Family Health Clinics as a Source of Social Capital.

PURPOSE: To examine the extent to which Family Health Clinics (FHCs) contribute to the formation of social capital among mothers, and determine whether it is influenced by socioeconomic factors. In FHCs, social capital can be gained by relationships between mothers (bonding social capital), by relationships between mothers and FHCs team, or between mothers of different origins/culture (bridging social capital) and health services institutional bodies (linking social capital). DESIGN: This is a mixed method study. For the quantitative part, data were collected from 673 mothers using a questionnaire. The qualitative part was conducted with six focus groups. RESULTS: The FHC constitutes a source of social capital in all dimensions. Bridging social capital was most prominent and is formed by interactions between mothers and FHC nurses. The factors that explain the formation of social capital were: mothers' spoken language being Arabic, participation in group training, and lower level of education. The focus groups revealed that participation in group training increased the social capital. Mothers noted that FHC nurses supplied updated information about their children's care. Regarding linking social capital, mothers perceive FHC nurses as mediators between them and the local and national health services. CONCLUSIONS: FHC clinics are a source for gaining social capital. The FHC services should be adapted to mother's needs. IMPLICATIONS: FHC nurses should try to create conditions for mothers to meet to create bonding social capital, relate to mother's needs for the creation of bridging social capital, and provide culturally adapted care for the formation of linking social capital.

Maternal and child health in Israel: building lives.

Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development. Israel has already exceeded the developed regions' Sustainable Development Goal 2030 targets for maternal mortality, neonatal mortality, and mortality in children younger than 5 years in all population groups. Yet these accomplishments are marred by Israel's high prevalence of child poverty (more than 30%), particularly among Arabs (63%) and ultra-Orthodox Jews (67%). Although infant mortality has improved in all subpopulations since Israel was founded in 1948, infant mortality among Arabs is still more than twice as high as among Jews. To address these disparities in health, the Israeli Ministry of Health has created a special division and has funded an intervention programme to reduce the infant mortality among Bedouin Arabs. Other interventions include targeted and culturally appropriate health-care programmes and services for communities with a high number of at-risk children and young adults, dental health service for all children up to 15 years, and improved collaboration between health, education, and welfare services. The challenges faced by the Israeli health-care system include a growing trend towards medicalisation of prenatal care, ensuring staff are trained to treat developmental, behavioural, and psychosocial issues in children and their families, securing sustainable funding for health promotion and injury prevention programmes, expanding and improving the coordination of services for children with special needs or who are at risk, and programme assessment. Ensuring adequate funding for dedicated, preventive paediatric care and taking action on a nationwide scale to reduce child poverty are essential for maintaining health gains in children. In this Series paper, we describe the health indices, highlight disparities, and discuss the challenges in delivering and maintaining maternal and child health care in Israel.

Continuous decrease of consanguineous marriages among Arabs in Israel.

OBJECTIVES: To describe the trend in the rate of consanguineous marriages among the Israeli Arab population and to identify factors associated with this custom shift in recent years. METHODS: The study was conducted between November 2009 and January 2010 in Family Health Centers. A questionnaire was presented to parents during routine visits to the center with their children. RESULTS: Information on 6,437 couples was collected. The rate of consanguineous marriages decreased from 35.8% among those married before 2000, to 28.2% among those married in 2000-2004, and to 24.0% among those married in 2005-2009 (P for trend <0.001). First cousin marriages were the most common type of consanguineous marriages in all the time periods. Consanguineous marriages were associated with consanguinity between the couples' parents (both husband and wife), a high consanguinity rate in the place of residence and younger age at marriage (wife). CONCLUSIONS: The rates of consanguineous marriages among Israeli Arabs are decreasing but still high. Because consanguineous marriages are widely acceptable, the role of public health professionals and primary care personnel is to provide comprehensive information about the potential genetic risks of consanguinity on offspring health and to increase the accessibility of premarital and preconception counseling services.

The Role of Organizational Factors in Nurses' Perceived Preparedness to Screen, Intervene and Refer in Cases of Suspected Postpartum Depression.

Routine screening for postpartum depression (PPD) is widespread, yet little attention has been given to the perceived preparedness of health providers to perform screening procedures, or to the role of organizational factors in their preparedness, although these are crucial elements for optimal implementation. The aim of this study was to examine organizational factors associated with public health nurses' (PHNs) perceived preparedness to screen women for PPD, intervene, and refer them in cases of suspected PPD. Two hundred and nineteen PHNs completed a self-report survey regarding their perceived preparedness to carry out a screening program (including screening, intervening, and referring women), and their perceived organizational support, supervisor's support, colleagues' support, and colleagues' preparedness. A path analysis model was used to analyze the data. The results showed that perceived colleagues' preparedness was significantly associated with the three perceived preparedness constructs (screen, intervene, and refer). Perceived supervisor's support was positively associated with perceived preparedness to screen, and perceived organizational support was positively associated with perceived preparedness to intervene. This paper highlights the manner in which formal and informal organizational factors play an important role in the perceived preparedness of PHNs to carry out a PPD screening program, and how these factors impact the three different aspects of the screening program. Organizations implementing PPD screening should support PHNs in all aspects of the implementation process, provide guidance, and enhance peer-group continued learning through which PHNs could share knowledge, discuss barriers, and foster professional development.

Nurses perceived preparedness to screen, intervene, and refer women with suspected postpartum depression.

OBJECTIVE: Postpartum depression affects many women worldwide, and screening initiatives for its detection are being implemented in several places. Although perceived preparedness to carry out an intervention is essential for successful implementation, the perceived preparedness of those who conduct screening initiatives for postpartum depression has not been investigated. The aim of this study was to examine the perceived preparedness of Israeli Mother-and-Child Health Clinic public health nurses to screen postpartum women for postpartum depression symptoms, conduct an initial intervention and refer women, as well as factors associated with this perceived preparedness. DESIGN: This was a cross sectional study. SETTING: Mother-and-Child Health Clinics in Israel. PARTICIPANTS: Public health nurses (n = 219) working at these clinics participated in the study. MEASUREMENTS: Participants answered questionnaires regarding their perceived preparedness, attitudes, perceived knowledge and perceived competence to screen, intervene and refer women with PPD symptoms. FINDINGS: Formal and informal training, attitudes, perceived knowledge and perceived competence were associated with perceived preparedness to screen; attitudes, perceived knowledge and perceived competence were associated with perceived preparedness to intervene; and attitudes and perceived knowledge were associated with perceived preparedness to refer. Differences in these associations were found between nurses based on their age, academic degree and experience. KEY CONCLUSIONS: Findings suggest that training, attitudes, knowledge and perceived competence are important factors leading to perceived preparedness to conduct screening initiatives for postpartum depression. IMPLICATIONS FOR PRACTICE: In order for public health nurses to feel prepared to screen, intervene and refer in cases of postpartum depression, ongoing training, both formal and informal, focusing on enhancing knowledge, positive attitudes and competence should be provided.

Parents' perceptions of childhood immunization in Israel: Information and concerns.

BACKGROUND: Immunization has a significant impact in protecting from severe diseases. Various factors that could influence child immunization coverage and parents' decisions about vaccinating their children should be further explored in specific population groups. OBJECTIVES: The current study has two main objectives: to assess the main information sources that affect parental decisions to vaccinate their children and to measure the extent to which these factors differ demographically by exploring the opinions and attitudes within four main population groups in Israel: ultra-Orthodox Jews, all other Jews, non-Bedouin Arabs, and Bedouins. METHODS: 1504 parents, with similar representation among four main population groups, participated in this study. A structured, anonymous, self-administered questionnaire was used. RESULTS: The most influential source on parents' decisions to vaccinate their children was the nurse at Mother and Child Health Clinics (MCHCs). Positive attitudes were shown regarding the key role of immunization in preventing severe diseases, while the most important concern expressed was the potential pain to the child while being vaccinated (rather than the safety of the vaccine). Higher compliance rates were reported among participants with a non-academic education level (χ2 = 12.21, p <0.001), an average level of income (χ2 = 26.66, p <0.001), and a greater level of religiosity (χ2 = 5.13, p <0.01). Multivariate analysis showed that higher reliance on Ministry of Health publications (OR = 2.24, 95% CI = 1.49-3.35) and a belief that vaccinations prevent severe diseases (OR = 1.55, 95% CI = 1.06-2.25) predicted higher vaccination compliance. A concern about unsafe components of the vaccinations predicted lower compliance (OR = 0.41, 95% CI = 0.25-0.66). Bedouins demonstrated the highest compliance rate (99%), were most influenced by all information sources, and demonstrated the most pro-vaccination positions. CONCLUSIONS: The factor that most influenced Israeli parents' decisions to vaccinate their children was their degree of trust in information sources about vaccinations, particularly the nurses at the MCHCs.

The Israeli public health response to wild poliovirus importation.

In 2013, a silent wild poliovirus type 1 importation and sustained transmission event occurred in southern Israel. With the aim of preventing clinical poliomyelitis and ensuring virus re-elimination, the public health response to the importation event included intensification of clinical and environmental surveillance activities, enhancement of vaccine coverage, and supplemental immunisation with a bivalent oral polio vaccine against wild poliovirus types 1 and 3. A national campaign launched in August, 2013, resulted in vaccination of 943,587 children younger than 10 years (79% of the eligible target population). Expanded environmental surveillance (roughly 80% population coverage) documented a gradual disappearance of wild poliovirus type 1 in the country from September, 2013, to April, 2014. No paralytic poliomyelitis case was detected. A prompt extensive and coordinated national public health response, implemented on the basis of evidence-based decision making, successfully contained this serious importation and sustained transmission event of wild poliovirus to Israel. On April 28, 2015, WHO officially declared Israel as a polio-free country.

Prevalence of consanguineous marriages and associated factors among Israeli Bedouins.

The Bedouin population in Israel is a semi-nomadic traditional patriarchal society. Consanguineous marriages are very common, contributing to high rates of congenital malformations and genetic diseases, resulting in high infant mortality. Data on consanguineous marriages among Bedouins in Israel are limited. This study examined the current prevalence of consanguineous marriages and their determinants among Israeli Bedouins. One thousand two hundred ninety Bedouin women who delivered in the maternity wards of the only hospital serving the Bedouin population were interviewed between November 2009 and January 2010. The prevalence of consanguineous marriages was 44.8 %. The most common type of spousal relationship was first cousins (65.7 % of all consanguineous marriages). The mean inbreeding coefficient was 0.0238. Factors significantly associated with consanguinity were less years of schooling (OR 0.94, 95 % CI (0.88-0.99), p = 0.02) and younger age at marriage of the wife (OR 0.90, 95 % CI (0.80-0.96), p = 0.0002). In conclusion, the rate of consanguineous marriages among Bedouins is very high, making this population at risk for congenital malformations and genetic diseases. Efforts should be directed at better education and provision of premarital and prenatal counseling on the health consequences of consanguineous marriages and the possibilities to lower those risks.