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1.
Fluids Barriers CNS ; 19(1): 72, 2022 Sep 08.
Artículo en Inglés | MEDLINE | ID: mdl-36076213

RESUMEN

BACKGROUND: Systemic drug delivery to the central nervous system is limited by presence of the blood-brain barrier (BBB). Low intensity focused ultrasound (LiFUS) is a non-invasive technique to disrupt the BBB, though there is a lack of understanding of the relationship between LiFUS parameters, such as cavitation dose, time of sonication, microbubble dose, and the time course and magnitude of BBB disruption. Discrepancies in these data arise from experimentation with modified, clinically untranslatable transducers and inconsistent parameters for sonication. In this report, we characterize microbubble and cavitation doses as LiFUS variables as they pertain to the time course and size of BBB opening with a clinical Insightec FUS system. METHODS: Female Nu/Nu athymic mice were exposed to LiFUS using the ExAblate Neuro system (v7.4, Insightec, Haifa, Israel) following target verification with magnetic resonance imaging (MRI). Microbubble and cavitation doses ranged from 4-400 µL/kg, and 0.1-1.5 cavitation dose, respectively. The time course and magnitude of BBB opening was evaluated using fluorescent tracers, ranging in size from 105-10,000 Da, administered intravenously at different times pre- or post-LiFUS. Quantitative autoradiography and fluorescence microscopy were used to quantify tracer accumulation in brain. RESULTS: We observed a microbubble and cavitation dose dependent increase in tracer uptake within brain after LiFUS. Tracer accumulation was size dependent, with 14C-AIB (100 Da) accumulating to a greater degree than larger markers (~ 625 Da-10 kDa). Our data suggest opening of the BBB via LiFUS is time dependent and biphasic. Accumulation of solutes was highest when administered prior to LiFUS mediated disruption (2-fivefold increases), but was also significantly elevated at 6 h post treatment for both 14C-AIB and Texas Red. CONCLUSION: The magnitude of LiFUS mediated BBB opening correlates with concentration of microbubbles, cavitation dose as well as time of tracer administration post-sonication. These data help define the window of maximal BBB opening and applicable sonication parameters on a clinically translatable and commercially available FUS system that can be used to improve passive permeability and accumulation of therapeutics targeting the brain.


Asunto(s)
Barrera Hematoencefálica , Microburbujas , Animales , Barrera Hematoencefálica/fisiología , Encéfalo/diagnóstico por imagen , Encéfalo/fisiología , Sistemas de Liberación de Medicamentos/métodos , Femenino , Imagen por Resonancia Magnética , Ratones , Permeabilidad , Sonicación/métodos
2.
Proc Natl Acad Sci U S A ; 119(13): e2121822119, 2022 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-35320043

RESUMEN

SignificanceWhether sympatric speciation (SS) is rare or common is still debated. Two populations of the spiny mouse, Acomys cahirinus, from Evolution Canyon I (EC I) in Israel have been depicted earlier as speciating sympatrically by molecular markers and transcriptome. Here, we investigated SS both genomically and methylomically, demonstrating that the opposite populations of spiny mice are sister taxa and split from the common ancestor around 20,000 years ago without an allopatric history. Mate choice, olfactory receptors, and speciation genes contributed to prezygotic/postzygotic reproductive isolation. The two populations showed different methylation patterns, facilitating adaptation to their local environment. They cope with abiotic and biotic stresses, due to high solar interslope radiation differences. We conclude that our new genomic and methylomic data substantiated SS.


Asunto(s)
Aislamiento Reproductivo , Simpatría , Animales , Especiación Genética , Genoma , Israel , Murinae/genética , Simpatría/genética
3.
Clin Genet ; 100(5): 522-528, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34297361

RESUMEN

As a result of the preference for consanguineous/endogamous marriages, the Israeli Arab population is composed of isolated communities with relatively frequent autosomal recessive (AR) conditions in each community. Clinical diagnosis of affected individuals has uncovered the pathogenic variants throughout the years. We investigated the diversity of pathogenic AR variants in a single village in northern Israel by exome analysis of 50 random, healthy adults descendants of the founders. Only likely pathogenic and pathogenic variants in known AR genes were selected. In this study 48 AR variants were found, of which 12 had been previously diagnosed in patients from this village, and for 11 with a frequency compatible with the frequency already known. Among the other 36 variants, 12 had been previously diagnosed in affected individuals in other Arab communities in Israel and 24 variants had not been previously characterized in this population. Of the 35 variants associated with conditions of moderate-severe medical consequences, only eight were known previously in this village. These findings emphasize the importance to better delineate the conditions at risk in a defined community, in particular for the development of preventive measures such as screening tests for reproductive couples, and for genetic counseling.


Asunto(s)
Genes Recesivos , Genética de Población , Aislamiento Reproductivo , Adulto , Alelos , Sustitución de Aminoácidos , Consanguinidad , Femenino , Predisposición Genética a la Enfermedad , Humanos , Patrón de Herencia , Israel , Masculino , Persona de Mediana Edad , Mutación , Adulto Joven
4.
Rev. enferm. Inst. Mex. Seguro Soc ; 29(1): 27-34, Ene-Mar 2021. tab, graf
Artículo en Español | LILACS, BDENF - Enfermería | ID: biblio-1284101

RESUMEN

Introducción: en la actualidad, la diabetes se considera una emergencia mundial debido al aumento de su prevalencia, posibles complicaciones y elevada mortalidad. Algunos factores culturales, como las creencias fatalistas, pueden representar una barrera para su control. Objetivo: revisar la evidencia científica disponible de la relación entre el fatalismo y el control glucémico en adultos con diabetes tipo 2. Metodología: se realizó una búsqueda en EBSCO Academic Search Complete, Science Direct, Web of Science, Pubmed, Springer, Redalyc, Latindex, Mediclatina y Fuente Académica vía EBSCO, delimitada a 10 años (2008-2018). Se utilizaron los descriptores DeCS y MeHS y la búsqueda de los estudios se efectuó en español e inglés. Los estudios se evaluaron para su validez a través de la guía para estudios analíticos transversales del Joanna Briggs Institute Critical Appraisal. Resultados: de 275 resultados que arrojó la búsqueda, se seleccionaron cinco estudios correlacionales-transversales, publicados en inglés en Estados Unidos, Líbano, Turquía e Israel, que incluyeron entre 130 y 615 pacientes con diagnóstico (5-14.4 años) de diabetes tipo 2. La evidencia disponible sugiere que existe una relación entre el fatalismo y el control glucémico. Conclusión: la relación entre el fatalismo y el control glucé-mico en adultos con diabetes tipo 2 es compleja y represen- ta en pacientes fatalistas una barrera para el control de la enfermedad.


Introduction: Diabetes is currently considered a worldwide emergency due to its increased prevalence, possible complications, and high mortality. Some cultural factors, such as fatalistic beliefs, may represent a barrier to diabetes control. Objective: Review scientific evidence avaible on the relationship between fatalism and glycemic control in adults with Type 2 Diabetes. Methods: A search was carried out in EBSCO Academic Search Complete, Science Direct, Web of Science, Pubmed, Springer, Redalyc, Latindex, Mediclatina y Fuente Académica EBSCO, limited to ten years (2008-2018). DeCS and MeHS descriptors were used, the search for studies was in Spanish and English. The studies were evaluated for validity through the Joanna Briggs Institute Critical Assessment guide for cross-sectional analytical studies. Results: The information query delivered 275 results and 5 from these studies were included. These are correlational-cross-sectional studies, published in English, from countries such as The United States of America, Lebanon, and Israel, which studied between 130 and 615 patients with diagnosis of T2D (between 5 and 14.4 years). Available evidence suggests that there is a relationship between fatalism and glycemic control. Conclusion: The relationship between fatalism and glycemic control in adults with Type 2 Diabetes is complex and represents, in more fatalistic patients, a barrier to disease control.


Asunto(s)
Humanos , Factores Culturales , Diabetes Mellitus Tipo 2/etnología , Autocuidado , Hemoglobina A Glucada/análisis , Conocimientos, Actitudes y Práctica en Salud
5.
Proc Natl Acad Sci U S A ; 117(51): 32499-32508, 2020 12 22.
Artículo en Inglés | MEDLINE | ID: mdl-33277437

RESUMEN

Speciation mechanisms remain controversial. Two speciation models occur in Israeli subterranean mole rats, genus Spalax: a regional speciation cline southward of four peripatric climatic chromosomal species and a local, geologic-edaphic, genic, and sympatric speciation. Here we highlight their genome evolution. The five species were separated into five genetic clusters by single nucleotide polymorphisms, copy number variations (CNVs), repeatome, and methylome in sympatry. The regional interspecific divergence correspond to Pleistocene climatic cycles. Climate warmings caused chromosomal speciation. Triple effective population size, Ne , declines match glacial cold cycles. Adaptive genes evolved under positive selection to underground stresses and to divergent climates, involving interspecies reproductive isolation. Genomic islands evolved mainly due to adaptive evolution involving ancient polymorphisms. Repeatome, including both CNV and LINE1 repetitive elements, separated the five species. Methylation in sympatry identified geologically chalk-basalt species that differentially affect thermoregulation, hypoxia, DNA repair, P53, and other pathways. Genome adaptive evolution highlights climatic and geologic-edaphic stress evolution and the two speciation models, peripatric and sympatric.


Asunto(s)
Evolución Biológica , Spalax/genética , Simpatría , Adaptación Biológica , Animales , Variaciones en el Número de Copia de ADN , Epigénesis Genética , Evolución Molecular , Flujo Génico , Variación Genética , Genética de Población , Genoma , Israel , Desequilibrio de Ligamiento , Masculino , Polimorfismo de Nucleótido Simple , Aislamiento Reproductivo , Spalax/fisiología
6.
Infect Genet Evol ; 86: 104593, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33053414

RESUMEN

Taxonomy based only on morphology, although extremely important for the classification of sandflies, has been shown to be insufficient for the delimitation of some taxa. Thus, integrative taxonomy could play a fundamental role in clarifying these and other taxonomic issues, since data from different areas are used to aggregate greater reliability in species classification. Experimental crosses are important taxonomic tools, since the presence of reproductive barriers when associated with divergence between two evolutionary lineages, confirms the specific status of taxa based on the biological species concept. In the subfamily Phlebotominae, experimental crosses were mostly focused on the study of the Lutzomyia longipalpis complex, which helped to identify different evolutionary lineages for that group of vectors. Considering the difficulty of classifying some Phlebotominae species and the importance of hybridization studies for taxonomy, we grouped all the information associated with experimental crosses in sandflies in a mini-review. In view of the results grouped in this review, it is evident that i) experimental crossings are important tools to aggregate studies of integrative taxonomy in the Phlebotominae subfamily; ii) these analyses should be applied in the taxonomic studies of cryptic species; iii) Lu longipalpis populations have pre and/or post-zygotic reproductive barriers; iv) Lu. longipalpis represents more than one species and efforts must be applied to differentiate the taxa of the Lu. longipalpis complex; v) Phlebotomus populations do not present intraspecific reproductive barriers; vi) the absence of reproductive barriers between Ph. sergenti from Israel and Turkey (representing populations of the same evolutionary lineage) does not rule out the possible existence of cryptic species, it being necessary to perform experimental crosses between the different strains indicated by the molecular markers; and finally, vii) different species of Phlebotomus have post-zygotic barriers, confirming the specific status of Ph. duboscqi, Ph. papatasi, and Ph. bergeroti.


Asunto(s)
Variación Genética , Hibridación Genética , Psychodidae/clasificación , Psychodidae/genética , Animales , Cruzamientos Genéticos , Evolución Molecular , Genética de Población , Aislamiento Reproductivo
7.
Ethn Health ; 25(2): 255-272, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-29284285

RESUMEN

Objectives: In recent years, there has been a mass migration of Eritreans (many seeking political asylum) into Israel after precarious irregular movement across international borders. This study qualitatively explores the structural barriers to family planning (i.e. contraceptive services) for Eritrean women in Israel that are rooted in their temporary legal status and the patchwork of family planning services.Design/Methods: From December 2012 to September 2013, we interviewed 25 key informants (NGO workers, researchers, Eritrean community activists, International NGO representatives and Ministry of Health officials) and 12 Eritrean asylum seekers. We also conducted 8 focus groups with Eritrean asylum seekers. Data were analyzed using both inductive and deductive coding.Results: We identified 7 main barriers to accessing family planning services: (1) distance to health facilities; (2) limited healthcare resources; (3) fragmentation of the healthcare system; (4) cost of contraceptive services; (5) low standard of care in private clinics; (6) discrimination; and (7) language barriers.Conclusion: The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers' efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.


Asunto(s)
Anticonceptivos/provisión & distribución , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud , Refugiados , Adulto , Barreras de Comunicación , Anticonceptivos/economía , Eritrea/etnología , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Israel , Masculino , Persona de Mediana Edad , Embarazo , Investigación Cualitativa , Salud Reproductiva
8.
Oncol Nurs Forum ; 46(5): 561-571, 2019 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-31424452

RESUMEN

PURPOSE: To identify how oncology nurses address mental health distress and suicidality in patients, what strategies they employ in treating this distress, and the barriers they face in addressing distress and suicidality in patients with cancer. PARTICIPANTS & SETTING: 20 oncology nurses at two cancer centers in Israel were interviewed. METHODOLOGIC APPROACH: The grounded theory method of data collection and analysis was employed. FINDINGS: Strategies used in addressing patients' mental health distress were being emotionally available, providing practical support, treating physical symptoms, and referring to counseling. Strategies in addressing suicidality were assessing the situation, offering end-of-life or palliative care, treating physical symptoms, and referring for assessment. Barriers to addressing distress were lack of training, stigma, workload or lack of time, and limited availability and accessibility of mental health resources. Barriers in addressing suicidality were lack of knowledge and training, patient reluctance to receive care, and lack of protocol. IMPLICATIONS FOR NURSING: Developing guidelines for addressing and responding to mental health distress and suicidality is essential to improving patients' quality of life and reducing disease-related morbidity and mortality. Reducing mental healthcare stigma for patients is critical.


Asunto(s)
Neoplasias/enfermería , Relaciones Enfermero-Paciente , Enfermería Oncológica , Estrés Psicológico/enfermería , Ideación Suicida , Adulto , Barreras de Comunicación , Emociones , Femenino , Humanos , Entrevistas como Asunto , Israel , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Diagnóstico de Enfermería , Manejo del Dolor , Cuidados Paliativos , Derivación y Consulta , Estrés Psicológico/diagnóstico , Estrés Psicológico/etiología , Cuidado Terminal
9.
Isr J Health Policy Res ; 8(1): 58, 2019 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-31266531

RESUMEN

BACKGROUND: Organizational language practice and policy are not neutral elements but reflect social and political power relations. The micro-level of working groups is subject to the influence of political conflicts and power relations at the macro-level. In conflict zones in particular, these involve complex considerations. Consequently, the present research sought to examine tensions arising from the language spoken among mixed Jewish-Arab teams in Israeli public hospitals. METHODS: In-depth interviews were conducted during 2016-2017, with 50 Jewish and Arab healthcare practitioners - 10 managers, 20 physicians, and 20 nurses - employed in 11 public hospitals in Israel. RESULTS: Our interviews with healthcare practitioners revealed that speaking Arabic in the presence of the patient (not with the patient) may evoke negative feelings and resentment among both Jewish patients and colleagues. Moreover, conflicting attitudes may come into play when Arab practitioners speak Arabic among themselves. Two contexts of language use in Israeli public hospitals can be noticed: the language used in the presence of the patient; and the language used among the practitioners when no patient is present. The former involves the principles of cultural and linguistic competency, and is therefore governed by clear guidelines and procedures. The latter echoes the tensions between the two ethno-national groups in Israel, Jews and Arabs, and is not regulated by a clear policy formulated by the Ministry of Health or by the hospitals' managements. CONCLUSIONS: Our analysis of language practice and policy as a multi-leveled phenomenon, where the micro-level of everyday interactions is influenced by the macro-level of political life, indicates a need for meso-level policy, led by the Ministry of Health. A policy of linguistic competency should be publicized and enforced to ensure that in the presence of the patient, practitioners speak a language s/he understands. This policy should also stipulate that among mixed teams of healthcare professionals every language is permissible, while the language spoken in a particular context should be understood by everyone present.


Asunto(s)
Barreras de Comunicación , Personal de Salud/psicología , Política de Salud/tendencias , Comunicación Interdisciplinaria , Adulto , Asistencia Sanitaria Culturalmente Competente/normas , Asistencia Sanitaria Culturalmente Competente/tendencias , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Entrevistas como Asunto/métodos , Israel , Masculino , Investigación Cualitativa
10.
EBioMedicine ; 43: 460-472, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31162113

RESUMEN

BACKGROUND: Disease progression and delayed neurological complications are common after aneurysmal subarachnoid hemorrhage (aSAH). We explored the potential of quantitative blood-brain barrier (BBB) imaging to predict disease progression and neurological outcome. METHODS: Data were collected as part of the Co-Operative Studies of Brain Injury Depolarizations (COSBID). We analyzed retrospectively, blinded and semi-automatically magnetic resonance images from 124 aSAH patients scanned at 4 time points (24-48 h, 6-8 days, 12-15 days and 6-12 months) after the initial hemorrhage. Volume of brain with apparent pathology and/or BBB dysfunction (BBBD), subarachnoid space and lateral ventricles were measured. Neurological status on admission was assessed using the World Federation of Neurosurgical Societies and Rosen-Macdonald scores. Outcome at ≥6 months was assessed using the extended Glasgow outcome scale and disease course (progressive or non-progressive based on imaging-detected loss of normal brain tissue in consecutive scans). Logistic regression was used to define biomarkers that best predict outcomes. Receiver operating characteristic analysis was performed to assess accuracy of outcome prediction models. FINDINGS: In the present cohort, 63% of patients had progressive and 37% non-progressive disease course. Progressive course was associated with worse outcome at ≥6 months (sensitivity of 98% and specificity of 97%). Brain volume with BBBD was significantly larger in patients with progressive course already 24-48 h after admission (2.23 (1.23-3.17) folds, median with 95%CI), and persisted at all time points. The highest probability of a BBB-disrupted voxel to become pathological was found at a distance of ≤1 cm from the brain with apparent pathology (0·284 (0·122-0·594), p < 0·001, median with 95%CI). A multivariate logistic regression model revealed power for BBBD in combination with RMS at 24-48 h in predicting outcome (ROC area under the curve = 0·829, p < 0·001). INTERPRETATION: We suggest that early identification of BBBD may serve as a key predictive biomarker for neurological outcome in aSAH. FUND: Dr. Dreier was supported by grants from the Deutsche Forschungsgemeinschaft (DFG) (DFG DR 323/5-1 and DFG DR 323/10-1), the Bundesministerium für Bildung und Forschung (BMBF) Center for Stroke Research Berlin 01 EO 0801 and FP7 no 602150 CENTER-TBI. Dr. Friedman was supported by grants from Israel Science Foundation and Canada Institute for Health Research (CIHR). Dr. Friedman was supported by grants from European Union's Seventh Framework Program (FP7/2007-2013; grant #602102).


Asunto(s)
Barrera Hematoencefálica/metabolismo , Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/metabolismo , Adulto , Anciano , Biomarcadores , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Encéfalo/patología , Angiografía por Tomografía Computarizada , Progresión de la Enfermedad , Diagnóstico Precoz , Femenino , Escala de Consecuencias de Glasgow , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Evaluación del Resultado de la Atención al Paciente , Pronóstico , Curva ROC , Reproducibilidad de los Resultados , Hemorragia Subaracnoidea/diagnóstico , Adulto Joven
11.
Qual Health Res ; 29(13): 1954-1966, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31043144

RESUMEN

Patient trust is positively related to health outcomes, but there remain barriers to patient trust in physicians. This narrative study analyzed patient experiences and highlights barriers to patient trust underlying communication with physicians in acute care. Snowball sampling was used. Informants were 12 participants, in poor physical health, upon discharge from a 3-week hospitalization in an acute-care setting at an Israeli public general hospital. Two narrative interviews were conducted with each participant upon and after discharge. Findings suggest presurgery barriers to trust (lack of acknowledgment of patient's crisis, underrating patient's autonomy, and use of unique empathy) and postsurgery barriers to trust (lack of attentive listening, lack of medical professionalism, and delegitimization to patients' self-alienation). Two common narrative identities emerged linking trust with self-worth. To build trust, physicians are called upon to extend their dedication from dedication to improve clinical outcomes to dedication to improve clinical outcomes and preserve patients' self-worth.


Asunto(s)
Barreras de Comunicación , Hospitales Generales/estadística & datos numéricos , Relaciones Médico-Paciente , Autoimagen , Confianza , Adulto , Anciano , Anciano de 80 o más Años , Empatía , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Investigación Cualitativa , Factores Socioeconómicos
12.
Isr J Health Policy Res ; 7(1): 61, 2018 11 19.
Artículo en Inglés | MEDLINE | ID: mdl-30449283

RESUMEN

BACKGROUND: Cultural competence (CC) in health systems is the ability to provide care to patients with different values, beliefs and behaviors, and to match the care to their social, cultural and linguistic needs. In 2011, the Director-General of Israel's Ministry of Health issued a cultural competence directive to health care providers that sought to minimize health inequalities caused by cultural and linguistic gaps. This study assesses the status of organizational CC in Israeli general hospitals in the wake of the 2011 directive. METHOD: Organizational CC was assessed using a 75-item structured questionnaire based on the 2011 directive and on international standards. Data were gathered via interviews conducted between December 2012 and February 2014. 35 of Israel's 36 general hospitals participated in the study, for a response rate of 97%. A composite CC score was calculated for each hospital as the average of the 75 items in the questionnaire. RESULTS: The average composite score of all the hospitals was low to moderate (2.3 on a scale of 0-4), the median score was 2.4, and the range of composite scores was large, 0.7-3.2. The interquartile range was [1.94, 2.57]. Hospital CC is positively associated with non-private ownership status and location in the southern or central districts. Still, these differences are not statistically significant and immutable hospital characteristics such as ownership status and location account for only 21% of the inter-hospital variation in CC. This suggests that hospital leaders have significant discretion in the priority to be given to CC. Dimensions of CC with relatively low average scores include hospital connections with the community (1.28), staff training on CC (1.35), oral translation (i.e. interpreting) during treatment (1.62), and CC adaptation of human resources recruitment and evaluation (1.64). These areas appear to be particularly in need of improvement. CONCLUSION: The study findings suggest that hospitals and policy-makers can take significant steps to improve CC; these include setting more concrete and measurable implementation guidelines. We conclude with suggestions for policy and practices to improve cultural competence in the health system.


Asunto(s)
Competencia Cultural , Hospitales/normas , Cultura Organizacional , Barreras de Comunicación , Disparidades en Atención de Salud/normas , Hospitales/estadística & datos numéricos , Humanos , Israel , Encuestas y Cuestionarios
13.
Qual Health Res ; 28(5): 711-720, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29441815

RESUMEN

Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.


Asunto(s)
Árabes/psicología , Judíos/psicología , Racismo/etnología , Negativa del Paciente al Tratamiento/etnología , Barreras de Comunicación , Hospitales Públicos , Humanos , Entrevistas como Asunto , Israel , Lenguaje , Investigación Cualitativa
14.
Disabil Rehabil ; 40(17): 2098-2104, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28494627

RESUMEN

PURPOSE: Problem-based learning (PBL) is an educational method that fosters self-directed study in small groups. The purpose of this study was to describe the Tel Aviv University's occupational therapy (OT) program and the challenges implementing such program. In addition, the study compared the PBL grades obtained by students who are native Hebrew speakers with those students who are native Arabic speakers; and, assessed the correlation between the grades in the PBL course and the grades in the clinical fieldwork studies. METHOD: 166-second year OT undergraduate students participated. All completed three PBL courses and seven weeks of clinical fieldwork studies. Data collection included students' grades in PBL course (based on PBL evaluation forms) and in clinical fieldwork studies (based on preceptor's evaluation and a written assignment). RESULTS: Pearson correlations revealed significant correlations between PBL grades and clinical fieldwork studies grades. T-test analysis between students who are native Hebrew speakers and those who are native Arabic speakers revealed significant differences in PBL grades. CONCLUSIONS: Findings imply partial congruence between students' grades in the PBL course and their achievements in the fieldwork studies. Findings might suggest that adjustments should be made in order to assist students from minorities (challenged by language requirements) in gaining higher grades in the PBL program. Implications for Rehabilitation Problem-Based Learning (PBL) is an educational method, which fosters independent, self-directed study in small groups. PBL studies have the potential to prepare students for their clinical experience during studies. The PBL program should be adjusted for students from minorities (challenged by language requirements and different cultural backgrounds) in order to assist them in gaining more benefits from the program.


Asunto(s)
Barreras de Comunicación , Cultura , Terapia Ocupacional/educación , Aprendizaje Basado en Problemas/métodos , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Árabes , Comparación Transcultural , Curriculum/normas , Evaluación Educacional/métodos , Femenino , Humanos , Israel , Judíos , Masculino
15.
Isr J Health Policy Res ; 6(1): 61, 2017 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-29141680

RESUMEN

BACKGROUND: Israel hosts approximately 50,000 asylum seekers, most of them from Eritrea. Exclusive policies restrict their access to healthcare. In 2013, local activists partnered with Eritrean asylum seekers to assess health needs as well as willingness to pay for health insurance among the Eritrean communities. This initiative was meant as a step towards jointly advocating access to Israel's public healthcare system and towards strengthening collective efficacy among the asylum-seeking communities, as well as a first attempt to apply a community-based participatory research (CBPR) approach to migrant health research in Israel. METHODS: Applying a CBPR approach, a 22-item survey was developed by a team of activists, academics and community members. It was administered by community members in four different cities. Cell weighting was applied to align sample estimates with the population distribution. The results were analyzed by means of a Generalized Linear Model. Six follow-up interviews and two focus group discussions helped interpret the quantitative findings and provided additional information. RESULTS: The results from 445 questionnaires show that most (95%) asylum seekers are interested in purchasing health insurance. To this end, more than half of the respondents are willing to invest up to 300 NIS monthly, which represents a significant part (5-7.5%) of their median monthly income. Willingness to pay for health coverage was independent from employment and income; it was significantly associated with city of residence - which translates into current healthcare options - understanding of health insurance, and health seeking motives. The study further highlights the role of labor policies in shaping not only asylum seekers' access to care but also psychosocial wellbeing. CONCLUSIONS: The study provides initial evidence for asylum seekers' willingness to pay monthly contributions into a public health insurance scheme, in spite of economic hardship, and it points to understanding of and trust in the healthcare system as a central factor influencing willingness to pay. The outcomes of this initiative further offer some support for the potential of CBPR to enhance research into the health of marginalized populations and, moreover, to counter their social exclusion through capacity building and strengthening of collective efficacy.


Asunto(s)
Investigación Participativa Basada en la Comunidad/métodos , Accesibilidad a los Servicios de Salud/normas , Refugiados/estadística & datos numéricos , Adulto , Barreras de Comunicación , Eritrea/etnología , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Israel , Masculino , Proyectos Piloto , Investigación Cualitativa , Encuestas y Cuestionarios , Traducción
17.
Soc Sci Med ; 147: 89-97, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26552014

RESUMEN

More than 150,000 irregular migrants reside in Israel, yet data regarding their utilization of and perceived barriers to health care services are limited. Drawing on semi-structured interviews conducted with 35 irregular migrant adults between January and September 2012, this article analyzes the role of migration as a social determinant of health for irregular migrants, and especially asylum seekers. We analyze two kinds of barriers faced by migrants when they attempt to access health care services: barriers resulting directly from their migration status, and barriers that are common among low-income communities but exacerbated by this status. Migration-related barriers included a lack of clear or consistent legislation; the threat of deportation; the inability to obtain work permits and resulting poverty and harsh living and working conditions; and discrimination. Barriers exacerbated by migrant status included prohibitive cost; poor and confusing organization of services; language barriers; perceived low quality of care; and social isolation. These findings support recent arguments that migrant status itself constitutes a social determinant of health that can intersect with other determinants to adversely affect health care access and health outcomes. Findings suggest that any meaningful effort to improve migrants' health will depend on the willingness of clinicians, public health officials, and policymakers to address the complex array of upstream political and socio-economic factors that affect migrants' health rather than focusing on narrower questions of access to health care.


Asunto(s)
Emigración e Inmigración/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud , Refugiados , Determinantes Sociales de la Salud , Adolescente , Adulto , Anciano , Barreras de Comunicación , Femenino , Teoría Fundamentada , Accesibilidad a los Servicios de Salud/economía , Humanos , Israel , Masculino , Persona de Mediana Edad , Pobreza , Refugiados/legislación & jurisprudencia , Determinantes Sociales de la Salud/estadística & datos numéricos , Adulto Joven
18.
Int J Drug Policy ; 25(4): 691-9, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24947993

RESUMEN

BACKGROUND: There is increased interest in the therapeutic potential of cannabis in recent decades. Canada, the Netherlands, Israel and some states in the United States have developed programs to allow access to cannabis for therapeutic purposes (CTP). In Canada, enrollment in the federal CTP program represents fewer than 5% of the estimated users of CTP. The discrepancy between the number of Canadians who report using CTP and the rate of utilization of the federal CTP program suggests the existence of barriers to access to this program. METHODS: In the present study we employ a health services analytical framework to examine barriers to access to CTP among 628 current CTP users. We define barriers to access as areas of poor fit between clients and services. We use five dimensions of accommodation, accessibility, availability, affordability, and acceptability to examine access to CTP. RESULTS: Our findings reveal that it is difficult for Canadians to find a physician to support their application to access CTP. Accessing CTP from unauthorized sources was common; only 7% of respondents accessed CTP exclusively from authorized sources. Access to CTP was positively associated with the presence of medical cannabis dispensaries, which were not included in the regulatory regime. Access to CTP varied by medical condition and general quality of health. Affordability of CTP was a substantial barrier to access. CONCLUSIONS: Strategies need to be developed to encourage scientific inquiry into CTP and address the barriers to access to CTP and the stigma and controversy that surround CTP and strain patient-physician relationships.


Asunto(s)
Disparidades en Atención de Salud , Fumar Marihuana , Marihuana Medicinal/provisión & distribución , Adolescente , Adulto , Canadá , Barreras de Comunicación , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Encuestas y Cuestionarios
19.
Med Law ; 33(3): 35-48, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27359016

RESUMEN

AIMS: The purpose of the current article is to discuss the culturally competent nursing practice according to the patient's rights law and to suggest strategies and models to facilitate culturally competent nursing care. BACKGROUND: According to the patient's rights law, health care providers have to inform the patient about his/her health condition by an understandable language that is also appropriate to their culture. However, communication with culturally and linguistically diverse patients has been known to be difficult. Cultural and linguistic differences may impede access to health care, accurate diagnosis, and effective treatment. The culturally competent nursing approach was suggested as the most appropriate way to minimize these difficulties. CONCLUSION: This paper contributes to nursing care quality by suggesting the best available standards and models of care and improving culturally appropriate care. Nurses should place cultural competence as a priority, and protect their patients' diverse cultural and ethnical rights.


Asunto(s)
Competencia Cultural , Atención de Enfermería , Derechos del Paciente/legislación & jurisprudencia , Barreras de Comunicación , Humanos , Israel , Relaciones Enfermero-Paciente
20.
Am Nat ; 182(4): 514-23, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24021403

RESUMEN

Sexual trait divergence has been shown to play a role in the evolution of reproductive isolation. While variation in multiple sexual signals is common among closely related species, little is known about the role of these different axes of phenotype variation with respect to the evolution of behavioral reproductive isolation. Here we study a unique population of barn swallows (Hirundo rustica transitiva) that can be distinguished phenotypically from its neighboring populations only on the basis of two features of male plumage: exaggerated expression of both long tail streamers and dark ventral coloration. Using phenotype manipulation experiments, we conducted a paternity study to examine whether both traits are sexually selected. Our results show that an exaggerated form of the local male phenotype (with both tail elongation and color darkening) is favored by local females, whereas males whose phenotypes were manipulated to look like males of neighboring subspecies suffered paternity losses from their social mates. These results confirm the multiple signaling role of the unique tail and color combination in our diverging population and suggest a novel possibility according to which multiple sexual signals may also be used to discriminate among males from nearby populations when prezygotic reproductive isolation is adaptive.


Asunto(s)
Evolución Biológica , Preferencia en el Apareamiento Animal , Aislamiento Reproductivo , Golondrinas/anatomía & histología , Golondrinas/fisiología , Animales , Femenino , Israel , Masculino , Estaciones del Año , Golondrinas/genética , Cola (estructura animal)/anatomía & histología
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