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Background/Objective:The recent rapid increase in childhood obesity rates suggests that a consideration of the role of the schools in addressing this problem is necessary. 'Fits me' program functions to promote eating daily and healthy breakfast among elementary school children.Methods:Separate children groups were sampled each year by clusters from seven regions around Israel. They filled a self-administered questionnaire at the beginning of 2003, before the program started, and in 2003-2005, after the program. A separate sample was collected in 2006 in a case-control structure. The answer to the question: 'what do you eat for breakfast?' considered as a healthy breakfast if it included one of the following food items: A sandwich (not including chocolate, jam or butter), cereals, vegetable, fruit, egg and dairy product.Results:As compared with 2003 before the program, more children reported eating daily breakfast over the years (51-65% before and until 2005, respectively, P for trend<0.01). Odds ratio (OR) and 95% confidence interval (95% CI) for eating a healthy breakfast, in 2006 in the intervention (n=417) vs controls (n=572), adjusted for sex and age were OR=1.53 (95% CI: 1.15-2.04). However, only a third of 75% of the children who ate a healthy breakfast in the intervention group estimated that they were eating a healthy breakfast.Conclusions:After implementation an educational program to promote daily and healthy breakfast eating, the goal of a healthier breakfast was achieved. However, one should strive to define an exact definition of a healthy breakfast. [ABSTRACT FROM AUTHOR]

In the face of global adversities such as pandemics, military conflicts, and socio-political unrest, the resilience and well-being of populations can be severely tested. This study examines the fluctuating levels of distress within the Israeli population over a period of 2.5 years, encompassing events like the COVID-19 pandemic and various socio-political and security crises. Utilizing a quasi-longitudinal design, data were collected at thirteen time-points, mirroring the demographic makeup of the Israeli Jewish adult population. Measures of psychological distress, societal and individual resilience, hope, morale, and perceived danger were assessed, alongside demographic variables. Statistical analyses included ANOVA and stepwise regression models. Distress levels displayed significant oscillations in response to adverse events. High distress was noted during the latter stages of the study, particularly following a major security incident on October 7, 2023. The regression analyses identified morale and perceived danger as consistent important associations with distress, with individual resilience also inversely related across all time points. The study reveals the dynamic nature of psychological distress in relation to a range of adversities. Morale emerged as a key buffer against distress, whereas perceived danger was a significant stressor, especially during acute- existential threats. These findings have important implications for mental health interventions and policy-making aimed at fostering resilience and mitigating distress in crisis conditions., (© 2024. The Author(s).)

Introduction: Combat ground maneuvers consist of various platforms and have several environmental characteristics, influenced by the terrain, the operational mission, and the force's capabilities. This study assesses data on injuries sustained during urban warfare, aiming to evaluate the relationship between injury characteristics, maneuver platform, and personal protective gear on the battlefield., Materials and Methods: IDF soldiers injured infantry soldiers from the "Cast Lead" and the "Protective Edge" operations in the Gaza Strip (2008-2009 and 2014, respectively) were divided into four groups according to the maneuver platform and the environment: mounted infantry (armored and unarmored vehicle) and dismounted infantry (urban and open area). The primary outcome was the severity of the injury, and the secondary outcome was the injured body part., Results: Overall, 588 casualties were included in the final analysis, of whom 507 were dismounted infantry soldiers (265 in open terrain and 242 in urban area) and 81 were mounted infantry soldiers (20 in unarmored and 61 were injured in armored vehicles). The Injury Severity Score was similar in all subgroups. Open terrain subgroups were found to have fewer head injuries and higher levels of lower extremity injuries, similar to the unarmored vehicle group. More facial injuries were documented in the urban area group., Conclusions: The Injury Severity Score was not influenced by environmental protection. Although we found differences in the injured body parts, further studies on the exact mechanism of injury are needed to elucidate further the relationship and differences between the various platforms used and injuries seen in urban warfare, aiming for tailor-made protection., (© The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The scientific literature on coronavirus disease (COVID-19) is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's national emergency prehospital medical organization, in the pre-exposure period, before widespread governmental action. These efforts were based on (1) phone diagnosis, dispatch, and transport; and (2) border management checkpoints., Methods: This is a descriptive study of MDA's role in pandemic response during the pre-exposure period. Medical emergency telephone calls from either individuals or medical sources were identified by a dispatcher as "suspected COVID-19" based on symptoms and travel exposure. Data were also collected for travelers approaching the MDA border checkpoint at Ben-Gurion International Airport., Results: The total number of protected transports during this time was 121. Of these, 44 (36.3%) were referred by medical sources, and 77 (63.7%) were identified as "suspected COVID-19" by dispatchers. The checkpoint was accessed by 156 travelers: 87 were sent to home-quarantine; 12 were transported to the hospital; 18 were refused entry; and 39 required no further action., Conclusion: EMS can work effectively in the pre-exposure period through instructing home quarantine, providing protected transport, and staffing border control checkpoints.

Detrimental health impacts of heatwaves, including excess mortality, are increasing worldwide. To assess risk perceptions, protective knowledge and behaviors concerning heatwaves in Israel, a study was initiated, comparing attitudes of majority (Jewish) and minority (Arab) populations. A quantitative survey was disseminated through an internet panel, to a representative sample of 556 individuals (79% Jews; 21% Arabs). Overall, 74% consider heatwaves a problem, 93% believe that heatwaves' frequencies will increase, 27% are very concerned about the effects of heatwaves. Higher levels of awareness to heatwaves were found among Jewish compared to Arab respondents; 90 vs. 77% (respectively) could name heatwaves' symptoms ( p < 0.001); 81 vs. 56% (respectively) reported knowing how to protect themselves ( p < 0.001); 74 vs. 47% (respectively) reported knowing what to do when someone suffers from heat stroke ( p < 0.001). Arab compared to Jewish respondents presented higher levels of concern about heatwaves' effects (3.22 vs. 3.09 respectively; t -2.25, p = 0.03), while knowledge of protective measures was higher among Jews compared to Arabs (3.67 vs. 3.56 t = 2.13 p = 0.04). A crucial component of enhancing preparedness to heatwaves is empowerment of minority as well as majority groups, to strengthen their capacity to implement protective behavior and elevate their self-belief in their individual ability and fortitude., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Siman-Tov, Vanderplanken, Guha-Sapir, van Loenhout and Adini.)

In the ongoing COVID-19 pandemic, maintenance of protective behavior is a continued challenge in the effort to contain the spread of the virus. A cross-sectional study via an internet questionnaire was utilized to elucidate changes in compliance to protective behavior among the Israeli population ( n = 1120), after the beginning of the vaccination campaign. Comparison was made between individuals who were previously infected with the virus, those who received one dose of inoculation with the vaccine, and individuals that were neither infected or vaccinated. The study results indicate that those who were previously infected with the COVID-19 virus were less careful about mask wearing (18.8%) and social distancing (29.7%), as compared to the other examined groups (regarding mask wearing, 8.2% and 11.6% respectively, and with regard to social distancing 12.8% and 19.2%), and may require targeted risk communication campaigns to address this population. Furthermore, the study revealed that those that were non-Jewish (as compared to Jewish study counterparts) or that were older (19+) were more vigilant in their protective behavior (29.6% vs. 11.2% respectively for social distancing and 29.6% vs. 11.1% respectively for mask wearing). Despite a successful initial vaccination campaign in Israel, public health officials need to engage all members of the public to unremittingly observe compliance to directed health guidelines, to ensure that the results of previous governmental efforts in fighting the pandemic (such as lockdowns) will be effectively sustained, and the road to containment will be hastened.

Introduction: Out of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018., Methods: All 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768)., Results: DA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC., Conclusions: OHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2020. Published by Elsevier Inc.)

Background: COVID-19 created lifestyle changes, and induced a fear of contagion affecting people's decisions regarding seeking medical assistance. Concern surrounding contagion and the pandemic has been found to affect the number and type of medical emergencies to which Emergency Medical Services (EMS) have responded., Aim: To identify, categorize, and analyze Magen David Adom (MDA), Israel's national EMS, pre-hospital activities including patients' refusal to hospital transport, during the COVID-19 pandemic crises., Methods: A comparative before and after design study of MDA incidents during March/April 2019 and March/April 2020. Medical type, frequency, demographic, location, and transport refusal proportions and outcomes were analyzed., Results: A decrease of 2.6% in the total volume of incidents was observed during March and April 2020 compared with the equivalent period in 2019. This contrasted with the retrospective trend of annually increase observed through 2016-2019. Medical categories showing increase in 2020 were infectious disease, cardiac arrest, psychiatric, and labor and deliveries, with out-of-hospital deliveries increasing by 14%. Decreases in 2020 were seen in neurology and trauma, with trauma incidents occurring at home showing an 8.6% increase. Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020., Conclusion: EMS must be prepared for changes in patients' behavior due to COVID concerns. Targeting populations at risk for refraining or refusing hospital transport and implementing diverse models of EMS, especially during pandemic times, will allow EMS to assist patients safely, either by reducing truly unnecessary ED visits minimizing contagion or by increasing hospital transports for patients in urgent or emergent conditions., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021. Published by Elsevier Inc.)

Background: There is an expected increase in heatwaves globally. As such, it is imperative to have sufficient levels of heatwave-protective knowledge and behaviour in areas regularly affected by heatwaves. Our study assessed this among urban populations in Tunisia, Georgia and Israel., Methods: We undertook a cross-sectional population survey in the three countries. The questionnaire focused on obtaining information on respondents' knowledge level regarding 1) symptoms due to overheating, 2) risk groups for heatwaves, 3) actions to take when someone is overheated, and 4) heatwave-protective measures. Furthermore, we asked respondents about protective measures they applied during the last heatwave. We compared the results between the countries., Results: Heatwave-protective knowledge was highest in Israel, and lowest in Georgia, for all indicators except for heatwave-protective measures, for which knowledge was highest in Tunisia. Most respondents who named certain protective measures had also applied these during the last heatwave: more than 90% for all measures except for one in Tunisia and Israel, and more than 80% for all measures in Georgia., Conclusion: There is a need to further improve heatwave-protective knowledge in Tunisia, Georgia and Israel. One potential solution to achieve this is by implementing a National Heat Health Action Plan. Improving knowledge is a vital step before adaptive behaviour can take place.

Background: Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC., Methods: The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling., Results: Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12-1.65) and TBI (OR = 1.51,95%CI = 1.12-1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12-0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00-1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61-0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39-0.7). In-hospital mortality was not associated with ethnicity., Conclusions: Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.

Background: To identify and minimize unnecessary calls to emergency numbers and to assess the effectiveness of call-tracking technology in addressing the problem., Methods: A retrospective, interventional study was conducted of all emergency calls made to Magen David Adom (MDA), Israel's national Emergency Medicine Service (EMS) during years 2012-2016. In 2015 a tiered technological intervention was developed and implemented by MDA. The call-tracking technology self-identified harassment calls by call duration and frequency. The system automatically diverted harassing calls to a non-emergency number system in order not to lose any call. The rates of harassment calls were analyzed by shift, region, and season. Trends were compared before and after intervention., Results: During the years 2012-2016, 53,527 shifts took place, and 8.2% (4277) of shifts identified as receiving incoming harassment calls. The evening shift (11.5%), the Jerusalem region (16.9%), and the summer season (9.6%) were most prone to harassment calls. After implementing an intervention using specialized call-tracking technology, the prevalence of harassment calls decreased significantly (from 10.9% to 2.9% p < .001). The Jerusalem region showed the greatest decrease of 92% (from 26.5%-2.0% p < .001)., Conclusions: MDA's call tracking technology has been shown to identify and minimize harassment calls and can be implemented by emergency organizations to reduce abuse of emergency call services., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Early application of tourniquets has reduced injury death rates. At the end of 2013, the Israel Defense Forces Medical Corps completed a military-wide introduction of the Combat Application Tourniquet as the standard-issued tourniquet. The accompanying clinical practice guideline encouraged combat soldiers and medical teams towards a liberal use of tourniquets for extremity injuries, even when in doubt., Objectives: This study aimed to assess the effects of the wide introduction of advanced tourniquets on the rate of tourniquet applications, the type of tourniquet applied, and the differences in hospitalisation outcomes following the introduction., Methods: The study population was composed of hospitalised military casualties with an extremity injury treated by military medical teams between 2006 and 2015. Prehospital data were extracted from the Israel Defense Forces Trauma Registry and matched to corresponding hospital data from the Israeli National Trauma Registry. Two periods were compared: 2006-2013 "pre-intervention period" and 2014-2015 "post-intervention period"., Results: A total of 1,578 casualties were recorded during the study period. Of these, 320 (20.3%) occurred between 2014-2015. Characteristics of casualties in the post-intervention period were similar to those in the pre-intervention period including the rate of traumatic amputations (2.5% vs 2.2%, p = 0.93) and Injury Severity Score of 16 or above (12.8% vs 14.9%, p = 0.40). The rate of tourniquet application was more than four-fold in the post-intervention period compared to the pre-intervention period (22.8% vs 5.5%, p < 0.001). Nevertheless, rates of in-hospital amputations (1.6% vs 1.6%, p = 1.00) and death (0.9% vs 1.3%, p = 0.53) were similar in the two periods., Conclusion: Following the IDF military-wide introduction of advanced tourniquets, the tourniquet application rate rose sharply, the use of old tourniquets ceased over time, and in-hospital amputation rate did not increase. These findings suggest that the awareness for haemorrhage control using advanced tourniquets rose., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Road traffic accidents (RTA) are not equally distributed between ethnic groups, disproportionately affecting minorities. In Israel, Arabs are at higher risk of involvement in RTA relative to their proportion in the population. This study aims to compare the risk of in-hospital mortality from RTA between Arabs and Jews in Israel and to identify the factors associated with mortality in each population group., Methods: This study is based on the Israeli National Trauma Registry of patients hospitalized due to road traffic injuries (Injury Severity Score 16+) between 2008 and 2017. Demographic, injury and hospitalization characteristics, evacuation means and in-hospital mortality were analyzed. Hierarchical multivariate logistic regression with random intercept for the treating hospital was performed to estimate the risk of mortality., Results: Of the 11,523 hospitalizations reported, 29% were Arabs, which is higher than their proportion in the Israeli population (21%). When comparing Arabs with Jews they were younger (ages 0-24 years - 61% vs 30%), injured as a car driver (28% vs 20%) or passenger (21% vs 15%) and less likely to be a motor cyclist (8.8% vs. 19.2%). In addition, Arabs were more likely to suffer from critical injuries (51% vs 44%) and head injuries (71% vs 66%). Although Arabs were less likely to be evacuated by ambulance (68% vs 80%), they were more likely to be evacuated by a private vehicle or an emergency medical helicopter. Transfers between hospitals were greater among Arabs (14% vs 22%), as were hospital admissions "outside official work hours" (70% vs 78%) and hospital resource utilization. After accounting for demographic, injury, and hospitalization characteristics the risk of in-hospital mortality was significantly higher among Arabs compared to Jews (OR: 1.63, 95% CI: 1.14-2.32). The significantly higher mortality among Arabs was apparent in the sub-group of patients who were critically injured and in those who arrived at the hospital "outside official work hours"., Conclusions: This study suggests the need for developing appropriate interventions focusing on the Arab community in general, and according to the analysis of risk groups and areas of injury in particular, including rapid access to emergency medical services and definitive care.

Background : A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods : Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results : Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs ( p = 0.006), training and exercises ( p = 0.003), and in the overall score ( p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals' geographical location (F (1,20 ) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20 ) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20 ) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions : Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks., Competing Interests: There are no conflicts of interests to any of the authors.

Purpose: To examine whether hours of a day and days of a week influence injury pattern, means of evacuation, and hospital resource utilization., Methods: A study based on the Israeli National Trauma Registry of patients hospitalized due to injury between 2008 and 2015., Results: Of 293,077 subjects included; 32.8% were admitted on weekends (weekend-days 16.7% and weekend-nights 16.1%), 20.0% on weeknights and 47.2% on weekdays. Compared with weekday admissions, weekend and weeknight admissions had higher risk of hospitalization from violence and fall-related injuries, but lower risk from road traffic injuries (RTI) except for weekend-day admissions adjusted for age, gender, and ethnicity. Hospitalization due to burn injuries was greater on weekends, particularly on weekend-days. Hospitalization for violence and burn injuries was greater on weekend-nights vs weeknights, while injuries from other unintentional causes were greater on weeknights than weekend-nights. Furthermore, patients admitted on weekends and weeknights were more likely to have severe and critical injuries, greater utilization of intensive care unit and to be referred for rehabilitation, but were less likely to receive prehospital emergency medical service. In stratified analyses, RTI-related hospitalization was greater on weekends among youth and adults aged 15-64 years, males and Arabs, while burn injuries were more likely among weekend admissions for children aged 0-14 years, female and Jews., Conclusions: Injury pattern and resource utilization are related to time. Therefore, injury prevention and intervention efforts should account for hours of a day and days of a week, particularly in relation with age, gender, and ethnicity.

Background: Asylum-seekers from Africa immigrate to Israel through the Sinai desert and are often exposed to traumatic events., Objective: To identify the scope and types of medical services required by asylum-seekers and the relationship between delayed medical care to development of post-traumatic stress disorder (PTSD) and overutilization of medical services., Methods: Asylum-seekers that entered Israel between 2009 and 2012 who utilized the Open Clinic of Physicians for Human Rights were interviewed to record their experiences in the Sinai, and document the traumatic events they were exposed to, their medical diagnoses, and clinic visits. Linkages between diagnoses to exposure to traumatic events and period of time until presentation to the clinic were investigated., Results: Male vs female asylum-seekers visited the clinic more times (24% vs 15% respectively, utilized > 5 visits). Higher ransom and longer periods in Sinai correlated with higher number of clinic visits and PTSD. Asylum-seekers with PTSD versus other medical complaints approached the clinic more times (> 5 visits). Asylum-seekers that approached the clinic closer to their arrival time (up to 18 months from arrival) versus a later period (> 18 months) presented a significantly lower prevalence of PTSD (3.4 and 40.5% respectively; p < 0.001) and lower utilization of clinic's services (p < 0.001)., Conclusions: PTSD among asylum-seekers appears to be associated more with length of exposure to stressful events than number/types of traumatic events and with delay in receiving medical care. Improving access to medical care may reduce asylum-seekers' development of PTSD and lead to lower utilization of services.

Objective: Despite efforts by civil defense authorities, levels of households' preparedness to emergencies remain insufficient in many countries. Engaging the public in preparedness behavior is a challenge worldwide. The purpose of this study was to explore the efficacy of psychological intervention in promoting preparedness behavior to armed conflicts in Israel., Methods: A randomized controlled trial (N = 381) with two control groups and three intervention groups was used. The psychological interventions studied were elevated threat perception, external reward, and manipulation of a cognitive cluster related to preparedness., Results: The results of the analysis suggest a significant effect of intervention on the increase of reported preparedness (F4,375 = 4.511, P = 0.001). The effect is attributed to the intervention group in which external reward was offered. Participants in this group were about two times more likely to report greater levels of preparedness compared to the control group (RR = 1.855; 95% CI: 1.065, 3.233)., Conclusions: The findings suggest that preparedness behavior can be promoted through external incentives. These are presumably effective motivators because they encourage preparedness while allowing subjects to retain their denial as an adaptive coping mechanism. Innovative thinking is required to overcome the psychological barriers associated with public reluctance to engage in preparedness. (Disaster Med Public Health Preparedness. 2018;13:713-723).

Background: Populations of different ethnicity and country of origin living in the same country may possess particular features of violence-related injuries. This study aims to compare violence-related injury characteristics and circumstances, hospital resource utilization and in-hospital mortality among the major ethnic groups in Israel., Methods: A study based on the Israeli National Trauma Registry database of patients hospitalized due to violence-related injuries between 2008 and 2017. Data included demographic, injury and hospitalization characteristics and in-hospital mortality. Statistical analysis included χ 2 -test and multiple logistic regression., Results: During the study period, 16,151 violence related-hospitalizations were reported, of which; 46.1% were Arab Israelis (AI), 3.2% were Israelis born in Ethiopia (IBE), 12.7% were Israelis born in the former Soviet Union (IBFSU) and 38.0% were all other Israelis (AOI). The proportion of violence-related hospitalizations among AI, IBE and IBFSU was greater than their respective proportion in the Israeli population. In comparison to the other groups, stab injuries were significantly greater among IBE (30% vs 39%); unarmed brawl-related injuries were greater among IBFSU (22-41% vs 49%) and firearm injuries were greatest among AI (2-8% vs 23%). These differences in violence mechanism persisted even after accounting for age, gender, injury place and time differences. The foreign born groups had higher rates for injuries sustained on the street/road (58% for IBE, 54% for IBFSU vs 46% for AI and AOI, each), with IBE also showing higher rates for weekend and weeknight injuries compared to the other groups (83% vs 71-75%). IBE were more likely to suffer from severe and critical injuries (19% vs 12-16%), to be admitted to the intensive care unit (17% vs 9-11%) and to have prolonged hospital stays of seven days or more (20% vs 16-17%), with no significant difference in in-hospital mortality between the comparison groups., Conclusions: Characteristics of violence-related casualties differed significantly among diverse ethnic populations living in the same country. Each population group showed specific attributes regarding injury mechanism, circumstances, severity and hospital utilization. Violence prevention programs should be culturally adapted and take into account ethnicity and country of origin of the target population.

Objective: To determine if ethnic disparities exist with regard to the risk of injury and injury outcomes among elderly hospitalized casualties in Israel., Methods: A retrospective study based on data from the Israeli National Trauma Registry between 2008 and 2017. Data included demographic, injury and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences between Jewish and Arab casualties, aged 65 and older., Result: The study included 96,795 casualties. The proportion of elderly hospitalized casualties was 2.8 times greater than their proportion in the population (3.1 times greater among Jews and 2.1 times among Arabs). In comparison to Arabs, Jews suffered from a greater percentage of head injuries (10.5 and 8.9%, respectively for Jews and Arabs p < .001), but fewer extremity injuries (46.7% vs. 48.0% respectively for Jews and Arabs p < .05). Among severe/critical casualties and among casualties with severe head injuries, Arabs were more likely to be transported to the hospital in a private car (27% vs. 21% respectively for Arabs and Jews p < .001; 30.5% vs. 23.3% respectively for Arabs and Jews p < .001). Logistic regression analysis, adjusted for age, gender, injury severity, type of injury, type of trauma center and year of admission, shows that Jews, relative to Arabs, were more likely to be hospitalized for more than seven days, admitted to the intensive care unit (ICU) and to be discharged to a rehabilitation center (OR: 1.3, 1.3 and 2.4 respectively). No differences regarding surgery (OR: 0.95) or in-hospital mortality (OR: 0.99) were found., Conclusions: Ethnic disparities between Jewish and Arab hospitalized casualties were observed with regard to hospital stay, ICU admission and rehabilitation transfer. However, no differences were found with regard to mortality and surgery. While the reported disparities may be due in part by cultural differences and accessibility, health policy decision makers should aim to reduce the gaps by optimizing the accessibility of ambulance and rehabilitation services as well as increasing awareness regarding the availability of these medical services among the Arab population.

Background: Hemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma-induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty's remaining factors. The Israel Defense Force Medical Corps decided to use freeze-dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting. The aim of our study is to compare the differences of coagulation, perfusion measurements, resource utilization, and outcome between casualties receiving FDP to casualties who did not receive FDP in the prehospital setting., Methods: This is a retrospective matched cohort study based on two groups of casualties (those treated with FDP vs. those without FDP treatment). The control group was compiled in three steps of precision for age, sex, mechanism of injury and maximum level of severity for each nine injured body regions. Data were collected from the IDF Trauma Registry and The National Israel Trauma Registry., Results: The study group comprised 48 casualties receiving FDP and 48 controls with no differences in demographic, evacuation time, and injury characteristics. The FDP group demonstrated a lower level of hemoglobin (12.7 gr/dzl) (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.10-8.80), lower level of international normalized ratio (1.1) (OR, 3.09; 95% CI, 1.04-9.14), and lower level of platelets (230 × 109/L) (OR, 3.06; 95% CI, 1.16-8.06). No other differences were found between the two groups., Conclusion: The use of FDP in the prehospital setting has logistic benefits and a positive effect on coagulation profile, with no other significant effects. Future studies need to be performed on larger groups to verify trends or nullify our hypotheses., Level of Evidence: Therapeutic, level IV.

Background: Dog bites are a substantial public health concern. Rarely has hospitalizations resulting from dog bites been examined. We examined, at a national level, demographic and injury characteristics of dog-bites injuries requiring hospitalization to target prevention programs and policies for those who are at higher risk., Methods: Data on hospitalizations due to dog-bite injuries with an ICD9-CM E906.0 coding were extracted from the Israeli National Trauma Registry between 2009-2016. We calculated the annual incidence of hospitalized dog-bite injuries and compared rates by Chi-squared test. Mantel Haenszel chi-squared test and Dickey-Fuller time-series analysis were used to test linear age and temporal trends, respectively., Results: Overall 986 persons were hospitalized for dog-bite injuries between 2009-2016. An increasing significant trend over the 8-year-period in the proportion of hospitalized dog-bite injuries among all trauma hospitalizations was revealed among children between 0 and 14 years old (p = 0.01). Children had also approximately twice the risk for dog-bite injuries compared to persons aged between 15 and 94 years old (relative risk [RR] = 1.89, 95% confidence interval [CI] = 1.35-2.66, p < 0.0001); the 2016 (latest year) rate per 100,000 was significantly higher for boys than for girls (RR = 2.85, 95%CI = 1.57-5.19, p < 0.0001); no gender differences were detected in the other age groups. Injury in the face/head/neck was most common in children between 0 and 14 years old (49.7%), specifically among the youngers (<1, 1-3 and 4-5 year olds) compared with the 6-11 and 12-14 age groups (p < 0.0001), with 4-fold-risk compared with persons aged between 15 and 94 years old (RR = 3.78, 95%CI, 3.01-4.75). There was no overall significant temporal trend in the annual incidence rates (from 1.84 (95%CI = 1.54-2.15) in 2009 to 1.54 (95%CI = 1.28-1.81) in 2016 per 100,000 population., Conclusions: Children younger than 15 years, with greater extent in boys than girls, represent the high-risk demographic group for dog bites. Prevention programs targeting at this group should be implemented and translated into an actual reduction in the incidence of dog-bites. In addition, an ongoing monitoring and reporting system specific for all dog-bites should be established in Israel, in order to better understand how to minimize the incidence of dog-bites and evaluate prevention efforts., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Aim: To measure individual and environmental risk factors predicting reported child injuries., Methods: A prospective, follow-up study was performed including 380 parents of children aged 1-6 years, living in various communities throughout Israel. Parents were interviewed three times, 3 months apart. Injuries were defined as including minor injuries that required parental attention and medically attended injuries: doctor or nurse visit, emergency medical services or hospitalisation. Parents reported the level of safety for both indoor and outdoor environments, covering 11 items pertaining to safety elements dedicated to prevent child injury. Socio-demographic and parents' attitudes towards child injury were also measured., Results: During the 6-month follow-up period, 37% of parents reported that their child was injured, and 29% of them received medical attention. Reported outdoor safety environment was found to be a predictor of child injury, suggesting that the risk of child injury is higher among children living in unsafe outdoor environments. However, this depended on levels of religiosity (with an odds ratio of 2.48 and 95% confidence interval of 1.09-5.64 for traditional families and an odds ratio of 3.65 and 95% confidence interval of 1.58-8.46 for religious families)., Conclusions: Safe environments play a major role in decreasing the risk of injury among children. In order to decrease injury rates among young children, attention should be given to the immediate outdoor environment in which children grow up and play. Decision makers might particularly want to pay closer attention to the influence of religious backgrounds on child safety through safe environments., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Objective: The effects of televised trauma on the emotional well-being of television viewers has received some scientific attention in recent years, suggesting that the general public is placed at risk of developing distress and possibly posttraumatic psychopathology as a result of secondary exposure via mass media. At the break of a recent war in Gaza, we assessed the psychological effects of the extensive news broadcasting., Method: An omnibus survey was performed two weeks into Operation Protective Edge with a sample of 500 participants representing the adult (> 18) Jewish population of Israel., Results: The results suggest that a vast majority (87.2%) of the population tuned in to the newscasts and the majority (76.7%) of viewers increased their news consumption compared to normal. Increased frequency of viewing newscasts was associated with reported anxiety reflected in uncontrolled fear, physiological hyperarousal, sleeping difficulties, and fearful thoughts. A regression model revealed that viewers watching the constant newscasts more than usual are 1.6 times more likely to report at least one anxiety symptom compared to those watching at the same frequency or less, standardized to gender and age., Conclusions: Increased viewing patterns of televised traumatic content, as well as negative perception of such broadcasts, are associated with the report of anxiety symptoms or psychopathology. The public health implications of the findings are discussed.

Hypothesis: Following the introduction of changes to the trauma system there would be a period of time during which the impact on mortality would be minimal. A decrease in mortality rates would be noted as the TS matured and would continue over time., Design: A retrospective cohort study of all severely injured patients (injury severity score ≥ 16) recorded in the Israeli National Trauma Registry at six level I trauma centres in Israel from 2000 to 2010. Inpatient death rates were examined overall and by sub groups., Setting: The National Trauma Registry contains hospitalized patients, transfer patients to or from other hospitals and those who died in the emergency department. It excludes patients who were dead on arrival, discharged following treatment in the emergency department, and patients whose injuries by definition are not classified as trauma., Main Outcome Measures: In-hospital mortality, Results: Data included 23,143 severe trauma patients available for analysis. Inpatient mortality rates decreased significantly from 16% in 2000 to 11% in 2010. The odds ratio for mortality in 2010 vs. 2000, adjusted for year, age, sex, mechanism of injury, traumatic brain injury, penetrating injury, and severity of injury (ISS ≥ 25), was 0.53, confirming a downward trend., Conclusions: A steady significant reduction in the inpatient mortality rate for severe trauma patients hospitalized at all level I trauma centres in Israel between 2000 and 2010 was observed. Although a single factor that explains the reduction was not identified, evidently the establishment of the trauma system brought about a significant decrease in hospital mortality. Integrated cooperation between components of the national trauma system in Israel over the years may explain the reduction., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To examine the differences and characteristics of road traffic injuries (RTIs) among Jewish and Arab children, ages 0-17 years, in Israel., Design: A retrospective study based on data from the Israeli National Trauma Registry between 2001 and 2010. This study relates specifically to traffic-related hospitalizations among children ages 0-17 years. Data include demographic, injury, and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences of RTIs between the two ethnic groups., Results: A total of 18,884 children were included, of which Arab children comprised 38.2% of the total and 44.1% of the severely injured. Among Arab children 41.8% were pedestrians compared to 33.4% among Jewish children (p<0.0001). Arab children were younger, had more severe injuries and more traumatic brain injury (TBI) compared to Jewish children. Adjusted logistic regression analysis shows that the probability of an Arab child, relative to a Jewish child, to undergo surgical procedures was 1.2 (p<0.0001), to be hospitalized in intensive care units (ICUs) was 0.8 (p=0.003), and to be transferred to rehabilitation was 0.5 (p<0.0001). There was no significant difference in inpatient mortality between the two ethnic groups., Conclusions: Arab children in Israel are more likely to be hospitalized due to road accidents in comparison to Jewish children. Intervention programs should focus on Arab children and their unique characteristics.

Bicycle riding is a popular form of recreation with positive health and environmental effects. These road users are vulnerable to serious injuries, especially when motor vehicles are involved. The goal of this study was to characterize cyclist-related injuries according to motor vehicle involvement for adults versus children. A retrospective study was carried out using data from 11 trauma centers in the Israeli National Trauma Registry (2001-2007). Injuries were classified according to whether a motor vehicle was involved, and differences in injury characteristics were assessed for adults (18+ years) versus children (1-17 years). A total of 5529 patients were hospitalized for bicycle injuries, of whom 1765 were adults and 3764 were children. Thirty percent (n=1662) of all bicycle injuries involved motor vehicles, although the rate of injuries resulting in hospitalization was 37% among adults and 27% among children. Injury characteristics and hospital resource utilization differed substantially by age group. Cyclists struck by a motor vehicle presented with more severe injuries requiring more hospital resources and resulting in poorer outcomes than those not involved with motor vehicles. The interaction effect between motor vehicle involvement and age was significant for torso injuries and need for medical imaging. We found that injury characteristics, hospital resource utilization and health-related outcomes for bicycle injuries are highly dependent on patient's age and mechanism of injury. Effect modification of motor vehicle involvement by age may in part reflect physicians' attitudes toward pediatric imaging. The risks identified in this study should be used for preparedness and management of trauma hospitalizations from bicycle injuries., (2010. Published by Elsevier Ltd.)