Emergence of corpse cremation during the Pre-Pottery Neolithic of the Southern Levant: A multidisciplinary study of a pyre-pit burial.

Renewed excavations at the Neolithic site of Beisamoun (Upper Jordan Valley, Israel) has resulted in the discovery of the earliest occurrence of an intentional cremation in the Near East directly dated to 7031-6700 cal BC (Pre-Pottery Neolithic C, also known as Final PPNB, which spans ca. 7100-6400 cal BC). The funerary treatment involved in situ cremation within a pyre-pit of a young adult individual who previously survived from a flint projectile injury. In this study we have used a multidisciplinary approach that integrates archaeothanatology, spatial analysis, bioanthropology, zooarchaeology, soil micromorphological analysis, and phytolith identification in order to reconstruct the different stages and techniques involved in this ritual: cremation pit construction, selection of fuel, possible initial position of the corpse, potential associated items and funerary containers, fire management, post-cremation gesture and structure abandonment. The origins and development of cremation practices in the region are explored as well as their significance in terms of Northern-Southern Levantine connections during the transition between the 8th and 7th millennia BC.

Reducing disparities in mammography-use in a multicultural population in Israel.

BACKGROUND: In the past mammography-use has been reported to be low in Israel compared to other western countries. The objectives of this study were (1) to assess the increase in mammography-use during the years 2002 to 2007 in four population groups in Maccabi Healthcare Services (MHS), Israel: non-immigrant non-ultraorthodox, ultraorthodox, and immigrant Jewish women and Arab women; (2) to assess ethnic and socioeconomic disparities in mammography-use. METHODS: A random telephone survey of 1,550 women receiving healthcare services from MHS was performed during May-June 2007. Information from MHS claims-records database regarding mammography-use was obtained for each woman for the period 2002 to 2007. Since mammography-use serves as a quality assurance measure for primary care, MHS sent mail and telephone invitations for mammography to all women since the end of 2004. RESULTS: At the beginning of the follow-up period (2002) mammography-use among Jewish non-immigrant non-ultraorthodox and ultraorthodox women was higher than among Arab and Jewish immigrant women. During the 5 year follow-up these disparities decreased significantly. In 2007, mammography-use by Arab women was only slightly lower compared to all groups of Jewish women. In 2007, after adjustment for socioeconomic factors there was only a borderline significant difference between Jewish and Arab women. The socioeconomic variables were not associated with mammography-use in 2002 and 2007 in any of the groups except for marital status in immigrant women in 2002. CONCLUSION: The interventions implemented by MHS may have increased mammography-use in all population groups, decreasing disparities between the groups, however the differences between Jewish and Arab women have not been completely eliminated and indicate a need for further targeted interventions. No significant socioeconomic disparities in mammography-use were observed.

Increased mammographic screening and use of percutaneous image-guided core biopsy in non-palpable breast cancer: impact on surgical treatment.

BACKGROUND: Major efforts are being directed at the early diagnosis of breast cancer. The diagnosis rate of non-palpable tumors is steadily growing as a result of increased screening by mammography. In most patients with non-palpable lesions, percutaneous image-guided biopsies have replaced wire localization with surgical excision for obtaining tissue diagnosis. In recent years the Israel Ministry of Health initiated a mammograpy screening program. Percutaneous image-guided biopsies have also become widely available. OBJECTIVE: To assess the impact of these changes on breast cancer surgical treatment in our hospital. METHODS: The charts of 483 patients operated on in our department for primary breast carcinoma during the years 1997 to mid-2001 were reviewed. Data on the mode of diagnosis, tumor stage, resection margins, and number and types of operations were recorded and analyzed. The term non-palpable tumors relates to tumors necessitating wire localization for surgical excision. RESULTS: The percentage of patients diagnosed with non-palpable tumors rose from 16.2% in 1997 to 47.4% in 2001, with an average size of 2.6 cm for palpable and 1.7 cm for non-palpable tumors. The rate of preoperative diagnosis for non-palpable tumors rose from 6.2% in 1997 to 96.4% in 2001. The rate of involved or very close margins was reduced by 73% in the patient group diagnosed preoperatively as compared to those without a preoperative diagnosis (10.6% vs. 39.4%). Finally, the percentage of patients who had two operations fell from 56.2% in 1997 to 11.1% in 2001. CONCLUSIONS: The mammography screening program in Jerusalem in 1997-2001 was effective in increasing the relative percentage of non-palpable breast cancers with reduced tumor size at diagnosis. The improved availability of preoperative tissue diagnosis in these patients reduced the number of surgical procedures needed.

[Informed consent--a simulation workshop for surgeons and gynaecologists].

BACKGROUND: Informed consent as part of the Israeli Patient's Rights Act (1996) is poorly known and only partly followed among physicians in Israel. PURPOSE: A one-day workshop on informed consent was designed with a dual purpose: a) to instruct on the legal requirements for obtaining consent to surgery for physicians in the surgical disciplines, and b) to practice effective and humane physician-patient relationships. METHODS: Sixty-one residents and senior staff took part in 6 sessions of a one-day workshop. Participants watched twice and performed twice videotaped simulated consent conversations with standardized patients. Six professional actors personified patients with common surgical problems and different characters and behaviours. Each participant was challenged with medical problems in her/his discipline. Following the first simulation, the participants attended a group discussion concerning legal requirements for informed consent, and expectations of patients and physicians in terms of communication skills and patient-physician relationships. Three types of feed-back were employed: a) non-professional personal feedback from the actors; b) personal feedback from a communication specialist using one of the videotaped encounters; and c) group discussions of each of the 6 types of simulations with examples from the encounters. RESULTS: Feedback from the participants was positive and showed interest and need of knowledge of the law as well as of communicative skills. CONCLUSIONS: There is a place, among residents and senior physicians, for experiential learning of how to effectively and humanely obtain informed consent.

Organisational efforts to improve quality while reducing healthcare disparities: the case of breast cancer screening among Arab women in Israel.

OBJECTIVES: (1) To improve quality and equity by increasing utilisation of mammography screening among Israeli Arab women. (2) To explore effectiveness of designing interventions with a combined top-down and bottom-up approach. DESIGN: Retrospective study at two periods of time: 2004--intervention's preliminary stages; 2005--intervention's implementation. SETTING: Maccabi Healthcare Services (MHS), an Israeli health plan serving 1.7 million members at study period; 7% of them are Arabs by 139 branches, 13 of which serve Arabs exclusively. MACRO-ORGANISATIONAL INTERVENTION (TOP DOWN): Development of a computerised Mammography Promotion System, phone contacts with non-respondents and intraorganisational reporting of screening rates. INTENSIVE INTERVENTION (BOTTOM UP): A local analysis of barriers to care and implementation of tailored solutions. This intervention was initiated and documented in three Arab branches, with spillover to the entire Arab sector. MEASURE DEFINITION: Biennial breast cancer (BC) screening of eligible women. Improvement measures Changes in BC screening rates in Arabs and comparisons with overall MHS BC screening rates for 2004 and 2005. RESULTS: In 2005, average BC screening rates in Arab branches increased from 26.7% to 46.2% (73% improvement), while overall MHS screening rates increased from 49.0% to 63.1% (29% improvement). Analysis of the relative differences between 2004 and 2005 BC screening rates indicated statistically significant differences (p<0.006) in rates between the Arab and other branches. These results did not change after adjustment for branch size, region and branch average age. CONCLUSIONS: Combined top-down interventions and bottom-up initiatives are effective for formulating programmes to reduce inequality.

Fatalism and Mammography in a Multicultural Population.

Purpose/Objectives: To assess levels of fatalistic beliefs and their association with mammography use in four population groups in Israel.Design: Telephone survey.Setting: Maccabi Healthcare Services in Israel.Sample: A random sample of 1,550 Arabic and Jewish women.Methods: A random telephone survey was performed during May and June 2007. Women's fatalistic beliefs were measured. Information from claims records regarding mammography use was obtained for each woman.Main Research Variables: Levels of fatalistic beliefs and mammography use.Findings: Fatalistic beliefs included general beliefs that God or fate (external force) was the cause of cancer and related to cancer survivorship. The higher-educated women reported less fatalistic beliefs. Arab women reported more fatalistic beliefs compared to the other women. Mammography use was associated with fatalistic beliefs that external forces were the cause of cancer among Arab and immigrant women but not among veteran Jewish and ultraorthodox women. Fatalistic beliefs about cancer survivorship were not associated with mammography in any of the population groups. Levels of fatalism and education may explain the difference in rates of mammography among Arab and Jewish women.Conclusions: High levels of fatalism may inhibit women from having a mammogram, particularly Arab and immigrant women in Israel. However, this is not a generalizable result for all population groups and all types of fatalism.Implications for Nursing: Interventions to decrease fatalism in Arabs and immigrants may increase compliance with mammography. Nurses may achieve this by developing tailored messages for women who believe that external forces are the cause of cancer.

Validity of self-reported mammography in a multicultural population in Israel.

OBJECTIVE: To validate self-reported mammography against claims records in women aged 52-74 living in Israel and belonging to the Jewish (non-orthodox pre-1989 native or former Soviet Union immigrant or ultra-orthodox) or Arab populations. METHODS: In a spring 2007 random telephone survey, 1550 women receiving healthcare at Maccabi Health Services were asked whether they had had a mammography during the previous 2 years. The same information was obtained from claims records and treated as the gold standard. RESULTS: Self-reported mammography and claims records disagreed for 17.4%. Compared to the other populations, Arab women tended to report more often that they had obtained a mammogram when it was not registered in the claims data (specificity=47.3%, 95% CI%=38.4, 56.3). Ultra-orthodox women more often failed to report having had the mammogram while the claims records indicated they had had (sensitivity=90.3%, 95% CI%=86.1, 93.6). CONCLUSION: Agreement between self-reported mammography and claims records depends on cultural and socioeconomic factors.