Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women.

Menopause occurs around midlife and is an inevitable component of women's aging. The study aimed to investigate the associations between the lifetime prevalence of menopausal symptoms and health-related characteristics among Israeli postmenopausal women aged 55-75 years. Additionally, this study aimed to estimate the use of hormone replacement therapy (HRT) and women's attitudes toward this treatment. Data for this study were extracted from a cross-sectional national telephone survey conducted in Israel between 2018 and 2020. For the current study, only postmenopausal women aged 55-75 years were included. Multivariate analyses were used to identify demographic and health-related characteristics associated with menopausal symptoms. The study included 688 participants. Most (68.8%) reported one or more menopausal symptoms, specifically vasomotor symptoms (50.4%). According to the multivariate logistic regression analysis, menopausal symptoms were associated with moderate-high anxiety and/or depression symptoms (OR = 2.01, 95% CI 1.12-3.58) and with osteoporosis (OR = 1.78, 95% CI 1.08-2.92). Although most (78.3%) symptomatic women were bothered by their symptoms, 29.1% received any treatment for symptom relief and only 12.6% reported current or past use of HRT. The findings show that menopausal symptoms were associated with a higher prevalence of anxiety and/or depression symptoms and osteoporosis in the years following menopause. Most symptomatic women did not receive any treatment and the majority were against HRT. Knowledge and awareness about menopause and treatment options should be increased among Israeli women. Additionally, the promotion of positive attitudes toward menopause and HRT use among women and healthcare providers is strongly recommended.

Rise in depression and anxiety during the COVID-19 pandemic: results from a cross-sectional national survey.

The Coronavirus disease 2019 (COVID-19) pandemic has introduced many mental stressors. This study aimed to evaluate the prevalence of depression and anxiety during the pandemic and characterize those at higher risk. We conducted a national cross-sectional telephone interview survey among Israeli adults from May to September 2020, between the first two national lockdowns. Mental health status was measured using the 5-item Mental Health Inventory (MHI-5). A score of ≤60 was defined as poor mental health with moderate to high anxiety and depression symptoms. Multivariate analysis was used to identify demographic, health-related, and COVID-19-related risk factors associated with poor mental health. From 4,712 households that were eligible for inclusion in this study, 2,634 participants (55.9%) completed the survey. Levels of anxiety and depression symptoms increased significantly throughout the pandemic (from 12.9% to 20.3%, P < 0.001). Loneliness also increased over time (from 48.8% to 58.8%, P < 0.001), and fear of the pandemic remained high (66.5%) throughout the study. According to the multivariate analysis, poor mental health was associated with younger age, female gender, lower education, Arab ethnicity, decrease in household income during the pandemic, having a pre-existing chronic illness, obesity, smoking, ever being quarantined, feeling lonely and fear of the pandemic. Our findings show an increase in anxiety and depression over time among the Israeli population during the COVID-19 pandemic. These findings highlight the need for strengthened mental health services and the flexibility of reallocation of funds and health resources to support the growing mental health needs during the health crisis.

Current use of nutrition facts tables and attitudes towards new red and green front-of-package labels among Israeli consumers.

Front-of-package labels (FOPL) are designed to simplify nutrition information and to help consumers make healthier food choices. The Israeli government has implemented new regulations requiring mandatory red warning FOPL for high levels of sodium, sugar, or saturated fats. A voluntary green positive FOPL for products fitting the national nutritional recommendations was concurrently encouraged. In order to characterise adult consumers' current use of Nutrition Facts Tables (NFT) and their attitudes towards the new FOPL, a nationally representative cross-sectional telephone survey was conducted. Most of the 1,042 survey respondents reported frequent NFT use (76.2%) and intentions to purchase fewer red-labelled (81.1%) and more green-labelled products (85.0%). Consumers with higher BMI and lower education expressed higher intentions to use the new FOPL, but not higher current use of NFT. This finding suggests that these high-risk groups, which the new labels are meant to target, may indeed benefit from the new policy.

COVID-19 vaccine hesitancy among Israeli adults before and after vaccines' availability: A cross-sectional national survey.

Vaccine hesitancy (VH) is a major health threat to the efforts to tackle COVID-19 morbidity and mortality. This study's objectives were to assess COVID-19VH before and after vaccines' availability and to analyze the associations between COVID-19VH and participants' characteristics. A national cross-sectional telephone interview survey among Israeli adults aged 21 and older was conducted from September 2020 through May 2021. Attitudes towards COVID-19 vaccines were assessed pre/post vaccines' availability. Multivariate logistic regression analyses were used to identify associations between demographic and health-related characteristics and COVID-19 VH. Most study participants (72.0 % of 2,998) were willing to be vaccinated against COVID-19 across the survey period. The COVID-19 VH declined significantly from 45.6 % pre-vaccine availability to 16.3 % post-vaccine availability (P < 0.001). The multivariable analysis demonstrated that post-vaccine availability, COVID-19 VH was associated with younger age, Arab ethnicity, higher level of religiosity, lower education, past diagnosis of COVID-19, and influenza VH. The main reasons for VH after the vaccine availability included insufficient data on the vaccine (37.4 %) and fear of the vaccine's side effects (33.8 %). Despite the significant decrease in COVID-19 VH following vaccine availability, 16.3% of the population still refuses to get vaccinated. As Israel may face additional waves of the COVID-19 pandemic and booster vaccinations, multimedia vaccine promotions targeting the above-mentioned hesitant populations and their reasons for VH are urgently needed.

Falls and fear of falling among Israeli community-dwelling older people: a cross-sectional national survey.

BACKGROUND: Falls and fear of falling are a major problem for older people and a leading cause of functional decline and institutionalization. There is limited data on the prevalence of falls in a 12-month period among Israeli older adults. Our main objective was to evaluate the prevalence of falls among Israeli community-dwelling older people aged ≥65 years and to identify factors associated with falls and fear of falling. METHODS: A national cross-sectional interview survey was conducted between February 2018 and April 2019 by the Israeli Center for Disease Control. The prevalence of falls was assessed by asking participants about falling within the 12 months prior to the survey. Fear of falling was assessed by asking participants about the fear of future falls. Multivariate analysis was used to identify factors associated with falls and with fear of falling. RESULTS: From 5281 households that were eligible for inclusion in this study, 3242 participants (61.4%) completed the survey. Falling at least once in the past year was reported by 23.8% of the respondents and fear of falling by 48.2%. The majority of the participants (91.1%) reported that they had never received any instruction about fall prevention from their medical care provider. In the multivariate analysis, falls and fear of falling were each a risk factor for the other; and were also significantly associated with female gender, major functional difficulties, the use of walking aids, cardiac disease, diabetes mellitus and psychotropic medications. CONCLUSION: The prevalence of falls and fear of falling among Israeli community-dwelling older people is comparable to the rates published in other countries. Efforts should be made to increase awareness about falls and their health consequences among older people. The development of specific interventions to target those at higher risk for falls and fear of falling is strongly recommended.

The effect of body mass index (BMI) and gestational weight gain on adverse obstetrical outcomes in pregnancies following assisted reproductive technology as compared to spontaneously conceived pregnancies.

OBJECTIVE: To compare the effect of pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) on adverse obstetrical outcomes among women undergoing assisted reproductive technology (ART) treatments as compared to spontaneously-conceived (SC) pregnancies. METHODS: This prospective cohort study included 1058 pregnant women from two medical centres; 504 women who conceived following ART treatments and 554 who conceived spontaneously. The women were recruited at 8 weeks of gestation and follow-up telephone interviews were conducted 6 weeks after delivery. Obstetrical outcomes included pregnancy hypertension, gestational diabetes (GD), low birth weight (LBW) (<2500g) and small for gestational age (SGA). Multivariate analyses were used to assess the effect of pre-pregnancy BMI and inappropriate GWG on these obstetrical outcomes adjusted for risk factors. RESULTS: The effect of pre-pregnancy BMI and inappropriate GWG on adverse obstetrical outcomes did not differ between ART and SC pregnancies. Pre-pregnancy obesity was found to be associated with increased risk for pregnancy hypertension (OR=2.16; 95%CI 1.16-4.03), GD (OR=2.89; 95%CI 1.61-5.17), caesarian section (OR=1.77; 95%CI 1.10-2.85) and SGA (OR=1.91; 95%CI 1.05-3.46). GWG below recommendations was associated with increased risk for GD (OR=1.73; 95%CI 1.06-2.82) and SGA (OR=1.69; 95%CI 1.17-2.40) while GWG above recommendations was associated with increased risk for pregnancy hypertension (OR=1.77; 95%CI 1.02-3.06). CONCLUSIONS: Pre-pregnancy obesity and inappropriate GWG were associated with adverse obstetrical outcomes in both ART and SC pregnancies. Emphasis should be given on the importance of an optimal pre-pregnancy BMI and appropriate GWG during pregnancy.

Long-Term Outcomes of Medication Intervention Using the Screening Tool of Older Persons Potentially Inappropriate Prescriptions Screening Tool to Alert Doctors to Right Treatment Criteria.

OBJECTIVES: To compare 24-month outcomes of participants of a prospective randomized controlled trial (RCT) assigned to undergo a medication intervention of orally communicated recommendations based on Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) (intervention group) with outcomes of those assigned to undergo written medication review (control group). DESIGN: Retrospective cohort study. SETTING: Chronic care geriatric facility. PARTICIPANTS: Of 359 participants from a prospective RCT conducted between April 2012 and September 2013, 306 were evaluable for another 12-month follow-up. MEASUREMENTS: Outcomes at 24-month follow-up included quality of prescribing (assessed according to STOPP/START), hospitalizations, falls, costs of medications, and all-cause mortality. Outcomes were compared with those reported at the beginning (baseline) and end (12-month follow-up) of the RCT. RESULTS: There was a significant rise in potentially inappropriate prescriptions (PIPs) (P = .01) and potentially prescriptions omissions (PPOs) (P < .001) in the intervention group between 12 and 24 months, although the prevalence of PIPs was significantly lower in the intervention group (33.3%) than the control group (48.4%) at 24-month follow-up (P = .02). Costs of medications were significantly lower in the intervention group than the control group (P < .001) at 24-month follow-up. The average number of falls in both groups dropped significantly between baseline and study closure (P = .04 and P = .008, respectively). There was no significant difference in hospitalizations and mortality between the two groups at 24-month follow-up. CONCLUSION: The effect of an orally communicated medication intervention with the STOPP/START criteria on falls was maintained over time. Direct communication between pharmacists and prescribing physicians is more efficient than written medication review and is recommended every 6 months in geriatric facilities.

The impact of facility characteristics on the use of antipsychotic medications in nursing homes: a cross-sectional study.

BACKGROUND: Antipsychotic medications (APMs) are commonly prescribed in nursing homes (NHs) and their excessive use raises concerns about the quality of care. They are often seen as "chemical restraints", and were shown to increase morbidity and mortality risks in NH residents. The objective of this study was to investigate the variability in prevalence in APM use in a sample of Israeli NHs and to examine the effect of facility characteristics on the use of APMs. METHODS: A retrospective cross-sectional study was conducted in 2011 using data which were collected in a sample of NHs in the Tel Aviv district during the annual certification process. Prevalence of APMs was determined on the basis of all residents using antipsychotics on a regular basis. The association between facility characteristics and APM use was assessed by multivariate analysis. RESULTS: Forty-four NHs providing care for 2372 residents were investigated. The prevalence of APM use varied between facilities from 14.8 to 70.6 %, with an overall prevalence of 37.3 %. Multiple linear regression analysis revealed that greater use of APMs was associated with for-profit facilities, facilities in which most of the residents were self-pay, the presence of a "mentally frail" unit, a medical director non-specialized in geriatrics, shortage of social workers and occupational therapists, presence of unsafe/non-fitting equipment or self-aids (e.g., unsafe bath/toilet seats, unsuitable height of tables) and shortage of recreational activities. CONCLUSIONS: A wide variation in APM use was recorded in NHs in the Tel Aviv district. This variation was associated with facility characteristics that undermine quality of care. Application of APM use as a measure of quality in NHs and publicizing their utilization may decrease their overall use.

The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division.

BACKGROUND: Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) have been increasingly used to evaluate potentially inappropriate prescriptions (PIPs) and potentially prescription omissions (PPOs). The impact of hospitalization on PIPs/PPOs has not been investigated in depth. OBJECTIVE: To compare the prevalence of PIPs/PPOs in elderly patients on hospital admission and discharge and to identify associated risk factors. SETTING: An acute medical geriatric division of the Tel Aviv Medical Center (Israel). METHOD: This retrospective cross-sectional study included patients admitted from 12/2011 to 12/2012 aged ≥65 years. Data from patients' records included demographic details, diagnoses and medications at admission and discharge. STOPP/START criteria were applied to each patient's record. MAIN OUTCOME MEASURE: Prevalence of PIPs/PPOs on hospital admission and discharge. RESULTS: Three hundred patients were included (mean ± SD age 81.9 ± 7.2 years). Admission PIPs prevalence was 39.3 % (118 patients, 172 PIPs) and it increased to 46.0 % (138 patients, 209 PIPs) at discharge (P = 0.009). Admission PPOs prevalence was 41.0 % (123 patients, 153 PPOs) and it decreased to 28.3 % (85 patients, 99 PPOs) at discharge (P < 0.001). Having at least one PIP/PPO at discharge but not at admission was associated with length of hospital stay (OR 1.02, 95 % CI 1.001-1.03). History of falls increased the risk of being a "new PIP patient" (OR 2.25, 95 % CI 1.03-4.9), whereas diabetes increased the risk of being a "new PPO patient" (OR 3.86, 95 % CI 1.2-12.5). CONCLUSION: Hospitalization in a geriatric division resulted in an increase in PIPs and a decrease in PPOs. Strategies to reduce PIPs need to be implemented, especially for patients with longer hospital stay and a history of falls.

Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial.

OBJECTIVES: To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) medication intervention on clinical and economic outcomes. DESIGN: Parallel-group randomized trial. SETTING: Chronic care geriatric facility. PARTICIPANTS: Residents aged 65 and older prescribed with at least one medication (N = 359) were randomized to receive usual pharmaceutical care or undergo medication intervention. INTERVENTION: Screening medications with STOPP/START criteria followed up with recommendations to the chief physician. MEASUREMENTS: The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls, Functional Independence Measure (FIM), quality of life (measured using the Medical Outcomes Study 12-item Short-Form Health Survey), and costs of medications. RESULTS: The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year (P < .001). The average drug costs in the intervention group decreased by 103 shekels (US$29) per participant per month (P < .001). The average number of falls in the intervention group dropped significantly (P = .006). Rates of hospitalization, FIM scores, and quality of life measurements were similar for both groups. CONCLUSION: Implementation of STOPP/START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended.

Potentially inappropriate prescribing among older residents in a geriatric hospital in Israel.

BACKGROUND: STOPP/START ("screening tool of older persons potentially inappropriate prescriptions"/"screening tool to alert doctors to right treatment") criteria were formulated to identify potentially inappropriate prescriptions (PIP) and potential prescription omissions (PPO) in older people. OBJECTIVE: To determine the prevalence of PIP and PPO using STOPP/START criteria and to identify associated risk factors. METHOD: Data were prospectively collected from 382 residents' records in an Israeli geriatric hospital. The study population included subjects ≥ 65 years of age who were taking at least one medication. Data on demographics, medical histories, current diagnoses, current medications and biochemistry results were collected and analyzed. STOPP/START criteria were applied to each medical file. RESULTS: A total of 359 residents comprised the study group (mean age [± SD] 82.7 ± 8.7, 66.6 % females). STOPP identified 430 instances of PIP in 243 (67.7 %) residents, and START identified 151 PPO in 122 (34 %) residents. The number of medications (OR: 1.2, 95 % CI 1.11-1.3), falls (OR: 1.16, 95 % CI 1.021-1.32) and hospitalizations (OR: 1.25, 95 % CI 1.025-1.53) were identified as predictors for STOPP-defined PIP. The Charlson Comorbidity Index (OR: 1.4, 95 % CI 1.17-1.7) was associated with START-defined PPO. CONCLUSION: A high prevalence of PIP/PPO was found among geriatric patients and was associated with number of medications, falls, hospitalizations and Charlson Comorbidity Index score.