Patients' preferences for telemedicine versus in-clinic consultation in primary care during the COVID-19 pandemic.

BACKGROUND: The Hybrid Patient Care system integrates telehealth and in-clinic consultation. While COVID-19 increased telehealth use, healthcare providers are still seeking the best combination of virtual and in-clinic consultation. Understanding patients' tele-consultation-related preferences is vital for achieving optimal implementation. The discrete choice experiment (DCE) is the stated preference technique for eliciting individual preferences and is increasingly being used in health-related applications. The study purpose was to evaluate attributes and levels of the DCE regarding patients' preferences for telemedicine versus traditional, in-clinic consultation in primary care during the COVID-19 pandemic, in order to facilitate successful implementation. METHODS: A three-phase structure was used in the qualitative stage of the DCE: (1) a literature review and preparation of interview guides; (2) Eight focus group interviews comprised of 26 patients and 33 physicians; and (3) Attribute selection: a ranking exercise among 48 patients. The Think Aloud technique, in which respondents are asked to verbalize their thoughts, was used in the focus groups. Interview data were analyzed by thematic analysis. RESULTS: Eight attributes were proposed by the patients in the focus groups. The four most important attributes were then selected in pre-testing, and are described in this study: Availability, time until the appointment, severity of the medical problem, patient-physician relationship, and flexible reception hours. CONCLUSIONS: This study has a theoretical contribution in post-COVID-19 patients' preferences in Hybrid Medicine patient care. This provides a foundation to assess the rigors of this stage and provide additional evidence to the limited existing literature on attributes development for DCE patient preferences.

Passive smoking, NAT2 polymorphism, and breast cancer risk in Israeli Arab women: a case-control study.

BACKGROUND: The effect of passive smoking (PS) on breast cancer (BC) is controversial, and may be modified by polymorphism of the N-Acetyl-transferase (NAT) 2 enzyme which is involved in tobacco carcinogen metabolism. We aimed to evaluate the relationship between PS and BC by NAT2 variants in Arab-Israeli women, a unique population with low active smoking rates, and high exposure to PS. METHODS: A population-based case-control study was carried out on non-smoking 137 prevalent breast cancer patients and 274 population-based controls, aged 30-70 years. Data on past and current PS, sociodemographic, and other characteristics were retrieved through interviews, and buccal smears were provided for NAT2 analyses. Logistic regression models adjusting for potential confounders assessed the odds ratios (ORs) and 95% confidence intervals (95% CI) of the association between PS and BC. RESULTS: Ever PS was associated with increased BC risk: OR = 2.22, 95% CI 1.28-3.87. Higher lifetime PS exposure was associated with higher BC risk: Compared to never exposed women, women exposed to PS most of their lives had a threefold higher BC risk (OR = 3.16, 95% CI 1.70-5.87, P trend < 0.001). NAT2 polymorphism did not modify these associations. CONCLUSIONS: PS exposure in non-smoking Israeli Arab women is significantly associated with increased risk for BC, potentially allowing for specific intervention; NAT2 polymorphism does not modify this association.

Trends and predictors of primary dental care health services for adults in Israel.

OBJECTIVES: Guided by the Andersen-Aday Behavioral Model of Health Care Utilization, this study compared primary dental care use trends between 2000 and 2010, and differences in primary dental care use between Israel's two largest ethnic groups, Jews and Arabs. METHODS: Two waves (years 2000 and 2010) of existing cross-sectional data collected from a nationwide sample on the population's health knowledge, attitudes and practice were used. This study uses the sample of Israeli-Jews (n = 2806) from 2000; and the nationally representative sample of Israeli-Jews (n = 2539) and Israeli-Arabs (n = 1723) from 2010. RESULTS: Primary dental care use increased between 2000 and 2010 in Israel. Israelis who had at least a high school diploma, average or higher income, no dental pain and reported flossing their teeth were more likely to use primary dental care, but this was true of fewer Israeli-Arabs than Israeli-Jews. Other variables, associated with use of primary dental care but differing by ethnic group, were: being older than 65 years, being a native-born Israeli, employment, and health risk factors such as smoking and obesity. CONCLUSIONS: As with other western societies and as indicated by the model's three factors (i.e., predisposing, enabling and reinforcing/need), disparities in primary dental care use were found based on income (i.e., enabling); immigrants and ethnic minority status (i.e., predisposing), and health risk such as smoking (i.e., reinforcing/need). It is evident that health promotion activities are needed to target specific population subgroups to reduce disparities in primary dental care utilisation.

What lies behind the low rates of vaccinations among nurses who treat infants?

BACKGROUND: In most countries rates of immunizations of health care workers with recommended vaccines are not satisfactory. OBJECTIVES: To identify reasons behind the low rates of compliance of Israeli nurses in Mother and Child Healthcare Centers (MCHC) with an official request for pertussis vaccination. METHODS: Three focus groups were conducted. Qualitative analysis identified themes that could explain the nurses' non-compliance. RESULTS: Trust in health authorities was low, mainly following the A/H1N1 purported influenza pandemic. In addition, nurses did not see the importance of being role models for the public and demanded the autonomy to decide whether to receive vaccinations. The nurses differentiated between their role as nurses and their personal life, expressed fear of new vaccines and exhibited low levels of risk perception. Misconceptions regarding vaccinations were expressed by the nurses. CONCLUSIONS: Antivaccinationist ideas were expressed by MCHC nurses and these attitudes may have led to non-compliance with vaccination guidelines.

General subjective health status or age-related subjective health status: does it make a difference?

This study examines the agreement between two subjective health measures, a general question on subjective health and an age-related question on subjective health. The study identifies specific groups differing in their answer to the two questions. These measures are used frequently in health-related studies where a short measure is needed to estimate health. Therefore, it is important to understand how the population estimates its health. The study based on 793 telephone interviews shows that among respondents aged 65-75 with no reported diseases and those with less than 12 years of education with no reported diseases, the agreement between the two questions was poor. These two groups reported better health when they were asked to compare their health to people of their age and sex. Excellent agreement between the two questions was reported in those aged 55-64 with no diseases. The respondents having more years of education reported better health than the less educated but only when using the age-related subjective health measure. These findings demand caution when using different wordings in questions on subjective health in non-homogeneous populations.

Evaluation of the consumer model: relationship between patients' expectations, perceptions and satisfaction with care.

OBJECTIVE: To evaluate the consumer model in a health care system, by studying the relationship between four variables: expectations, perceived degree of fulfillment, satisfaction and changing of physicians. DESIGN: Cross-sectional study; telephone interview of patients who had visited a primary care physician 1-2 months previously. SETTING: The Maccabi health plan, Israel. STUDY PARTICIPANTS: A random sample of 759 patients, aged 18 and over residing in two towns in Israel. Response rate to telephone interview was 50.7% (n=385). MAIN OUTCOME MEASURES: Expectation, perceived expectations fulfilled by the physician, satisfaction with the visit to the primary care physician and intention to change physician. RESULTS: The gap between the expectations and their fulfillment showed a low correlation with satisfaction. For attributes where a large difference was found, no correlation was found with patient satisfaction. Attributes such as 'diagnosis', 'preventive health care' and 'answering questions' presented correlation coefficients of 0.3. The correlation between the perceived fulfillment of these attributes and satisfaction presented higher correlation coefficients (between 0.4-0.5). This limits the consumer model as a way to predict satisfaction. Satisfaction correlated highly with intention to change physician. The mean score for the satisfaction of those intending to change doctors was 3.8 compared to 5.5 in the group of consumers not intending to change doctors. CONCLUSION: The consumer model is able to explain only to a modest extent the variation in satisfaction, but dissatisfaction is a good predictor of the intention to change doctors.

Differences in trends of lung carcinoma by histology type in Israeli Jews and Arabs, 1981-1995.

Between 1981 and 1995 the national cancer register in Israel received reports on 13,600 new cases of lung cancer. We evaluated the trends in total lung cancer and the histologic subtypes, in Jewish and Arab Israelis. During this period, the age-adjusted incidence of lung cancer increased in the male Arab population, while for male Jews there was a non-significant decrease, for women in both population groups the rates were stable. When analyzed by age group, there was a significant decrease in incidence rates in Jewish males aged 75 years and older. An analysis by histologic subtypes showed two different trends. In the Jewish population, the age adjusted incidence rates of squamous cell carcinoma (SQCC) decreased and the incidence rates of adenocarcinoma (AC) increased, whereas in the Arab population the incidence rates of both subtypes increased, although statistically significantly only for SQCC. The changes found in the Jewish population are similar to those found in other western countries, where the rates of AC are increasing and the rates of SQCC are decreasing. The trends in the Arab population in Israel are different. This may be due to different trends in the prevalence of smoking in the two populations.

Self-reported health status of immigrants from the former Soviet Union in Israel.

BACKGROUND: A mass influx of immigrants from the former Soviet Union to western countries and Israel followed the demise of the Soviet Bloc at the beginning of the 1990s. It was expected that these immigrants would have a higher morbidity and mortality rate similar to that in the former USSR. OBJECTIVES: To measure and compare self-reported diseases, subjective health and health services utilization of a representative sample of veteran Israeli Jews and immigrants from the former USSR. METHODS: A cross-sectional survey of Israeli adults was performed by telephone interviews. The survey included 793 Israeli Jews, of whom 124 were immigrants from the former USSR who arrived in Israel after 1989 (response rate 52%). RESULTS: The immigrants reported a higher rate of diseases and sub-optimal health after adjustment for other variables. However, no excess in health services utilization was reported. A time trend of reporting sub-optimal subjective health was observed: the longer the immigrants spent in Israel the more their reporting patterns resembled those of immigrants who arrived in Israel before 1970. Those who arrived after 1994 more frequently reported having a chronic disease. CONCLUSIONS: Acculturation seems to have been the main effect on the immigrants' health, together with a healthy migrant effect at the beginning of the 1990s. The immigrants' health was worse in the later years of the immigration wave, partially reflecting the poor state of health in the former Soviet Union compared to Israel.

[Smoking and incidence of lung cancer, 1981-1995].

Smoking is the dominant risk factor for lung cancer. We compared trends in smoking with those of the incidence of lung cancer in Israel. The proportion of smokers has declined during the past 20 years; the decrease is greater in men than in women, and more marked in the elderly. Since 1980 the age-adjusted incidence of lung cancer in Jewish men has decreased slightly, but in women it has remained constant. Among Arab men there was an increase in age-adjusted incidence of lung cancer and since 1986 it has been higher than in Jewish men. The largest decrease in lung cancer incidence was among Jewish men aged 75 and over. This may be explained by data on the age of smoking cessation in the population. It was observed that the main decrease in smoking occurred among men over the age of 55 in the past 20 years, which correlates with the decline in lung cancer observed in the older age group. Lung cancer rates in Israel are lower than in other western countries despite the similar prevalence of smoking, for unknown reasons.

Intercellular communication-filling in the gaps.

Coordination and synchrony of a variety of cellular activities in tissues of plants and animals occur as a consequence of the transfer of low molecular weight biosynthetic and signaling molecules through specialized structures (plasmodesmata in plant cells and gap junctions in mammalian cells) that form aqueous channels between contacting cells. Investigations with rat liver demonstrated that cell-cell communication is mediated by a 32 kilodalton polypeptide that forms a hexameric pore structure in the plasma membrane. Following association with the same structure in a contiguous cell, a trans-double membrane channel is created that has been termed a gap junction. In plant tissue, long tubelike structures called plasmodesmata are suggested to serve a similar cell-cell linking function between cytoplasmic compartments. Although morphologically distinct, dynamic observations suggest similarities in transport properties between gap junctions and plasmodesmata. Recent work now provides evidence that these functional similarities may reflect a more profound identity between the paradigm animal gap junction polypeptide (32 kilodalton rat liver polypeptide) and an immunologically homologous protein localized to plant plasma membrane/cell wall fractions that may be a component of plasmodesmata.

Dynamic continuity of cytoplasmic and membrane compartments between plant cells.

Fluorescence photobleaching was employed to examine the intercellular movement of fluorescein and carboxyfluorescein between contiguous soybean root cells (SB-1 cell line) growing in tissue culture. Results of these experiments demonstrated movement of these fluorescent probes between cytoplasmic (symplastic) compartments. This symplastic transport was inhibited with Ca2+ in the presence of ionophore A23187, and also with the tumor promoter 12-O-tetradecanoyl-phorbol-13-acetate (TPA). Both of these agents have previously been demonstrated to inhibit gap junction-mediated cell-cell communication in animal cells. In a companion experiment, a fluorescent phospholipid analogue, N-4-nitrobenzo-2-oxa-1,3-diazole phosphatidylcholine (NBD-PC), was incorporated into soybean cell membranes to examine whether dynamic membrane continuity existed between contacting cells, a transport route not existing between animal cells. Photobleaching single soybean cells growing in a filamentous strand demonstrated that phospholipid did exchange between contiguous cells.

Pectins as mediators of wall porosity in soybean cells.

The non-invasive technique of fluorescence redistribution after photobleaching was employed on soybean (Glycine max (L.) Merr.) root cells grown in suspension culture to examine macromolecular transport across plant cell walls. Using both fluorescently derivatized dextrans and proteins of graded size, a functional range of diameters for putative trans-wall channels was determined to be 6.6-8.6 nm. A mild treatment with pectinase apparently enlarged the channels, without adversely affecting cell viability, enabling significantly larger molecules to pass through the wall. Treatment of the cells with cellulysin or protease did not have this enlargement effect. It appears that the organization of pectic substances is a major control element in defining the sieving properties of the wall.