. CONCLUSIONS: This multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures.

Evaluation of an intervention to reduce child injury in Bedouin communities in Southern Israel.

BACKGROUND: Child injury is particularly prevalent in low socioeconomic populations and minorities. In Israel, Bedouin children exhibit high rates of injuries and death. A multifaceted community intervention to reduce injury in children in and around the home was run in nine Bedouin communities in Southern Israel during 2014-2018. The aim of the study was to evaluate the effect of the intervention on injuries among children aged 0-4 by comparing emergency room (ER) visits and hospitalisations before and after the intervention. METHODS: Child injury data (ages 0-4, 5-17) for 2013-2018 were obtained from Soroka Medical Center, including ER visits and hospitalisations. Further data on reason for hospitalisation and injury severity score (ISS) were obtained from the National Centre for Trauma Research for 2011-2018. Reach was assessed by calculating the per cent of participants from the total relevant population in each town. Poisson regression was used to assess change over time, from preintervention (2013) to postintervention (2018). RESULTS: A high proportion of educational institutions took part in the intervention, and around 20% of relevant households received a home visit (n=6334). There was a significant reduction in ER visits (7.6%) in children aged 0-4 in 2018 compared with 2013. Hospitalisations did not decrease significantly, although the number of admissions for burns and falls was reduced significantly at follow-up. CONCLUSIONS: This multifaceted intervention programme resulted in reduced injury in children aged 0-4 years in the Bedouin community. The use of simultaneous multiple intervention methods was effective in increasing child safety.

Design and implementation of a multifaceted injury prevention intervention in Bedouin children in southern Israel.

BACKGROUND: Child injury is prevalent in the Bedouin community of southern Israel, with higher injury rates compared with the general population. Bedouin children aged 0-4 were twice as likely as children from other population groups to suffer any injury, and for example, incidence of burns in Bedouin children was 0.91/1000 children, compared with 0.46/1000 in Jewish children. METHODS: A multifaceted injury prevention intervention was developed based on best practice methods, culturally adapted and implemented in nine Bedouin towns in collaboration with local authorities. Intervention elements included a youth leadership scheme, workshops for mothers in maternal child health centres, home safety visits, a preschool intervention and a media campaign. Outcome assessment of change following home visits was conducted. Process evaluation included a survey of mothers and focus groups with youth participants. RESULTS: High participation was demonstrated indicating acceptability of the programme. Assessment of home visits showed an improvement in the level of household safety between first and second visits, as measured by a checklist. Youth participants expressed satisfaction in the programme, which gave them confidence and practical tools. CONCLUSION: A multifaceted intervention programme was conducted in the Bedouin community in southern Israel and found to be acceptable, with high participation levels. Collaboration between national and local authorities improved implementation, and multiple programmes in different settings enabled broad exposure to the programme.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region.

BACKGROUND: The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region. METHODS: Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use. RESULTS: In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour. CONCLUSION: We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

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.

Willingness and concerns of transfusion-dependent hematological patients toward the option of home transfusion therapy.

BACKGROUND: One of the main obstacles of providing home-based palliative care to transfusion-dependent hematology patients is the lack of home transfusions services. While healthcare professionals are concerned with safety and cost of home transfusions, the attitude of the patients toward home transfusions are mostly unknown. AIM: To obtain quantitative data regarding the willingness and concerns of transfusion-dependent patients with hematological diseases toward the option of home transfusions. DESIGN: A cross sectional survey including a self-administered questionnaire in one of the three main spoken languages in Israel was administered to patients in 17 hospital hematology outpatient clinics between May 2019 and March 2020. RESULTS: About 52% of 385 patients that participated in the survey preferred home transfusions to hospital transfusions. Gender, age, education, or type of disease were not associated with preference for home transfusions, nor were hospital location or its size. The likelihood to prefer home transfusions was significantly higher among the Hebrew-speakers and those who had not experienced adverse effects previously. The most significant factor associated with preference of home transfusions was a perceived negative effect of hospital-based transfusion on quality of life. The main reason to reject home transfusions was fear of possible adverse effects and concerns over losing contact with the medical staff at the treating hospital. CONCLUSION: These data suggest that a significant portion of transfusion-dependent patients in Israel view home transfusions as a preferred treatment option and that its successful implementation requires maintaining ongoing contact with the treating hospital.

Preferences and barriers to the utilization of primary health care by sick physicians: a nationwide survey.

BACKGROUND: Physicians are often dissatisfied with their own medical care. Self-prescribing is common despite established guidelines that discourage this practice. From a pilot study, we know primary care physicians' (PCP) preferences, but we lack information regarding other specialties and work places. OBJECTIVES: The goal of this study was to examine whether physicians are satisfied with their personal primary care and how this could be improved. METHODS: We distributed an electronic survey to all physicians registered with the Israeli Medical Association. The questionnaire examined satisfaction with medical care, preferences for using formal care versus informal care, self-prescribing and barriers to using formal care. RESULTS: Two thousand three hundred and five out of 24 360 invited physicians responded. Fifty-six per cent of the respondents were satisfied with their personal primary care. Fifty-two per cent reported initiating self-treatment with a medication during the last year. Five and four per cent initiated treatment with a benzodiazepine and an antidepressant, respectively, during the last year. This was despite the fact that most physicians did not feel competent to treat themselves. Having a personal PCP was correlated with both a desire to use formal care and self-referral to formal care in practice. Regression analysis showed that the highest odds ratio (OR) for experiencing a large gap between desired and actual care were for physicians who had no personal PCP (OR = 1.92). CONCLUSIONS: Physicians frequently engage in self-treatment and in informal medical care. Whether the root cause is the health care system structure that does not meet their needs or the convenience of self-treatment is not known.

Health may be compromised by social interactions depending on culture among postpartum Arab and Jewish Israeli women.

BACKGROUND: Social support is generally perceived to facilitate health in postpartum women; however, previous research shows that this is not always true. Social interactions intended to provide support can be perceived as negative and in turn, may have negative impacts on maternal health. The purpose of the present study was to asses if social support and negative interactions at one month after childbirth can predict maternal health four months after childbirth, and if this relationship is influenced by culture. METHODS: This prospective longitudinal cohort study included randomly selected Arab (n = 203) and Jewish (n = 202) women who attended Mother and Child Health Clinics in Northern Israel one month after giving birth. The women were interviewed at one and four months after childbirth using a questionnaire including measures of health (self-reported health (SRH) and health problems), socioeconomic and demographic status, obstetric characteristics, social support, negative social interactions and perceptions of customs and traditions intended to help the mother cope after childbirth. Multivariable regressions were run to identify the variables predicting health four months after childbirth. RESULTS: The response rate for both interviews was 90%. Negative social interactions one month after childbirth significantly predicted health problems in Arab and Jewish women (Beta 0.20 and 0.37 respectively) and SRH among Arab women only (odds ratio (OR) 0.32, confidence interval (CI) 0.19-0.54) four months after childbirth. Social support at one month after childbirth significantly predicted better SRH in both Jewish and Arab women four months after childbirth (OR 2.33, CI 1.38-3.93 and 1.59, CI 1.01-2.46 respectively) and fewer health problems only among Jewish women (Beta - 0.37). CONCLUSIONS: Social support and negative social interactions appear to be predictive of health in postpartum women. Associations varied between Arabs and Jews, indicating that social support may be more important for predicting health among Jewish women and negative interactions may be more important among Arab women. Healthcare practitioners should be aware of the cultural context and social circumstances of postpartum women to ensure they receive the social support and care they need.

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study.

BACKGROUND: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. METHODS: This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014-2017. The consultations were analyzed for factors that may have affected the online physicians' decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians' decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. RESULTS: The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians' means for ensuring high patient safety - by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions. CONCLUSIONS: The results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians' ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings - with the aim of ensuring patient safety.

Internal locus of control, health literacy and health, an Israeli cultural perspective.

The association between health literacy (HL) and health outcomes, including self-perceived health (SPH) has been well documented. Yet the complexity of this association is not yet completely clear. Drawing on the Health Literacy Scale (HLS) study in Israel, we examined the association between HL, Internal Health Locus of Control (IHLOC) and SPH among Jews and Arabs. A face-to-face survey was conducted among 242 Arabs and 358 Jews. The questionnaire measured SPH, IHLOC and two measures of HL: a European HLScale (HLS-EU-16) and the Hebrew/Arabic Health Literacy Test (H/AHLT), based on the Short Test Of Functional Health Literacy in Adults. Analysis included multivariable logistic regressions and bootstrapping to identify mediation effects. Among Jews, IHLOC seems to be a significant mediator between HL and SPH. IHLOC was strongly associated with SPH (OR = 6.13; CI = 3.2, 11.8), while HL was not significantly associated directly with SPH. Similar results were observed when using the H/AHLT as a measure of HL. Among Arabs a different pattern emerges; IHLOC was neither associated with SPH nor was it a mediator of the association between HL and SPH. The two measures of HL seem to have different associations with SPH among Arabs, as only H/AHLT was associated significantly with SPH, and not HLS-EU-16. Thus, those with higher levels of IHLOC assess their health as better than those with low IHLOC only among Jews, and not among Arabs. IHLOC seems to be a significant mediator between HL and SPH among some cultures. Among Arabs, only functional HL seems to be positively associated with SPH.

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.

Physicians' experiences, attitudes and challenges in a Pediatric Telemedicine Service.

BACKGROUND: Telemedicine in general, and telephone triage, in particular, is considered a high-stress clinical activity and involves decision making under conditions of uncertainty and urgency. AIM: We wanted to explore the experiences, attitudes, and challenges of the physicians in a Pediatric Telemedicine Service operated in Israel, and to explore whether the doctors are using non-medical factors (not related to the medical problem), when making the clinical decisions in this setting. METHODS: We used a qualitative methodology in order to obtain rich data that would reflect the participants' subjective experiences. Fifteen physicians who worked during the last 5 years in the "Pediatrician Online of Clalit" service were interviewed. Data were analyzed thematically. FINDINGS: Seven main themes concerning the physicians' challenges during their work at this service were revealed, including difficulties diagnosing from a distance, treating unfamiliar patients, working alone, urgency and load of calls, technological obstacles, and a "moral conflict" between the desire to meet parents' expectations and maintain standards of care. The physicians stated that non-medical factors also affect their decisions. CONCLUSIONS: In telemedicine setting, physicians face various difficulties and challenges, requiring special expertise, qualities and skills. Special measures are needed to obtain proper diagnosis and decisions.

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.

Reported safety environment predicts injuries among children aged 1-6 years in specific communities.

AIM: To measure individual and environmental risk factors predicting reported child injuries. METHODS: A prospective, follow-up study was performed including 380 parents of children aged 1-6 years, living in various communities throughout Israel. Parents were interviewed three times, 3 months apart. Injuries were defined as including minor injuries that required parental attention and medically attended injuries: doctor or nurse visit, emergency medical services or hospitalisation. Parents reported the level of safety for both indoor and outdoor environments, covering 11 items pertaining to safety elements dedicated to prevent child injury. Socio-demographic and parents' attitudes towards child injury were also measured. RESULTS: During the 6-month follow-up period, 37% of parents reported that their child was injured, and 29% of them received medical attention. Reported outdoor safety environment was found to be a predictor of child injury, suggesting that the risk of child injury is higher among children living in unsafe outdoor environments. However, this depended on levels of religiosity (with an odds ratio of 2.48 and 95% confidence interval of 1.09-5.64 for traditional families and an odds ratio of 3.65 and 95% confidence interval of 1.58-8.46 for religious families). CONCLUSIONS: Safe environments play a major role in decreasing the risk of injury among children. In order to decrease injury rates among young children, attention should be given to the immediate outdoor environment in which children grow up and play. Decision makers might particularly want to pay closer attention to the influence of religious backgrounds on child safety through safe environments.

[SOCIAL-ECONOMIC-DEMOGRAPHIC DIFFERENCES IN REASONS NOT TO COMPLY IN TIME WITH ROUTINE CHILDHOOD VACCINATIONS].

BACKGROUND: In recent years, there has been an increase in parents who do not comply with recommended routine vaccines. The vaccination coverage rates in Israel are known, but the reasons for not completing immunizations are unknown. The aim of this study was to assess the extent of failure to complete the routine vaccinations in time and the reasons among different population groups. METHODS: This is a retrospective case-control cohort study, among children born in 2009. A total of 14,232 medical records of children who received services at Mother-Child Health Clinics were checked. The children who received all three core vaccines (3th Hepatitis B, 4th DTaP and MMR vaccines) were considered fully compliant and those missing at least one vaccination were considered non-compliant. Six reasons for not complying were identified: medical reasons, parental refusal to vaccinate, requests for a deferred schedule of vaccinations, parental behavior, organizational reasons and others. The differences between groups were analyzed by univariate analysis and logistic regression. RESULTS: In this study, 7.4% of children, were not fully compliant with all three core vaccines within two years. The main reasons in the Jewish population were: refusal and requests for variation in scheduling (44.3%) and in the Arabic population: parental behavior (40.8%). The risk for not completing the vaccinations was higher in children of Jewish mothers, residence in the Hadera sub-district, parents who had an academic education and older parents. CONCLUSIONS: There are differences between Arab and Jewish populations in the reasons for not complying in time with childhood vaccinations. In order to obtain herd immunity in the Israeli population, we need to tailor interventions suitable for each population group according to their characteristics.

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.