Elevated hemoglobin levels in renal transplant recipients with polycystic kidney disease versus other etiologies: exploring mechanisms and implications for outcomes.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD)-related end-stage kidney disease (ESKD) often necessitates transplantation. However, the impact of ADPKD on post-transplant outcomes, specifically hemoglobin levels, remains unknown. METHODS: We retrospectively analyzed 513 Kidney Transplant Recipients (KTRs), of whom 81 had ESKD due to ADPKD (20 with pre-transplant native nephrectomy and 61 without). Hemoglobin levels were evaluated at multiple time intervals post-transplant. RESULTS: Kidney transplant recipients with ADPKD vs. KTRs with ESKD due to other causes exhibited significantly higher hemoglobin levels in repeated measurement analysis. Multivariable analyses confirmed ADPKD as an independent predictor for elevated hemoglobin levels. In a multivariable logistic regression analysis, the odds for maximum hemoglobin > 15 mg/dL at 3-12 months post-transplant were more than twice as high in ADPKD patients vs. all the other KTRs (Odds Ratio [OR] 2.31, 95% Confidence Interval [CI] 1.3-4.13, p < 0.001). Pre-transplant native nephrectomy revealed a trend toward lower hemoglobin levels. Elevated hemoglobin levels were linked to improved estimated glomerular filtration rate (eGFR) at one year post-transplant. Patient survival was enhanced among KTRs with ADPKD compared to other ESKD causes. CONCLUSIONS: Kidney transplant recipients with ADPKD exhibited elevated hemoglobin levels post-transplant, possibly due to prolonged native kidney erythropoietin production. These elevated hemoglobin levels were linked to improved outcomes, including allograft function and patient survival. Future research should further investigate the underlying mechanisms driving favorable ADPKD KTR outcomes.

Perceived functional resilience in schools according to key stakeholders.

Amid the COVID-19 outbreak, Israel and numerous other governments closed schools as a precaution, leading to a sudden shift to online learning. The aim of the current study is to provide foundational insight into the perceived readiness of the school system to withstand future adversities, based on the challenges, complexities, as well as successes in adaptation faced by stakeholders during COVID-19. In this cross-sectional study, we assess the perceived levels of functional resilience of the school system among the key stakeholders of the Israeli education system-high school students, parents, teachers, and principals, as well as a composite functional resilience scale. The composite functional resilience consists of 10 main indexes: communication during distance learning (DL) and frontal learning (FL); Perceived stress scale-4 (PSS); psychosocial aspects during distance learning (DL) and frontal learning (FL); digital literacy; pedagogic support; resources; infrastructure; and distance versus frontal learning. The study findings demonstrate differences according to the stakeholders with regard to the perceived functional resilience and the composite functional resilience scores (e.g., students with respect to both of these scores exhibit the lowest results, while teachers display the highest scores). Furthermore, no one variable was significant across the board for all stakeholders in predicting the perceived functional resilience, with the most common predictors among the stakeholders being digital literacy, pedagogic support, PSS, as well as communication during distance and frontal learning. The findings of this study reveal areas for recommended priority actions to be conducted among school system stakeholders.

Assessing Health-Related Quality of Life in Non-Directed Versus Directed Kidney Donors: Implications for the Promotion of Non-Directed Donation.

Living kidney donation has increased significantly, but little is known about the post-donation health-related quality of life (HRQoL) of non-directed donors (NDs) vs. directed donors (DDs). We thus examined the outcomes of 112 living kidney donors (82 NDs, 30 DDs). For the primary outcomes-namely, the mean physical component summary (PCS) and mental component summary (MCS) scores of the 12-item Short Form Survey (SF-12) questionnaire-scores were significantly higher for the NDs vs. the DDs (PCS: +2.69, MCS: +4.43). For secondary outcomes, NDs had shorter hospital stays (3.4 vs. 4.4 days), returned to physical activity earlier (45 vs. 60 days), exercised more before and after donation, and continued physical activity post-donation. Regression analyses revealed that donor type and white blood cell count were predictive of the PCS-12 score, and donor type was predictive of the MCS-12 score. Non-directed donation was predictive of a shorter hospital stay (by 0.78 days, p < 0.001) and the odds of having PCS-12 and MCS-12 scores above 50 were almost 10 and 16 times higher for NDs, respectively (p < 0.05). These findings indicate the safety and potential benefits of promoting non-directed donation. However, careful selection processes must be maintained to prevent harm and exploitation.

An innovative tool to assess the functional resilience of a school system: learning from the COVID-19 pandemic.

Introduction: Preparing the school system for a future crisis requires the ability to examine the effectiveness of schools' functioning during distant learning and their level of preparedness for future crises. Functional resilience (FR) is defined as the ability to maintain vital operational continuity in the face of disturbance. The study objectives included to develop a FR index of schools and to evaluate and validate it. Methods: To enable examination of the study objectives, the study design included tool development, followed by a validation process among 20 content experts. Concurrently, an eDelphi process for building an inclusive index, based on various components of resilience was conducted. The final study tool consists of four tailored questionnaires to examine perceptions of key stakeholders, i.e.- teachers, principals, parents, and highschool students regarding communication, psychosocial aspects, perceived stress, infrastructure, resources, pedagogic support, digital literacy, and perceived FR. Using an internet panel, the tool was disseminated cross-sectionally among the four groups of stakeholders. Results: The results showed high reliability of most of the scales developed. Furthermore, a high consensus level was reached on the relative importance of each component/ stakeholder to the schools FR. The findings further suggest that there were no significant differences in the composite FR score based on characteristics such as school type/ size/geographic location. However, the findings revealed interesting variations among stakeholders, with findings suggesting greater vulnerability among some. Discussion: To increase resilience and preparedness for future adversities that school systems may face, it is recommended to periodically incorporate an assessment based on a structured tool.

Assessment of First-line Therapy With Midazolam for Prehospital Seizures in Children.

This cohort study assesses the effectiveness of midazolam treatment in terminating pediatric seizures in the prehospital setting.

Do first responders and populations perceive risks similarly? A comparative study of seven countries.

Introduction: Risk perception illustrates the subjective evaluation of individuals concerning the characteristics, severity, and capacity to cope with potential hazards. Risk perception influences attitudes and actions individuals take to protect themselves from future threats. Risk perceptions might change among different stakeholder groups such as society and first responders. Identifying risk perceptions of stakeholders is essential to establish effective protective measures. Method: This study investigated the commonalities and diversities in risk perception among first responders and the public, within and between seven European and beyond countries. A self-administered questionnaire was used to gather data from both first responders and civilians. They were asked to assess their risk perception level for five categories of risks (Extreme weather-related events, nature-related events, social disruptions, critical services dependencies, and pandemics). Results: Using Univariate Analysis of Variance showed disparity concerning both the levels of risk perception between the public and first responders, as well as their relative ranking. For example, concerning extreme weather-related and nature-related events, risk perception levels of the first responders is higher than that of the population in six out of the seven studied countries. In contrast, the population's risk perception is higher compared to the first responders in six out of the seven countries, concerning critical infrastructure dependencies and pandemics. Discussion: The relative gaps between the first responders versus the population, within each country, vary considerably. Norway for example presents significant differences between the two internal populations concerning all risks (except for extreme weather), while in Sweden, no significant gaps were identified, concerning all five risks.

Combat Injury Profile in Urban Warfare.

INTRODUCTION: Combat ground maneuvers consist of various platforms and have several environmental characteristics, influenced by the terrain, the operational mission, and the force's capabilities. This study assesses data on injuries sustained during urban warfare, aiming to evaluate the relationship between injury characteristics, maneuver platform, and personal protective gear on the battlefield. MATERIALS AND METHODS: IDF soldiers injured infantry soldiers from the "Cast Lead" and the "Protective Edge" operations in the Gaza Strip (2008-2009 and 2014, respectively) were divided into four groups according to the maneuver platform and the environment: mounted infantry (armored and unarmored vehicle) and dismounted infantry (urban and open area). The primary outcome was the severity of the injury, and the secondary outcome was the injured body part. RESULTS: Overall, 588 casualties were included in the final analysis, of whom 507 were dismounted infantry soldiers (265 in open terrain and 242 in urban area) and 81 were mounted infantry soldiers (20 in unarmored and 61 were injured in armored vehicles). The Injury Severity Score was similar in all subgroups. Open terrain subgroups were found to have fewer head injuries and higher levels of lower extremity injuries, similar to the unarmored vehicle group. More facial injuries were documented in the urban area group. CONCLUSIONS: The Injury Severity Score was not influenced by environmental protection. Although we found differences in the injured body parts, further studies on the exact mechanism of injury are needed to elucidate further the relationship and differences between the various platforms used and injuries seen in urban warfare, aiming for tailor-made protection.

The Role of Israel's Emergency Medical Services During a Pandemic in the Pre-Exposure Period.

OBJECTIVE: The scientific literature on coronavirus disease (COVID-19) is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's national emergency prehospital medical organization, in the pre-exposure period, before widespread governmental action. These efforts were based on (1) phone diagnosis, dispatch, and transport; and (2) border management checkpoints. METHODS: This is a descriptive study of MDA's role in pandemic response during the pre-exposure period. Medical emergency telephone calls from either individuals or medical sources were identified by a dispatcher as "suspected COVID-19" based on symptoms and travel exposure. Data were also collected for travelers approaching the MDA border checkpoint at Ben-Gurion International Airport. RESULTS: The total number of protected transports during this time was 121. Of these, 44 (36.3%) were referred by medical sources, and 77 (63.7%) were identified as "suspected COVID-19" by dispatchers. The checkpoint was accessed by 156 travelers: 87 were sent to home-quarantine; 12 were transported to the hospital; 18 were refused entry; and 39 required no further action. CONCLUSION: EMS can work effectively in the pre-exposure period through instructing home quarantine, providing protected transport, and staffing border control checkpoints.

Effect of a Concise Educational Program on COVID-19 Vaccination Attitudes.

Background: Vaccination has been recognized as a vital step for containing the COVID-19 outbreak. To ensure the success of immunization efforts as a public health containment measure, a high level of public vaccination compliance is essential. Targeted educational programs can be utilized to improve attitudes toward vaccination and improve the public's uptake of protective measures. Methods: In this cross-sectional study, we aimed to evaluate the impact of a concise educational program on perceived knowledge regarding the COVID-19 vaccine, vaccine importance and trust, protection and fear from COVID-19, trust in authorities, as well as individual resilience. Results: The study evaluated 503 participants that completed the questionnaire before and after viewing a concise video tutorial on vaccination. Following the educational program, scores of five variables increased significantly compared to their pre-viewing level: knowledge, personal resilience, trust in authorities, vaccine importance, as well as perceived protection. Those that were vaccinated and/or intend to be vaccinated (N = 394) report higher levels of knowledge, trust in authorities, vaccine importance, vaccine trust, and fear of being infected as compared to those that are unwilling to get vaccinated. Positive significant correlations were found between resilience and trust in authorities (r = 0.169, p < 0.001), vaccine importance (r = 0.098, p = 0.028), and feeling protected (r = 0.310, p < 0.001). Trust in authorities was positively correlated with vaccine importance (r = 0.589, p < 0.001) and vaccine trust (r = 0.177, p < 0.001). Vaccine importance was positively correlated with vaccine trust (r = 0.149, p = 0.001), but not correlated with knowledge score. Conclusion: The findings of the study demonstrate the benefits of educational programs on improving attitudes toward vaccination acceptability. Incorporation of such concise educational programs by authorities may improve uptake of COVID-19 vaccination and help overcome public vaccine hesitancy. We recommend that such a concise and easily implementable educational program be incorporated as a response component to the current and future outbreaks.

Factors that enhance or impede compliance of the public with governmental regulation of lockdown during COVID-19 in Israel.

INTRODUCTION: In the ongoing COVID-19 global pandemic, compliance to governmental orders is a challenge in the effort to contain the spread of the virus. A cross-sectional study of the Israeli population during the first wave of the outbreak is utilized to elucidate factors that enhance or impede public compliance to the governmental regulation of lockdown and illustrate the practical complexities of staying at home for an elongated time duration. METHODS: A structured questionnaire was utilized to investigate compliance with home isolation, factors that enhance and impede compliance, activities engaged during lockdown, personal resilience, and level of individual distress during the first wave of COVID-19 in Israel. RESULTS: The most salient factors for enhanced compliance were concern for family or self-health (63.4 % and 56.3 % respectively), while deterrence played little role (18.5 %). Desire to maintain a normal life and fear of economic loss were the most significant factors that impeded compliance. A negative correlation between the levels of resilience and distress symptoms (r = 0.318 p < .001), and a positive correlation between resilience and enhanced compliance with home isolation (r = 0.225 p < .001) were identified. CONCLUSIONS: Utilizing tools for empowering the population rather than instilling fear or other deterrence measures are more effective approaches to increase compliance with governmental directives during the COVID-19 pandemic. Public health officials and authorities need to engage the public in resilience building activities, in order to promote compliance to isolation measures. These findings have valuable implications for authorities in ensuring compliance to current and potential future stay-at-home orders for outbreaks.

Does Ethnic Diversity Impact on Risk Perceptions, Preparedness, and Management of Heat Waves?

Detrimental health impacts of heatwaves, including excess mortality, are increasing worldwide. To assess risk perceptions, protective knowledge and behaviors concerning heatwaves in Israel, a study was initiated, comparing attitudes of majority (Jewish) and minority (Arab) populations. A quantitative survey was disseminated through an internet panel, to a representative sample of 556 individuals (79% Jews; 21% Arabs). Overall, 74% consider heatwaves a problem, 93% believe that heatwaves' frequencies will increase, 27% are very concerned about the effects of heatwaves. Higher levels of awareness to heatwaves were found among Jewish compared to Arab respondents; 90 vs. 77% (respectively) could name heatwaves' symptoms (p < 0.001); 81 vs. 56% (respectively) reported knowing how to protect themselves (p < 0.001); 74 vs. 47% (respectively) reported knowing what to do when someone suffers from heat stroke (p < 0.001). Arab compared to Jewish respondents presented higher levels of concern about heatwaves' effects (3.22 vs. 3.09 respectively; t -2.25, p = 0.03), while knowledge of protective measures was higher among Jews compared to Arabs (3.67 vs. 3.56 t = 2.13 p = 0.04). A crucial component of enhancing preparedness to heatwaves is empowerment of minority as well as majority groups, to strengthen their capacity to implement protective behavior and elevate their self-belief in their individual ability and fortitude.

From Isolation to Containment: Perceived Fear of Infectivity and Protective Behavioral Changes during the COVID-19 Vaccination Campaign.

In the ongoing COVID-19 pandemic, maintenance of protective behavior is a continued challenge in the effort to contain the spread of the virus. A cross-sectional study via an internet questionnaire was utilized to elucidate changes in compliance to protective behavior among the Israeli population (n = 1120), after the beginning of the vaccination campaign. Comparison was made between individuals who were previously infected with the virus, those who received one dose of inoculation with the vaccine, and individuals that were neither infected or vaccinated. The study results indicate that those who were previously infected with the COVID-19 virus were less careful about mask wearing (18.8%) and social distancing (29.7%), as compared to the other examined groups (regarding mask wearing, 8.2% and 11.6% respectively, and with regard to social distancing 12.8% and 19.2%), and may require targeted risk communication campaigns to address this population. Furthermore, the study revealed that those that were non-Jewish (as compared to Jewish study counterparts) or that were older (19+) were more vigilant in their protective behavior (29.6% vs. 11.2% respectively for social distancing and 29.6% vs. 11.1% respectively for mask wearing). Despite a successful initial vaccination campaign in Israel, public health officials need to engage all members of the public to unremittingly observe compliance to directed health guidelines, to ensure that the results of previous governmental efforts in fighting the pandemic (such as lockdowns) will be effectively sustained, and the road to containment will be hastened.

Differences in levels of psychological distress, perceived safety, trust, and efficacy amongst hospital personnel during the COVID-19 pandemic.

The COVID-19 pandemic poses significant challenges to healthcare systems worldwide. A key consideration is the adverse psychological impact on healthcare workers (HCWs). This study aimed to investigate the variable levels of psychological distress, perceived safety, trust, and self- and collective-efficacy during the COVID-19 crisis amongst varied HCWs. A survey was disseminated to nurses, physicians, interns, and administrative and logistical staff at an acute-care hospital in Israel during the first wave of COVID-19. The survey consisted of items on a 5-point Likert scale, measuring HCW's perceptions concerning the aforementioned variables as well as demographic information. A total of 716 hospital personnel completed the survey. Nurses reported higher levels of psychological distress and lower levels of trust in the hospital's COVID-19 guidelines compared to physicians (2.3 vs. 2.0 and 3.7 vs. 4.0, respectively). Nurses and interns felt the least safe when working in the hospital. Nurses reported the highest levels of concern regarding fear of uncontrollable spread, infection, and family transmission of the virus. Interns reported the lowest levels of self- and collective-efficacy. In a regression model, the variables that predicted 32% of distress among nurses were age, gender, level of religiosity, indices of perceived safety, and self-efficacy. This study demonstrated differences in distress and perceived safety, trust, and efficacy between varied HCWs during COVID-19. This variability should be considered when designing policies to protect HCWs' wellbeing during future pandemics.

Heatwave-protective knowledge and behaviour among urban populations: a multi-country study in Tunisia, Georgia and Israel.

BACKGROUND: There is an expected increase in heatwaves globally. As such, it is imperative to have sufficient levels of heatwave-protective knowledge and behaviour in areas regularly affected by heatwaves. Our study assessed this among urban populations in Tunisia, Georgia and Israel. METHODS: We undertook a cross-sectional population survey in the three countries. The questionnaire focused on obtaining information on respondents' knowledge level regarding 1) symptoms due to overheating, 2) risk groups for heatwaves, 3) actions to take when someone is overheated, and 4) heatwave-protective measures. Furthermore, we asked respondents about protective measures they applied during the last heatwave. We compared the results between the countries. RESULTS: Heatwave-protective knowledge was highest in Israel, and lowest in Georgia, for all indicators except for heatwave-protective measures, for which knowledge was highest in Tunisia. Most respondents who named certain protective measures had also applied these during the last heatwave: more than 90% for all measures except for one in Tunisia and Israel, and more than 80% for all measures in Georgia. CONCLUSION: There is a need to further improve heatwave-protective knowledge in Tunisia, Georgia and Israel. One potential solution to achieve this is by implementing a National Heat Health Action Plan. Improving knowledge is a vital step before adaptive behaviour can take place.

An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19.

BACKGROUND: COVID-19 created lifestyle changes, and induced a fear of contagion affecting people's decisions regarding seeking medical assistance. Concern surrounding contagion and the pandemic has been found to affect the number and type of medical emergencies to which Emergency Medical Services (EMS) have responded. AIM: To identify, categorize, and analyze Magen David Adom (MDA), Israel's national EMS, pre-hospital activities including patients' refusal to hospital transport, during the COVID-19 pandemic crises. METHODS: A comparative before and after design study of MDA incidents during March/April 2019 and March/April 2020. Medical type, frequency, demographic, location, and transport refusal proportions and outcomes were analyzed. RESULTS: A decrease of 2.6% in the total volume of incidents was observed during March and April 2020 compared with the equivalent period in 2019. This contrasted with the retrospective trend of annually increase observed through 2016-2019. Medical categories showing increase in 2020 were infectious disease, cardiac arrest, psychiatric, and labor and deliveries, with out-of-hospital deliveries increasing by 14%. Decreases in 2020 were seen in neurology and trauma, with trauma incidents occurring at home showing an 8.6% increase. Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020. CONCLUSION: EMS must be prepared for changes in patients' behavior due to COVID concerns. Targeting populations at risk for refraining or refusing hospital transport and implementing diverse models of EMS, especially during pandemic times, will allow EMS to assist patients safely, either by reducing truly unnecessary ED visits minimizing contagion or by increasing hospital transports for patients in urgent or emergent conditions.

Impact of dispatcher assisted CPR on ROSC rates: A National Cohort Study.

INTRODUCTION: Out of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018. METHODS: All 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768). RESULTS: DA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC. CONCLUSIONS: OHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates.

Motorcycle-related head and neck injuries: increased risk among ethnic minorities.

BACKGROUND: Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC. METHODS: The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling. RESULTS: Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12-1.65) and TBI (OR = 1.51,95%CI = 1.12-1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12-0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00-1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61-0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39-0.7). In-hospital mortality was not associated with ethnicity. CONCLUSIONS: Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.

Impact of a Brief Educational Intervention on Knowledge, Perceived Knowledge, Perceived Safety, and Resilience of the Public During COVID-19 Crisis.

Extraordinary and unprecedented public health measures have been implemented to contain the ongoing spread of the coronavirus disease 2019 (COVID-19) pandemic. There is paramount importance of cooperation and population engagement in reducing disease infection rates and relieving an outbreak's burden on society. The civil society's engagement may be achieved through disaster education interventions. In this cross-sectional study, a pre-post questionnaire was used to investigate the impact of a brief educational intervention on knowledge, perceived knowledge, perceived safety, and the individual resilience of the population relating to the COVID-19 outbreak. The results of the study display the benefits of the educational intervention to include a significant overall increase in all examined variables. The study also reviewed the overall trust of the public concerning the main responding authorities, as well as practices concerning protective measures for COVID-19. This study demonstrates that educational interventions, such as the brief video, provide an easily implementable design and effective means for educating and empowering the public and should, thus, be considered as a component of future outbreak responses.

Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay.

AIM: To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving. BACKGROUND: Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving. METHODS: A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses. RESULTS: Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement. CONCLUSIONS: The interface between high education and having few opportunities for advanced positions may lead to resignation. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.

Inequality in in-hospital mortality due to road traffic accident between ethnic populations in specified groups living in the same country.

BACKGROUND: Road traffic accidents (RTA) are not equally distributed between ethnic groups, disproportionately affecting minorities. In Israel, Arabs are at higher risk of involvement in RTA relative to their proportion in the population. This study aims to compare the risk of in-hospital mortality from RTA between Arabs and Jews in Israel and to identify the factors associated with mortality in each population group. METHODS: This study is based on the Israeli National Trauma Registry of patients hospitalized due to road traffic injuries (Injury Severity Score 16+) between 2008 and 2017. Demographic, injury and hospitalization characteristics, evacuation means and in-hospital mortality were analyzed. Hierarchical multivariate logistic regression with random intercept for the treating hospital was performed to estimate the risk of mortality. RESULTS: Of the 11,523 hospitalizations reported, 29% were Arabs, which is higher than their proportion in the Israeli population (21%). When comparing Arabs with Jews they were younger (ages 0-24 years - 61% vs 30%), injured as a car driver (28% vs 20%) or passenger (21% vs 15%) and less likely to be a motor cyclist (8.8% vs. 19.2%). In addition, Arabs were more likely to suffer from critical injuries (51% vs 44%) and head injuries (71% vs 66%). Although Arabs were less likely to be evacuated by ambulance (68% vs 80%), they were more likely to be evacuated by a private vehicle or an emergency medical helicopter. Transfers between hospitals were greater among Arabs (14% vs 22%), as were hospital admissions "outside official work hours" (70% vs 78%) and hospital resource utilization. After accounting for demographic, injury, and hospitalization characteristics the risk of in-hospital mortality was significantly higher among Arabs compared to Jews (OR: 1.63, 95% CI: 1.14-2.32). The significantly higher mortality among Arabs was apparent in the sub-group of patients who were critically injured and in those who arrived at the hospital "outside official work hours". CONCLUSIONS: This study suggests the need for developing appropriate interventions focusing on the Arab community in general, and according to the analysis of risk groups and areas of injury in particular, including rapid access to emergency medical services and definitive care.