The Impact of the Syrian Civil War on One Department in an Israeli Hospital.

During the Syrian civil war, Syrian refugees crossed the Israeli border to receive medical treatment. During this time, Galilee Medical Center (GMC) became the main center for multidisciplinary treatment of these war-wounded patients. This retrospective study compares the demographics of local Israeli and refugee Syrian patients, as well as the volume and types of procedures each group received over a 5-year period. From January 2013 to December 2017, 963 unique patients underwent 1,751 procedures in the GMC Plastic Surgery Department. Of these patients, 176 were Syrian-including 42 children-and 787 were Israeli. These groups underwent 393 and 1,358 procedures, respectively, for a procedure-per-patient ratio of 2.23 versus 1.72, respectively. On average, Syrian patients tended to be younger than Israeli patients (23.6 vs. 49.25 years), had longer median hospitalization time (50 vs. 8 days), longer median operative times (102 vs. 85 minutes), and higher incidence of infection with multidrug-resistant bacteria (52.2 vs. 5.8%). Further, Syrian patients had more trauma-related procedures, such as skin grafts, wound debridement, and microsurgery, than Israeli patients. Through this process, GMC's plastic surgery department gained unprecedented exposure to a variety of complex procedures.

Assistance of Medical Clowns Improves the Physical Examinations of Children Aged 2-6 Years.

BACKGROUND: A good physical exam is necessary to help pediatricians make the correct diagnosis and can save unnecessary imaging or invasive procedures. Distraction by medical clowns may create the optimal conditions for a proper physical examination. METHODS: Children aged 2-6 years who required physical examination in the pediatric emergency department were recruited and randomly assigned to one of two groups: physical exam by a pediatrician in the presence of caregivers vs. physical exam with the assistance of a medical clown. Outcome measures consisted of the level of child's discomfort, anxiety, and the quality of the physical examination. RESULTS: Ninety three children participated. Mean age was 3.3 ± 3.6 years (range 2-6). The duration of the physical exam was similar between the clown and control groups (4.6 ± 1.4 minutes vs. 4.5 ± 1.1 minutes (P = 0.64). The duration of discomfort was shorter in the clown group (0.2 ± 0.6 minutes) than the control group(1.6 ± 2.0 minutes, P = 0.001). In the medical clown group, 94% of pediatricians reported that the medical clown improved their ability to perform a complete physical examination. A trend of less hospitalization in the medical clown group was also noticed (11.3% in the medical clown group vs. 18.3% in the control group, P = 0.1); however, further study is required to verify this observation. CONCLUSIONS: Integration of a medical clown in physical examination improves the overall experience of the child and the caregivers and helps the pediatrician to perform a complete physical examination.

Fear of clowns in hospitalized children: prospective experience.

Medical clowns (MC) have become an integral part of the pediatric staff of hospital wards. While several studies have demonstrated the huge benefits of MC, there are almost no data regarding fear of clowns, a known phenomenon that means an irrational fear of clowns. In the current study, we sought to examine the prevalence of fear of clowns in pediatrics wards, and to characterize the affected children. The clinical work of three certified MCs was prospectively assessed. Every child with fear of clowns was noted, data were retrieved from the medical records, and the parents/child completed a specific questionnaire with a research assistant. Fear of clowns was defined as crying, anxiety response or effort to avoid contact with the MCs in small children, while in older children, it was determined if the child either reported fear of MCs or made actions to avoid clowns' intervention. A total of 1160 children participated in the study. All were hospitalized in the department of pediatrics or the pediatric emergency medicine department at Carmel Medical Center, and were exposed to a MC intervention session. Of the 1160 children, 14 children experienced fear of clowns (1.2%). The average age of children who experienced fear of clowns was 3.5 years (range 1-15). Interestingly, most of the children demonstrating fear of clowns were girls (12 out of 14, 85.7%). We found no association between fear of clowns and specific diagnosis, fever, clinical appearance, religion, or ethnicity. CONCLUSION: The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known: • Fear of clowns is a phenomenon known for more than several decades and related to the increased use of clowns as negative characters in horror movies and TV shows. • The increased use of medical clowns in hospital wards and corridors increases the significance of defining and characterizing this phenomenon in hospital wards. What is New: • The study is novel by giving new data related to the extent of fear of clowns in pediatrics wards and giving demographic characteristic of children experiencing fear of clowns.

[Determining health policy for sensible mobile phone use--current world status].

Mobile phones have become the leading communication system, with more than 4.5 billions users around the world. The sharp increase in the number of users, and its penetration to all populations, including children, has raised concern about possible adverse health effects, particularly cancer This article reviews the public health policies introduced in Israel and several other countries regarding mobile phone use in view of the lack of clarity concerning the safety of this new technology. The data show that most countries have adopted the precautionary principle as the leading guideline, recommending the use of simple and low-cost safety measures which could substantially reduce exposure to the brain and other body organs from mobile phones. These include the use of text messages, hands-free kits, and/or the loud-speaker mode of the phone. Accordingly, recommendations, guidelines, standards, and legislation aimed at the general population, drivers, state institutions and the industry have been formulated. For children, who are considered to be more susceptible to cancer development following exposure to carcinogens, there is widespread consensus for a stricter approach. In some countries, measures such as banning use of mobile phones in schools, prohibiting sales/advertisements targeted at young age groups, expanding warnings on phones/ packages, and encouraging educational campaigns have been adopted for this population. Regulations regarding phone use while driving have been instituted in most countries. In conclusion, many public health practitioners have moved from the theoretical level (adoption of the precautionary principle) to an active phase of introducing regulations, with specific emphasis to various populations.