Academic activism on behalf of children during the COVID-19 pandemic in Israel; beyond public health advocacy.

Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC's activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society's vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.

Prediagnostic self-assessed health and extent of social networks predict survival in older individuals with cancer: a population based cohort study.

OBJECTIVES: To assess the association between social networks on survival after cancer diagnosis in a population-based sample of elderly Israelis (>60 yo) living in the community in 1985 and followed for up to 20 years. MATERIALS AND METHODS: We conducted a historical prospective study, using baseline measurements from a 1985 survey of a representative sample of community-dwelling population. Five distinct social networks were defined using information regarding number and intensity of social contacts: traditional-family (reference category), friends and neighbors, narrow-family, diverse, and attenuated. Cancer was ascertained through the Israel Cancer Registry, and mortality through the Population Registry after 20 years of follow-up. RESULTS: The final study population included 676 participants diagnosed with cancer after 1985. Persons in the diverse network showed a lower risk of death (HR=0.74, 95% CI: 0.56-0.98) after adjusting for age, sex, smoking and self-assessed health. On the other hand, poor self-rated health at baseline (HR=1.39, 95% CI: 1.10-1.74 poor vs. all other categories of self-assessed health) was associated with increased risk of death. After excluding cancers amenable to early detection (breast, prostate, and colon) a borderline significant decreased risk of death following a diagnosis of cancer (HR=0.72, 95% CI: 0.52-1.01) was found. CONCLUSION: There is evidence of a significant protective association between diverse social networks present before a cancer diagnosis and survival after the onset of disease. Social support from a variety of sources may be an important element in improving cancer survival in older individuals.

Time trends in cardiovascular disease mortality in Russia and Germany from 1980 to 2007 - are there migration effects?

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the industrialized world. Large variations in CVD mortality between countries and also between population subgroups within countries have been observed. Previous studies showed significantly lower risks in German repatriates and Jews emigrating from Russia than in the general Russian population. We examined to what degree the migration of large subgroups influenced national CVD mortality rates. METHODS: We used WHO data to map the CVD mortality distribution in Europe in 2005. Supplemented by data of the Statistisches Bundesamt, the mortality trends in three major CVD groups between 1980 and 2007 in Russia and Germany are displayed, as well as demographic information. The effects of migration on demography were estimated and percentage changes in CVD mortality trends were calculated under the assumption that migration had not occurred. RESULTS: Cardiovascular disease mortality patterns within Europe showed a strong west-east gradient with ratios up to sixfold. In Germany, the CVD mortality levels were low and steadily decreasing, whereas in Russia they fluctuated at high levels with substantial differences between the sexes and strong correlations with political changes and health campaigns. The trends in both Russia and Germany were affected by the migration that occurred in both countries over recent decades. However, our restricted focus in only adjusting for the migration of German repatriates and Jews had moderate effects on the national CVD mortality statistics in Germany (+1.0%) and Russia (-0.6%). CONCLUSIONS: The effects on CVD mortality rates due to migration in Germany and Russia were smaller than those due to secular economical changes. However, migration should still be considered as a factor influencing national mortality trends.

Noncommunicable disease mortality and life expectancy in immigrants to Israel from the former Soviet Union: country of origin compared with host country.

OBJECTIVE: To assess the influence of country of origin effects and of adjustment and selection processes by comparing noncommunicable disease mortality and life expectancy among migrants to Israel from the former Soviet Union (FSU) with noncommunicable disease mortality and life expectancy among Israelis and the population of the Russian Federation. METHODS: Data from 926,870 FSU-immigrants who migrated to Israel between 1990 and 2003 (study cohort) were analysed. Life expectancy was calculated for the study cohort, all Israelis, and the population of the Russian Federation. Age-standardized death rates were calculated for grouped causes of death. FSU immigrants were additionally compared with other Israelis and with inhabitants of the Russian Federation using cause-specific standardized mortality ratios (SMRs). FINDINGS: Life expectancy at age 15 years in 2000-2003 was 61.0 years for male and 67.0 years for female FSU immigrants to Israel. Age-standardized death rates for FSU immigrants in Israel were similar to those of other Israelis and much lower than those of inhabitants of the Russian Federation. Relative to Israelis, the study cohort had a higher SMR for neoplasms, and particularly for stomach cancer. Mortality from brain cancer was higher when immigrants were compared to the Russian Federation (SMR: 1.71, 95% confidence interval, CI: 1.50-1.94 for males; SMR: 1.77, 95% CI: 1.56-2.02 for females), whereas mortality from stomach cancer was lower among immigrants relative to the Russian Federation (SMR: 0.43, 95% CI: 0.40-0.47 for males; SMR: 0.56, 95% CI: 0.52-0.61 for females). Mortality from external causes was lower among immigrants relative to the population of the Russian Federation (SMR: 0.20, 95% CI: 0.19-0.21 for males; SMR: 0.35, 95% CI: 0.33-0.37 for females) but significantly higher relative to other Israelis (SMR: 1.41, 95% CI: 1.35-1.47 for males; SMR: 1.08, 95% CI: 1.02-1.15). CONCLUSION: Noncommunicable disease mortality among FSU immigrants to Israel is lower than in the population of the Russian Federation. Mortality rates in FSU immigrants, particularly from circulatory diseases, have rapidly adjusted and have become similar to those of the destination country. However, immigrants from the FSU have considerably higher mortality than other Israelis from external causes and some noncommunicable diseases such as cancer. Mortality rates in these diaspora migrants show a mixed picture of rapid assimilation together with persistent country of origin effects, as well as the effects of adjustment hardships.

Stomach cancer mortality in two large cohorts of migrants from the Former Soviet Union to Israel and Germany: are there implications for prevention?

OBJECTIVES: Prevention and early detection are key elements for the reduction of stomach cancer mortality. To apply pertinent measures effectively, high-risk groups need to be identified. With this aim, we assessed stomach cancer mortality among migrants from the Former Soviet Union (FSU), a high-risk area, to Germany and Israel. METHODS: We calculated standardized mortality ratios (SMRs) comparing stomach cancer mortality in two retrospective migrant cohorts from the FSU to Germany (n=34,393) and Israel (n=589,388) to that in the FSU and the host country. The study period ranges from 1990 to 2005 in Germany and from 1990 to 2003 in Israel. Vital status and cause of death were retrieved from municipal and state registries. To assess secular mortality trends, we calculated annual age-standardized mortality rates in the cohorts, the FSU, and the two host countries and conducted Poisson regression modeling. RESULTS: SMRs (95% confidence intervals) for men in the German migrant cohort were 0.51 (0.36-0.70) compared with the FSU population and 1.44 (1.04-1.99) compared with the German population, respectively. For women, SMRs were 0.73 (0.49-1.03) compared with the FSU population and 1.40 (0.98-1.99) compared with the German population. SMRs for men in the Israeli migrant cohort were 0.49 (0.45-0.53) compared with the FSU population and 1.79 (1.65-1.94) compared with the Israeli population. SMRs for women in the Israeli cohort were 0.65 (0.59-0.72) compared with the FSU population and 1.82 (1.66-1.99) compared with the Israeli population. Poisson modeling showed a secular decrease in all populations with a time lag of 4-5 years between migrants and 'natives' in Germany and converging rates between migrants and the general population in Israel. CONCLUSION: Stomach cancer mortality in migrants from the FSU remains elevated after migration to Germany and Israel but is much lower than in the FSU. Due to a secular decline, it can be expected that mortality among migrants from the FSU reaches within a few years levels similar to those of the host countries today. Therefore, migrant-specific prevention and early detection measures cannot be recommended. Detailed risk factor profiles, however, need to be obtained through further studies.

Chronic disease mortality associated with infectious agents: a comparative cohort study of migrants from the Former Soviet Union in Israel and Germany.

BACKGROUND: Prevalence of infectious diseases in migrant populations has been addressed in numerous studies. However, information is sparse on their mortality due to chronic diseases that are aetiologically associated with an infectious agent. This study investigates mortality related to infectious diseases with a specific focus on cancers of possibly infectious origin in voluntary migrants from the Former Soviet Union residing in Israel and in Germany. METHODS: Both groups of migrants arrived from the Former Soviet Union in their destination countries between 1990 and 2001. Population-based data on migrants in Israel were obtained from the Israel Central Bureau of Statistics. Data for migrants in Germany were obtained from a representative sample of all migrants from the Former Soviet Union in Germany. Cause of death information was available until 2003 for the Israeli cohort and until 2005 for the German cohort. Standardized mortality ratios were calculated relative to the destination country for selected causes of death for which infectious agents may be causally involved. Multivariate Poisson regression was applied to assess differences in mortality by length of residence in the host country. RESULTS: Both in Israel and in Germany these migrants have lower overall mortality than the population in their destination countries. However, they have significantly elevated mortality from viral hepatitis and from stomach and liver cancer when compared to the destination populations. Regression analysis shows that in Israel stomach cancer mortality is significantly higher among migrants at shorter durations of residence when compared to durations of more than nine years. CONCLUSION: Higher mortality from cancers associated with infection and from viral hepatitis among migrants from the Former Soviet Union might result from higher prevalence of infections which were acquired in earlier years of life. The results highlight new challenges posed by diseases of infectious origin in migrants and call attention to the link between communicable and non-communicable diseases.

The Israel National Health Survey: issues and methods.

OBJECTIVE: The Israel National Health Survey--World Mental Health Survey (INHS) was designed to collect data on (a) the prevalence of mental disorders; (b) the prevalence of impairments and disabilities; (c) chronic conditions, disability, physical health, health services utilization and out-of-pocket medical expenditure which might be associated with mental disorder; and (d) socioeconomic and demographic correlates of mental disorder. This paper presents an overview of the methods used in this survey. METHOD: The INHS was a cross-sectional survey based on a representative sample of 5,000 adults, 21 years or older, from the general population of Israel. The Composite International Diagnostic Interview (WMH-CIDI) was administered in face-to-face interviews at the respondents' homes between May, 2003, and April, 2004, using computer assisted personal interview (CAPI) technology. RESULTS: The overall response rate was 72.6%. CONCLUSION: The methodology and the quality control procedures used have made the INHS database a unique source of information about the prevalence, disability burden and unmet health needs of people suffering from common mental disorders and substance disorders in Israel.