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1.
Int J Qual Health Care ; 33(1)2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33528499

RESUMEN

BACKGROUND: Transferring medical information among professionals and between shifts is a crucial process, allowing continuity of care and safety, especially for complex patients in life-threatening situations. This process, handover, requires focusing on specific, essential medical information while filtering out redundant and unnecessary details. OBJECTIVES: To create and implement a tool for handover that would be flexible enough to meet the unique needs of specific departments. METHODS: We used Plan-Do-Study-Act (PDSA) methodology to prospectively develop, implement, evaluate and reassess a new handover tool in a 900-bed teaching hospital in central Israel. Nurses from 35 departments participated in developing a tool that presents the staff's viewpoint regarding the most critical information needed for handover. RESULTS: A total of 78 nurse managers and 15 doctors (63.7%) completed the questionnaire. Based on exploratory factor analysis, 15 items explained 58.9% of the variance. Four key areas for handover were identified, in addition to basic patient identification: (i) updated clinical status, (ii) medical information, (iii) special clinical treatment and (iv) treatments not yet initiated. Subsequently, a Flexible Handover Structured Tool (FAST) was designed that identifies patients' needs and is flexible for the specific needs of departments. Revisions based on hands-on experience led to high nurse satisfaction with the new tool in most departments. The FAST format was adopted easily during the COVID-19 pandemic. CONCLUSION: Implementing a new handover tool-FAST-was challenging, but rewarding. Using PDSA methodology enabled continuous monitoring, oversight and adaptive corrections for better implementation of this new handover reporting tool.


Asunto(s)
Comunicación Interdisciplinaria , Pase de Guardia/organización & administración , Humanos , Israel , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Encuestas y Cuestionarios
2.
Isr Med Assoc J ; 23(2): 76-81, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595210

RESUMEN

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic presented a major medical management challenge to ophthalmology departments throughout Israel. OBJECTIVES: To examine the managerial challenges, actions taken, and insights of directors of ophthalmology departments in Israel during the COVID-19 pandemic. METHODS: We conducted a cross sectional survey of directors of ophthalmology departments during the COVID-19 pandemic while the Israeli population was quarantined. RESULTS: All 21 directors answered the survey. The majority of the COVID-19 admissions were located in the center of Israel (53%) and Jerusalem (30%). E-communication took a central role in coping with the pandemic with 80% of the directors satisfied with this form of communication; 75% reported a reduction in clinical and surgery volume of at least 25%, and 40% reported reallocations of manpower. Most of the medical staff used gloves, a face shield, disposable robe, and a mask with no uniformity across departments. Cross satisfaction was noted regarding a hospital's ability to equip the departments. Lack of preparation for post-pandemic era was reported by all directors, but one (95%). Directors sought guidelines and uniformity regarding outpatient referral to the hospital (p = 0.035). CONCLUSIONS: Guidelines via safe digital platforms aid in management decisions and uniformity across departments. Advanced preparation is needed to prevent adverse clinical outcomes and to maintain treatment continuum. Our results can be used to guide and help improve the preparedness of ophthalmology departments during COVID-19 and for future pandemics.


Asunto(s)
Departamentos de Hospitales/organización & administración , Oftalmología/organización & administración , Equipo de Protección Personal/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Adulto , Comunicación , Estudios Transversales , Equipos Desechables/estadística & datos numéricos , Guantes Protectores/estadística & datos numéricos , Departamentos de Hospitales/normas , Humanos , Israel , Máscaras/estadística & datos numéricos , Persona de Mediana Edad , Equipo de Protección Personal/provisión & distribución , Cuarentena , Derivación y Consulta , Encuestas y Cuestionarios
3.
Isr Med Assoc J ; 23(2): 82-86, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595211

RESUMEN

BACKGROUND: The novel coronavirus disease (COVID-19) pandemic changed medical environments worldwide. OBJECTIVES: To evaluate the impact of the COVID-19 pandemic on trauma-related visits to the emergency department (ED). METHODS: A single tertiary center retrospective study was conducted that compared ED attendance of patients with injury-related morbidity between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2018 and 2019. RESULTS: Overall, 6513 patients were included in the study. During the COVID-19 outbreak, the daily number of patients visiting the ED for acute trauma declined by 40% compared to the average in previous months (P < 0.01). A strong negative correlation was found between the number of trauma-related ED visits and the log number of confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Israel (Pearson's r = -0.63, P < 0.01). In the COVID-19 period there was a significant change in the proportion of elderly patients (7% increase, P = 0.002), admissions ratio (12% increase, P < 0.001), and patients brought by emergency medical services (10% increase, P < 0.001). The number of motor vehicle accident related injury declined by 45% (P < 0.01). CONCLUSIONS: A significant reduction in the number of trauma patients presenting to the ED occurred during the COVID-19 pandemic, yet trauma-related admissions were on the rise.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Estudios Transversales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria , Heridas y Traumatismos/terapia , Adulto Joven
4.
Isr Med Assoc J ; 23(2): 94-98, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595214

RESUMEN

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is emerging as an important public health condition. The effect of Ramadan fasting on several metabolic conditions has been previously assessed. OBJECTIVES: To assess the impact of Ramadan fasting on non-alcoholic steatohepatitis (NASH) severity scores. METHODS: A retrospective, case control study was conducted in Nazareth Hospital between 2017 and 2019. We included NAFLD patients who had been diagnosed by abdominal ultrasonography. The study population was divided in two matched groups: NASH subjects who fasted all of Ramadan and NAFLD/NASH subjects who did not fast (control). Metabolic/NASH severity scores, homeostatic model assessment of ß-cell function and insulin resistance (HOMA-IR), NAFLD Fibrosis Score (NFS), BARD scores, and fibrosis-4 (FIB4) scores were assessed in both groups before and after the Ramadan month. RESULTS: The study included 155 NASH subjects, 74 who fasted and 81 who did not. Among the fasting group, body mass index decreased from 36.7 ± 7.1 to 34.5 ± 6.8 after fasting (P < 0.003), NFS declined from 0.45 ± 0.25 to 0.23 ± 0.21 (P < 0.005), BARD scores declined from 2.3 ± 0.98 to 1.6 ± 1.01 (P < 0.005), and FIB4 scores declined from 1.93 ± 0.76 to 1.34 ± 0.871 (P < 0.005). C-reactive protein decreased from 14.2 ± 7.1 to 7.18 ± 6.45 (P < 0.005). Moreover, HOMA-IR improved from 2.92 ± 1.22 to 2.15 ± 1.13 (P < 0.005). CONCLUSIONS: Ramadan fasting improved on inflammatory markers, insulin sensitivity, and noninvasive measures for NASH severity assessment.


Asunto(s)
Ayuno/fisiología , Resistencia a la Insulina/fisiología , Islamismo , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Adulto , Anciano , Biomarcadores/metabolismo , Índice de Masa Corporal , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
5.
Medicine (Baltimore) ; 100(5): e24271, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592870

RESUMEN

ABSTRACT: Recent reports have documented an unchanged rate of occurrence of colorectal cancer (CRC) and have publicised doubts regarding the benefit of prompt colonoscopy procedures after an episode of acute diverticulitis (AD). These reports mandate further evaluation of colonoscopy yield and timing in this regard. The current study aims to determine whether the rate of advanced colonic neoplasia after AD differs from that of average-risk patients, and to identify risk factors that are associated with their development.In this retrospective study, we included all patients who had been hospitalized to the surgery ward in the years 2008 to 2016 with radiographically confirmed AD, and had completed colonoscopies within one year of index hospitalization. Patients who were referred for screening colonoscopies during the same years were included as a control group. We compared the rates of diagnosis of CRC and advanced polyps for both groups before and after adjustment for multiple confounders. Moreover, we investigated risk factors that were associated with increased rate of advanced neoplasia diagnosis.A total of 350 patients were included in the AD group and 1502 patients in the screening colonoscopy control group. The CRC diagnosis rates (1.7% vs 0.3%; P = .09) and overall diagnosis rates of advanced neoplasia (12.3% vs 9.6%; P = .19) were not significantly different when findings were compared between the AD and control groups, respectively. Cases of complicated diverticulitis, however, were associated with increased risk of advanced neoplasia diagnosis (odds ratio (OR) 3.729, 95% confidence interval (CI) 1.803-7.713; P = .01).The diagnosis rate for advanced neoplasia after AD was not significantly different from that of average-risk populations. A course of complicated AD, however, was a potential risk factor.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales/diagnóstico , Diverticulitis del Colon , Detección Precoz del Cáncer , Neoplasias , Brote de los Síntomas , Colonoscopía/métodos , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Correlación de Datos , Diverticulitis del Colon/complicaciones , Diverticulitis del Colon/epidemiología , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias/diagnóstico por imagen , Neoplasias/patología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos
6.
Euro Surveill ; 26(6)2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33573712

RESUMEN

The BNT162b2 mRNA COVID-19 vaccine showed high efficacy in clinical trials but observational data from populations not included in trials are needed. We describe immunogenicity 21 days post-dose 1 among 514 Israeli healthcare workers by age, ethnicity, sex and prior COVID-19 infection. Immunogenicity was similar by ethnicity and sex but decreased with age. Those with prior infection had antibody titres one magnitude order higher than naïve individuals regardless of the presence of detectable IgG antibodies pre-vaccination.


Asunto(s)
/inmunología , Inmunogenicidad Vacunal , Adulto , Factores de Edad , Anciano , /administración & dosificación , Relación Dosis-Respuesta Inmunológica , Grupos Étnicos/estadística & datos numéricos , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Factores Sexuales , Vacunas Sintéticas/administración & dosificación , Vacunas Sintéticas/inmunología
7.
Isr J Health Policy Res ; 10(1): 12, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33596962

RESUMEN

This commentary compares Israel's COVID-10 vaccination response to the much slower and less successful vaccination campaign in Canada. Although Canada did start with some structural disadvantages relative to Israel including less centralized and coherent emergency planning and a more complex demographic geography, there are, nonetheless, some important policy lessons Canada can draw from Israel. These include a more strategic use of national leadership in the vaccination campaign and the greater use of primary care resources and providers.


Asunto(s)
Canadá , Humanos , Israel , Vacunación
8.
Isr J Health Policy Res ; 10(1): 9, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522945

RESUMEN

This commentary on Rosen, Waitzberg, and Israeli's assessment of Israel's COVID response points to differences in the coherence of each national government's strategy as the key factor influencing the effectiveness of the vaccine drive. The strengths of the Israeli healthcare system facilitated implementation of the roll-out, but the government's unambiguous prioritization of vaccination drove implementation success.


Asunto(s)
Humanos , Israel , Vacunación
9.
Artículo en Inglés | MEDLINE | ID: mdl-33557395

RESUMEN

Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child's age and the type of session were evaluated using Spearman's correlations and the Kruskal-Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.


Asunto(s)
Pandemias , Telerrehabilitación/tendencias , Adolescente , Niño , Humanos , Israel
10.
Quintessence Int ; 0(0): 0, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33533236

RESUMEN

OBJECTIVES: The spread of COVID-19 has posed significant challenges for dental professionals worldwide. The aims of the present study were twofold: (i) to study the attitudes, emotional responses, and worries among the dental personnel; and (ii) to look for the ability of dental personnel to experience posttraumatic self-growth as a result of the distress caused by the pandemic. METHOD AND MATERIALS: A cross-sectional online survey using an anonymous questionnaire was performed simultaneously in Israel, Canada, and France during the initial lockdown period. RESULTS: Israeli dental practitioners were less worried about their physical health, mental health, or relationships with family and friends than their Canadian and French counterparts. The Canadian dental practitioners were most committed and most willing to treat their patients, as well as most concerned about not being able to treat patients in the same personal way as before the lockdown. French dental practitioners showed the highest level of fear to treat patients. There were no differences in dental practitioners' levels of anxiety, depression, or posttraumatic growth among the countries. Dental practitioners' posttraumatic growth was significantly associated with worries regarding their physical health. CONCLUSION: Responses of dental personnel to the COVID-19 pandemic varied worldwide. Despite the differences, evidence exists that some of the dental practitioners' worries and concerns are associated with psychologic growth as a result of the pandemic. Better understanding and acknowledgment of dental personnel's worries and concerns can facilitate growth and enable positive functioning under the continuous situation of uncertainty.


Asunto(s)
Crecimiento Psicológico Postraumático , Ansiedad , Actitud , Canadá/epidemiología , Control de Enfermedades Transmisibles , Estudios Transversales , Odontólogos , Francia/epidemiología , Humanos , Israel/epidemiología , Pandemias , Rol Profesional
11.
PLoS Comput Biol ; 17(2): e1008559, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33571188

RESUMEN

One of the significant unanswered questions about COVID-19 epidemiology relates to the role of children in transmission. This study uses data on infections within households in order to estimate the susceptibility and infectivity of children compared to those of adults. The data were collected from households in the city of Bnei Brak, Israel, in which all household members were tested for COVID-19 using PCR (637 households, average household size of 5.3). In addition, serological tests were performed on a subset of the individuals in the study. Inspection of the PCR data shows that children are less likely to be tested positive compared to adults (25% of children positive over all households, 44% of adults positive over all households, excluding index cases), and the chance of being positive increases with age. Analysis of joint PCR/serological data shows that there is under-detection of infections in the PCR testing, which is more substantial in children. However, the differences in detection rates are not sufficient to account for the differences in PCR positive rates in the two age groups. To estimate relative transmission parameters, we employ a discrete stochastic model of the spread of infection within a household, allowing for susceptibility and infectivity parameters to differ among children and adults. The model is fitted to the household data using a simulated maximum likelihood approach. To adjust parameter estimates for under-detection of infections in the PCR results, we employ a multiple imputation procedure using estimates of under-detection in children and adults, based on the available serological data. We estimate that the susceptibility of children (under 20 years old) is 43% (95% CI: [31%, 55%]) of the susceptibility of adults. The infectivity of children was estimated to be 63% (95% CI: [37%, 88%]) relative to that of adults.


Asunto(s)
/transmisión , Composición Familiar , Adolescente , Adulto , /epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Israel/epidemiología , Funciones de Verosimilitud , Procesos Estocásticos , Adulto Joven
12.
Isr J Health Policy Res ; 10(1): 6, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33499905

RESUMEN

As of the end of 2020, the State of Israel, with a population of 9.3 million, had administered more COVID-19 vaccine doses than all countries aside from China, the US, and the UK. Moreover, Israel had administered almost 11.0 doses per 100 population, while the next highest rates were 3.5 (in Bahrain) and 1.4 (in the United Kingdom). All other countries had administered less than 1 dose per 100 population.While Israel's rollout of COVID-19 vaccinations was not problem-free, its initial phase had clearly been rapid and effective. A large number of factors contributed to this early success, and they can be divided into three major groups.The first group of factors consists of long-standing characteristics of Israel which are extrinsic to health care. They include: Israel's small size (in terms of both area and population), a relatively young population, relatively warm weather in December 2020, a centralized national system of government, and well-developed infrastructure for implementing prompt responses to large-scale national emergencies.The second group of factors are also long-standing, but they are health-system specific. They include: the organizational, IT and logistical capacities of Israel's community-based health care providers, the availability of a cadre of well-trained, salaried, community-based nurses who are directly employed by those providers, a tradition of effective cooperation between government, health plans, hospitals, and emergency care providers - particularly during national emergencies; and support tools and decisionmaking frameworks to support vaccination campaigns.The third group consists of factors that are more recent and are specific to the COVID-19 vaccination effort. They include: the mobilization of special government funding for vaccine purchase and distribution, timely contracting for a large amount of vaccines relative to Israel's population, the use of simple, clear and easily implementable criteria for determining who had priority for receiving vaccines in the early phases of the distribution process, a creative technical response that addressed the demanding cold storage requirements of the Pfizer-BioNTech COVID-19 vaccine, and well-tailored outreach efforts to encourage Israelis to sign up for vaccinations and then show up to get vaccinated.While many of these facilitating factors are not unique to Israel, part of what made the Israeli rollout successful was its combination of facilitating factors (as opposed to each factor being unique separately) and the synergies it created among them. Moreover, some high-income countries (including the US, the UK, and Canada) are lacking several of these facilitating factors, apparently contributing to the slower pace of the rollout in those countries.


Asunto(s)
/prevención & control , Pandemias , Vacunación , /virología , Planificación en Salud , Humanos , Israel/epidemiología , Vacunación/estadística & datos numéricos , Cobertura de Vacunación
14.
Lancet ; 397(10270): 208-219, 2021 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-33453783

RESUMEN

BACKGROUND: Management of type 1 diabetes is challenging. We compared outcomes using a commercially available hybrid closed-loop system versus a new investigational system with features potentially useful for adolescents and young adults with type 1 diabetes. METHODS: In this multinational, randomised, crossover trial (Fuzzy Logic Automated Insulin Regulation [FLAIR]), individuals aged 14-29 years old, with a clinical diagnosis of type 1 diabetes with a duration of at least 1 year, using either an insulin pump or multiple daily insulin injections, and glycated haemoglobin (HbA1c) levels of 7·0-11·0% (53-97 mmol/mol) were recruited from seven academic-based endocrinology practices, four in the USA, and one each in Germany, Israel, and Slovenia. After a run-in period to teach participants how to use the study pump and continuous glucose monitor, participants were randomly assigned (1:1) using a computer-generated sequence, with a permuted block design (block sizes of two and four), stratified by baseline HbA1c and use of a personal MiniMed 670G system (Medtronic) at enrolment, to either use of a MiniMed 670G hybrid closed-loop system (670G) or the investigational advanced hybrid closed-loop system (Medtronic) for the first 12-week period, and then participants were crossed over with no washout period, to the other group for use for another 12 weeks. Masking was not possible due to the nature of the systems used. The coprimary outcomes, measured with continuous glucose monitoring, were proportion of time that glucose levels were above 180 mg/dL (>10·0 mmol/L) during 0600 h to 2359 h (ie, daytime), tested for superiority, and proportion of time that glucose levels were below 54 mg/dL (<3·0 mmol/L) calculated over a full 24-h period, tested for non-inferiority (non-inferiority margin 2%). Analysis was by intention to treat. Safety was assessed in all participants randomly assigned to treatment. This trial is registered with ClinicalTrials.gov, NCT03040414, and is now complete. FINDINGS: Between June 3 and Aug 22, 2019, 113 individuals were enrolled into the trial. Mean age was 19 years (SD 4) and 70 (62%) of 113 participants were female. Mean proportion of time with daytime glucose levels above 180 mg/dL (>10·0 mmol/L) was 42% (SD 13) at baseline, 37% (9) during use of the 670G system, and 34% (9) during use of the advanced hybrid closed-loop system (mean difference [advanced hybrid closed-loop system minus 670G system] -3·00% [95% CI -3·97 to -2·04]; p<0·0001). Mean 24-h proportion of time with glucose levels below 54 mg/dL (<3·0 mmol/L) was 0·46% (SD 0·42) at baseline, 0·50% (0·35) during use of the 670G system, and 0·46% (0·33) during use of the advanced hybrid closed-loop system (mean difference [advanced hybrid closed-loop system minus 670G system] -0·06% [95% CI -0·11 to -0·02]; p<0·0001 for non-inferiority). One severe hypoglycaemic event occurred in the advanced hybrid closed-loop system group, determined to be unrelated to study treatment, and none occurred in the 670G group. INTERPRETATION: Hyperglycaemia was reduced without increasing hypoglycaemia in adolescents and young adults with type 1 diabetes using the investigational advanced hybrid closed-loop system compared with the commercially available MiniMed 670G system. Testing an advanced hybrid closed-loop system in populations that are underserved due to socioeconomic factors and testing during pregnancy and in individuals with impaired awareness of hypoglycaemia would advance the effective use of this technology FUNDING: National Institute of Diabetes and Digestive and Kidney Diseases.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/instrumentación , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Sistemas de Infusión de Insulina , Insulina/uso terapéutico , Adulto , Femenino , Alemania , Humanos , Hiperglucemia/prevención & control , Israel , Masculino , Estados Unidos , Adulto Joven
16.
Isr J Health Policy Res ; 10(1): 2, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33451324

RESUMEN

Measles is a highly contagious disease. A 24 years old patient, recently exposed to measles (unvaccinated), presented in the emergency department with severe agitation, compatible with an acute psychotic episode, during the measles epidemic which spread in Israel in 2018-2019. Upon hospital admission, strict isolation was instructed, yet, without compliance, probably due to the patient's status. Measles diagnosis was promptly confirmed. As measles transmission was eminent, public health measures were employed through immediate implementation of the section 15 of the Public Health Ordinance, allowing for compulsory short-term isolation. The patient's condition improved within a few days and the measures were no longer necessary. This measles case occurred in the pre-Coronavirus disease 2019 (COVID-19) epidemic when use of a Public Health Ordinance was considered an extreme measure. This is in contrast to the current global use of Public Health laws to enforce strict quarantine and isolation on persons infected or potentially exposed to COVID-19. Nevertheless, minimizing infectious diseases transmission is a core function of public health law. Utilizing legal enforcement in circumstances of immediate public health hazard, such as nosocomial measles transmission, necessitates careful consideration. The integrative clinical and public health approach and prompt measures employed in this exceptional case, led to prevention of further infection spread.


Asunto(s)
Infección Hospitalaria/prevención & control , Sarampión/prevención & control , Aislamiento de Pacientes/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Enfermedad Aguda , Servicio de Urgencia en Hospital , Hospitalización , Humanos , Israel/epidemiología , Masculino , Sarampión/complicaciones , Sarampión/epidemiología , Trastornos Psicóticos/etiología , Trastornos Psicóticos/terapia , Adulto Joven
17.
Harefuah ; 160(1): 13-18, 2021 Jan.
Artículo en Hebreo | MEDLINE | ID: mdl-33474873

RESUMEN

INTRODUCTION: Preterm labor is defined as delivery before 37 weeks of gestation. Up to 17% of twin pregnancy are preterm. Arabin cervical pessary has been proven as preventing preterm labor in singleton pregnancies. The benefit of it in twin pregnancy is controversial. OBJECTIVES: The purpose of this study was to compare the rate of preterm delivery in twin gestation with short cervical length in Israel- one center utilized the combined treatment of Arabin cervical pessary and vaginal progesterone (study group) and the others utilized vaginal progesterone approach (control group). METHODS: Multi-center retrospective cohort study, including "Shamir", "Wolfson", "Shaare Zedek" and "Galilee" medical centers, between the years 2012-2016. Inclusion criteria were twin gestations and short cervical length (<25mm) between 16-28 weeks' gestation. RESULTS: The study group included 68 women, the control group 78 women. The study group had shorter cervical length at intervention in comparison to the control group (13.6 ± 5.9 vs. 16.5 ± 5.7, respectively, p = .002). The treatment started later for the study group compared to the control group (23.2 +2.2 vs 22.6 +3.0). CONCLUSIONS: Despite having shorter cervical length at recruitment, the rate of spontaneous delivery < 34-weeks' gestation was similar in both groups (36.8 vs. 37.2%, respectively). DISCUSSION: Considering the conclusion in this research it seems that the combination of the mechanical effect of the pessary by embracing the cervix, keeping the cervical mucus, bending it in a way that the pressure is towards the anterior cervical wall together with the progestative effect which increases the estrogen/progesterone ratio, creating uterine quiescence and keeping the structural connective tissue of the cervix have an added benefit. It seems that the combined use of Arabin cervical pessary and vaginal progesterone in twin pregnancy with short cervical length have a synergic effect which may have a benefit in preventing preterm labor. The combination of cervical pessary and progesterone does not negatively affect twin pregnancy outcome and does not cause preterm birth.


Asunto(s)
Embarazo Gemelar , Nacimiento Prematuro , Administración Intravaginal , Cuello del Útero/diagnóstico por imagen , Femenino , Humanos , Recién Nacido , Israel , Pesarios , Embarazo , Nacimiento Prematuro/prevención & control , Progesterona , Estudios Retrospectivos
18.
Harefuah ; 160(1): 45-48, 2021 Jan.
Artículo en Hebreo | MEDLINE | ID: mdl-33474878

RESUMEN

INTRODUCTION: In the last decade of the 19th century, some hundred years after the introduction of the smallpox vaccine, a heated controversy broke out in London regarding the compulsory vaccination of children against the disease. Amongst those affected by the legislation, mandating the immunization of children against smallpox was a Jewish father who was eventually imprisoned for refusing to have his son vaccinated. His grounds for refusal were his religious beliefs and it is with his case and its aftermath that the present article is concerned. The two major protagonists in the controversy were Chief Rabbi of England, Dr. Herman Adler and Mr. J. H. Levi. According to the Chief Rabbi, members of the Anglo-Jewish community were required to comply with the law of the land and act in accordance with mainstream medical opinion regarding the vaccination of their children as a matter of their Jewish faith. Levi who was a prominent economist at London University and a champion of liberalism and individual freedom, strongly opposed the Chief Rabbi's ruling on Jewish as well as general grounds. The debate between the two protagonists as it emerges from newspaper clippings and articles of the period is similar in many ways to the contemporary vaccination controversy in both London and Israel. One salient feature of the 19th century debate is the failure of the health authorities to publish precise and ongoing reports on the importance and effectiveness of vaccination throughout the year and not only prior to anticipated outbreaks of the disease. One of the lessons to be learned from the present article is the need for the medical establishment to acquire expertise in the areas of communication and media in order to deal successfully with the phenomenon of vaccine refusal. Amongst the issues that would need to be confronted is that of the halakhic objections, if any, to compulsory vaccination, which is a central theme of this article.


Asunto(s)
Judíos , Vacunación , Niño , Historia del Siglo XIX , Humanos , Israel , Judaísmo , Londres
19.
Harefuah ; 160(1): 38-44, 2021 01.
Artículo en Hebreo | MEDLINE | ID: mdl-33474877

RESUMEN

INTRODUCTION: Despite the impressive decline in mortality from atherosclerotic cardiovascular diseases (ASCVD), these diseases still account for a large proportion of the overall morbidity and mortality worldwide. A vast amount of research has demonstrated the key role played by circulating lipoproteins, and especially low-density lipoprotein (LDL), in the etiology of atherosclerosis, and numerous studies have proven the efficacy of interventions that lower the atherogenic lipoproteins in reducing morbidity and mortality from ASCVD. While previous guidelines placed an emphasis on the use HMG-CoA reductase inhibitors (statins) for the treatment of dyslipidemia, recent studies have shown that other LDL cholesterol lowering drugs, including ezetimibe and the PCSK9 inhibitors, can provide additional benefit when used in combination with (and in certain cases instead of) statins. These studies have also shown that blood LDL cholesterol levels lower than previously recommended targets provide additional benefit, without evidence of a threshold beyond which the benefit ceases and without excess adverse effects. The updated guidelines were formulated by a committee that consisted of representatives from the Israeli Society for the Research, Prevention and Treatment of Atherosclerosis, the Israel Society of Internal Medicine, the Israeli Heart Association, the Israeli Neurology Association and the Israel Association of Family Medicine. They provide recommendations for revised risk stratification of patients, novel target goals, and the use of evidence-based treatment and follow-up strategies with reference to specific patient sub-groups.


Asunto(s)
Anticolesterolemiantes , Enfermedades Cardiovasculares , Dislipidemias , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/tratamiento farmacológico , Humanos , Israel , Proproteína Convertasa 9
20.
Isr J Health Policy Res ; 10(1): 7, 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33499907

RESUMEN

National Immunization Technical Advisory Groups (NITAGs) are defined by the World Health Organization as multidisciplinary groups of health experts who are involved in the development of a national immunization policy. The NITAG has the responsibility to provide independent, evidence-informed advice to the policy makers and national programme managers, on policy issues and questions related to immunization and vaccines.This paper aims to describe the NITAG in Israel. The Israeli NITAG was established by the Ministry of Health in1974. The NITAG's full formal name is "the Advisory Committee on Infectious Diseases and Immunizations in Israel". The NITAG is charged with prioritizing choices while granting maximal significance to the national public health considerations. Since 2007, the full minutes of the NITAG's meetings have been publicly available on the committee's website (at the Ministry of Health website, in Hebrew).According to the National Health Insurance Law, all residents of Israel are entitled to receive universal health coverage. The health services basket includes routine childhood immunizations, as well as several adult and post - exposure vaccinations. The main challenge currently facing the NITAG is establishing a process for introducing new vaccines and updating the vaccination schedule through the annual update of the national health basket. In the context of the annual update, vaccines have to "compete" with multiple medications and technologies which are presented to the basket committee for inclusion in the national health basket. Over the years, the Israeli NITAG's recommendations have proved essential for vaccine introduction and scheduling and for communicable diseases control on a national level. The NITAG has established structured and transparent working processes and a decision framework according to WHO standards, which is evidence-based and country-specific to Israel.The recent global COVID-19 pandemic is a major concern for all countries as well as a challenge for NITAGs. Currently, the NITAGs have a key role in advising both on sustainment of the routine immunization programs and on planning of the COVID-19 vaccination campaigns, with ongoing updates and collaboration with the Ministry of Health and health organizations.


Asunto(s)
Comités Consultivos , Política de Salud , Programas de Inmunización , Inmunización , Vacunación , Vacunas , Control de Enfermedades Transmisibles , Salud Global , Humanos , Israel , Pandemias
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