The variability of diagnosed migraine epidemiology amongst different municipalities in southern Israel.

BACKGROUND: Appropriate and timely diagnosis is one of the most important milestones in effective migraine care and is affected by public awareness, access to medical care, health care systems, and physicians' knowledge. We assessed the variability in migraine diagnosis rates in different communities under universal national health coverage in Israel. METHODS: In this population-based retrospective, observational, cohort study, adult (≥18 years) migraine patients were identified in the computerized database of the southern district of the Clalit Health Services Health Maintenance Organization (HMO) based on recorded diagnosis and/or purchase of specific anti-migraine acute medication (triptans). Migraine prevalence in 2018 was calculated in the entire study population and in different municipalities. We utilized a standardized (age and gender) mortality ratio (SMR) approach for comparison among the municipalities. RESULTS: In 2018, a total of 29,938 migraine patients were identified out of 391,528 adult HMO members, with an overall prevalence (per 10,000) of migraine of 764.64 (7.65%), 1143.34 (11.43%) for women, and 374.97 (3.75%) for men. Among the municipalities, adjusted prevalence (per 10,000) ranged from 386.15 (3.86%) to 1320.60 (13.21%). The female-to-male ratio ranged from 1.8:1 to 5.1:1. Prevalence rates were positively associated with the socioeconomic status of the municipalities (Spearman rho = 0.472, P = 0.031). CONCLUSIONS: High variability in the prevalence of diagnosed migraine suggests underdiagnosis. Resources for awareness and educational programs should be directed to low diagnosed prevalence communities.

Infectious diseases among Ethiopian immigrants in Israel: a descriptive literature review.

The mass immigration of Ethiopian Jews to Israel began in the 1980s. For most of these immigrants this was a time of sharp transition from a village life with very basic living conditions, in most cases without a regular supply of water, electricity, or healthcare services, to a modern Western urban society. The aim of this review was to search the medical literature on the characteristics of infectious diseases that are typical in Ethiopian immigrants (EI), using relevant keywords. There has been success in coping with diseases among EI, that are rare although recognized in Israel, in terms of screening and early identification. TB was common in Ethiopia over all the years of immigration to Israel. In contrast, HIV appeared in EI from 1999 when they had long stayovers in transition camps in Gondar and Addis Ababa where there was a high risk of infection with sexually transmitted diseases. There were often delays in diagnosing 'exotic' diseases that are endemic in Africa, but not well known in Israel, such as Onchocerciasis, Schistosomiasis, Strongyloidiasis, and Bartonella endocarditis, which cause severe morbidity and mortality among EI. We describe the effect on general morbidity in Israel, and how the healthcare services coped with these diseases, including obstacles, and failures and successes. In light of the ongoing immigration of African refugees to the United States and Europe, the Israeli experience can be of value to healthcare policy makers in developing strategies for the effective management by medical staff treating these immigrants.