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The need to ensure the economic wellbeing and quality of life of those who reach the official retirement age is a matter of concern in the world of social services and in social policy making. Since some working older adults may be forced to retire when they reach the official retirement age while others retire voluntarily, the study is based on a dedicated survey among 508 persons who retired both willingly and unwillingly for good after reaching the official retirement age and 437 persons who continued working uninterruptedly. The findings show that the odds of staying on the job after retirement age are contingent on the socio-demographic and health-related characteristics of the older adult. Furthermore, the economic predictors of remaining in the labour force after retirement age depend on how strongly the older adult wishes to retire. Those who continue working after retirement age and those who retire willingly are undifferentiated in the level of financial support that they give others. Comparing older adults who continue working uninterruptedly with those who retire unwillingly, the chances of being among the former are higher among those who are better off before reaching retirement age. These results emphasise the need to extend welfare and financial-support policies to older adults who are forced to retire, in order to minimise the economic blow that this path to retirement causes.

Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient-physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel.A cross-sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level).A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient-provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital.The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient-physician encounters.Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses.

It is frequently assumed that the inheritance of wealth undermines economic activity. If such an assumption is valid, the expected wave of bequests may have a negative impact on labour market activity of heirs, what might further weaken the financing of state pension systems. This paper provides a detailed review of the empirical findings on the associations of inheritances with labour market activity, that is labour force participation status and working hours, and presents own analyses based on the survey of health, ageing, and retirement in Europe. We find that the receipt of an inheritance is not related to labour force participation in general. Inheritance expectations even have a small, but statistically significant positive effect on remaining in the labour force for men. Women who expect an inheritance tend to reduce working hours, but the effect of having received an inheritance is not significant, neither for men nor for women. We conclude that the receipt of an inheritance will not affect labour market decisions, so that the expected wave of bequests will not undermine active ageing policies.The online version contains supplementary material available at 10.1007/s10433-022-00706-1.

Purpose The purpose of this study is to determine which element of advance care planning (ACP) - an advance directives (AD) document or an end-of-life discussion between patient and family (DwF), if any—improves the likelihood of cancer patients’ attaining their preferences regarding treatments in the last month of life and dying in the place they prefer. Methods First-degree relatives of deceased cancer patients, interviewed by telephone, were asked if the treatments the patients received in their last month of life and their place of death corresponded to the patients’ preferences. Nominal logistic regression analyses were conducted in search of significant association between having an AD document and/or conducting a DwF and patients’ treatment and place of death in accordance with their preferences. Results 491 deceased patients were included in the study. Their average age was 68; 52% were women. According to 32% of the relatives, the patients’ treatment in the last month of life was aligned with their preferences and 55% said the patients had died in their preferred place. Only 16.5% had an AD document, 58.5% only discussed their treatment preferences with relatives, and 25% did neither. DwF and ability to speak until last week of life were significantly related to receiving treatment consistent with patients’ preferences. Dying where the patient prefers is significantly associated with having an AD and a DwF, with an AD yielding higher odds. Conclusion A multifaceted interconnection exists between the two elements of ACP in attaining cancer patients’ wishes and abetting better end of life care.

To promote long-term care policies for older adults, accurate mapping of the often invisible and insufficiently recognized role of their informal caregivers is needed. This paper measures the prevalence of informal caregivers in the European population, illustrates current difficulties in gathering unequivocal information on this topic and deals with the scientific and policy implications of the problem. Using the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS) and the Study on Health and Ageing in Europe (SHARE), the current difficulties in gathering unequivocal information on this topic are illustrated. In most countries, the share of informal caregivers varies, sometimes markedly, among the three surveys. As for the sex of caregivers, while confirming the well-known higher prevalence of caregivers among women than among men, large variations emerge across the three surveys in most countries in respect of the two sexes. The takeaway message of the paper is that it is urgent to promote international concerted action in gathering comprehensive informal caregiving information and/or exploring in greater depth the different intercultural understandings of informal care itself.

Objectives The COVID-19 pandemic has provided a rich environment for ageist attitudes towards both older and younger people. However, publications on ageism during the outbreak have been mostly non-empirical and have concentrated on ageist beliefs directed towards older people. To overcome these limitations, we examined empirically the prevalence and the determinants of ageism towards older and younger people in the wake of COVID-19. Study design A cross-sectional study using an online survey was conducted with 503 Israeli adults (51.9% male, 79.5% Jews, mean age 47 years). Main measures We used a structured questionnaire that measured the following: COVID-19 ageism towards older people, COVID-19 ageism towards younger people, stereotyping, the experience of discrimination, perceived fears about contracting COVID-19, subjective knowledge about COVID-19, and sociodemographic characteristics. Results Overall, participants reported a relatively low level of COVID-19 ageism towards older people but a significantly higher level of COVID-19 ageism towards younger people. Hierarchical regressions revealed that negative age stereotypes were the most important determinants of both types of ageism. Sociodemographic variables (including age and majority/minority) were significant determinants only for COVID-19 ageism towards older people. That is, older and Jewish participants reported lower levels of this type of ageism. Conclusions Our findings demonstrate that negative age-related stereotypes have played a central role in ageist beliefs towards both older and younger people during the COVID-19 crisis. It is recommended that the public and scientific media start disseminating messages aimed at reducing rather than increasing negative stereotypes directed towards younger and older people.

Replacement rates have gained acceptance as a useful metric for assessing the conditions of retirees and households at point of retirement. Here we use data from the SHARE longitudinal database to investigate income dynamics within a comparative European context. Our analysis, centering on households as opposed to the individuals on whom international data commonly focus, reduces replacement rates to their components—pension, work income, etc.—and looks at the dynamics among household members in relation to work and pension income. Total replacement rates vary widely among the fourteen countries sampled: overall replacement rates are around the Bismarckian 70% across the entire sample, 80% in countries that have Social Democratic and Continental social-policy regimes, and 60% in countries that have East European and Middle Eastern regimes. Looking at the pension and wage components, however, the latter accounts for about 30% of household income—an important fact for decision-makers to consider. Couples tend to retire together, especially if close in age, and work income compensates amply for lower pension income. The Gini coefficients of our sample are compared before/after retirement to determine whether the social programs that underlie pensions mitigate income inequality after retirement. Finally, we examine the well-being and quality of life of retirees and their households. We find a positive correlation between replacement rate and indicators of retirees’ and their households’ quality of life, e.g., satisfaction with life, ability to consume healthcare services, and ability to cover unforeseen expenses.

Researchers engaged in text and data mining (TDM) research collect vast amounts of digitized material and use software to analyze and extract information from it. TDM is a crucial first step to many machine learning, digital humanities, and social science applications, addressing some of the world’s greatest scientific and societal challenges, from predicting and tracking COVID-19 to battling hate speech and disinformation. Although applications of TDM often occur across borders, with researchers, subjects, and materials in more than one country, a patchwork of copyright laws across jurisdictions limits where and how TDM research can occur. With the World Intellectual Property Organization (WIPO) Standing Committee on Copyright and Related Rights, and legislatures around the world, deliberating the harmonization of copyright exceptions for various research uses, we discuss policy measures that can ensure that TDM research is unambiguously authorized under copyright law.

Fiil-Flynn, Sean M, Butler, Brandon, Carroll, Michael, Cohen-Sasson, Or, Craig, Carys, Guibault, Lucie, Jaszi, Peter, Jütte, Bernd Justin, Katz, Ariel, Quintais, João Pedro, Margoni, Thomas, de Souza, Allan Rocha, Sag, Matthew, Samberg, Rachael, Schirru, Luca, Senftleben, Martin, Tur-Sinai, Ofer, Contreras, Jorge L. (2022): Legal reform to enhance global text and data mining research. Science (New York, N.Y.) 378 (6623): 951-953, DOI: 10.1126/science.add6124, URL: http://dx.doi.org/10.1126/science.add6124

Background:Patient centeredness is a core element in healthcare. However, there is a gap between the understanding of this term by health care professionals, and patients’ capability, self-efficacy and willingness to take part in medical decisions. We aimed to expose standpoints toward "patient centeredness" among junior medical managers (JMM), as they bridge between policy strategies and patients. We tried to reveal cultural differences by comparing the views of the majority and the minority subpopulations of Israel (Arabic and Hebrew speakers).Methods:A cross-sectional survey among JMM studying for an advanced degree in health systems management at three academic training colleges in Israel was conducted in February-March 2022. The respondents completed a structured questionnaire, comprising four sections: a) perceptions towards trust, accountability, insurance coverage and economic status; b) perception regarding decision-making mechanisms; c) preferences toward achieving equity and d) demographic details.Results:A total of 192 respondents were included in the study, 50% were Hebrew speakers and 50% were Arabic speakers. No differences were found between Arabic and Hebrew speakers regarding perception towards trust, accountability, insurance coverage and economic status. JMM from both subpopulations perceived that patients' gender and age do not influence the attitude of physicians, but Arabic speaking respondents perceived that healthcare professionals prefer educated patients, or those with supportive families. All respondents perceived that patients would like to be more involved in medical decisions; yet, Arabic-speakers believe that patients tend to rely on physicians’ recommendations, while Hebrew speakers believe patients wish to lead the medical decision by themselves.Conclusions:Patient centeredness strategy needs to be implemented bottom-up as well as top-down, in a transparent nationwide manner. JMM are key actors to accomplish this strategy, as they realize policy guidelines in the context of social disparities, thus they can achieve a friendly personalized dialogue with their patients. We believe that empowerment of these JMM may create a ripple effect yielding a bottom- up perception of equity and initiating change.

In recent years, several studies have examined the effect of parents and friends on cyberbullying victims. Less is known about their combined effect on cyber perpetrators, especially among Jewish and Arab teens in Israel. We collected data from a representative sample of 350 Jewish and Arab adolescents (aged 15-16) and their parents. We repeated the interviews twice within a year. The survey included measurements of three parental practices: support, monitoring, and protectiveness, as reported by parents at the first time of data collection. We measured the adolescents' engagement in sensation-seeking and cyberbullying as perpetrators and perceptions about peers' involvement in these behaviors. Path-analysis models revealed that the perception of peers' involvement in cyberbullying perpetration was positively linked with involvement in such behavior among Jewish and Arab teens. Contrary to our expectations, no parental practice had a direct effect on cyberbullying perpetration among teens in either ethnic group. The study presents important and unique findings. The results indicate that youngsters involved in cyberbullying are strongly influenced by their peers. The prevalence of this pattern in both the Jewish and the Arab populations indicates its universal nature. On a practical level, it may be suggested that bullying behaviors may be mitigated by taking measures in formal and informal education. Another aspect of the results is the decline in parental influence on adolescents' cyberbullying behaviors, especially among Arab teens. This may be an indicator of cultural changes taking place in the Arab population in Israel alongside widening of the generation gap.

Background Concern about the cost and affordability of cancer drugs is widespread and well known. Even in countries with universal healthcare systems or health insurance for all, additional patient out-of-pocket (OOP) expenses are prevalent. Studies showed that honest communication between oncologists and patients is an important component in alleviating financial burden of cancer care. The study explores patient-caregiver-oncologist communication regarding the affordability of OOP medication and the extent to which this communication is related to families’ financial burden after their loved ones’ death. Methods A cross-sectional survey is conducted in Israel among 491 primary caregivers of deceased cancer patients, Jewish and Arab, in three oncology centers. Results About 43% caregivers said that they and/or the patients had paid OOP for medications during the last half-year of the patient's life. Most (73%) oncologists who suggested an OOP medication hardly asked or did not ask about financial ability and took little or no interest in ability to afford it, 43% hardly explained or did not explain the advantages of an OOP medication, and 52% hardly explained or did not explain any treatment alternatives. A linear regression analysis reveals that older age and female gender are related to less communication about an OOP medication and that better education, greater affluence, and having private health insurance are related to more communication. About 56% of caregivers say that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. A regression analysis revealed that physicians’ interest in their financial ability and in the explanation they gave decreased their burden. Conclusions Discussing and explaining the meaning of OOP payment alleviates the financial burden that families experience. It is crucial to develop and invest in improving oncologists’ education and skills to communicate costs more openly. Key messages

© 2021 Elsevier Ltd. All rights reserved., Liver diseases have become a major health threat across Europe, and the face of European hepatology is changing due to the cure of viral hepatitis C and the control of chronic viral hepatitis B, the increasingly widespread unhealthy use of alcohol, the epidemic of obesity, and undiagnosed or untreated liver disease in migrant populations. Consequently, Europe is facing a looming syndemic, in which socioeconomic and health inequities combine to adversely affect liver disease prevalence, outcomes, and opportunities to receive care. In addition, the COVID-19 pandemic has magnified pre-existing challenges to uniform implementation of policies and equity of access to care in Europe, arising from national borders and the cultural and historical heterogeneity of European societies. In following up on work from the Lancet Commission on liver disease in the UK and epidemiological studies led by the European Association for the Study of the Liver (EASL), our multidisciplinary Commission, comprising a wide range of public health, medical, and nursing specialty groups, along with patient representatives, set out to provide a snapshot of the European landscape on liver diseases and to propose a framework for the principal actions required to improve liver health in Europe. We believe that a joint European process of thinking, and construction of uniform policies and action, implementation, and evaluation can serve as a powerful mechanism to improve liver care in Europe and set the way for similar changes globally., The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193; COMPARE: CIT5-CT-2005-028857; SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909; SHARE-LEAP: GA N°227822; SHARE M4: GA N°261982; DASISH: GA N°283646), and Horizon 2020 (SHARE-DEV3: GA N°676536; SHARE-COHESION: GA N°870628; SERISS: GA N°654221; SSHOC: GA N°823782) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2; P01_AG005842; P01_AG08291; P30_AG12815; R21_AG025169; Y1-AG-4553-01; IAG_BSR06-11; OGHA_04-064; HHSN271201300071C), and from various national funding sources is gratefully acknowledged. PC acknowledges support by the French National Agency for HIV, hepatitis and emerging infectious diseases research (ANRS / EMERGING INFECTIOUS DISEASES).

The lengthening of the amount of time adult children depend on their parents' support and rising longevity have pushed scholars to devote increasing attention to the phenomenon of older sandwich family generations. This brief report develops a descriptive portrait of the prevalence of being demographically and socially sandwiched in the population aged 50 or more years, in Europe. It is shown that the prevalence of social sandwiching is highly sensitive to the types of support utilized to operationalize the concept; also, differences between welfare and transfer regimes are significantly affected by different operationalizations. Next, the analyses highlight the dynamic nature of social sandwiching over the adult life cycle, and show that demographic events and the changing needs of older parents are the main drivers of moving in/out the status of socially sandwiched. Support to adult children is ubiquitous in all European societies. Among the pivot generation family solidarity prevails over competition, but children enjoy a strategic advantage when older parents are in good health.

Background Antisense oligonucleotide (ASO)-based drugs for splicing modulation were recently approved for various genetic diseases with unmet need. Here we aimed to develop an ASO-based splicing modulation therapy for Cystic Fibrosis (CF) patients carrying the 3849+10 kb C-to-T splicing mutation in the CFTR gene. Methods We have screened, in FRT cells expressing the 3849+10 kb C-to-T splicing mutation, ~30 2′-O-Methyl-modified phosphorothioate ASOs, targeted to prevent the recognition and inclusion of a cryptic exon generated due to the mutation. The effect of highly potent ASO candidates on the splicing pattern, protein maturation and CFTR function was further analyzed in well differentiated primary human nasal and bronchial epithelial cells, derived from patients carrying at least one 3849+10 kb C-to-T allele. Results A highly potent lead ASO, efficiently delivered by free uptake, was able to significantly increase the level of correctly spliced mRNA and completely restore the CFTR function to wild type levels in cells from a homozygote patient. This ASO led to CFTR function with an average of 43% of wild type levels in cells from various heterozygote patients. Optimized efficiency of the lead ASO was further obtained with 2′-Methoxy Ethyl modification (2′MOE). Conclusion The highly efficient splicing modulation and functional correction, achieved by free uptake of the selected lead ASO in various patients, demonstrate the ASO therapeutic potential benefit for CF patients carrying splicing mutations and is aimed to serve as the basis for our current clinical development.

During the first lockdown in Israel, citizens were instructed to visit community clinics only for urgent cases. However, they were not informed that emergency departments (EDs) were safe. Reports from the National Ambulance Services showed a 22% increase in at-home deaths during the lockdown. Perhaps, the reason is because some critically ill patients postponed referrals and came “at the last minute”. After the first lockdown, the Ministry of Health (MOH) declared that hospital EDs were safe. The objective of the study was to examine the rates of admission from EDs to hospital wards, and non-COVID-19 in-hospital deaths during the first lockdown in Israel, compared with the second and third lockdowns. From the business intelligence software of the Rambam Medical Center in Israel, we collected data about the rates of admission to the ED, the non-COVID-19 in-hospital deaths during the three lockdowns, during the same periods in the previous three years, and the main five causes of non-COVID-19 deaths. Data comparison was done using multiple chi-square tests. ED admission numbers were significantly higher during the first lockdown than during the second (χ2 (1, n = 36,245) = 24.774, p = 0.00001) and third lockdowns (χ2 (1, n = 36,547) = 8.7808, p = 0.0030). We found a significantly higher number of non-COVID-19 in-hospital deaths vs. discharges during the first lockdown than in the second and third lockdowns (χ2 (2, n = 26,268) = 7.794, p = 0.0203) The number of deaths due to respiratory diseases was significantly higher during the first lockdown than in the second lockdown (χ2 (1, n = 572) = 8.8185, p = 0.0029) and in the third lockdown (χ2 (1, n = 624) = 9.0381, p = 0.0026), and deaths from infectious diseases were higher during the first lockdown than during both the second and third lockdowns (χ2 (1, n = 566) = 5.9479, p = 0.0147, and χ2 (1, n = 624) = 9.5978, p = 0.0019), respectively. The onset of CVA and CVD are abrupt, while respiratory and infectious diseases may have an insidious pattern; this may have led patients to postpone referrals to hospitals to the “last minute” during the first lockdown, perhaps due to fears of contracting COVID-19, and as a result of vague instructions. Citizens and policymakers must be made aware of this point during future pandemics.

Conditional Access Agreements could improve replicability of research and enhance Open Science without jeopardizing intellectual property rights.

Our study aimed to enhance understanding of memory decline (MD) in old age by evaluating longitudinal effects of personal and national contributing factors. We used data collected by the Survey of Health, Ageing and Retirement in Europe (SHARE) from 12 European countries and Israel. Our sample included 11,930 retirees aged 50+, interviewed at baseline and four years later. MD was evaluated by the change in the number of recalled words from first to second interview. Except for gender, all of our explanatory variables had a significant unique effect on MD – age, education, type of occupation, European geographical region, early retirement, time elapsed from retirement, reason for retirement, active lifestyle, re-employment, health/function status, depressive symptoms, and decline in physical and mental health – over the four years of the study. Our findings indicate that MD can be postponed by national policies such as those which prolong years of education and participation in the workforce, and by social interventions directed to promote active lifestyles in late life, especially in Mediterranean and Eastern European nations.

Metropolitan Haifa, Israel, has three hospitals: Rambam Health Care Campus, Bnai Zion Medical Center, and Carmel Medical Center. In 2007–2014, the length of stay at RHCC’s emergency department increased, while the number of visits decreased. We ask whether the increase in LOS is associated with the falling numbers of visits to other EDs, whether an increase in LOS induces more referrals to competing hospitals in the metropolitan area, and whether it pays to be a crowded ED in mitigating moral hazard. Average LOS at Rambam climbed from 3.5 h in 2000–2007 to 6.4 in 2008–2018. While the number of visits to Rambam decreased significantly, those to Bnai Zion increased significantly and quite linearly. A one-way ANOVA test reveals a statistically significant difference among the three hospitals. In addition, Rambam was significantly different from Carmel but not from Bnai Zion. When LOS stabilized at Rambam from 2016 to 2018 and increased at Bnai Zion, referrals to Rambam went up again. Policymakers should instruct all hospitals to publish LOS data, regulate referrals to EDs, and find an optimal LOS that will reduce competition, non-urgent visits, and moral hazard.

The upturn in life expectancy and its consequence, population aging, are challenging labor, pension, and social-security systems throughout the developed world. The focal aim of this study is to measure the extent of out-of-pocket funding of healthcare services by the older adult population. The study has three objectives: to profile the healthcare services for which older adults pay out of pocket, profile the older adults who pay out of pocket for medical services and detect changes over the years, and identify predictors of out-of-pocket healthcare services funding by older adults. The study is predicated on the SHARE-Israel database (SHARE—Survey of Health, Ageing and Retirement in Europe). Relating to information yielded by the last two waves of SHARE-Israel (Wave 7 and Wave 8), it sheds light on the characteristics of those who reported having paid out-of-pocket for medical services. A large majority of the older-adult population in Israel that consumes healthcare services is asked to pay for services out of pocket. Having supplemental health insurance, personal state of health and changes in it, and economic resources are found to have the strongest effect on the probability of out-of-pocket funding. The motive of financial and/or social support that older adults receive from and/or give to their immediate surroundings makes it more likely that they will pay out of pocket for healthcare services. The probability of such funding varies between nationalities and immigration statuses. It is found with emphasis that the share of out-of-pocket funding of healthcare in older adult households' total annual income is trending upward. Furthermore, economic motives are central in determining whether such expenditure will stabilize over time. The findings stress the need to enhance the healthcare system's awareness of the profile of older adults who find it necessary to pay out of pocket for healthcare services.

Family factors may play a role in adolescents’ weight-control behaviours (WCB), and economic determinants strongly affect adolescents’ health in terms of unhealthy weight-control behaviours (UWCB). This study examines the nexus of socioeconomic status, perceived family wealth, and number of employed parents and Israeli adolescents’ WCB and asks whether family-related variables mediate WCB. Data from the 2014 Israeli Health Behaviour in School-Aged Children study are analysed using structural equation modelling. High family affluence and high perceived family wealth are negatively associated with UWCB. Having two employed parents related to lower levels of UWCB. Family-related variables such as family communication and support and parental monitoring mitigate UWCB. Family meals have a significantly positive effect on healthy weight-control behaviour (HWCB) and a significantly negative impact on unhealthy weight-control activities. The findings suggest that economic factors such as socioeconomic status and number of employed parents should be taken into account in long-term weight-control practice. The combination of WCB and family meals is the most effective method for adolescents’ healthy weight-control behaviour.

For young women, mammography has limited effectiveness and entails exposure to radiation, discomfort, and additional expense. This study identifies factors associated with women's willingness to undergo mammography despite official guidelines to the contrary. Using the Health Belief Model, we surveyed Israeli women aged 40-51 who are not at high risk of breast cancer and who had or had never undergone mammography. The results show that sociodemographic characteristics, private insurance coverage, out-of-pocket payments to physicians, and three Health Belief Model categories - lower perceived barriers to mammography, higher expectations of benefits, and stronger health motivation - are associated with the decision to undergo mammography. In addition, higher levels of perceived susceptibility to illness and experience with mammography are significant predictors of intentions to undergo early mammography. Understanding the determinants of women's tendency to undergo mammography contrary to recommendations may help nurses and healthcare policymakers to create health promotion programs targeting this group of women. Preventing unnecessary mammograms may reduce costs to households and health maintenance organizations, mitigate ineffective use of medical facilities, and alleviate the burden on the healthcare system.

Background Youth whose parents are unemployed have poorer health and well-being, including more injuries that result in hospitalization. The current study examined the possibility of an association of parents’ employment status with youth injury and the interaction of this status with other socio-economic factors and ethnicity. Methods We distributed to adolescents aged 11–15 years, in class, the Israel Health Behavior in School-Aged Children Survey. We distinguished between any injury and severe injury, defining the latter as one necessitating the use of a cast, stitches and crutches or overnight hospitalization. Results Of 13 705 respondents, 6224 (45%) had an injury in the past year that required medical treatment and 1827 pupils (13.5%) reported severe injuries. The odds of any injury were 1.86 for boys as against girls (95% confidence interval [CI] 1.73–1.99), 0.80 for school grade (95% CI 0.78–0.82), 1.56 for Arabs vs. Jews (95% CI 1.43–1.70) and 1.10 for high Family Affluence Scale (FAS) vs. medium FAS (95% CI 1.01–1.21). Only in the low FAS group, when two parents were unemployed, the odds for severe injury was 1.36 (95% CI 1.03–1.78); when one or two parents were employed, the odds of severe child injury were the same (OR 1.13 and 95% CI 0.92–1.40). Conclusion Factors that were found to increase the risk of injury among youth were parental unemployment, low socio-economic status and Arab ethnicity. The home environment was the most common place for injury.

The growing population of elderly households, and their diverse economic circumstances, underscores the need to study the patterns of financial assistance in advanced ages. The proposition presented conceptualizes intergenerational financial support as contingent and dynamic. Data are drawn from Wave I to Wave VI of SHARE-Europe. The empirical examination models changes over time in financial support. The study’s findings show that steady giving and receiving is quite exceptional. Most respondents did not engage in giving or receiving financial support at any two time points during the 12 year period covered by our study. Aging, changing living arrangements, and especially economic circumstances affect the likelihood of shifting between giving and not giving as well as receiving or not receiving financial assistance. Comparisons across four European welfare regimes reveal that the propensity to refrain from giving any financial support is salient mainly in Mediterranean and Eastern European states, whereas the likelihood of not receiving sustained financial support from offspring is salient mainly in states characterized by the Continental and the Mediterranean welfare regimes. There appears to be no reciprocity with respect to financial support in Social Democratic and Continental welfare regimes, but we do find evidence of such reciprocity in the Mediterranean and Eastern European regimes. Nonetheless, patterns of intergenerational exchanges of financial and social support are manifested in all welfare regimes.

In this article we examine the association between national welfare regime and the propensity of middle–aged and older individuals with adult children of their own to provide social support to aged parents. Using data from mature adults (50+) in 26 European countries, we examine whether older and younger generations compete for the time resources of the middle “sandwiched” generation, and whether national policy context shapes this competition. Contrary to expectations, we found that sandwich generation members were less likely to provide support to their parents in Conservative–Mediterranean and East European regimes, but more likely to do so in universalistic Social– Democratic regimes. This evidence supports the hypothesis that well–developed welfare states “crowd–in” family support to older individuals. Middle generation members who provided social support to their adult children tended to provide to their older parents as well. This was particularly true in the two regimes where resources and public benefits tend to be more generous and may be interpreted as state benefits that reduce intergenerational competition. Findings are discussed in terms of the capacity of state policies to shape the allocation of family resources to older adults where extended family lineages have become the norm. state benefts that reduce intergenerational competition. Findings are discussed in terms of the capacity of state policies to shape the allocation of family resources to older adults where extended family lineages have become the norm.

Informal caregivers are people providing some type of unpaid, ongoing assistance to aperson with a chronic illness or disability. Long-term care measures and policies cannot take place without taking into account the quantitatively crucial role played by informal caregivers. We use the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS), and the Study on Health and Ageing in Europe (SHARE) to measure the prevalence of informal caregivers in the European population, and analyze associated socio-demographic factors. This rate ranges between about 13 percent in Portugal and Spain, and more than 22 percent in Luxembourg, Belgium, and Denmark. It declines in older age groups and, on average, is lower in men than in women in all countries studied, and lower among the poorly educated compared to those with higher levels of education. However, large variance was observed in the average share of informal caregivers for most countries between the three surveys. Our findings, estimated through the three surveys, reveal common trends, but also a series of disparities. Additional research will be needed to enable policy makers to access a richer and more harmonized body of data, allowing them to adopt truly evidence-based and targeted policies and interventions in this field.

Background In most countries, including those with national health insurance or comprehensive public insurance, some expenses for cancer treatment are borne by the ill and their families. Objectives This study aims to identify the areas of out-of-pocket (OOP) spending in the last half-year of the lives of cancer patients and examine the extent of that spending; to examine the probability of OOP spending according to patients’ characteristics; and to examine the financial burden on patients’ families. Methods 491 first-degree relatives of cancer patients (average age: 70) who died 3–6 months before the study were interviewed by telephone. They were asked about their OOP payments during the last-half year of the patient's life, the nature of each payment, and whether it had imposed a financial burden on them. A logistic regression and ordered logit models were used to estimate the probability of OOP expenditure and the probability of financial burden, respectively. Results Some 84% of cancer patients and their relatives incurred OOP expenses during the last half-year of the patient’s life. The average levels of expenditure were US$5800on medicines, $8000 on private caregivers, and $2800 on private nurses. The probability of paying OOP for medication was significantly higher among patients who were unable to remain alone at home and those who were less able to make ends meet. The probability of spending OOP on a private caregiver or private nurse was significantly higher among those who were incapacitated, unable to remain alone, had neither medical nor nursing-care insurance, and were older. The probability of a financial burden due to OOP was higher among those unable to remain alone, the incapacitated, and those without insurance, and lower among those with above-average income, those with better education, and patients who died at home. Conclusions The study yields three main insights. First, it is crucial that oncology services provide cancer patients with detailed information about their entitlements and refer them to the National Insurance Institute so that they can exercise those rights. Second, oncologists should relate to the financial burden associated with OOP care at end of life. Finally, it is important to sustain the annual increase in budgeting for technologies and pharmaceuticals in Israel and to allocate a significant proportion of those funds to the addition new cancer treatments to the benefits package; this can alleviate the financial burden on patients who need such treatments and their families.

The COVID-19 pandemic has created challenges in providing medical care for people with health conditions other than COVID-19. The study aims to assess the prevalence of older adults' reportage of decline in health relative to pre-pandemic and to identify its determinants. The study is based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data collected during the pandemic. It comprised 51,778 people in twenty-seven European countries and Israel. Participants were asked about changes in their health status relative to pre-pandemic. Bivariate analysis and logistic regression were used to identify factors associated with worsening of health. Nine percent of people (average age 70 years) reported a worsening of health relative to pre-pandemic. A logistic regression revealed a significant relation of the probability of a downturn in health to forgoing, postponing, or being denied an appointment for medical care. Multiple chronic illnesses, developing COVID-19, having at least one form of psychosocial distress, higher age, and lower economic capacity were also found significantly related to the probability of a decline in health. Older adults' comprehensive health needs must be addressed even when healthcare services are under strain due to pandemic outbreaks. Policymakers should attend to the healthcare needs of people whose vulnerability to the pandemic is amplified by chronic health conditions and low socioeconomic status. Public healthcare systems may experience a massive rebound of demand for health care, a challenge that should be mitigated by delivery of healthcare services and the provision of the financial resources that they need.

DNA replication is a complex process tightly regulated to ensure faithful genome duplication, and its perturbation leads to DNA damage and genomic instability. Replication stress is commonly associated with slow and stalled replication forks. Recently, accelerated replication has emerged as a non-canonical form of replication stress. However, the molecular basis underlying fork acceleration is largely unknown. Here, we show that mutated HRAS activation leads to increased topoisomerase 1 (TOP1) expression, causing aberrant replication fork acceleration and DNA damage by decreasing RNA-DNA hybrids or R-loops. In these cells, restoration of TOP1 expression or mild replication inhibition rescues the perturbed replication and reduces DNA damage. Furthermore, TOP1 or RNaseH1 overexpression induces accelerated replication and DNA damage, highlighting the importance of TOP1 equilibrium in regulating R-loop homeostasis to ensure faithful DNA replication and genome integrity. Altogether, our results dissect a mechanism of oncogene-induced DNA damage by aberrant replication fork acceleration., This research was supported by grants from the Israel Science Foundation (grant nos. 176/11 and 1284/18), the Israeli Centers of Research Excellence (I-CORE), and Gene Regulation in Complex Human Disease, Center No. 41/11, and by the ISF-NSFC joint program (grant no. 2535/16) to B.K. and by grants from the Agencia Estatal de Investigación from the Spanish Ministry of Science and Innovation (PID2019-104270GB-I00/BMC), the European Research Council (ERC2014 AdG669898 TARLOOP), the European Union (FEDER), and the Foundation “Vencer el Cancer” to A.A. The authors thank Dr. Naomi Melamed-Book for her assistance in confocal microscopy and the Mantoux Bioinformatics Institute of the Nancy and Stephen Grand Israel National Center for Personalized Medicine, Weizmann Institute of Science, for assistance in deep sequencing and bioinformatics analysis. The authors thank the members of the Kerem lab for thoughtful discussions and advice.

Objective: Our article aims to investigate changes in the rate of informal care provision, which occurred in Israel and Italy in the last decade. In addition, we analyze typology and magnitude of the main factors contributing to explain the probability of providing informal care. Method: We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) at two selected time points (2006/2007 and 2015). Results: The probability of offering social support to elder family members who live outside the household has been trending down substantially over the years. The likelihood of providing unpaid care is significantly higher when one performs volunteer or charitable work and/or engages in leisure activities, and the importance of these two variables has been growing over the years. Discussion: Israel and Italy have experienced over the years a remarkable decline in the share of older adults providing informal care. The article helps to identify which factors have been associated with this phenomenon.

The study uses the deterioration of security situation in Israel (the “Intifada”) to investigate the uniqueness of results obtained previously in regard to Israel’s security-guard industry, as against other economic sectors, in regard to the employment stability and its implications for future career path. The findings emphasize the negative effect of a person’s mere presence in the labor market during the Intifada on his career path, irrespective of the industry in which he worked. They emphasize the variance attributed to the economic sector in which people hold their first job on their future employment career, as well as the variance attributed to working as a security guard during the Intifada, with the upturn in terror associated with it. The findings stress the role that policymakers should play for minimizing possible adverse effects on the earning trajectory and labor-market attachment of employed persons at a time of declining security and the emphasis and attention that should be given to persons employed in the security-guard industry at any time—due to the inferiority of permanent employment patterns in this industry in contrast to other industries—to minimize possible impairment to their earning trajectory and assure their long-term attachment to the labor market.

Social innovations in long-term care (LTC) may be useful in more effective responses to the challenges of population aging for Western societies. One of the most investigated aspects in this regard is the role of family/informal care and strategies to improve its integration into the formal care system, yielding a more holistic care approach that may enhance opportunities for aging in place. This article reports the findings of a comparative research focusing on the Italian and Israeli LTC systems as representative of the Mediterranean "family-based" care model. To analyze the innovative solutions that have been adopted or are needed to improve LTC provision in these two contexts, focus groups and expert interviews have been carried out in both countries to identify the most relevant challenges and responses to them and to highlight promising policies and strategies to be adopted or up-scaled in the future. These include multidisciplinary case and care management, a stronger connection between prevention and LTC provision, and more systematic recognition of the role and limits of informal caregivers' contributions.

Many aspects of interrelations among urban units in a metropolis and their economic effects on the central city have been explored in research so far. Questioned in this context are the extent of dominance that one may attribute to the metropolis for goingson in surrounding towns and the effect of municipal boundaries on these cities’ economic developments. The geographic structure of Israel’s main metropolitan center is helpful in studying the economic importance of municipal boundaries because it facilitates comparison of developments in areas abutting both sides of the municipal border. The main purpose of the study is to determine the value of a municipal boundary as a stratification variable. To test this, a unique database, including wage and self-employed income and home-sale transactions data, is used, and Gini indices for income and home prices are estimated and deconstructed using the ANOGI method. The following is found: the municipal boundary of the economic-activity center is losing its acuity over time, in terms of both income and income inequality. Contrastingly, the boundary is a good stratification variable for home prices and their inequality index. The inequality index is higher for income than for home prices. Some of the difference in home prices among groups in geographically adjacent areas originates in measured variance in the characteristics of the areas (“explained difference”). However, an “unexplained difference”—possibly stemming from areaspecific characteristics such as the quality of public services, level of taxation, and reputation—also has a considerable effect on the difference in housing prices.

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

Antisense oligonucleotide (ASO)-based drugs for splicing modulation were recently been approved for various genetic diseases with unmet need. Here we aimed to develop an ASO-based splicing modulation therapy for Cystic Fibrosis (CF) patients carrying the 3849+10kb C-to-T splicing mutation in the CFTR gene. We have screened, in FRT cells expressing this mutation, ~30 ASOs chemically modified with 2′-O-Methyl on a phosphrothioate backbone, targeted to prevent the recognition and inclusion of a cryptic exon generated due to the mutation. The screening identified five ASO candidates able to promote CFTR correct splicing and rescue channel activity. Further analyses in well differentiated primary human nasal and bronchial epithelial cells (HNEs, HBEs), derived from patients carrying at least one 3849+10kb C-to-T allele, led to the identification of a highly potent lead ASO. The ASO was efficiently delivered by free uptake into patients’ HNEs and HBEs and completely restored CFTR function to wild type levels in cells from a homozygous patient and led to 43±8% of wild type levels in cells from various heterozygous patients. Optimized efficiency was further obtained with 2’-Methoxy Ethyl chemical modification. The results demonstrate the therapeutic potential and clinical benefit of ASO-based splicing modulation for genetic diseases caused by splicing mutations.

Trust is an essential element in patient-physician relationships, yet trust is perceived differently among providers and customers exist. During January-February 2020 we examined the standpoints of medical managers and administrative directors from the private and public health hospitals on patient-physician trust, using a structured questionnaire. Thirty-six managers in public and private hospitals (24 from the public sector and 12 from the private sector) responded to the survey. Managers in the private sector rated trust higher in comparison to managers in the public sector, including trust related to patient satisfaction, professionalism and accountability. Managers from public hospitals gave higher scores to the need for patient education and shared responsibility prior to medical procedures. Administrative directors gave higher scores to various dimensions of trust and autonomy while medical managers gave higher scores to economic considerations. Trust is a fundamental component of the healthcare system and may be used to improve the provision and quality of care by analyzing standpoints and comparable continuous monitoring. Differences in position, education and training influence the perception of trust among managers in the health system. This survey may allow policy makers and opinion leaders to continue building and maintaining trust between patients and care providers.

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009-2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.

The COVID-19 pandemic that has gripped the world since early 2020 has underscored the need for an effective right to repair medical equipment. As healthcare systems have been pushed to the limit, keeping critical medical equipment (such as ventilators) in working order has become a matter of life and death. Unfortunately, the ability of hospitals and other health care providers to service and fix their medical equipment is often hindered by the tight control that original equipment manufacturers keep over repair of their products. On top of direct contractual restrictions on repair, one of the major difficulties encountered by hospital-based and third-party service providers is the lack of access to service manuals, service keys, schematics, replacement parts, and repair tools. The ability to block access to these critical items is abetted, in large part, by intellectual property laws. In August 2020, a new federal legislation was introduced to address this problem—the Critical Medical Infrastructure Right-to-Repair Act of 2020 (the “Act”). The Act is designed to facilitate repair of critical medical infrastructure during the current COVID-19 pandemic, and to do so, it addresses various relevant intellectual property issues. This Article provides a critical analysis of the Act and examines the extent to which it could serve its prescribed goal. We also investigate the role that courts could play, alongside such legislation, by using policy levers that already exist in intellectual property law to provide relief to hospital-based and independent service technicians and mandate manufacturers to cooperate with them in certain circumstances.

Research has shown that health status and self-rated health (SRH) are correlated not only with age and gender but also with socioeconomic determinants, such as income, education, and employment status, in the course of life and in late life. Much less investigated, however, are gender differences in the association between socioeconomic factors and SRH and how the connection differs among the European welfare state regimes. This study examines the association between SRH and socioeconomic status in later life and in relation to gender and welfare state regime characteristics. Using SHARE data, it builds an analytical sample of respondents aged 60–70 (1275 men, 1544 women) who participated in Wave 1 and, ten years later, in Wave 6. The analysis regresses SRH by gender on socioeconomic status, controlling for various sociodemographic, health, and socioeconomic variables, as well as welfare regime indicators, at two points in time. Past health variables are also controlled for in order to evaluate their effect on SRH at the time of the investigation. A significant gender gap in SRH is found from childhood to late life. The association of socioeconomic status with poorer SRH is significant over time and within welfare state regimes. Consequently, the relationship between gender and SRH, and the extent to which it varies by socioeconomic position, does appear to differ across welfare state regimes. In all regimes and all points in time, including retrospective childhood SRH, women report poorer health than men. The analysis underscores the association between SRH and socioeconomic status in relation to gender in late life and finds that it correlates differently for men and women. The odds of women experiencing poorer SRH are higher, although they become more moderate over time. Even under the most egalitarian welfare regimes, gender differences in the nexus of SRH and socioeconomic status do not favor women.

Background Residential segregation can foster health inequality mechanisms by increasing stress related to neighborhood violence and disorder. Aims We studied the association between neighborhood violence and disorder and inequalities in anxiety between two groups of perinatal Israeli women (Jewish, Palestinian-Arab) living in ethno-nationally segregated neighborhoods, and explored the influence of neighborhood characteristics; social support and chronic stress to this inequality. Methods We linked survey data on neighborhood violence and disorder, neighborhood social characteristics (collective efficacy, social capital and social support) and aggregate discrimination to neighborhood SES census data. The survey data was obtained from the “Family Relations, Violence and Health” study (2014–2015) and included a stratified national sample of women (Palestinian-Arab = 436, Jewish = 965) residing in 63 segregated neighborhoods. We conducted multi-variable logistic regression analysis for anxiety (measured based on State-trait Anxiety Inventory) using generalized estimating equation (GEE) to estimate odds ratios of the association with neighborhood violence and disorder (total score for 10 problems) while considering neighborhood characteristics (SES; social characteristics; aggregate discrimination), social support and chronic stress in different models for the total sample, and separately for Palestinian-Arab and Jewish women. Results Palestinian-Arab women had higher anxiety (60.5% vs. 42.1%, respectively) and higher severity of neighborhood violence and disorder (49.5% vs. 16.2%, respectively) compared to Jewish women. After considering individual and neighborhood variables, adjusted odds ratio (AOR) and 95% confidence intervals (CI) = 1.63, 1.04–2.56. The association between neighborhood violence and disorder and anxiety was significant for low vs. no problems in the final model for the total sample (AOR, 95%CI = 1.28, 1.00–1.64). Similarly, significant association was found only for low severity vs. no problems for Jewish women (1.40, 1.07–1.86). While among Palestinian-Arab women the association between neighborhood violence and disorder and anxiety rendered insignificant in the final model. Neighborhood social cohesion and social support were protective factors from anxiety in both groups, high neighborhood SES was protective factor only among Jewish women, and neighborhood aggregate discrimination was a risk factor only in Palestinian-Arab women. Conclusions Inequalities in anxiety related to neighborhood violence and disorder in ethno-national perinatal groups of women likely reflect residential segregation. Policies entrenching segregation might have affected neighborhood mechanisms (SES inequalities, aggregate discrimination and low social cohesion) that lead to higher stress and ethno-national inequalities in anxiety among perinatal women.

Background The increasing prevalence of cognitive decline (CD) in old age has become a global challenge. Our study aims to enhance understanding of this phenomenon by evaluating longitudinal effects of personal and national determinants on memory decline (MD) among European retirees. Methods We used data from two interviews collected in 12 European (EU) countries and in Israel by SHARE - a multidisciplinary, cross-national bank of survey data. Our sample included 11,930 retirees aged 50+ who were interviewed at baseline (T1) and again four years later (T2). MD was evaluated by the change in the recalled number of words at T2 compared to those remembered at T1. Ten words were presented at each interview and participants were asked to repeat them, first immediately and again after a few minutes (maximum 20 words). The scale for evaluation of change over time ranged from -20 to + 20. Results Except for gender, all of our explanatory variables had a significant effect on MD including age, education, health/function status, depressive symptoms, early retirement, active lifestyle and EU-countries divided into four geographical regions. Decline over time in physical and mental health variables had an additional significant negative effect on memory. Conclusions These findings lead us to suggest focusing on what we know and are able to change in order to postpone MD. In addition to promotion of national policies to prolong years of education and participation in the workforce, we recommend introducing programs that encourage people to postpone retirement, and adjusting workplace conditions in order to enable older persons to continue contributing to the workforce. We also suggest promoting an active lifestyle among older adults, especially in Mediterranean and eastern European nations by implementing health and active leisure education programs. Key messages Declines in health and functioning negatively affect memory, while education and active lifestyle have a protective effect. Moreover, early retirement has a similar negative effect on memory change in each of the studied EU-regions even when controlling for all of the personal and behavioral factors.

Background For young women, mammography has limited effectiveness and entails exposure to radiation, discomfort and additional costs. As in other countries, the Israel Ministry of Health does not officially recommend mammograms for women under age 50 who do not belong to risk groups. The study identifies factors associated with the willingness to undergo mammography, contrary to the official guidelines. Methods Using the Health Belief Model (HBM), we surveyed Israeli women aged 40-51 who are not at high risk for developing breast cancer and who had or had never undergone mammography. Results The results show that socio-demographic characteristics, private insurance coverage, out-of-pocket payments to physicians, and two HBM categories-lower levels of perceived barriers to mammography (OR = 0.70, 95% CI = 0.53-0.92) and higher levels of health motivation (OR = 1.65, 95% CI = 1.19-2.29) - are associated with the decision to undergo mammogram. In addition, higher levels of perceived susceptibility to illness (OR = 1.32, 95% CI = 1.00-1.73) and previous experience with mammography (OR = 8.26, 95% CI = 3.71-18.41) are significant predictors of women's intentions to undergo early mammography. Conclusions Understanding the factors associated with women's tendency to have mammograms contrary to recommendations can help nurses and healthcare policymakers in creating health-promotive programs targeting this group of women. Taking policy steps to increase women's confidence in Ministry of Health guidelines will reduce the potential damage of cumulative radiation over the lifetime of young women and lower the number of false positives. Preventing unnecessary mammograms might reduce costs to households and HMOs, lessen ineffective use of medical facilities and help relieve the burden on the health system. Key messages Taking policy steps to increase women's confidence in Ministry of Health guidelines will reduce the potential damage of cumulative radiation over lifetime and lower the number of false positives. Preventing unnecessary mammograms will reduce costs to households and HMOs, lessen ineffective use of medical facilities and help relieve the burden on the health system.

Background Cancer imposes a substantial economic burden on society, health and social care systems, patients and their families. This study aims to examine the out-of-pocket spending of cancer patients in their last year of life, in six countries with health insurance systems that have a defined benefits package. Methods Data from SHARE and SHARE End-of-Life surveys, conducted between 2006 and 2015 among people aged 50+ were analyzed. Family members of deceased persons were interviewed in order to learn about the circumstances of their relative's death. Results This study found that out-of-pocket spending of cancer patients during their last year of life, in six developed countries with universal health insurance systems, is 4.5% on average of the total household income at that time. The results also show differences among the countries in out-of-pocket expenditures of the total household income: 2.2% in the Netherlands, 4.3% in Israel, 5% in Germany, 5.1% in Austria, 5.1% in Belgium and 8.2% in Switzerland. Whereas the out-of-pocket spending on nursing home care was 7.8% of the total household income in Switzerland, in the Netherlands and in Israel it was negligible. In contrast, the out-of-pocket spending for home care due to disability surged to 5.6% in Israel and 3.7% in Austria, whereas in other countries it was very low. Conclusions This is probably due to the split between the health and the social systems in Israel. The social security administration in Israel is responsible for financing personal care, and the patients have to apply for it themselves. Since the deterioration in functional ability of cancer patients might be quite rapid, many of them pay for professional assistance themselves, until they are approved as eligible for public funds, a process that may last a few weeks. This information is important to health and social policy makers, in order to better adapt the benefits package to the patients' needs. Key messages Cancer imposes a substantial economic burden during the last year of life. The economic burden varies across European countries with health insurance systems. Even countries with a universal benefits package take different approaches to prioritizing services and drugs for cancer care and leave some components of care to individual out-of- pocket payment.

OBJECTIVE Cancer imposes a substantial economic burden on society, health and social care systems, patients and their families. This study aims to examine the out-of-pocket spending of cancer patients in their last year of life, in six countries with health insurance system hat have a defined benefits package. METHODS Data from SHARE and SHARE End-of-Life surveys among people aged +50 were analysed. Family members of deceased persons were interviewed in order to learn about the circumstances of their relative's death. RESULTS The average out-of-pocket spending for health and social services during the last year of life was 4.5% of the total household income, 2.2% in the Netherlands, 4.3% in Israel, 5% in Germany, 5.1% in Austria, 5.1% in Belgium and 8.2% in Switzerland. Whereas the out-of-pocket spending on nursing home care was 7.8% of the total household income in Switzerland, in the Netherlands and in Israel it was negligible. In contrast, the out-of-pocket spending for home care due to disability surged to 5.6% in Israel and 3.7% in Austria, whereas in other countries it was very low. CONCLUSION This information is important to health and social policymakers, in order to better adapt the benefits package to the patients' needs.

Common fragile sites (CFSs) are regions susceptible to replication stress and are hotspots for chromosomal instability in cancer. Several features were suggested to underlie CFS instability, however, these features are prevalent across the genome. Therefore, the molecular mechanisms underlying CFS instability remain unclear. Here, we explore the transcriptional profile and DNA replication timing (RT) under mild replication stress in the context of the 3D genome organization. The results reveal a fragility signature, comprised of a TAD boundary overlapping a highly transcribed large gene with APH-induced RT-delay. This signature enables precise mapping of core fragility regions in known CFSs and identification of novel fragile sites. CFS stability may be compromised by incomplete DNA replication and repair in TAD boundaries core fragility regions leading to genomic instability. The identified fragility signature will allow for a more comprehensive mapping of CFSs and pave the way for investigating mechanisms promoting genomic instability in cancer., Common fragile sites are regions susceptible to replication stress and are prone to chromosomal instability. Here, the authors, by analyzing the contribution of 3D chromatin organization, identify and characterize a fragility signature and precisely map these fragility regions.

Recent years have seen a surge in the use of automotive telematics. Telematics is the integration of telecommunications and informatics technologies. Using telematics in cars enables transmission of data communications between the car and other systems or devices. This opens up a wide range of possibilities, including the prospect of conducting remote diagnostics based on real-time access to the vehicle. Yet, as with any new technology, alongside its potential benefits, the use of automotive telematics could also have potential downsides. This Article explores the significant negative impact that the growing reliance on telematics systems could have on competition in the market for repair services. Our analysis highlights two main areas where the use of telematics for vehicle diagnostics may pose a threat to competition and consumer choice. First, we focus on the manner by which manufacturers communicate with their customers via the telematics system. Due to the special relationship between car manufacturers and their consumers, which is often based on trust and loyalty, alongside the “captive audience” status of drivers, we argue that communications emanating from the car’s telematics system could be deceptive. Second, we explore the negative impact that the shift away from on-board diagnostics to telematics could have on independent repair shops’ access to diagnostic information. Fortunately, the law can adapt to keep pace with these new technological and commercial developments. This Article articulates the combined multi-prong, multi-agency policy approach needed to maintain an effective right to repair cars in the new age of telematics. Among other things, our analysis supports an update of state consumer protection legislation and an increased policing by the Federal Trade Commission of practices employed by car manufacturers. In addition, we highlight the need to consider certain amendments to intellectual property laws that effectively aid car manufacturers in maintaining exclusive control over their telematics systems and diagnostic data.

Informal caregivers are people providing some type of unpaid, ongoing assistance to a person with a chronic illness or disability. Long-term care measures and policies cannot take place without taking into account the quantitatively crucial role played by informal caregivers. We use the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS), and the Study on Health and Ageing in Europe (SHARE) to measure the prevalence of informal caregivers in the European population, and analyze associated socio-demographic factors. This rate ranges between about 13 percent in Portugal and Spain, and more than 22 percent in Luxembourg, Belgium, and Denmark. It declines in older age groups and, on average, is lower in men than in women in all countries studied, and lower among the poorly educated compared to those with higher levels of education. However, large variance was observed in the average share of informal caregivers for most countries between the three surveys. Our findings, estimated through the three surveys, reveal common trends, but also a series of disparities. Additional research will be needed to enable policy makers to access a richer and more harmonized body of data, allowing them to adopt truly evidence-based and targeted policies and interventions in this field.