Israel Journal of Health Policy Research最新文献

{"title":"Latent profiles of mental health and care barriers among heterosexual and sexual minority adolescents.","authors":"Ateret Gewirtz-Meydan, Ruth Berkowitz, Shir Maoz, Guy Shilo, Yehuda Neumark","doi":"10.1186/s13584-026-00781-0","DOIUrl":"10.1186/s13584-026-00781-0","url":null,"abstract":"<p><strong>Background: </strong>Adolescents often navigate complex psychological, behavioral, and identity-related challenges, yet many do not seek the mental health support they need. Sexual minority youth face additional identity-based barriers that further hinder access to care.</p><p><strong>Method: </strong>A sample of 1,129 Israeli adolescents aged 16-18 (M = 17.42, SD = 1.03), including 30% who identified as sexual minorities, completed measures of mental health, substance use, suicidal ideation, and perceived barriers to care. Latent Profile Analysis (LPA) identified subgroups based on mental health and behavioral risk, and Exploratory Graph Analysis (EGA) identified latent dimensions of help-seeking barriers. Moderation analyses tested whether sexual orientation shaped associations between profile membership, perceived barriers, and help-seeking intentions.</p><p><strong>Results: </strong>Four mental health profiles emerged: Within Normal Ranges, Emotional Struggles and Suicidal Ideation, Tobacco and E-cigarette Users, and Cannabis Users. Barriers to care clustered into three domains: Identity-Related Barriers, Accessibility and Structural Barriers, and Emotional and Internal Barriers. Higher-risk profiles reported greater barriers and lower intentions to seek help, with stronger effects among sexual minority youth. Sexual orientation moderated these associations, revealing lower help-seeking intentions among sexual minority Tobacco and E-cigarette Users but higher intentions among sexual minority Cannabis Users.</p><p><strong>Conclusion: </strong>Patterns of psychological distress, substance use, and marginalized identity intersect to shape adolescents' access to mental health care. Tailored, identity-affirming outreach and efforts to reduce structural and emotional barriers are essential for reaching youth who face the greatest obstacles to seeking support.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From licensure to residency: structural barriers and policy options in Israel's residency admission process.","authors":"Ayala Burger, Alexey Belinsky, Joseph Mendlovic, Daniel Minerbi Padon, Michal Laron","doi":"10.1186/s13584-026-00774-z","DOIUrl":"10.1186/s13584-026-00774-z","url":null,"abstract":"<p><strong>Background: </strong>Israel faces a growing need for medical professionals due to population growth and aging, yet the number of licensed physicians per capita remains below the OECD average. The gap is particularly evident in the number of medical specialists. One factor contributing to this shortage may be the delay between medical licensure and the commencement of residency training.</p><p><strong>Objective: </strong>The objective of this study was to assess the extent to which delays in the commencement of residency programs occur, to identify and analyze barriers that delay the start of residency training among newly licensed physicians in Israel, and to explore possible solutions to optimize this process.</p><p><strong>Methods: </strong>This mixed-methods study included a quantitative analysis of administrative datasets from the Israeli Ministry of Health (n = 18,480), and qualitative analysis based on 31 semi-structured interviews conducted with department heads, residents, and residency candidates between January and August 2023.</p><p><strong>Results: </strong>Despite a steady increase in the number of licensed physicians, the median time between licensure and the start of residency has remained constant at approximately four months. According to interviewees' accounts in the study, delays were often associated with inconsistent and opaque admission processes, regional disparities in hospital demand, and mismatched expectations between candidates and departments, and could in part be explained by the absence of a centralized residency allocation system. Factors such as elective choices during internship and geographic location further influenced the timeline. Interviewees did not commonly report postponing residency for personal reasons.</p><p><strong>Conclusions: </strong>Delays in residency placement, compounded by inefficient workforce allocation, may reduce the effective capacity of the healthcare system. A more transparent and structured national framework - similar to those in the US, Canada, and Spain - could help streamline the process and reduce inefficiencies. Policy recommendations include improved data transparency, standardization of admission criteria, and better support for hospitals in peripheral regions. Establishing a unified, annual data reporting system on the physician workforce is a necessary prerequisite for any effective reform or national workforce planning.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When social media becomes medicine: clinician-moderated online consultations as an informal healthcare access point.","authors":"Inna Bleicher, Maya Peled-Raz, Sun Bleicher, Sharon Tzemah","doi":"10.1186/s13584-026-00777-w","DOIUrl":"10.1186/s13584-026-00777-w","url":null,"abstract":"<p><strong>Background: </strong>Social media has evolved significantly as a platform for healthcare communication, education, and consultation, especially following the COVID-19 pandemic. While these platforms are increasingly used for medical advice, they operate largely outside formal health policy frameworks, creating a growing \"informal layer\" of healthcare.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted using an anonymous online questionnaire distributed to the \"Ask an M.D.\" group members from April to July 2023. Demographic characteristics, consultation patterns, motivations for using the platform, and comparisons between users from central and peripheral regions of Israel were analyzed, to identify potential disparities in digital health access.</p><p><strong>Results: </strong>Of approximately 19,000 members who viewed the survey, 1,508 responded (8%). Respondents were predominantly female (85%), with a mean age of 38.5 years, and 61.5% reported higher education. Common reasons for using the group included seeking a second opinion (36%), delays in obtaining a doctor's appointment (34%), and urgent health concerns (28%). Consultation topics most often involved gynecology and obstetrics (19%), pediatrics (15%), and dermatology (10.5%). Peripheral respondents were underrepresented relative to their proportion in the wider population. Within the respondent sample, central and peripheral participants showed broadly similar reported patterns of platform use.</p><p><strong>Conclusions: </strong>Clinician-moderated social media groups such as \"Ask an M.D.\" may serve as a supplementary source of health information and informal consultation for some users, particularly when immediate formal care is less accessible. The lower representation of peripheral respondents in this survey should be interpreted cautiously and may reflect differences in survey exposure, response propensity, platform reach, or other factors. Because this study did not assess clinical outcomes, it cannot determine whether participation in the platform improves care, safety, or health equity.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental unit waterlines in Israel: evidence of widespread microbial contamination and a need for national regulation.","authors":"Luda Groisman, Eti Burla, Daniel Kushnir, Shereen Assaly, Roni Gat, Efrat Rorman, Shoshanit Ohad, Ehud Kaliner","doi":"10.1186/s13584-026-00778-9","DOIUrl":"10.1186/s13584-026-00778-9","url":null,"abstract":"<p><strong>Background: </strong>Dental unit waterlines (DUWLs) are susceptible to microbial contamination because of biofilm formation within their complex water delivery systems. Although the US CDC and several professional organizations recommend maintaining dental treatment water at potable water quality, Israel currently lacks specific national standards and regulatory requirements for monitoring and maintaining DUWLs. This study assessed the prevalence of Legionella and other microbial contaminants in DUWLs across dental clinics in central Israel and examined factors associated with contamination to inform patient and dental stuff safety and national policy development.</p><p><strong>Methods: </strong>This survey included 52 randomly selected dental clinics, with 359 water samples collected from DUWL components and water sources. Samples were tested for Legionella spp., Legionella pneumophila, Pseudomonas aeruginosa, and heterotrophic plate count (HPC). Water quality indicators - residual chlorine and turbidity were also measured. Statistical analyses were used to explore associations between microbial and common water quality and clinic characteristics.</p><p><strong>Results: </strong>Of the clinics tested, 94% exhibited at least one abnormal water quality result. Legionella exceeded the threshold in 74% of samples, Pseudomonas in 25%, and HPC in 53%. Contamination was most frequent in turbine and syringe connectors. Low chlorine levels and high turbidity were significantly associated with increased microbial counts. Legionella pneumophila concentrations above 2,500 GU/L were found in 19% of Legionella-positive samples. No consistent effect of dental chair age or clinic operating frequency was observed.</p><p><strong>Conclusions: </strong>The widespread microbial contamination identified in Israeli dental unit waterlines represents a potential patient and occupational health concern and highlights an important regulatory gap in the oversight of dental water quality. These findings support the need to develop national standards for DUWL monitoring, maintenance, and treatment, together with routine surveillance and regulatory oversight, to improve patient safety and ensure safe dental care environments.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitfalls encountered while projecting the future Israeli anesthesiologist workforce: lessons from the Israel anesthesiologist workforce study.","authors":"Ariel Wimpfheimer, Yehuda Ginosar, Daniela Quesada, Shai Fein, Charles Weissman","doi":"10.1186/s13584-026-00780-1","DOIUrl":"10.1186/s13584-026-00780-1","url":null,"abstract":"<p><strong>Background: </strong>The smooth and efficient operation of a country's healthcare system is highly dependent on the size and specialty composition of its physician workforce. Therefore, it is incumbent upon a country's healthcare leadership to continually examine the workforce situation in each medical specialty, especially critical specialties like anesthesiology, so as to detect issues that could lead to shortfalls and surpluses and then apply effective corrective actions. The aim was to assess the accuracy of the different predictive methods and identify possible ways of improving their predictive capabilities. Our assumption was that the accuracy of workforce predictions is primarily affected by unforeseen and disruptive events.</p><p><strong>Methods: </strong>Cross-sectional surveys of the Israeli anesthesiology workforce were performed in 2005 (n = 711 anesthesiologists) and 2021 (n = 1330 anesthesiologists). This permitted comparing needs and demand-based workforce forecasts made in 2005 with the actual 2021 workforce. Reasons for discrepancies between the 2005 forecasts and the reality in 2021 were sought.</p><p><strong>Results: </strong>The 2005 needs-based projections underestimated the actual increase in anesthesiologists because the population grew at a rate faster than that estimated in 2005. Furthermore, there was an increase in the proportion of the population > 65 years old, an increase in life expectancy and a higher birth rate requiring a greater number of caesarean sections and epidural catheter insertions. Moreover, the 2011 union contract between the government and the Israel Medical Association increased anesthesiologist vacation time by two weeks per year. The demand-based projection underestimations were attributed to the significant increase in anesthetics performed outside operating rooms, such as, in cardiac catheterization laboratories and invasive radiology and endoscopy suites. Comparing anesthesiologist workforce projections made in 2005 to the workforce realities 16 years later revealed that many unpredictable (greater population growth) and disruptive (union contract) factors that ensued during that time period led to underestimating future workforce needs.</p><p><strong>Conclusions: </strong>Forecasting the future Israeli physician anesthesiologist workforce is an endeavor fraught with unpredictable challenges. To facilitate frequently updated forecasts of future workforce needs, healthcare systems require robust, long-term forecasting capabilities that use near real-time data obtained from the ubiquitous electronic medical and hospital record systems. These data should then be entered into sophisticated data analytic tools, rather than simple needs and demand-based methods. Such up-to-date forecasts should help healthcare system leaders and policy makers make more informed workforce decisions.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National adverse event reporting for medical devices in Israel, 2013-2024.","authors":"Meital Mishali, Nadav Sheffer, Maya Negev","doi":"10.1186/s13584-026-00776-x","DOIUrl":"10.1186/s13584-026-00776-x","url":null,"abstract":"<p><strong>Background: </strong>Post-market surveillance systems are essential for identifying medical device-related adverse events and ensuring patient safety. In Israel, the Ministry of Health has operated a national medical device reporting system for decades. The system is modeled on United States and European regulatory frameworks, although the Medical Devices Act has not yet entered into force.</p><p><strong>Methods: </strong>Following formal approval, anonymized aggregate data were obtained from the Ministry of Health Medical Device Division for reports submitted between 2013 and 2024. The dataset included annual reporting volumes, report classification as adverse events or Field Safety Notices, reporting source, and event type (death, injury, or malfunction), where available. Availability varied across the study period; analyses were therefore restricted to years in which the relevant variables were recorded.</p><p><strong>Results: </strong>Overall reporting volumes increased over time, from 406 in 2013 to 874 in 2024. Non-linear trends were observed, with declines in 2017, 2020, 2022, and 2024. Since 2019, adverse events accounted for approximately 61.9-75.5% of reports annually, while Field Safety Notices comprised 21.4-33.3%. From 2022 onward, most adverse events were classified as injuries, increasing from 87.1% in 2022 to 89.8% in 2023 and remaining high at 89.1% in 2024. Malfunctions accounted for 10.3% of adverse events in 2022, 7.9% in 2023, and 8.5% in 2024, whereas deaths remained relatively stable at 2.2-2.5%. Reporting was dominated by registration holders (70-80%), primarily importers and distributors, followed by manufacturers, with consistently limited contributions from healthcare institutions and voluntary reporters.</p><p><strong>Conclusions: </strong>This analysis of Israel's national medical device reporting database provides an empirical baseline for assessing the structure and functioning of the country's post-market surveillance system. Increasing reporting activity and improved event classification indicate system maturation. The predominance of reports from registration holders, alongside more limited participation by healthcare institutions and voluntary reporters, points to areas for continued development. The following measures would strengthen post-market surveillance in Israel: full implementation of the legal framework; clearer reporting responsibilities and pathways: targeted guidance and training; electronic reporting and analytical tools; improved event documentation; and structured feedback and transparency mechanisms.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending geriatric care beyond traditional settings: lessons from a mobile assessment program.","authors":"Zorian Radomyslsky, Dor Atias, Bar Cohen, Ali Abu-Raya, Sara Kivity, Reuma Kurz, Eduardo Schejter, Jacob Segal, Ilan Yehoshua, Ori Liran, Miri Mizrahi Reuveni, Galit Kaufman, Daniela Rahamim-Cohen, Limor Adler","doi":"10.1186/s13584-026-00775-y","DOIUrl":"10.1186/s13584-026-00775-y","url":null,"abstract":"<p><strong>Background: </strong>As populations age, changing living conditions and declining self-advocacy often create barriers to essential care. Mobile Geriatric Teams (MGTs) offer a potential solution by providing assessments within a patient's regular environment, potentially reaching underdiagnosed and undertreated individuals who struggle to access routine healthcare. The aim of this study was to evaluate the clinical impact and reach of MGTs in the Northern District of Israel. Specifically, we aimed to assess the extent of MGT-initiated Comprehensive Geriatric Assessments and compare therapeutic and diagnostic outcomes between patients seen by MGTs and those receiving standard community-based geriatric consultations.</p><p><strong>Methods: </strong>This is a retrospective, data-based study serving as a proof-of-concept evaluation for MGT implementation in Israel. The intervention was implemented in MHS between January 1, 2020, and December 31, 2023, and data were collected 3 and 6 months after the MGT appointment. Group comparisons were conducted using chi-square tests, Fisher's exact tests, and Wilcoxon rank-sum tests. In addition, we performed matched logistic regression models.</p><p><strong>Results: </strong>A total of 8,152 individuals were included in the study; 4,348 were assessed by MGTs. The MGT group participants were slightly older and had a higher proportion of males and a lower SES category than the comparison group. The MGTs group had fewer diagnoses of mild cognitive impairment, dementia, and depression, compared to the comparison group. They also had more diagnoses of orthostatic hypotension, and they were more likely to be assessed for fall risk. The MGT group was also prescribed fewer medications in the months following the assessment. After the MGT intervention, we report an increase in primary care visits in the relevant population in the district where it was implemented, while the comparison group did not have a corresponding trend.</p><p><strong>Conclusions: </strong>In this study, we demonstrated that MGTs can reach a specific subpopulation of the elderly who might not otherwise undergo a geriatric assessment, primarily males, those of low SES, and possibly those with less urgent health concerns. These findings highlight the complementary role of MGTs in increasing accessibility, promoting equity, and addressing unmet needs in populations less likely to seek care on their own.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of forensic and legal systems in suicide prevention: Implications for Israeli healthcare policy.","authors":"Gadi Lubin, Liat Keysar Gersht, Ligat Shalev","doi":"10.1186/s13584-026-00773-0","DOIUrl":"10.1186/s13584-026-00773-0","url":null,"abstract":"<p><strong>Background: </strong>Suicide is a leading cause of death among young people worldwide and remains a significant cause of mortality across all age groups, especially in older adults. The underlying causes of suicide span various disciplines and are deeply influenced by societal attitudes, which fluctuate between glorification and severe condemnation of suicide. This study aims to evaluate the role of court rulings on suicidal behavior, with particular attention to implications for healthcare policy in Israel.</p><p><strong>Methods: </strong>We searched the national court rulings databases for alleged psychiatry malpractice in suicide-related cases and of pre-trial settlements from 1985 to 2023. For court decisions, we collected patients' socio-demographic and clinical characteristics, lawsuit characteristics, and the quality of medical documentation and decision-making processes. For pre-trial settlements, we collected data about lawsuit characteristics. Two researchers reviewed the qualitative data, while the quantitative data was analyzed with descriptive statistics.</p><p><strong>Results: </strong>Over the 38-year period, there were 20 psychiatry malpractice court lawsuits related to patient suicides, including 17 deaths and 3 life threatening attempts. Of these, 12 (60%) of cases were won by the plaintiff, and eight (40%) by the defendant. In 14 cases, the suicides occurred in inpatient units and in six cases in community settings. The number of lawsuits notably increased over time for suicide events, with 17 pre-court settlements between 1985 and 1997, and 56 cases in each of the subsequent periods (1998-2010 and 2011-2023).</p><p><strong>Conclusions: </strong>The number of malpractice lawsuits related to suicide in Israel is increasing over time. Our findings, which show a rise in both litigation and pre-trial settlements, may put pressure on psychiatrists to avoid certain kinds of work, especially in the public sector. Such a shift could have broader effects on the quality of suicide prevention efforts and overall mental health care. The study highlights the structural tension between retrospective legal accountability and prospective clinical and public-health approaches to suicide prevention. Addressing this challenge requires balanced policy responses, including strengthening patient-safety and risk-management systems, improving clinical documentation and decision transparency, fostering constructive collaboration between legal and mental health systems, and considering alternative compensation mechanisms that reduce adversarial pressures while supporting affected families.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing organizational resilience of emergency medical services through a designated intervention program.","authors":"Tamir Velner, Zohar Rubinstein, Bruria Adini","doi":"10.1186/s13584-026-00772-1","DOIUrl":"10.1186/s13584-026-00772-1","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical services (EMS) in conflict-affected settings face compounding operational demands, making organizational resilience (OR) a critical institutional asset. Israel's EMS have operated under ongoing security pressures for decades, intensified dramatically following the 7 October 2023 attacks. Despite growing recognition of OR as a measurable and modifiable property, longitudinal interventional evidence in pre-hospital settings remains sparse. This study reports the development and three-time-point evaluation of a targeted intervention program designed to enhance OR within Israeli EMS.</p><p><strong>Methods: </strong>A three-time-point quasi-longitudinal interventional study was conducted within a single EMS: T1 (pre-intervention baseline; n = 196), T2 (post-intervention; n = 205), and T3 (six-month follow-up; n = 172). OR was measured using the validated seven-domain Organizational Resilience Questionnaire (ORQ). The 70-hour intervention - comprising structured training (30 h, 4 weeks) and organizational embedding (40 h, 24 weeks) - was delivered by internal Resilience Trustees. OR changes were examined using one-way ANOVA with Bonferroni-corrected comparisons (Cohen's d) and independent-samples t-tests (α*=0.005). Sequential multivariable regression (pooled n = 573) and ANCOVA identified independent OR predictors and examined OR changes after covariate adjustment.</p><p><strong>Results: </strong>Composite OR increased significantly from T1 to T2 (Δ=+0.20; p = 0.018; d = 0.27), with a Bonferroni-corrected significant gain in situational awareness (Δ=+0.25; p < 0.001), with additional gains in adaptive capacity (Δ=+0.21; p = 0.006) and learning processes (Δ=+0.23; p = 0.006) reaching conventional but not Bonferroni-corrected significance. OR continued to rise at six-month follow-up (T1 mean = 3.86; T2 mean = 4.06; T3 mean = 4.09; Δ T1→T3 = + 0.23; p = 0.007; d = 0.32). The time effect remained significant after full covariate adjustment (ANCOVA: F = 7.41; p = 0.001; ηp²=0.026), with paramedics showing greater gains (+ 0.27) than other staff (+ 0.05; Time × Profession: p = 0.046). Transformational leadership, employee well-being, and technological advancement were the dominant OR predictors (pooled R²=0.770; β = 0.458, 0.274, 0.208, respectively; all p < 0.001).</p><p><strong>Conclusions: </strong>A structured, domain-targeted OR program was associated with significant, domain-coherent resilience gains that progressively consolidated under protracted conflict conditions. The ORQ and the Resilience Trustee model - for which the present study provides preliminary effectiveness evidence - together offer a promising framework for OR strengthening in EMS organizations confronting chronic operational disruption, with implications for national and global emergency health policy.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in developmental milestone attainment among Israeli children between 2019 and 2024.","authors":"Irena Girshovitz, Guy Amit, Inbal Goldshtein, Pinchas Akiva, Dalit Landesman Milo, Deena R Zimmerman, Ravit Baruch, Meital Avgil Tsadok, Yair Sadaka","doi":"10.1186/s13584-026-00771-2","DOIUrl":"10.1186/s13584-026-00771-2","url":null,"abstract":"<p><strong>Background: </strong>Monitoring developmental milestones is essential for identifying at-risk populations and for guiding effective intervention programs. Our previous report examined milestone attainment among Israeli children from 2016 to 2020. Using a similar methodology, this study analyzes trends in developmental milestone attainment in the Israeli population from 2019 to 2024, with primary focus on 2019 to 2023 because of changes in evaluation policy. This follow-up report complements the earlier analysis by providing updated estimates for the post-COVID period and enabling assessment of temporal trends and potential changes in socioeconomic and regional disparities that could not be evaluated previously.</p><p><strong>Methods: </strong>The dataset included over 1 million children with more than 5 million developmental assessments conducted at Maternal and Child Health Clinics (MCHCs) across Israel. These assessments were used to calculate failure rates across four developmental domains: language, social, gross motor, and fine motor skills, along with parental concern about child development. Data were stratified by maternal characteristics, such as age, education, employment, and marital status, and by family sociodemographic factors, including ethnicity, degree of Haredi observance and socioeconomic status. We applied multivariable logistic regression to estimate associations between sociodemographic factors and the odds of failure to attain milestones, while controlling for confounding.</p><p><strong>Results: </strong>A mild overall increase in milestone failure rates was observed from 2019 to 2023. Disparities based on maternal characteristics, particularly lower education, divorce status, unemployment, advanced maternal age, and immigration background, widened notably during periods of national disruption (COVID-19 and the war). In contrast, gaps associated with ethnicity and socioeconomic status remained stable or narrowed. Parental concern increased across most groups, particularly among Bedouin parents, suggesting growing awareness.</p><p><strong>Conclusions: </strong>Maternal-level characteristics were strongly associated with elevated developmental risk from 2019 to 2023, and may be particularly sensitive to national crises. The findings underscore the importance of strengthening parental awareness, prioritizing early identification of high-risk families, and maintaining access to developmental services during emergencies. The study's insights can support decision-makers in education, health, welfare, and local authorities in developing evidence-based strategies to promote equity and resilience in early childhood development systems.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}