Modeling mortality prediction in older adults with dementia receiving COVID-19 vaccination.

OBJECTIVE: This study compared COVID-19 outcomes between vaccinated and unvaccinated older adults with and without cognitive impairment. METHOD: Electronic health records from Israel from March 2020-February 2022 were analyzed for a large cohort (N = 85,288) aged 65 + . Machine learning constructed models to predict mortality risk from patient factors. Outcomes examined were COVID-19 mortality and hospitalization post-vaccination. RESULTS: Our study highlights the significant reduction in mortality risk among older adults with cognitive disorders following COVID-19 vaccination, showcasing a survival rate improvement to 93%. Utilizing machine learning for mortality prediction, we found the XGBoost model, enhanced with inverse probability of treatment weighting, to be the most effective, achieving an AUC-PR value of 0.89. This underscores the importance of predictive analytics in identifying high-risk individuals, emphasizing the critical role of vaccination in mitigating mortality and supporting targeted healthcare interventions. CONCLUSIONS: COVID-19 vaccination strongly reduced poor outcomes in older adults with cognitive impairment. Predictive analytics can help identify highest-risk cases requiring targeted interventions.

Exploring the Self-Reported Physical and Psychological Effects in a Population Exposed to a Regional Conflict.

BACKGROUND: Conflict profoundly impacts community health and well-being. While post-conflict research exists, little is known about initial effects during active hostilities. OBJECTIVE: To assess self-reported changes in health behaviors, distress, and care access within one month of regional warfare onset in a conflict-affected community. METHODS: An online survey was conducted in November 2023 among 501 residents (mean age 40.5 years) of a community where war began October 7th. Measures evaluated physical health, mental health, diet, substance use, sleep, weight changes, and healthcare access before and after the declaration of war. RESULTS: Relative to pre-war, respondents reported significantly increased rates of tobacco (56%) and alcohol (15%) consumption, worsening sleep quality (63%), elevated distress (18% sought help; 14% needed but didn't receive it), and postponed medical care (36%). Over a third reported weight changes. Distress was higher among females and those endorsing maladaptive coping. CONCLUSION: Within one month, substantial impacts on community psychosocial and behavioral health emerged. Unmet mental health needs and risk-taking behaviors were early indicators of conflict's health consequences. Continuous monitoring of conflict-affected communities is needed to inform tailored interventions promoting resilience and prevent entrenchment of harms over time.

A comparative vignette study: Evaluating the potential role of a generative AI model in enhancing clinical decision-making in nursing.

AIM: This study explores the potential of a generative artificial intelligence tool (ChatGPT) as clinical support for nurses. Specifically, we aim to assess whether ChatGPT can demonstrate clinical decision-making equivalent to that of expert nurses and novice nursing students. This will be evaluated by comparing ChatGPT responses to clinical scenarios to those of nurses on different levels of experience. DESIGN: This is a cross-sectional study. METHODS: Emergency room registered nurses (i.e. experts; n = 30) and nursing students (i.e. novices; n = 38) were recruited during March-April 2023. Clinical decision-making was measured using three validated clinical scenarios involving an initial assessment and reevaluation. Clinical decision-making aspects assessed were the accuracy of initial assessments, the appropriateness of recommended tests and resource use and the capacity to reevaluate decisions. Performance was also compared by timing response generations and word counts. Expert nurses and novice students completed online questionnaires (via Qualtrics), while ChatGPT responses were obtained from OpenAI. RESULTS: Concerning aspects of clinical decision-making and compared to novices and experts: (1) ChatGPT exhibited indecisiveness in initial assessments; (2) ChatGPT tended to suggest unnecessary diagnostic tests; (3) When new information required re-evaluation, ChatGPT responses demonstrated inaccurate understanding and inappropriate modifications. In terms of performance, the mean number of words utilized in ChatGPT answers was 27-41 times greater than that utilized by both experts and novices; and responses were provided approximately 4 times faster than those of novices and twice faster than expert nurses. ChatGPT responses maintained logical structure and clarity. CONCLUSIONS: A generative AI tool demonstrated indecisiveness and a tendency towards over-triage compared to human clinicians. IMPACT: The study shows that it is important to approach the implementation of ChatGPT as a nurse's digital assistant with caution. More study is needed to optimize the model's training and algorithms to provide accurate healthcare support that aids clinical decision-making. REPORTING METHOD: This study adhered to relevant EQUATOR guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION: Patients were not directly involved in the conduct of this study.

Optimising wound monitoring: Can digital tools improve healing outcomes and clinic efficiency.

BACKGROUND: Chronic wounds present significant challenges for patients and nursing care teams worldwide. Digital health tools offer potential for more standardised and efficient nursing care pathways but require further rigorous evaluation. OBJECTIVE: This retrospective matched cohort study aimed to compare the impacts of a digital tracking application for wound documentation versus traditional manual nursing assessments. METHODS: Data from 5236 patients with various wound types were analysed. Propensity score matching balanced groups, and bivariate tests, correlation analyses, linear regression, and Hayes' Process Macro Model 15 were utilised for a mediation-moderation model. RESULTS: Digital wound tracking was associated with significantly shorter healing durations (15 vs. 35 days) and fewer clinic nursing visits (3 vs. 5.8 visits) compared to standard nursing monitoring. Digital tracking demonstrated improved wound size reduction over time. Laboratory values tested did not consistently predict healing outcomes. Digital tracking exhibited moderate negative correlations with the total number of nursing visits. Regression analysis identified wound complexity, hospitalizations, and initial wound size as clinical predictors for more nursing visits in patients with diabetes mellitus (p < .01). Digital tracking significantly reduced the number of associated nursing visits for patients with peripheral vascular disease. CONCLUSION: These findings suggest that digital wound management may streamline nursing care and provide advantages, particularly for comorbid populations facing treatment burdens. REPORTING METHOD: This study adhered to STROBE guidelines in reporting this observational research. RELEVANCE TO CLINICAL PRACTICE: By streamlining documentation and potentially shortening healing times, digital wound tracking could help optimise nursing resources, enhance wound care standards, and improve patient experiences. This supports further exploration of digital health innovations to advance evidence-based nursing practice. PATIENT OR PUBLIC CONTRIBUTION: This study involved retrospective analysis of existing patient records and did not directly include patients or the public in the design, conduct, or reporting of the research.

Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict.

BACKGROUND: Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire. OBJECTIVES: To describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site. METHODS: A retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed. RESULTS: Patients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation. CONCLUSION: Insights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.

Evaluating the reliability of ChatGPT as a tool for imaging test referral: a comparative study with a clinical decision support system.

OBJECTIVES: As the technology continues to evolve and advance, we can expect to see artificial intelligence (AI) being used in increasingly sophisticated ways to make a diagnosis and decisions such as suggesting the most appropriate imaging referrals. We aim to explore whether Chat Generative Pretrained Transformer (ChatGPT) can provide accurate imaging referrals for clinical use that are at least as good as the ESR iGuide. METHODS: A comparative study was conducted in a tertiary hospital. Data was collected from 97 consecutive cases that were admitted to the emergency department with abdominal complaints. We compared the imaging test referral recommendations suggested by the ESR iGuide and the ChatGPT and analyzed cases of disagreement. In addition, we selected cases where ChatGPT recommended a chest abdominal pelvis (CAP) CT (n = 66), and asked four specialists to grade the appropriateness of the referral. RESULTS: ChatGPT recommendations were consistent with the recommendations provided by the ESR iGuide. No statistical differences were found between the appropriateness of referrals by age or gender. Using a sub-analysis of CAP cases, a high agreement between ChatGPT and the specialists was found. Cases of disagreement (12.4%) were further analyzed and presented themes of vague recommendations such as "it would be advisable" and "this would help to rule out." CONCLUSIONS: ChatGPT's ability to guide the selection of appropriate tests may be comparable to some degree with the ESR iGuide. Features such as the clinical, ethical, and regulatory implications are still warranted and need to be addressed prior to clinical implementation. Further studies are needed to confirm these findings. CLINICAL RELEVANCE STATEMENT: The article explores the potential of using advanced language models, such as ChatGPT, in healthcare as a CDS for selecting appropriate imaging tests. Using ChatGPT can improve the efficiency of the decision-making process KEY POINTS: • ChatGPT recommendations were highly consistent with the recommendations provided by the ESR iGuide. • ChatGPT's ability in guiding the selection of appropriate tests may be comparable to some degree with ESR iGuide's.

Inappropriate CT examinations: how much, who and where? Insights from a clinical decision support system (CDSS) analysis.

OBJECTIVE: To assess the appropriateness of Computed Tomography (CT) examinations, using the ESR-iGuide. MATERIAL AND METHODS: A retrospective study was conducted in 2022 in a medium-sized acute care teaching hospital. A total of 278 consecutive cases of CT referral were included. For each imaging referral, the ESR-iGuide provided an appropriateness score using a scale of 1-9 and the Relative Radiation Level using a scale of 0-5. These were then compared with the appropriateness score and the radiation level of the recommended ESR-iGuide exam. DATA ANALYSIS: Pearson's chi-square test or Fisher exact test was used to explore the correlation between ESR-iGuide appropriateness level and physician, patients, and shift characteristics. A stepwise logistic regression model was used to capture the contribution of each of these factors. RESULTS: Most of exams performed were CT head (63.67%) or CT abdominal pelvis (23.74%). Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to "usually appropriate." The mean radiation level for actual exam was 3.2 ± 0.45 compared with 2.16 ± 1.56 for the recommended exam. When using a stepwise logistic regression for modeling the probability of non-appropriate score, both physician specialty and status were significant (p = 0.0011, p = 0.0192 respectively). Non-surgical and specialist physicians were more likely to order inappropriate exams than surgical physicians. CONCLUSIONS: ESR-iGuide software indicates a substantial rate of inappropriate exams of CT head and CT abdominal-pelvis and unnecessary radiation exposure mainly in the ED department. Inappropriate exams were found to be related to physicians' specialty and seniority. CLINICAL RELEVANCE STATEMENT: These findings underscore the urgent need for improved imaging referral practices to ensure appropriate healthcare delivery and effective resource management. Additionally, they highlight the potential benefits and necessity of integrating CDSS as a standard medical practice. By implementing CDSS, healthcare providers can make more informed decisions, leading to enhanced patient care, optimized resource allocation, and improved overall healthcare outcomes. KEY POINTS: • The overall mean of appropriateness for the actual exam according to the ESR-iGuide was 6.62 ± 2.69 on a scale of 0-9. • Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to "usually appropriate." • Inappropriate examination is related to both the specialty of the physician who requested the exam and the seniority status of the physician.

Priority setting for health technology adoption at the national level: Lessons learned over 25 years' experience.

BACKGROUND: Limited health budgets and continual advancement of health technologies require mechanisms for prioritization. Israel, with a publicly funded health service basket, has implemented and optimized such a health technology assessment process since 1999.We describe the process of evaluating technologies according to the Israeli model, analyze its outputs and benefits over two decades of implementation, and compare its key features with international experience. METHODS: Retrospective data were collected between 1998 and 2023, including work processes, committee composition, number of applications submitted and approved by a clinical domain, and yearly cost of the basket. Features were evaluated within the evidence-informed deliberative process (EDP) framework. RESULTS: This national model involves relevant stake holders in a participatory and transparent process, in a timely manner, and is accepted by the public, health professionals, and policy makers, facilitating early adoption of the newest medical technologies. Between 11 and 19 percent of applications are approved for reimbursement annually, mostly pharmaceuticals. On average 26 percent of approved technologies are added to the list without additional budget. Major domains of approved technologies were oncology, cardiology, and neurology. CONCLUSIONS: Israel created a unique model for the expansion of the health service basket. Despite an increasing number of applications and rising costs, the mechanism enables a consensus to be reached on which technologies to fund, while remaining within budget constraints and facilitating immediate implementation. The process, which prioritizes transparency and stake holder involvement, allows just a resource allocation while maximizing the adoption of novel technologies, contributing to an outstanding national level of health despite relatively low health spending.

Socioeconomic and ethnic disparities along five waves of the COVID-19 pandemic: Lessons we have not yet learnt.

PURPOSE: The COVID-19 pandemic, now in its third year, has served as a magnifying glass, exposing the inequitable impact of the outbreak. The study aims to analyze the relationships between the socioeconomic and ethnic characteristics of the population and COVID-19 testing, infection, and vaccination throughout the first five pandemic waves. DESIGN: A secondary analysis of an existing national database was conducted in Israel from March 2020 to May 2022. During the study period, Israel underwent 5 pandemic peaks or waves (March-April 2020, September-October 2020, January-February 2021, September 2021, and January-February 2022). METHODS: Data on tests performed, confirmed COVID-19 cases, and uptake of vaccine doses one through four during the study period, were analyzed by the socioeconomic (SE) cluster (scale of 1 to 10) and ethnicity (Jewish, Arab, mixed Jewish- Arab ethnicity) of the residents' local authority. RESULTS: COVID-19 testing rate gradually increased from the lowest to the highest SE clusters, with rates 3.2 times higher in the second highest, compared with the lowest cluster. People living in Jewish localities were tested twice more than those in Arab or mixed localities. The rate of confirmed cases was 1.9, 3.0, 6.3, and 4.3 times higher, respectively, among cluster 1 (the lowest) compared with cluster 9 (second highest) in the first, second, third, and fourth pandemic waves, respectively. Rates among people living in Arab or mixed localities were higher compared with those living in Jewish localities in 3 of the 5 waves. Vaccine uptake revealed a clear social gradient, with the percentage of the population being vaccinated gradually increasing from cluster 1 (the lowest) to the higher clusters. The relative difference between the lowest and highest SE clusters increased from 2.4 in the first vaccine dose to 5.5 in the third and fourth doses. Ethnic disparities also grew with vaccine dose, with a Jewish to an Arab rate ratio of 1.1, 1.2, 1.6, and 4.5 for vaccine doses 1,2,3, and 4, respectively. CONCLUSIONS: Covering 26 consecutive months of the COVID-19 pandemic at the national level, the current study demonstrates that despite high accessibility of tests and vaccines to the entirety of the population and tailored outreach efforts, socioeconomic, and ethnic disparities not only failed to diminish, but they even widened along the five pandemic waves. CLINICAL RELEVANCE: The pandemic exposed the vulnerability of the weakest segments of the population. Therefore, the combined action of the Ministry of Health, health providers, and local authorities is required to further adapt health messages to the cultural characteristics of diverse populations, to equip the health professionals with practical tools to promote healthy choices among the vulnerable populations, and to build communities that promote healthy lifestyles. The pandemic has highlighted the importance of reducing health disparities and building trust between vulnerable populations and the healthcare system during "normal" or routine times, to better prepare for times of emergencies, such as the current pandemic.

Timely childhood vaccination in Israel: a national retrospective study of ethnic and socioeconomic disparities.

A large proportion of children do not receive vaccines within the recommended timeframe. This study examined ethnic and socioeconomic differences in age-appropriate immunization of children in Israel, where immunization is freely available. Percent of children receiving MMR/V at 12-13 months, and four doses of DTP/IPV/Hib by 18 months were obtained from the National Programme for Quality Measures between 2015 and 2018. Ethnic group (Jewish vs Arab) (defined by proxy by the neighbourhood in which the clinic was located), neighbourhood socioeconomic status and peripherality were obtained. Rates of MMR vaccination were 61% in the Jewish and 82% in the Arab population; for DPT/IPV/Hib 75% in the Jewish, compared to 92% in the Arab population. These patterns were stable over time. Lowest rates occurred in the most peripheral areas for Arab children, and in urban areas for Jewish children. Differences between ethnic groups were significant at higher SES levels. Greater adherence to the vaccination schedule occurred in the Arab minority in contrast to studies showing lower vaccination in ethnic minorities elsewhere. Lower immunization rates among rural Arab children suggest a need for improved access to clinics. Efforts should be directed towards lower SES groups, while emphasizing the importance of timely vaccination in wealthier groups in order to achieve herd immunity.

Clinical decision support system recommendations: how often do radiologists and clinicians accept them?

OBJECTIVE: To assess the acceptance and reliability of clinical decision support system (CDSS) imaging referral scores (ESR iGuide). METHODS: A pilot study was conducted in a tertiary hospital. Four different experts were invited to rate 40 simulated clinical cases on a 5-level scale, for the level of agreement with the ESR iGuide's recommended procedures. In cases of disagreement, physicians were asked to indicate the reason. Descriptive measures were calculated for the level of agreement. We also explored the degree of agreement between four different specialists, and examined the cases in which clinicians disagreed with ESR iGuide best practice recommendations. RESULTS: The mean rating of the four experts for the 40 clinical simulated cases was 4.17 ± 0.65, median 4.25 (on a scale of 1-5). All four raters totally agreed with the system recommendation in 75% of cases. No significant relationship was found between the degree of agreement and the number of indications and the patient's age or gender. In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement for the rating of the 40 simulated cases between the four experts was 77.28%. There were a total of 20 disagreements out of 160 cases with the ESR iGuide, of which 7 were among the two radiologists. CONCLUSIONS: CDSS can be an effective tool for guiding the selection of appropriate imaging examinations, thus cutting costs due to unnecessary imaging scans. Since this is a pilot study, further research on a larger scale, preferably at national level, is required. KEY POINTS: • The average of the mean rating of the four experts was 4.17 ± 0.65, median 4.25, on a scale of 1-5 where 5 represents total agreement with the CDSS tool. • In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement between the four experts was 77.28%. • Radiologists had fewer disagreements with the recommendations of the CDSS tool than other physicians, indicating a better fit of the support system to radiology experts' perspective.

Changes in infectivity, severity and vaccine effectiveness against delta COVID-19 variant ten months into the vaccination program: The Israeli case.

We present epidemiological data to examine trends in COVID-19 incidence, morbidity and mortality in Israel as well as changes in vaccine effectiveness, and discuss the impact of the delta variant and the third, "booster", vaccine. A retrospective-archive study was conducted from February 27th 2020 to October 16th, 2021. Data were obtained from the Israeli Ministry of Health's open COVID 19 database, including PCR-confirmed cases, number hospitalized - including severe cases, death rate, all by age and vaccination status, case fatality rate and changing effectiveness of the vaccine. After three COVID waves, confirmed cases rose from under 30 new daily cases in mid-June to a high of 11,000 in early September 2021. Severe hospitalized cases and death rates were lower than in previous waves and largely restricted to those not fully vaccinated. In the first three months of the vaccination campaign, non-vaccinated population demonstrated much higher morbidity rates. Four months after vaccination began, this gap was attenuated, with low rates of infection and hospitalization in all groups. The gap was regained following uptake of the third vaccine. Data from the fourth wave show reduced hospitalizations and mortality compared to previous waves and suggest that this may be related to high vaccine coverage. These trends suggest that countries with high vaccination might adopt a more permissive approach towards COVID even in the face of new variants.

Covid-19 in children aged 5-11: Examining the issues surrounding vaccination and public health policy.

BACKGROUND: Children under 12 are now the largest unvaccinated group. Following FDA approval, vaccination of 5-11 year olds is now being encouraged in some countries. We present data on child COVID-related morbidity in Israel and discuss the complexities surrounding vaccinating children aged 5-11. METHODS: Data were obtained from Israel's open COVID database regarding new confirmed daily COVID-19 cases, severe hospitalized cases and deaths by age group in Israel from February 2020-November 2021, as well as vaccination rate and adverse events following vaccination. RESULTS: In 5-11 year olds, there were 460 hospitalizations, including 72 moderate to critical (0.007% population rate), with 3 deaths (0.0003% population rate). Children (0-19) made up the largest proportion (41%) of cases, but comprised just <0.1% of deaths, and <1% of severe cases. Post-vaccine myocarditis was much lower than severe COVID risk except in boys aged 12-19 where it was equivalent to the risk of mechanical ventilation due to COVID in boys aged 10-19 (12 per 100,000). High numbers of children were quarantined. CONCLUSIONS: COVID risk is minimal for most children though rare complications do occur. Israeli and US pediatric associations have recommended vaccinating children, particularly in high-incidence scenarios where risk-benefit balance is more clear-cut. However only a quarter of eligible parents have vaccinated their children. Parents may consider health grounds but also restrictions on children, population vaccination levels, waning immunity and new variants, and should be provided with clear information to help them make an informed decision. Policymakers should reevaluate the need for isolations, testing and mask-wearing in school age children, which are detrimental to their wellbeing.

The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel.

BACKGROUND: The COVID 19 pandemic has had a crucial effect on the patterns of disease and treatment in the healthcare system. This study examines the effect of the COVID-19 pandemic on respiratory ED visits and admissions broken down by age group and respiratory diagnostic category. METHODS: Data on non-COVID related ED visits and hospitalizations from the ED were obtained in a retrospective analysis for 29 acute care hospitals, covering 98% of ED beds in Israel, and analyzed by 5 age groups: under one-year-old, 1-17, 18-44, 45-74 and 75 and over. Diagnoses were classified into three categories: Upper respiratory tract infections (URTI), pneumonia, and COPD or asthma. Data were collected for the whole of 2020, and compared for each month to the average number of cases in the three pre-COVID years (2017-2019). RESULTS: In 2020 compared to 2017-2019, there was a decrease of 34% in non-COVID ED visits due to URTI, 40% for pneumonia and a 35% decrease for COPD and asthma. Reductions occurred in most age groups, but were most marked among infants under a year, during and following lockdowns, with an 80% reduction. Patients over 75 years old displayed a marked drop in URTI visits. Pediatric asthma visits fell during lockdowns, but spiked when restrictions were lifted, accompanied by a higher proportion admitted. The percent of admissions from the ED visits remained mostly stable for pneumonia; the percent of young adults admitted with URTI decreased significantly from March to October. CONCLUSIONS: Changing patterns of ED use were probably due to a combination of a reduced rate of viral diseases, availability of additional virtual services, and avoidance of exposure to the ED environment. Improved hygiene measures during peaks of respiratory infections could be implemented in future to reduce respiratory morbidity; and continued provision of remote health services may reduce overuse of ED services for mild cases.

Teachers' characteristics predict students' guidance for healthy lifestyle: a cross-sectional study in Arab-speaking schools.

INTRODUCTION: Schools are valuable settings for implementing healthy lifestyle interventions. Teachers' health behaviors affect their health and well-being and might affect their position as role models for students. This study aimed a) to assess health behaviors, health perceptions, burnout, job satisfaction, and organizational commitment among Arab school teachers in Israel; b) to examine the relationship between these variables; and c) to explain the variance of healthy lifestyle promotion among students. METHODS: A cross-sectional study using a structured questionnaire was conducted among 150 teachers (mean age 39 years, 85% women) in May-June 2020. RESULTS: Most respondents (79%) were overweight and obese, 79% reported unhealthy nutrition and not reaching the recommended physical activity target, 47% slept >7 hours at night and 54% defined their health status as very good or excellent. Reported burnout levels were high. Organizational commitment and job satisfaction were high while students' guidance towards a healthy lifestyle was moderate. Burnout was negatively correlated with health perception, organizational commitment, and job satisfaction. Health perception was positively correlated with organizational commitment, job satisfaction and promoting a healthy lifestyle among students. Logistic regression analysis revealed that job satisfaction, performance of PA according to the recommendations and burnout predicted 51% of the variance of healthy lifestyle promotion among students. CONCLUSIONS: Teachers in Israeli Arab schools report unfavorable health behaviors and health perception as well as high burnout levels. The findings suggest implementing intervention programs to reduce teacher burnout and creating organizational conditions that would encourage teachers to adopt a healthy lifestyle and help them promote healthy lifestyle habits among their students.

Are we suffering from the Peltzman effect? Risk perception among recovered and vaccinated people during the COVID-19 pandemic in Israel.

OBJECTIVES: The challenge of waning immunity and reinfection has been an acknowledged concern since the beginning of the COVID-19 pandemic. In the ongoing outbreak, reinfection rates are increasing alongside breakthrough cases among vaccinated individuals. The objective of this study was to examine the demographic characteristics associated with vaccination uptake among individuals previously infected with COVID-19 and to evaluate the period elapsed between the last vaccine dose and infection. STUDY DESIGN: A retrospective-archive study was conducted. METHODS: Data were extracted from the Israeli Ministry of Health's open COVID-19 database. RESULTS: The study found that uptake of vaccination in previously infected individuals is relatively low. When examining gender, previously infected females were more likely to receive vaccination than previously infected males. Similarly, differences in vaccination uptake exist between age groups. When examining the interval between the last vaccine dose and infection, the most significant breakthrough infection rate was observed among individuals aged 20-59 years. CONCLUSIONS: This study shows that there are specific populations subgroups that may serve as reservoirs of viral spread. Individuals in these groups may experience a false sense of security from a perceived sense of acquired long-term immunity, resulting in low levels of vaccine uptake and non-compliance with protective behaviours. Targeted messaging should be used to reemphasise the need for continued protective behaviours.

Issues surrounding incentives and penalties for COVID-19 vaccination: The Israeli experience.

The purpose of this study was to examine patterns of COVID-19 vaccination in Israel and how these relate to different proposals made about benefits for those vaccinated, and to present the legal and ethical dilemmas surrounding these issues. A retrospective study of COVID-19 vaccination rates in Israel was conducted, with data obtained from the Ministry of Health (MOH). Information on benefits proposed or offered for vaccination and restrictions for non-vaccination were obtained from the MOH and presented in a timeline. By March 1st, 51% of the total population, and 91% of those aged 60 and over, had received their first COVID-19 vaccine. Exemption from quarantine was granted to vaccinated or recovered people from 17th January 2021. The 'green pass' incentive scheme, granting access to social, cultural and sporting events for those fully vaccinated or immune, was proposed in December 2020, and came into effect on February 21st 2021. Incentive schemes which impose limitations on those who choose not to vaccinate may motivate some people to take action. Policymakers should use a measured approach to protect public health, with minimum infringement on citizens' rights. Providing transparent and culturally appropriate information on immunization and ensuring maximal and equitable access to COVID-19 vaccines may help build trust.

Socioeconomic gradient in COVID-19 vaccination: evidence from Israel.

BACKGROUND: Low socioeconomic status (SES) groups have been disproportionately affected by the COVID-19 pandemic. We aimed to examine COVID-19 vaccination rate by neighborhood SES and ethnicity in Israel, a country which has achieved high vaccination rates. METHODS: Data on vaccinations were obtained from the Israeli Ministry of Health's open COVID-19 database, for December 20, 2020 to August 31, 2021. Correlation between vaccination rate and neighborhood SES was analyzed. Difference in vaccination rate between the first and second vaccine dose was analyzed by neighborhood SES and ethnicity. FINDINGS: A clear socioeconomic gradient was demonstrated, with higher vaccination rates in the higher SES categories (first dose: r = 0.66; second dose: r = 0.74; third dose: r = 0.92). Vaccination uptake was lower in the lower SES groups and in the Arab population, with the largest difference in uptake between Jewish and Arab localities for people younger than 60, and with the gap widening between first and third doses. CONCLUSIONS: Low SES groups and the Arab ethnic minority demonstrated disparities in vaccine uptake, which were greater for the second and third, compared with the first vaccine dose. Strategies to address vaccination inequity will need to identify barriers, provide targeted information, and include trust-building in disadvantaged communities.

Tipping the scales: a theoretical model to describe the differential effects of the COVID-19 pandemic on mortality.

BACKGROUND: The COVID-19 pandemic has resulted in changes in almost every aspect of life. The fatal consequences of the pandemic have been clearly reported, with direct and indirect effects; however, there is some evidence of a positive secondary impact, such as fewer motor accidents, lower influenza burden and reduced air pollution. METHODS/MODEL: We present a model to describe the differing effects of the COVID-19 pandemic on mortality, taking into account external pressures and internal resources and their relationship with resilience and health behaviors, which affect mortality risk, inspired by elements of the salutogenic model. Individuals with lower resources and from more deprived communities are likely to be more negatively affected by the external changes occurring, while those with more resources may be more likely to experience the benefits. Both individual and community resources affect coping and influence both mental and physical health. CONCLUSIONS: Decision makers should consider ways to incorporate the positive changes which occurred as part of the exit strategy. Societies should invest in building resources to improve both individual and community resilience to help people be better prepared and more able to cope and adapt in times of crisis. Special emphasis should be given to weaker populations most affected by external changes, including older people, low socioeconomic groups, those with mental health issues and minority groups, in order to reduce disparities.

The Effects of a Novel Mindfulness-based Intervention on Nurses' State Mindfulness and Patient Satisfaction in the Emergency Department.

INTRODUCTION: The objective of this study was to examine the effect of a novel mindfulness-based time-out intervention on state of mindfulness among emergency nurses and, accordingly, on patient satisfaction. METHODS: A pre-post intervention design among nurses in the emergency department was used with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the emergency department of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the emergency department was recruited (n = 1920 patients; 960 in each phase). The mindfulness-based time-out intervention was based on theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses' sociodemographic and professional characteristics and trait mindfulness were collected preintervention. Pre- and postintervention, data was collected on patients' sociodemographic and satisfaction, nurses' state mindfulness, and ED workload. RESULTS: An increase in nurses' state mindfulness and patients' satisfaction was found after the mindfulness-based time-out intervention compared with before the intervention (4.35 [SD = 0.64] vs 4.03 [0.82], P < .001 and 4.03 [0.41] vs 3.16 [0.44], P < .001, respectively). A positive correlation was found between patients' satisfaction and nurses' state mindfulness (r = 0.29, P < .001). The findings also demonstrated that state mindfulness was higher among nurses, characterized by high trait mindfulness, after the mindfulness-based time-out intervention implementation. DISCUSSION: By adapting mindfulness principles to the dynamic environment of the emergency department, we showed that the mindfulness-based time-out intervention was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.