Inappropriate CT examinations: how much, who and where? Insights from a clinical decision support system (CDSS) analysis.

OBJECTIVE: To assess the appropriateness of Computed Tomography (CT) examinations, using the ESR-iGuide. MATERIAL AND METHODS: A retrospective study was conducted in 2022 in a medium-sized acute care teaching hospital. A total of 278 consecutive cases of CT referral were included. For each imaging referral, the ESR-iGuide provided an appropriateness score using a scale of 1-9 and the Relative Radiation Level using a scale of 0-5. These were then compared with the appropriateness score and the radiation level of the recommended ESR-iGuide exam. DATA ANALYSIS: Pearson's chi-square test or Fisher exact test was used to explore the correlation between ESR-iGuide appropriateness level and physician, patients, and shift characteristics. A stepwise logistic regression model was used to capture the contribution of each of these factors. RESULTS: Most of exams performed were CT head (63.67%) or CT abdominal pelvis (23.74%). Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to "usually appropriate." The mean radiation level for actual exam was 3.2 ± 0.45 compared with 2.16 ± 1.56 for the recommended exam. When using a stepwise logistic regression for modeling the probability of non-appropriate score, both physician specialty and status were significant (p = 0.0011, p = 0.0192 respectively). Non-surgical and specialist physicians were more likely to order inappropriate exams than surgical physicians. CONCLUSIONS: ESR-iGuide software indicates a substantial rate of inappropriate exams of CT head and CT abdominal-pelvis and unnecessary radiation exposure mainly in the ED department. Inappropriate exams were found to be related to physicians' specialty and seniority. CLINICAL RELEVANCE STATEMENT: These findings underscore the urgent need for improved imaging referral practices to ensure appropriate healthcare delivery and effective resource management. Additionally, they highlight the potential benefits and necessity of integrating CDSS as a standard medical practice. By implementing CDSS, healthcare providers can make more informed decisions, leading to enhanced patient care, optimized resource allocation, and improved overall healthcare outcomes. KEY POINTS: • The overall mean of appropriateness for the actual exam according to the ESR-iGuide was 6.62 ± 2.69 on a scale of 0-9. • Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to "usually appropriate." • Inappropriate examination is related to both the specialty of the physician who requested the exam and the seniority status of the physician.

Overcoming the effect of pandemic fatigue on vaccine hesitancy-Will belief in science triumph?

PURPOSE: The study aims to examine the factors that impact vaccination uptake and additional protective behavior during the fourth wave of the pandemic in Israel, whereas the "pandemic fatigue" phenomenon has been identified as a hurdle to adherence to protective health behaviors against coronavirus disease 2019 (COVID-19). DESIGN: A cross-sectional, structured questionnaire was utilized for this investigation in September 2021, during the fourth wave of the pandemic. METHODS: A sample of the adult (18+) Israeli population was employed for the study. Recruiting participants for the study was conducted through an online internet panel company that consists of over 100,000 members, representing all geographic and demographic sectors of the Israeli population. RESULTS: Our findings indicate that pandemic fatigue has begun to have cascading effects on vaccination efforts. In particular, this study found that at this stage of the COVID-19 pandemic, trust in authorities, and even threat perception components, such as concern and fear of contracting the disease, are incapable of predicting vaccination uptake. Instead, perception of the importance of the vaccine and its effectiveness are predictive of vaccination uptake. CONCLUSION: The findings indicate that at this stage of the pandemic, focusing on the robustness of the science behind the vaccine is more important than trying to regain public trust. The findings also suggest that risk communication employing fear tactics is losing its capacity to generate motivation for vaccination. CLINICAL RELEVANCE: The findings of this study reveal lessons learned from the COVID-19 global pandemic. Specifically, the study reveals how in times of prolonged crisis, we can currently and, in the future, prepare improved strategies for public communication in order to promote uptake of protective health behavior, such as vaccination.

Socioeconomic and ethnic disparities along five waves of the COVID-19 pandemic: Lessons we have not yet learnt.

PURPOSE: The COVID-19 pandemic, now in its third year, has served as a magnifying glass, exposing the inequitable impact of the outbreak. The study aims to analyze the relationships between the socioeconomic and ethnic characteristics of the population and COVID-19 testing, infection, and vaccination throughout the first five pandemic waves. DESIGN: A secondary analysis of an existing national database was conducted in Israel from March 2020 to May 2022. During the study period, Israel underwent 5 pandemic peaks or waves (March-April 2020, September-October 2020, January-February 2021, September 2021, and January-February 2022). METHODS: Data on tests performed, confirmed COVID-19 cases, and uptake of vaccine doses one through four during the study period, were analyzed by the socioeconomic (SE) cluster (scale of 1 to 10) and ethnicity (Jewish, Arab, mixed Jewish- Arab ethnicity) of the residents' local authority. RESULTS: COVID-19 testing rate gradually increased from the lowest to the highest SE clusters, with rates 3.2 times higher in the second highest, compared with the lowest cluster. People living in Jewish localities were tested twice more than those in Arab or mixed localities. The rate of confirmed cases was 1.9, 3.0, 6.3, and 4.3 times higher, respectively, among cluster 1 (the lowest) compared with cluster 9 (second highest) in the first, second, third, and fourth pandemic waves, respectively. Rates among people living in Arab or mixed localities were higher compared with those living in Jewish localities in 3 of the 5 waves. Vaccine uptake revealed a clear social gradient, with the percentage of the population being vaccinated gradually increasing from cluster 1 (the lowest) to the higher clusters. The relative difference between the lowest and highest SE clusters increased from 2.4 in the first vaccine dose to 5.5 in the third and fourth doses. Ethnic disparities also grew with vaccine dose, with a Jewish to an Arab rate ratio of 1.1, 1.2, 1.6, and 4.5 for vaccine doses 1,2,3, and 4, respectively. CONCLUSIONS: Covering 26 consecutive months of the COVID-19 pandemic at the national level, the current study demonstrates that despite high accessibility of tests and vaccines to the entirety of the population and tailored outreach efforts, socioeconomic, and ethnic disparities not only failed to diminish, but they even widened along the five pandemic waves. CLINICAL RELEVANCE: The pandemic exposed the vulnerability of the weakest segments of the population. Therefore, the combined action of the Ministry of Health, health providers, and local authorities is required to further adapt health messages to the cultural characteristics of diverse populations, to equip the health professionals with practical tools to promote healthy choices among the vulnerable populations, and to build communities that promote healthy lifestyles. The pandemic has highlighted the importance of reducing health disparities and building trust between vulnerable populations and the healthcare system during "normal" or routine times, to better prepare for times of emergencies, such as the current pandemic.

Are we suffering from the Peltzman effect? Risk perception among recovered and vaccinated people during the COVID-19 pandemic in Israel.

OBJECTIVES: The challenge of waning immunity and reinfection has been an acknowledged concern since the beginning of the COVID-19 pandemic. In the ongoing outbreak, reinfection rates are increasing alongside breakthrough cases among vaccinated individuals. The objective of this study was to examine the demographic characteristics associated with vaccination uptake among individuals previously infected with COVID-19 and to evaluate the period elapsed between the last vaccine dose and infection. STUDY DESIGN: A retrospective-archive study was conducted. METHODS: Data were extracted from the Israeli Ministry of Health's open COVID-19 database. RESULTS: The study found that uptake of vaccination in previously infected individuals is relatively low. When examining gender, previously infected females were more likely to receive vaccination than previously infected males. Similarly, differences in vaccination uptake exist between age groups. When examining the interval between the last vaccine dose and infection, the most significant breakthrough infection rate was observed among individuals aged 20-59 years. CONCLUSIONS: This study shows that there are specific populations subgroups that may serve as reservoirs of viral spread. Individuals in these groups may experience a false sense of security from a perceived sense of acquired long-term immunity, resulting in low levels of vaccine uptake and non-compliance with protective behaviours. Targeted messaging should be used to reemphasise the need for continued protective behaviours.

The impact of 24/7 news coverage on the mental health of Israelis in the 'Iron Swords' War: A cross-sectional analysis among television audience.

This study aims to assess the impact of continuous 24/7 news broadcasting on the mental well-being of Jewish Israelis during the 'Iron Swords' War and compare it to findings from the 2014 Conflict. An internet-based cross-sectional panel survey was conducted on 11-12 October 2023, during the 'Iron Swords' War. The study focused on Israel's adult Jewish population, enabling comparisons with a previous 2014 study. Participants reported news consumption changes, attitudes towards newscasts (burdensome, relaxing, stressful, addictive, Fear Of Missing Out [FOMO], avoidance), opinions on 24/7 news, and anxiety symptoms. Among 802 adult Jewish participants in Israel, 83.8% increased news consumption. While more than 70% of respondents found the newscast stressing at least a medium level, more than 40% said they do not try to avoid them at all. Nearly 24% found it much addictive. Women and younger individuals reported more FOMO, stress, and addiction. More than 70% reported experiencing at least one anxiety symptom, and 21% of all four. Linear regression explained 42.9% of the variance of reported anxiety, with gender, age, news stress, addiction, and FOMO as predictors. The current study results show an increase in all measurements compared to a separate study conducted using the same tools in 2014. Jewish Israelis struggled with news consumption during the recent war, harming mental health. Heightened anxiety was observed, compared to 2014, and affected all demographics.

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.

A longitudinal study of societal resilience and its predictors during the Israel-Gaza war.

This study assesses the resilience of Israeli society during the ongoing Israel-Gaza conflict and pinpoints factors that influence this resilience in prolonged national crises. A longitudinal study was carried out with two surveys, both using the same questionnaire to gage societal, community, and individual resilience levels, along with hope, morale, distress, perceived threats, and government support. The initial survey was administered 5 days after the war escalated and the second 1 month later. The study's results reveal a decline in societal resilience over time. The regression analysis identified four major associations at both resilience measurement points. The key variables are community resilience and hope, both contributing positively. Attitudes towards government support (specifically being a government supporter vs. an opponent) also played a role. Additionally, there was a negative association with levels of religiosity, particularly distinguishing between ultra-orthodox and secular individuals. In the temporal analysis predicting future resilience (from data at the first time point to predict resilience at the second time point), societal resilience at the first measurement was the strongest forecaster of its resilience at the second measurement. Additionally, the main continuous variable from the previous analysis, community resilience, continued to be an influential and positive forecaster in the time-based analysis. The research suggests that the initial unifying effect of the conflict, similar to a "Rally around the flag" phenomenon, may be short-lived. The study underlines the importance of community strength, hope, government support, and religious considerations in shaping societal resilience in the face of conflict.

Exploring pre-MRI imaging tests: patient survey reveals potential implications for healthcare efficiency in Israel.

BACKGROUND: Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. METHODS: An online survey of patient experience of scheduling an MRI was conducted in January-February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. RESULTS: Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. CONCLUSIONS: These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective.

Dynamic Trends in Sociodemographic Disparities and COVID-19 Morbidity and Mortality-A Nationwide Study during Two Years of a Pandemic.

Social epidemiological research has documented that health outcomes, such as the risk of becoming diseased or dying, are closely tied to socioeconomic status. The aim of the current study was to investigate the impact of socioeconomic status on morbidity, hospitalization, and mortality outcomes throughout five waves of the pandemic amongst the Israeli population. A retrospective archive study was conducted in Israel from March 2020 to February 2022 in which data were obtained from the Israeli Ministry of Health's (MOH) open COVID-19 database. Our findings, though requiring careful and cautious interpretation, indicate that the socioeconomic gradient patterns established in previous COVID-19 literature are not applicable to Israel throughout the five waves of the pandemic. The conclusions of this study indicate a much more dynamic and complex picture, where there is no single group that dominates the realm of improved outcomes or bears the burden of disease with respect to morbidity, hospitalization, and mortality. We show that health trends cannot necessarily be generalized to all countries and are very much dynamic and contingent on the socio-geographical context and must be thoroughly examined throughout distinct communities with consideration of the specific characteristics of the disease. Furthermore, the implications of this study include the importance of identifying the dynamic interplay and interactions of sociodemographic characteristics and health behavior in order to enhance efforts toward achieving improved health outcomes by policymakers and researchers.

Distress following the COVID-19 Pandemic among Schools' Stakeholders: Psychosocial Aspects and Communication.

In response to the COVID-19 pandemic, many governments ordered school closures as a containment measure, with Israel being among over 100 countries to do so. This resulted in the abrupt shift to online and remote education for many students. Despite attempts to minimize the effects of disrupted education and create a dynamic virtual learning environment, the literature highlights various challenges including lack of communication with implications of distress faced by key stakeholders (students and their parents, teachers, and principals). In this cross-sectional study, we assess the perceived levels of communication and psychosocial aspects during both distance and frontal learning, as well as the long-term impacts (following over two and a half years of an ongoing pandemic) on distress among the key stakeholders of the Israeli education system- high school students, parents, teachers, and principals. The study findings demonstrate severe implications of distance learning on communication and psychosocial aspects, with lingering long-term impacts on distress, among all stakeholders (particularly among students). This reveals the need for tailored capacity building and resilience intervention programs to be integrated in the long-term response to the current ongoing pandemic to improve well-being and reduce distress among the various stakeholders, with particular attention to those that are most vulnerable and were hit the hardest.

Injury as a Result of Children and Adolescent Labor-An Association with Ethnicity and Peripherality: A Retrospective Cohort Study Based on the Israeli Trauma Registry.

BACKGROUND: Working children and adolescents face a heightened risk of work-related injuries. This research aimed to assess the rate of hospitalizations resulting from work-related injuries among children and adolescents in Israel, with a specific focus on disadvantaged populations. METHODS: This nationwide retrospective cohort study utilized The Israeli National Trauma Registry (INTR). It included 642 children and adolescents aged 13-17 hospitalized due to work-related injuries from 2015-2022. RESULTS: Arab children had over five times the risk of hospitalization due to work-related injuries compared to Jewish (RR = 5.5, 95% CI: 4.7-7.4). Despite the 2018 law prohibiting young people from entering this type of work, the most common type of work leading to hospitalization was construction, accounting for 40.2% of Arab and 11.9% of Jewish injuries (p < 0.001). After adjustment, road traffic accidents and falls presented the highest odds of at least severe injury. Arabs had three times significantly higher odds of at least moderate injury compared to Jews. CONCLUSIONS: Prioritizing the creation of safe job opportunities for Arab teenagers is imperative. Strict enforcement measures, particularly within the construction industry, especially among Arab youth and during night shifts, are essential. These initiatives should focus on establishing secure and sustainable employment opportunities for children and young individuals, effectively reducing the risks associated with hazardous labor practices. In addition, the implementation of educational programs in the school curriculum covering essential aspects of youth employment is vital.

Enhancing disaster response of emergency medical teams through "TEAMS 3.0" training package-Does the multidisciplinary intervention make a difference?

Background: In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management. Methods: To enhance the provision of EMT's field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary "TEAMS 3.0" project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training. Results: The results from all the trainings suggest an improvement for both teams' self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment. Conclusion: Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities.

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.

Severe trauma in Germany and Israel: are we speaking the same language? A trauma registry comparison.

Background: Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Israeli National Trauma Registry, INTR). Methods: The present study was a retrospective analysis of data from the described above trauma registries in Israel and Germany. Adult patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, type, distribution, mechanism, and severity of injury, treatment delivered and length of stay (LOS) in the ICU and in the hospital were included in the analysis. Results: Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic collisions were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 vs. 20), more patients were treated on an intensive care unit (92 vs. 32%), and mortality was higher (19.4 vs. 9.5%) as well. Conclusion: Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most probably, this was caused by different recruitment strategies of both registries, like trauma team activation and need for intensive care in TR-DGU. More detailed analyses are needed to uncover similarities and differences of both trauma systems.

A full-scale Russian invasion of Ukraine in 2022: Resilience and coping within and beyond Ukraine.

The study examined the resilience and coping of samples from Ukraine and five nearby countries during the war in Ukraine. The research focused on (1) the levels of community and societal resilience of the Ukrainian respondents compared with the populations of five nearby European countries and (2) commonalities and diversities concerning coping indicators (hope, well-being, perceived threats, distress symptoms, and sense of danger) across the examined countries. A cross-sectional study was conducted, based on data collection through Internet panel samples, representing the six countries' adult populations. Ukrainian respondents reported the highest levels of community and societal resilience, hope, and distress symptoms and the lowest level of well-being, compared to the population of the five nearby European countries. Hope was the best predictor of community and societal resilience in all countries. Positive coping variables, most notably hope, but also perceived well-being are instrumental in building resilience. While building resilience on a societal level is a complex, multifaceted task, various dimensions must be considered when planning actions to support these states. It is essential to monitor the levels of resilience, during and following the resolution of the crisis, both in Ukraine and in the neighboring countries.

COVID-19 Vaccination, Morbidity, and Mortality During a 12-Month Period in Israel: Can We Maintain a "Herd Immunity" State?

Despite widespread vaccination, the COVID-19 pandemic continues to cause global disruption. Authors describe the pace of COVID-19 vaccination in Israel and examine differences in morbidity and mortality rates over time between vaccinated and unvaccinated populations. Retrospective data were obtained between December 2020 and December 2021 on daily vaccine uptake by age group (20-39, 40-59, 60+ years): rate of hospitalized severely ill cases, vaccination status and age group, and death rate per 100,000 by date and vaccination status. Uptake of first and second doses was slower in 20-59-year olds, whereas in 60+-year olds, it occurred without delay. Once most adults were vaccinated, a gap appeared with much higher severe cases and deaths in unvaccinated versus vaccinated populations; this gap attenuated by late May with very low rates in both vaccinated and unvaccinated populations until mid-July, when rates began to rise again. A herd-immunity-like period occurred in Spring 2021, with unvaccinated benefitting from a highly vaccinated population. Staggered vaccine uptake led to unsynchronized high immunity, which contributed to the fourth pandemic wave. Population vaccination within a shorter timeframe or shorter intervals between boosters may be important to reduce viral transmission.

COVID-19 Risk Compensation? Examining Vaccination Uptake among Recovered and Classification of Breakthrough Cases.

The study has two primary aims: the first is to examine the uptake of COVID-19 vaccination patterns among those previously infected, and the second is an evaluation of the period elapsed between the patient's latest dose of the vaccine and the infection itself by demographic group. A retrospective study was conducted from 1 March 2020, to 31 May 2022, in Israel. The study found that among Israelis, vaccination uptake following infection is relatively low. When examining gender, one sees that the immunization rate among recovering females is higher than among men. Similarly, differences in uptake exist between age groups. When examining the interval between vaccine dose and infection according to age groups, the most significant breakthrough infection rate is among the ages of 20−59 (1−6 days­0.3%; 7−13 days­0.48%; two to three weeks­0.3%, p < 0.001). This study reveals potential reservoir groups of virus spread. Among previously infected, low vaccination uptake levels are observed (first dose­30−40%, second dose­16−27%, third dose­9% and fourth dose­2%, p < 0.001), despite findings that indicate surging reinfection rates. Among vaccinated, two critical groups (0−19; 20−59) exhibit highest levels of breakthrough cases varying per vaccine doses, with statistically significant findings (p < 0.001). These population groups may be subject to a false sense of security as a result of perceived acquired long-term immunity prompting low perceived risk of the virus and non-vigilance with protective behavior. The findings point to the possibility that individuals engage in more risky health behavior, per the Peltzman effect.

Women Are More Infected and Seek Care Faster but Are Less Severely Ill: Gender Gaps in COVID-19 Morbidity and Mortality during Two Years of a Pandemic in Israel.

In the context of COVID-19 outcomes, global data have deduced a gender bias towards severe disease among males. The aim is to compare morbidity and mortality during two years of the COVID-19 pandemic in female and male patients with COVID-19, as well as to assess length of stay, time of health-seeking behavior after positive diagnosis, and vaccination differences. A retrospective-archive study was conducted in Israel from 1 March 2020 to 1 March 2022 (two consecutive years). Data were obtained from the Israeli Ministry of Health's (MOH) open COVID-19 database. The findings indicate female infections are 1.12 times more likely, across almost all age groups, apart from the youngest (0-19) age groups. Despite this, the relative risk of severe illness, intubation and mortality is higher among men. In addition, our findings indicate that the mean number of days taken by unvaccinated men from positive diagnosis to hospital admission was greater than among unvaccinated women among the deceased population. The findings of this study reveal lessons learned from the COVID-19 global pandemic. Specifically, the study shows how human biological sex may have played a role in COVID-19 transmission, illness, and death in Israel. The conclusions of this study indicate that targeted approaches, which take into consideration sex and gender and the intersecting factors are necessary to engage in the fight against COVID-19 and ensure the most effective and equitable pandemic response.

Lockdown Efficacy in Controlling the Spread of COVID-19 May Be Waning Due to Decline in Public Compliance, Especially among Unvaccinated Individuals: A Cross-Sectional Study in Israel.

Public compliance is paramount for the success of public health measures and decision making, such as lockdowns, in controlling the spread of diseases. The aim of this population-based cross-sectional study was to investigate the level of reported compliance with home isolation among the adult Israeli population (n = 940) during the first three national lockdowns, compliance with a potential fourth national lockdown if enacted, risk perception of COVID-19, vaccination uptake status, perceived effectiveness of the vaccine, and compliance with additional protective health behaviors (e.g., mask wearing and social distancing). Following widespread compliance with initial lockdowns (90.7% reported "high" or "very high" compliance), as few as 60.1% of participants indicated that they would comply with a fourth lockdown if the government decides to enact it. Non-vaccinated individuals reported the lowest levels of compliance with previous lockdowns, compared to participants who received one or two vaccines and participants vaccinated with three doses. Adjusted for gender and age, the results suggest that fearing being infected with COVID-19, perceiving the vaccine to be effective, and reporting being compliant with other health behaviors-such as mask wearing and maintaining social distance from others-are predictors of lockdown compliance. Considering the effect of pandemic lockdown fatigue, there is little support for additional lockdowns among the Israeli public, unless dramatic changes occur in the characteristics of the COVID-19 pandemic. Compliance with lockdowns is reduced among individuals who are at higher risk of contracting COVID-19, therefore rendering this non-pharmaceutical intervention even less effective in reducing the spread of the disease.

Deciphering the COVID-19 Health Economic Dilemma (HED): A Scoping Review.

Lessons learnt from the initial stages of the COVID-19 outbreak indicate the need for a more coordinated economic and public health response. While social distancing has been shown to be effective as a non-pharmaceutical intervention (NPI) measure to mitigate the spread of COVID-19, the economic costs have been substantial. Insights combining epidemiological and economic data provide new theoretical predictions that can be used to better understand the health economy tradeoffs. This literature review aims to elucidate perspectives to assist policy implementation related to the management of the ongoing and impending outbreaks regarding the Health Economic Dilemma (HED). This review unveiled the need for information-based decision-support systems which will combine pandemic spread modelling and control, with economic models. It is expected that the current review will not only support policy makers but will also provide researchers on the development of related decision-support-systems with comprehensive information on the various aspects of the HED.