Glycemic outcomes and patient satisfaction and self-management improves in transition from standard to virtual multidisciplinary care.

AIMS: With advances in cloud-based technologies, there has been a rise in remote T1D care. We hypothesized that transitioning T1DM care to a virtual, multidisciplinary clinic could improve measures beyond HbA1c. METHODS: To assess the impact of transitioning from standard to virtual T1DM care, we evaluated glycemic measures and patient reported outcomes. RESULTS: Sixty-one adults with T1DM were included, with mean age 40.2 ± 13.5 years and diabetes duration 16.9 ± 9.0 years. Most patients were treated with insulin pumps and CGM. The number of annual diabetes care encounters rose from 2.1 ± 4.2 to 12.8 ± 5.5. Baseline HbA1c was 7.9 ± 1.6 %(63 ± 16.9 mmol/mol), declining to 7.3 ± 1.1 %(56 ± 8.5 mmol/mol) and 7.1 ± 1.0 %(54 ± 7.7 mmol/mol) at 6 and 12 months respectively (p < 0.001 for both). In parallel, TIR improved from 63.1 ± 19.3 % to 69.2 ± 13.8 % (p < 0.001) and 67.5 ± 19.4 % (p = 0.03) at 6 and 12 months respectively, while TBR declined. Scores from validated diabetes treatment and self-management questionnaires rose significantly and these rises were associated with a reduction in HbA1c, the latter score was also associated with increased TIR. There was a trend toward a correlation between encounter frequency and improvement in HbA1c and TIR. CONCLUSIONS: Transitioning from standard to virtual, coordinated, multidisciplinary T1DM care is associated with increased visit frequency, improving glycemic control, treatment satisfaction and self-care behaviors.

Problem-oriented coping and resilience among Fibromyalgia patients who live under security threats and have undergone a Fibrotherapy intervention program.

Our study examined the association between problem-focused coping and resilience among fibromyalgia (FM) patients who live under constant security threats. Resilience is a coping resource and detrimentally affects FM female patients (FMPs) to get up and cope with life. A cohort of 96 FMPs ages 19-75 was subjected to a Fibrotherapy intervention program in the Rehabilitation Help Center in Sderot (Ezra Le'Marpeh), Israel. We examined levels of problem-oriented coping and levels of resilience among the sample. In addition, we assessed whether there is a correlation between their resilience level and their medical metrics. The research included medical metrics and physical metrics. A cohort of 16 FMPs who participated in the quantitative phase composed the qualitative sample. Data from the t-test showed improved mental resilience among all the sample, with a significantly higher level among problem-oriented FMPs. We conclude that resilience is acquired through problem-oriented coping strategies. Furthermore, the association between resilience and problem-oriented coping helped to improve health indicators since coping with the disease included entering a regime of physicals activity and maintaining a healthy lifestyle.

Association between COVID-19 vaccination and critical outcomes among older adults with dementia: a comparative cohort study.

Background: As COVID-19 vaccines became available, understanding their potential benefits in vulnerable populations has gained significance. This study explored the advantages of COVID-19 vaccination in individuals with cognitive disorders by analyzing health-related variables and outcomes. Methods: A prospective cohort study analyzed electronic medical records of 25,733 older adults with cognitive disorders and 65,544 older adults without cognitive disorders from March 2020 to February 2022. COVID-19 vaccination status was the primary exposure variable, categorized as fully vaccinated or unvaccinated. The primary outcomes measured were all-cause mortality and hospitalization rates within 14 and 400 days post-vaccination. Data on vaccination status, demographics, comorbidities, testing history, and clinical outcomes were collected from electronic health records. The study was ethically approved by the relevant medical facility's Institutional Review Board (0075-22-MHS). Results: Vaccinated individuals had significantly lower mortality rates in both groups. In the research group, the mortality rate was 52% (n = 1852) for unvaccinated individuals and 7% (n = 1,241) for vaccinated individuals (p < 0.001). Similarly, in the control group, the mortality rate was 13.58% (n = 1,508) for unvaccinated individuals and 1.85% (n = 936) for vaccinated individuals (p < 0.001), despite higher COVID-19 positivity rates. In the research group, 30.26% (n = 1,072) of unvaccinated individuals tested positive for COVID-19, compared to 37.16% (n = 6,492) of vaccinated individuals (p < 0.001). In the control group, 17.31% (n = 1922) of unvaccinated individuals were COVID-19 positive, while 37.25% (n = 18,873) of vaccinated individuals tested positive (p < 0.001). Vaccination also showed potential benefits in mental health support. The usage of antipsychotic drugs was lower in vaccinated individuals (28.43%, n = 4,967) compared to unvaccinated individuals (37.48%, n = 1,328; 95% CI [0.92-1.28], p < 0.001). Moreover, vaccinated individuals had lower antipsychotic drug prescription rates (23.88%, n = 4,171) compared to unvaccinated individuals (27.83%, n = 968; 95% CI [-1.02 to -0.63], p < 0.001). Vaccination appeared to have a positive impact on managing conditions like diabetes, with 38.63% (n = 6,748) of vaccinated individuals having diabetes compared to 41.55% (n = 1,472) of unvaccinated individuals (95% CI [0.24, 0.48], p < 0.001). Discussion: The findings highlight the importance of vaccination in safeguarding vulnerable populations during the pandemic and call for further research to optimize healthcare strategies for individuals with cognitive disorders.

Addressing the second victim phenomenon in Israeli health care institutions.

BACKGROUND: The 'second victim' phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health's implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers' perceptions of the 'second victim' occurrence. METHODS: A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the 'second victim'. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of 'second victim', and identifying components of possible intervention programs and challenges to implementing those programs. RESULTS: Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager. CONCLUSIONS: Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.

Speech recognition in noise task among children and young-adults: a pupillometry study.

Introduction: Children experience unique challenges when listening to speech in noisy environments. The present study used pupillometry, an established method for quantifying listening and cognitive effort, to detect temporal changes in pupil dilation during a speech-recognition-in-noise task among school-aged children and young adults. Methods: Thirty school-aged children and 31 young adults listened to sentences amidst four-talker babble noise in two signal-to-noise ratios (SNR) conditions: high accuracy condition (+10 dB and + 6 dB, for children and adults, respectively) and low accuracy condition (+5 dB and + 2 dB, for children and adults, respectively). They were asked to repeat the sentences while pupil size was measured continuously during the task. Results: During the auditory processing phase, both groups displayed pupil dilation; however, adults exhibited greater dilation than children, particularly in the low accuracy condition. In the second phase (retention), only children demonstrated increased pupil dilation, whereas adults consistently exhibited a decrease in pupil size. Additionally, the children's group showed increased pupil dilation during the response phase. Discussion: Although adults and school-aged children produce similar behavioural scores, group differences in dilation patterns point that their underlying auditory processing differs. A second peak of pupil dilation among the children suggests that their cognitive effort during speech recognition in noise lasts longer than in adults, continuing past the first auditory processing peak dilation. These findings support effortful listening among children and highlight the need to identify and alleviate listening difficulties in school-aged children, to provide proper intervention strategies.

Equal Opportunities in Aging: Income Level Moderates the Relationship Between Infrequent Participation in Formal Social Activities and Loneliness Among Older Adults.

Infrequent participation in formal social activities among older adults increases the risk of loneliness. We examined whether a higher income level moderates the relationship between infrequent participation and loneliness. Utilizing data from wave #6 of the European Health, Aging, and Retirement Survey, we included participants aged 65+ (i.e., older adults), non-participants in the labor force (N = 24 819). Loneliness was measured by the R-UCLA loneliness questionnaire, formal social activity by participation frequency in volunteer/charity activities, educational course/training, sports/social/other clubs, and political/community organizations. Hierarchical multiple regression models examined relationships between variables, controlled by country. Infrequent participation in formal social activity associated with higher risk of loneliness. However, income moderated the association between participation and loneliness; infrequently participating older adults with low-to-moderate income were more vulnerable to loneliness than higher income older adults, for whom infrequent participation did not increase loneliness. This reinforces the need to encourage formal social activity with subsidy for low-to-moderate income older adults.

The Dilemma of Compulsory Vaccinations-Ethical and Legal Considerations.

The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children's immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and guidelines for physical distancing. In addition, parents' hesitancy, refusals, and delays in adhering to routine childhood immunizations seem to have increased during the pandemic. A decline in routine pediatric vaccine administration might indicate that the entire population faces increased risks for outbreaks of vaccine-preventable diseases. Throughout history, vaccines have raised questions about their safety, efficacy, and need among adults and parents who feared or hesitated to vaccinate their children. Objections derive from various ideological and religious reasons or concerns about the possible inherent dangers. Mistrust in the government and/or economic or political interests also raise concerns among parents. The importance of providing vaccines to maintain public health, as opposed to the autonomy of the individuals over their body and their children, raises ethical questions. In Israel, there is no legal obligation to get vaccinated. It is imperative to find a decisive solution to this situation without delay. Furthermore, where democratically one's principles are sacred and where one's autonomy over one's body is also unquestionable, such a legal solution would not only be unacceptable but also rather impossible to enforce. It seems that some reasonable balance between the necessity to preserve public health and our democratic principles should apply.

Converting qualitative data into quantitative values using a matched mixed-methods design: A new methodological approach.

BACKGROUND: Quantifying qualitative data as part of mixed-methods research (MMR) can add to the study results' analysis. Comparable results may reinforce the conclusions, while differences hold an opportunity for an in-depth discussion. To date, there is little guidance for researchers seeking to quantify their qualitative data. OBJECTIVES: Describing conversion of qualitative data to quantitative values, comparison with matched questionnaire results, discussing the benefits of this process and the matched MMR design. METHODS: We describe in detail how qualitative data from 46 interviews were converted into quantitative values (i.e., quantitative-qualitative values, QQVs) using MMR design, enabling a comparison of results from interviews and questionnaires obtained from the same participants. This process was embedded in a larger MMR study on family-caregivers caring for people-with-end-stage-dementia conducted between the years 2020-2021. RESULTS: A QQV was generated for three main themes and compared to the questionnaires' scores regarding the same topics. There were no significant differences between the scores regarding 'satisfaction with nurses and physicians care', and 'discussion with nurses and physicians about end-of-life care'. However, for 'burden', the QQV score was significantly higher than the questionnaires' score. DISCUSSION: We described how to use a matched MMR design to produce and compare QQV from interviews with questionnaire scores. This methodology may allow further valuable discussion if the results are either similar or not, and for better integration and easier presentation of the results. Comparable results can reinforce the conclusions from both parts of the MMR study, while differences hold an opportunity for an in-depth discussion regarding their meaning and context. Although we claim that this methodology can be embedded in the MMR structure and contribute significantly to the discussion's depth, it by no means replaces the traditional MMR design. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

Informal caregivers' negative affect: The interplay of caregivers' resilience, aging anxiety and burden.

OBJECTIVES: This study focused on the negative affect of informal caregivers of older adults. In a novel investigation, the interplay of aging anxiety, caregiving burden, and resilience as a protective factor was examined, suggesting that aging anxiety and caregiving burden are mediators for the link between resilience and negative affect. METHODS: In a cross-sectional design, 191 Israeli informal caregivers of older adults (65+) participated in the study. They completed questionnaires that assessed demographic and caregiving characteristics, resilience, aging anxiety, caregiving burden, and negative affect. RESULTS: The findings showed a serial mediation process in which higher resilience predicted lower caregiving burden, which subsequently predicted lower aging anxiety, which subsequently predicted lower negative affect. However, the indirect path from resilience to aging anxiety and negative affect was non-significant. CONCLUSION: Based on this study's findings, the aging anxiety of informal caregivers of older adults should be professionally addressed in the early stages of caregiving because it contributes to the caregiving burden and negative affect. Additionally, resilience should be enhanced by psycho-social interventions tailored to address informal caregiver challenges that often induce caregiving burden and negative affect.

Family Caregiver's Depression, Confidence, Satisfaction, and Burden Regarding End-of-Life Home Care for People With End-Stage Dementia.

To detect differences between two care services units: regarding family-caregiver (FC) depression, perceived-burden and confidence in the provision of care to people with end-stage dementia (PWESD); examine predictors such as FC age, depression, confidence in the provision of care to PWESD and satisfaction with the community-home-care service to burden; and explore a mediation model.The participants were 139 FC, caring for PWESD living at home. The questionnaire was composed of FC background characteristics, perceived-burden, satisfaction with the community-home-care services, depression, and confidence in the provision of care to the PWESD. HCUs' FC felt significantly more burdened than HHUs' FC. Furthermore, satisfaction with the community-home-care services mediated the relationship between FC confidence in the provision of care to the PWESD and FC burden. The study results may affect the development of end-of-life care policies and services which meet the needs of PWESD and their FC.

Review of Fibromyalgia (FM) Syndrome Treatments.

BACKGROUND: Fibromyalgia (FM) is a disease characterized by widespread musculoskeletal chronic pain that impairs the patient's quality of life and is considered a somatization disorder. The symptoms of the disease also affect the patient mentally, mainly since invisible pain is the only thing that indicates its existence. A typical symptom that characterizes FM patients is the lack of acceptance of the disease since its pathophysiology is not elucidated, hence the deficiencies in its management, or rather, cognitively, the belief that there is no disease to manage. The current paper aims to shed light on the new treatment methods at a holistic level, that is, cognitive, physical, and pharmacological therapies. METHOD: A literature review was carried out that discusses treatment methods that help alleviate the pain, accept it, and manage the symptoms of the disease. RESULTS: FM symptoms can be treated by taking a broad view of treatment that will include a response to the mind through pain management, response to the body through physical activity, and response to the pain through pharmacological treatment. CONCLUSIONS: Today, there is an evolutionary view that accepts FM and chronic pain diseases as syndromes in which the pain is the disease; therefore, the response to this disease can be applied through three channels: physical, bodily, and mental.

Primary Care Physicians' Perceptions on Nurses' Shared Responsibility for Quality of Patient Care: A Survey.

Nurses are key players in primary care in Israel and in the efforts to improve its quality, yet a survey conducted among primary care physicians (PCPs) in 2010 indicated that 40% perceived the contribution of nurses to primary care quality as moderate to very small. In 2020, we conducted a cross-sectional survey using self-report questionnaires among PCPs employed by health plans to examine the change in PCPs' perceptions on nurses' responsibility and contributions to quality of primary care between 2010 and 2020. Four-hundred-and-fifty respondents completed the questionnaire in 2020, as compared to 605 respondents in 2010. The proportion of PCPs who perceive that nurses share the responsibility for improving the quality of medical care increased from 74% in 2010 to 83% in 2020 (p < 0.01). Older age, males, self-employment status, and board certification in family medicine independently predicted reduced PCP perception regarding nurses' responsibility for quality-of-care. PCPs who believed that nurses contribute to quality of practice were 7.2 times more likely to perceive that nurses share the responsibility for quality-of-care. The study showed that over the past decade there was an increase in the extent to which PCPs perceive nurses as significant partners in improving quality of primary care.

The Effect of the Fibrotherapy Intervention Program on the Coping Patterns of Fibromyalgia Patients.

BACKGROUND: Fibromyalgia (FM) syndrome is characterized by physical symptoms such as pain, fatigue, and sleep disorders, as well as mental symptoms that include depression, mental exhaustion, and a sense of hopelessness. The current study focuses on 3 main strategies used by FM patients living in communities in the Gaza Envelope who are under constant security threat: problem-oriented, emotion-oriented, and avoidance. METHODS: The study introduces a groundbreaking intervention program based on a fibrotherapy intervention (FTI) program developed at the Rehabilitation Center "Ezra Le'Marpeh" led by Rabbi Avraham Elimelech Firer. The cohort study sample consists of 96 women who have been diagnosed with FM and have participated in the FTI program for 10 weeks. The study uses mixed methods of quantitative and qualitative analyses in which 16 women from the sample were interviewed. In addition to collecting demographic information and medical data, the study used the Brief Cope questionnaire. RESULTS: The findings corroborate the hypothesis and show a difference between the coping patterns of FM patients before and after the intervention. CONCLUSIONS: The sharing experience as a part of the FTI program can lead FM patients to adopt positive disease management strategies, which may improve their quality of life.

The correlation between problem-oriented coping and a sense of coherence among fibromyalgia patients who underwent the fibrotherapy model intervention programme.

OBJECTIVES: This study sought to examine whether the sense of coherence (SOC) among fibromyalgia (FM) increased after participation in a fibrotherapy intervention programme (FTI) and whether SOC among FM patients who changed their coping strategies to problem-oriented coping, increased. The study was conducted among FM female patients who are exposed to security threats in order to examine the coping resources of these patients. METHODS: 96 female patients aged 19-75 diagnosed with FM enrolled in the FTI programme led by Rabbi Firer in Sderot, Israel. Of this sample, 16 were interviewed for the qualitative part. RESULTS: The quantitative analysis found that there was a change in the level of SOC before and after participation in FTI and that an increasing trend in SOC was observed after participating in FTI, thus, confirming the first hypothesis. Also, a problem-oriented coping pattern emerged after participating in FTI. The data further show that according to the second study hypothesis, among problem-oriented patients, the levels of psychological distress decreased, and the physiological indicators (endurance) increased as well as an improved functional ability. In other words, following FTI, there was a positive improvement in the physical and mental health scores of problem-oriented patients. Participation in FTI has resulted in a comprehensive health improvement among the study sample. CONCLUSIONS: Participation in FTI improved FM patients' SOC and coping strategies and provided them with tools to understand the meaning of the disease and thereby accept and manage it.

Emotion work and feeling rules: Coping strategies of family caregivers of people with end stage dementia in Israel-A qualitative study.

BACKGROUND: End stage dementia is an inevitable phase following a prolonged deterioration. Family caregivers for people with end stage dementia who live in their home can experience an emotional burden. Emotion work and "feeling-rules" refers to socially shared norms and self-management of feelings, as well as projecting emotions appropriate for the situation, aiming at achieving a positive environment as a resource for supporting others' wellbeing. OBJECTIVES: Exploring and describing the experience of family caregivers of people with end stage dementia at home, in Israel, unpacking their emotional coping and the emotional-strategies they use, and placing family caregivers' emotion work in a cultural context. METHOD: We conducted fifty qualitative interviews using semi structured interviews analyzed through a thematic content analysis approach. FINDINGS: Four characteristics of emotion work were identified: (1) sliding between detachment and engagement, (2) separating the person from their condition (3), adoption of caregiving as a social role and a type of social reinforcement, and (4) using the caregiving role in coping with loneliness and emptiness. The emotional coping strategies are culturally contextualized, since they are influenced by the participants' cultural background. DISCUSSION: This article's focus is transparent family caregivers' emotion work, a topic which has rarely been discussed in the literature is the context of caring for a family member with dementia at home. In our study, emotion work appears as a twofold concept: the emotion work by itself contributed to the burden, since family caregivers' burden experience can evolve from the dissonance between their "true" feelings of anger and frustration and their expected "acceptable" feelings ("feeling-rules") formed by cultural norms. However, emotion work was also a major source of coping and finding strength and self-meaning. Understanding and recognizing the emotion work and the cultural and religious influence in this coping mechanism can help professionals who treat people with end stage dementia to better support family-caregivers.

Challenges in home care at the end stage of dementia: Hospice units vs. home care units. A qualitative study.

Home hospice units specializing in palliative end-of-life care are uncommon despite the theoretical benefit for people with end stage dementia (PWESD). We described the challenges of caring for PWESD and their families using 24 semi-structured in-depth interviews with professional staff members from two care settings-home hospice units and home care units-in Israel. Staff described end-of-life care for PWESD in four sub-themes: dementia as an end-stage disease; appropriateness of palliative care for PWESD; a family member at the center of care; and "dying-in-place" versus hospitalization. Our findings may enable better services and quality of care for PWESD living at home.

Secondary Traumatic Stress and Vigor Among Neonatal Intensive Care Unit Personnel: The Moderator Role of Coping Flexibility.

BACKGROUND: The demanding and highly stressful work environment of the neonatal intensive care unit (NICU) has led to the identification of a possible psychological stress reaction among NICU nurses and physicians, termed secondary traumatic stress (STS). PURPOSE: The current study aimed to explore the association between vigor at work (as an energy resource) and STS, while considering their association with the professional role (nurses/physicians-as a condition resource) as well as with coping flexibility (as a personal resource). METHODS: In this cross-sectional study physicians and nurses working in NICUs across Israel completed a questionnaire comprising sections on demographics and professional characteristics, self-rated health, STS, coping flexibility, and vigor. RESULTS: Of 280 physicians and nurses approached, 70% (195) completed the questionnaire. No significant differences between nurses and physicians were found in STS adjusted for gender, being in a committed relationship, and seniority in the NICU. Vigor was negatively correlated with STS-both in the entire sample and for each professional role alone. Coping flexibility was a statistically significant moderator between vigor and STS, whereas the interaction between vigor and professional role was not significant. Specifically, the negative relationship between vigor and STS was significant when coping flexibility was more than 10.10 (61% of the participants) but not significant at lower values. IMPLICATIONS FOR PRACTICE AND RESEARCH: The understanding of the relationship between vigor and STS, with coping flexibility as its moderator, encourages an intervention aimed at reducing stress by increasing these resources.

Risk and protective factors associated with multiproblem behaviours of Ethiopian young adults in Israel.

Immigrants and second-generation immigrants from Ethiopia in Israel are assumed to be more vulnerable to problematic risk behaviours than host culture population. The aim of this study was to assess risk and protective factors associated with multiproblem behaviours such as committing driving violations, alcohol use, drugs use and violence among Ethiopian young adult immigrants and second-generation immigrants in Israel. This is a cross-sectional study, based on a self-reported anonymous structured questionnaire distributed to 383 Ethiopian emerging adults (mean age 25.3; SD = 3.27, 59.3% female). Multiple Problem Behavior Index (MPBI) was created from their responses to 21 risk behaviour variables including driving violations, alcohol use, Marijuana use and violence. Logistic regression to predict multiproblem behaviours was used. We found that unplanned leisure activity hours during weekends (adjusted odds ratio - AOR = 2.594, p < .01, 95% CI 1.332-5.052), excitement seeking (AOR = 2.122, p<.01, 95% CI 1.257-3.582), depression symptoms (AOR = 2.521, p < .01, 95% CI 1.491-4.261) and gender (AOR = 0.277, p < .001, 95% CI 0.164-0.469) were associated with MPBI. In contrast, racism, perceived discrimination, Israeli and Ethiopian identities were not significantly associated with MPBI after adjusting for gender and family status. These results suggest that in a minority of Ethiopian emerging adult immigrants similar to host culture populations, risk factors such as unplanned leisure activities, excitement seeking and depression symptoms are stronger and significant factors associated with multiproblem behaviours rather than racism, perceived discrimination or Israeli and Ethiopian identities. Resources should be allocated to produce appropriate intervention programs with planned content for leisure time, especially on weekends.

The involvement of community pediatricians in the treatment of developmental-behavioral difficulties as perceived by directors of child development centers.

BACKGROUND: Developmental-behavioral issues are among the most frequent and disabling conditions of children and adolescents seen in ambulatory settings. Guidelines of the Israeli Pediatric Association and the Israeli Society for Developmental Pediatrics specify the role of the primary-care pediatrician in screening and early identification of mild developmental behavioral conditions and define the criteria for referral to child development institutes. The aims of this study were to examine and describe how directors of these institutes perceive the role and involvement of community pediatricians in child development. METHODS: Qualitative interviews of the directors of 22 child development institutes from the ministry of health and the four health plans. RESULTS: According to the interviewees, there is little involvement of community pediatricians in detecting developmental delays, and it is mainly nurses and preschool teachers who detect such delays. They report that the key barriers that deter community pediatricians from greater involvement in child development diagnosis and treatment are lack of time, lack of compensation, and insufficient clinical knowledge. The interviewees would like to see community pediatricians conducting the primary medical evaluation, providing parental guidance, referring to therapists in mild cases, exercising discretion before referring children to child development institutes and providing relevant information to the institutes in the referral process. The mechanisms that they proposed for increasing the involvement of community pediatricians were expansion of pediatricians' training, increased pediatricians' use of teleconsultation with child development specialists and incentives for thorough performance of developmental assessments. CONCLUSIONS: Due to the importance of the Issue, we strongly recommend that policymakers require child development principles, evaluation, and providing appropriate parental guidance in the curriculum of the Israeli pediatric residency program. In addition, health plans should compensate pediatricians who need to conduct longer visits for children with developmental delays. The health plans should also develop teleconsultation channels for pediatricians with child development specialists to reduce unnecessary referrals to child development institutes.

Factors associated with medical complications after body art among Israeli adults: a retrospective study.

INTRODUCTION: Body-art, including tattoos and piercings, is steadily increasing world-wide but with relatively limited reporting of adverse outcomes. The objective of the present study was to identify correlates that would facilitate a preventative strategy to minimize adverse effects of body-art. METHODS: We examined patterns of body-art, health risk and perceptions among 921 participants (54% female, mean age of 35; SD = 10.8) through in-person questionnaire. RESULTS: A significantly lower frequency of those with body-art acknowledged that not all venues (parlors, clinics, etc.) are safe in terms of health and hygiene (84.7%t vs. 96.6%, p < .001) as compared to those without body-art. Similarly, knowledge of the need for a Ministry of Health certification was reported with lower frequency (77.2% vs. 94.5%, p < .001) among those with body-art. Those who experienced medical complications reported higher frequencies of smoking cigarettes and hookah as well as using ecstasy (MDMA). The risk of medical complication after body-art was 4 times higher in those who used ecstasy (OR = 3.97; CI 1.0-14.4; p < 0.05). In addition, it was more than 3 times higher for street or home tattooing as compared to studio or a licensed medical center (OR = 3.59; CI 1.32-9.76; p < .01), as well as almost 3 times higher among those who did not receive information before performing body-art (OR = 2.70; CI 1.05-6.92; p < .05) and who had somebody other than themselves decide on the body-art design (OR = 2.68; CI 1.00-7.19; p < .05). CONCLUSIONS: A targeted informational-preventative program should be developed, informed by the risks highlighted in this study. In addition, it would be necessary to draft policies related to regulation and enforcement in order to more effectively manage body-art service provision. The Ministry of Health should supervise and guide tattooists and practitioners regarding the health risks of body-art and offer training and raise awareness among potential clients.