Israel Journal of Health Policy Research最新文献

{"title":"Keeping medical information safe and confidential: a qualitative study on perceptions of Israeli physicians.","authors":"Keren Semyonov-Tal","doi":"10.1186/s13584-024-00641-9","DOIUrl":"https://doi.org/10.1186/s13584-024-00641-9","url":null,"abstract":"<p><strong>Background: </strong>Patients expect their information to remain confidential, and physicians have a legal and ethical obligation to keep it this way. Confidentiality is not just a legal requirement but a crucial element in establishing trust between patients and healthcare providers. Patients must feel confident that their personal and medical information is kept confidential and shared only with those who need to know. Previous studies have primarily concentrated on patients' perceptions of medical confidentiality, data privacy, and data protection issues. However, research on the practical practices and perceptions of medical confidentiality among hospital physicians is scant, underscoring the need for a deeper understanding of this critical issue.</p><p><strong>Methods: </strong>Through qualitative methods and as part of a large-scale study on aspects of patient dignity and responsiveness in Israel, physicians shared their views and practices on managing medical information.</p><p><strong>Results: </strong>The study revealed the practical challenges physicians face in upholding various aspects of data protection within hospital settings. These challenges, strategies, and deviations from data protection principles that physicians discussed are of significant practical relevance. The importance of patient consent and the practical measures for safeguarding patient information were also highlighted. While physicians acknowledged the importance of protecting patient information, they also grappled with the realities of doing so in a complex healthcare environment. In future healthcare policies, it is critical to ensure robust measures are in place to safeguard and uphold medical confidentiality. These can include specific measures to increase compliance, such as regularly monitoring compliance with confidentiality policies, producing safe and anonymous channels to voice concerns, and enforcing consequences for any breaches to ensure accountability.</p><p><strong>Conclusions: </strong>While protecting medical information has emerged as an important goal, it is equally crucial to strike a balance between the need to share information to advance and provide quality medical care. Physicians and policymakers must navigate this delicate balance. Additionally, organizations should strengthen compliance to enhance their monitoring and enforcement of confidentiality policies. Ineffective implementation of medical confidentiality leads to theoretical guidelines that do not translate effectively into practice.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"54"},"PeriodicalIF":3.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356169","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":"Admission characteristics of patients with short term hospitalization.","authors":"Yael Frenkel Nir, Yuval Levy, Ehud Grossman, Eyal Klang","doi":"10.1186/s13584-024-00639-3","DOIUrl":"https://doi.org/10.1186/s13584-024-00639-3","url":null,"abstract":"<p><strong>Background: </strong>Sheba Medical Center (SMC) is the largest hospital in Israel and has been coping with a steady increase in total Emergency Department (ED) visits. Over 140,000 patients arrive at the SMC's ED every year. Of those, 19% are admitted to the medical wards. Some are very short hospitalizations (one night or less). This puts a heavy burden on the medical wards. We aimed to identify the characteristics of short hospitalizations.</p><p><strong>Methods: </strong>We retrospectively retrieved data of consecutive adult patients admitted to our hospital during January 1, 2013, to December 31, 2019. We limited the cohort to patients who were admitted to the medical wards. We divided the study group into those with short, those with non-short hospitalization and those who were discharged from the ED.</p><p><strong>Results: </strong>Out of 133,126 admissions, 59,994 (45.0%) were hospitalized for short term. Patients in the short hospitalization group were younger and had fewer comorbidities. The highest rate of short hospitalization was recorded during night shifts (58.4%) and the rate of short hospitalization was associated with the ED daily patient load (r = 0.35, p < 0.001). The likelihood of having a short hospitalization was most prominent in patients with suicide attempt (80.0% of those admitted for this complaint had a short hospitalization), followed by hypertension (68.6%). However, these complaints accounted for only 0.7% of the total number of short hospitalizations. Cardiac and neurological complaints however, made up 27.4% of the short hospitalizations. The 30-days mortality rate was 7.0% in the non-short hospitalization group, 4.3% in the short hospitalization group and 0.9% in those who were discharged from the ED.</p><p><strong>Conclusions: </strong>Short hospitalizations in medical wards have special characteristics that may render them predictable. Increasing the rate of treating personnel per patient during peak hours and referring subsets of patients with cardiac and neurological complaints to ED-associated short term observation units may decrease short admissions to medical departments.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"51"},"PeriodicalIF":3.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356166","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":"Improving contraceptive care for minors in Israel: practice, policy, and training gaps among OBGYNs.","authors":"Maya Peled-Raz, Orly Goldstick","doi":"10.1186/s13584-024-00638-4","DOIUrl":"https://doi.org/10.1186/s13584-024-00638-4","url":null,"abstract":"<p><strong>Background: </strong>Sexually active adolescents sometimes seek contraceptives without parental consent, posing challenges due to minors' confidentiality and consent regulations. This is especially the case under the un-nuanced Israeli legal scheme regarding adolescents' care.</p><p><strong>Methods: </strong>Israeli OBGYNs were contacted through mailing lists and social media groups and asked to fill an online questionnaire regarding their experience and protocols concerning prescription of contraceptives to minors. They were also asked about their comprehension of the relevant legal obligations, the importance they ascribe to different ethical interests and considerations, as well as their training.</p><p><strong>Results: </strong>Of the 177 responding gynecologists, 132 (74.58%) consulted minors about contraceptives during the past year, regardless of a vast lack of training on providing care to minors. More than a third of respondents believed that there is no legal requirement to involve parents in the process, and only 8% assumed a legal obligation for parental involvement in all minors under the age of 18. Three quarters would \"almost always\" prescribe contraceptives without parental knowledge, if requested, while 20% never would. No correlation was found between respondents' practices and their perception of the relevant legal obligations. Participants agreed that the risk to the health of the minor as a result of having sex without contraceptives is of utmost importance. Yet, those willing to prescribe gave greater weight to this consideration, while those who do not prescribe were more concerned with the legal ramifications of such an act. The majority identified the age of 15 as the threshold for consistently prescribing contraceptives to minors without parental involvement.</p><p><strong>Conclusion: </strong>This study highlights the significant gaps in both the legal framework and the training of Israeli OBGYNs, and further supports confidential prescription of contraceptives to minors 15 years and older, via Article 6 of the Israeli Legal Competence and Guardianship Law. Legislative reform, professional guidelines and education and training programs are all needed to ensure consistent and legally sound practices, that safeguard the health and rights of minors. It is imperative to guide healthcare providers, including OBGYNs prescribing contraceptives to minors, on managing the care of minors refusing parental involvement, clarifying the legal framework and ethical considerations involved.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"52"},"PeriodicalIF":3.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356168","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 effect of cessation of drinking water fluoridation on dental restorations and crowns in children aged 3-5 years in Israel - a retrospective study.","authors":"Shiran Shemesh Nezihovski, Mordechai Findler, Tali Chackartchi, Jonathan Mann, Doron Haim, Guy Tobias","doi":"10.1186/s13584-024-00637-5","DOIUrl":"https://doi.org/10.1186/s13584-024-00637-5","url":null,"abstract":"<p><strong>Background: </strong>Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3-5, treated in \"Assuta Tel Aviv\" dental clinics, under general anesthesia or deep sedation.</p><p><strong>Methods: </strong>The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014-2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation.</p><p><strong>Results: </strong>A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages.</p><p><strong>Conclusion: </strong>The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"50"},"PeriodicalIF":3.5,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298402","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":"Insights from a web-based questionnaire: examining diagnostic procedures prior to magnetic resonance imaging.","authors":"Jacob Sosna","doi":"10.1186/s13584-024-00636-6","DOIUrl":"https://doi.org/10.1186/s13584-024-00636-6","url":null,"abstract":"<p><p>The appropriate use of diagnostic imaging, particularly MRI, is a critical concern in modern healthcare. This paper examines the current state of MRI utilization in Israel, drawing on a recent study by Kaim et al. that surveyed 557 Israeli adults who underwent MRI in the public health system. The study revealed that 60% of participants had undergone other imaging tests before their MRI, with 23% having more than one prior examination. While these findings highlight potential inefficiencies in the diagnostic pathway, they also underscore the complexity of medical decision-making in imaging.The paper discusses various factors influencing MRI utilization, including regulatory pressures, healthcare system structure, and the need for evidence-based guidelines. It explores potential strategies for optimizing MRI justification and scheduling, such as implementing clinical decision support systems, enhancing interdisciplinary communication, and leveraging artificial intelligence (AI) for predictive analytics and resource optimization.The need for comprehensive research into MRI justification and scheduling optimization is presented. Key areas for investigation include the effectiveness of decision support tools, patient outcomes, economic analyses, and the application of quality improvement methodologies.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"49"},"PeriodicalIF":3.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298400","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 Israeli anesthesiology workforce crisis: a reassessment survey.","authors":"Ariel Wimpfheimer, Yehuda Ginosar, Shai Fein, Esty Goldberger, Charles Weissman","doi":"10.1186/s13584-024-00620-0","DOIUrl":"https://doi.org/10.1186/s13584-024-00620-0","url":null,"abstract":"<p><strong>Background: </strong>Anesthesiologists provide crucial anesthesiology services in the operating room and non-operating room locations. Combined with an aging and growing Israeli population, there is an increasing demand for anesthesiology services. A previous study performed in 2005 showed that most anesthesiologists are immigrant physicians with few Israeli medical school graduates. Since then, physician immigration decreased, many have retired and demand for anesthesia services has increased while insufficient numbers of new anesthesiologists were trained, leading to a shortage, limiting surgeries and other procedures in many hospitals. The present study examined the composition of the Israeli anesthesiology workforce in 2021and compared it to the 2005 workforce.</p><p><strong>Methods: </strong>A cross-sectional survey of demographic and professional information about each Israeli hospital anesthesiologists was solicited from 34 anesthesiology department chairs responsible for 36 Israeli acute care hospitals.</p><p><strong>Results: </strong>There are 1313 anesthesiologists in the 36 hospitals, resulting in a ratio of 14.2 anesthesiologists per 100,000 population. 22.6% of anesthesiologists will reach retirement age over the next ten years. The proportion of female anesthesiologists was 28.7%. While Israeli medical school graduates increased to 18.1% from 12.2% in 2005, non-Israeli citizens and non-permanent residents comprised 8.5% of the workforce.</p><p><strong>Conclusions: </strong>Despite growth in the ratio of anesthesiologists per population, a workforce shortage is expected to worsen over the next ten years due to retirements, shortened call hours, and the Yatziv reform which bans graduates of certain overseas medical schools from obtaining Israeli Medical Licenses. The current workforce has compensated for the existing shortage of anesthesiologists by enlisting non-Israeli trainees from overseas. Yet, it is crucial to maintain and enlarge the local Israeli workforce to forestall a worsening shortage.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"48"},"PeriodicalIF":3.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298403","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":"Chronically ill patients' perspectives on support services and activities of patient organizations.","authors":"Avi Zigdon, Eyal Eckhaus, Michal Rosenfeld, Ofek Zigdon","doi":"10.1186/s13584-024-00635-7","DOIUrl":"https://doi.org/10.1186/s13584-024-00635-7","url":null,"abstract":"<p><strong>Background: </strong>Patient Organizations (POs) are an important support factor in helping chronically ill patients cope with their illness. Patient involvement in the management of their disease helps to achieve the best possible care for the patient, streamline the work of healthcare providers, shape healthcare policy, and even influence the structures of healthcare systems. The perspective of chronically ill patients on the activities and services provided by patient organizations has not been evaluated yet. This study aimed to identify and map the services and activities of all types of non-profit patient organizations from the perspective of chronically ill patients so that they can be integrated as an integral part of the healthcare system.</p><p><strong>Methods: </strong>Nineteen services and activities of patient organizations were sampled from Israeli patient organizations and scientific literature. These services and activities were evaluated by chronically ill patients in Israel. Patient-Oriented Questionnaires (POQ) were distributed among patients with chronic diseases (N = 1395) using snowball sampling.</p><p><strong>Results: </strong>Exploratory factor analysis (EFA) was performed, followed by confirmatory factor analysis (CFA) for convergent and discriminant validity. Findings showed that twelve services and activities suggested by patient organizations were found to represent chronically ill patients' needs and categorized into three groups: Interpersonal support (five items), patients' rights (four items), and medical information (three items). CFA showed a good fit for the observed data. CFI = 0.98, NFI = 0.97, TLI = 0.96, RMSEA = 0.058.</p><p><strong>Conclusions: </strong>Well-organized patient organizations are an important pillar in reformed healthcare systems. They can serve as the social arm of the healthcare system and as an intermediary between patients and healthcare institutions. We narrowed down twelve services and activities given by patient organizations that were important to chronically ill patients in Israel. patient organizations can utilize patient needs or preferences into clinical practice and influence health policy planning, patient-caregiver relationships, research and even healthcare costs. patient organizations recognition by the healthcare system, and establishment of a national patient council will help to realize these processes.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"47"},"PeriodicalIF":3.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298399","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":"Augmented reality- virtual reality wartime training of reserve prehospital teams: a pilot study.","authors":"Arielle Kaim, Efrat Milman, Eyal Zehavi, Amnon Harel, Inbal Mazor, Eli Jaffe, Bruria Adini","doi":"10.1186/s13584-024-00634-8","DOIUrl":"https://doi.org/10.1186/s13584-024-00634-8","url":null,"abstract":"<p><strong>Background: </strong>In the realm of trauma response preparation for prehospital teams, the combination of Augmented Reality (AR) and Virtual Reality (VR) with manikin technologies is growing in importance for creating training scenarios that closely mirror potential real-life situations. The pilot study focused on training of airway management and intubation for trauma incidents, based on a Trauma AR-VR simulator involving reserve paramedics of the National EMS service (Magen David Adom) who had not practiced for up to six years, activated during the Israel-Gaza conflict (October 2023). The trauma simulator merges the physical and virtual realms by utilizing a real manikin and instruments outfitted with sensors. This integration enables a precise one-to-one correspondence between the physical and virtual environments. Considering the importance of enhancing the preparedness of the reserve paramedics to support the prehospital system in Israel, the study aims to ascertain the impact of AR-VR Trauma simulator training on the modification of key perceptual attitudes such as self-efficacy, resilience, knowledge, and competency among reserve paramedics in Israel.</p><p><strong>Methods: </strong>A quantitative questionnaire was utilized to gauge the influence of AR-VR training on specific psychological and skill-based metrics, including self-efficacy, resilience, medical knowledge, professional competency, confidence in performing intubations, and the perceived quality of the training experience in this pilot study. The methodology entailed administering a pre-training questionnaire, delivering a targeted 30-minute AR-VR training session on airway management techniques, and collecting post-training data through a parallel questionnaire to measure the training's impact. Fifteen reserve paramedics were trained, with a response rate of 80% (n = 12) in both measurements.</p><p><strong>Results: </strong>Post-training evaluations indicated a significant uptick in all measured areas, with resilience (3.717±0.611 to 4.008±0.665) and intubation confidence (3.541±0.891 to 3.833±0.608) showing particularly robust gains. The high rating (4.438±0.419 on a scale of 5) of the training quality suggests positive response to the AR-VR integration for the enhancement of medical training, CONCLUSIONS: The application of AR-VR in the training of reserve paramedics demonstrates potential as a key tool for their swift mobilization and efficiency in crisis response. This is particularly valuable for training when quick deployment of personnel is necessary, training resources are diminished, and 'all hands on deck' is necessary.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"46"},"PeriodicalIF":3.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11395220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298398","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":"Shared decision-making in end-of-life care for end-stage renal disease patients: nephrologists' views and attitudes.","authors":"Wassiem Bassam Abu Hatoum, Daniel Sperling","doi":"10.1186/s13584-024-00632-w","DOIUrl":"https://doi.org/10.1186/s13584-024-00632-w","url":null,"abstract":"<p><strong>Background: </strong>The term end-stage renal disease (ESRD) refers to the final stage of chronic kidney disease. Not all ESRD patients are suitable for dialysis treatment, which despite its advantages, is not without risks. Shared nephrologist-patient decision-making could be beneficial at this stage, yet little is known about such practices in Israel. This study aimed at examining the practice of shared decision-making (SDM) between nephrologists and ESRD patients in Israel, while exploring related conflicts, ethical dilemmas, and considerations.</p><p><strong>Methods: </strong>The descriptive-quantitative approach applied in this study included a validated questionnaire for nephrologists, based on Emanual and Emanual (1992). The survey, which was distributed via social-media platforms and snowball sampling, was completed by 169 nephrologists. Data analysis included t-tests for independent samples, f-tests for analysis of variance, and t-tests and f-tests for independence. Descriptive analysis examined attitudes towards SDM in end-of-life care for ESRD patients.</p><p><strong>Results: </strong>The findings show that the research sample did not include nephrologists who typically act according to the paternalistic decision-making style. Rather, 53% of the respondents were found to act in line with the informative decision-making style, while 47% act according to the interpretive decision-making style. Almost 70% of all respondents reported their discussing quality-of-life with patients; 63.4% provide prognostic assessments; 61.5% inquire about the patient's desired place of death; 58.6% ask about advance directives or power-of-attorney; and 57.4% inquire about cultural and religious beliefs in end-of-life treatment. Additionally, informative nephrologists tend to promote the patients' autonomy over their health (P < 0.001); they are also in favor of conservative treatment, compared to paternalistic and interpretive nephrologists, and use less invasive methods than other nephrologists (P = 0.02).</p><p><strong>Conclusions: </strong>Nephrologists in Israel only partially pursue an SDM model, which has the potential to improve quality-of-care for ESRD patients and their families. SDM programs should be developed and implemented for increasing such practices among nephrologists, thereby expanding the possibilities for providing conservative care at end-of-life.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"45"},"PeriodicalIF":3.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11385125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298401","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":"Adverse health effects of exposure to plastic, microplastics and their additives: environmental, legal and policy implications for Israel.","authors":"Ilana Belmaker, Evelyn D Anca, Lisa P Rubin, Hadas Magen-Molho, Anna Miodovnik, Noam van der Hal","doi":"10.1186/s13584-024-00628-6","DOIUrl":"10.1186/s13584-024-00628-6","url":null,"abstract":"<p><strong>Background: </strong>Israel is a regional \"hotspot\" of plastic pollution, with little discussion of potential adverse health effects from exposure to plastic. This review aims to stimulate discussion and drive policy by focusing on these adverse health effects.</p><p><strong>Main body: </strong>Plastics are synthetic polymers containing additives which can leach from food- and beverage-contact plastic into our food and beverages, and from plastic textiles onto our skin. Plastics persist in the environment for generations, fragmenting into MNPs: Micro (1 micron-5 mm)-Nano (1 nm-1 micron)-Plastic, which contaminate our atmosphere, water, and food chain. MNP can enter the human body through ingestion, inhalation and touch. MNP < 10 microns can cross epithelial barriers in the respiratory and gastrointestinal systems, and fragments < 100 nm can cross intact skin, enabling entry into body tissues. MNP have been found in multiple organs of the human body. Patients with MNP in atheromas of carotid arteries have increased risk of a combined measure of stroke, cardiovascular disease, and death. Toxic additives to plastics include bisphenols, phthalates, and PFAS, endocrine-disrupting chemicals (EDCs) which cause dysregulation of thyroid function, reproduction, and metabolism, including increased risk of obesity, diabetes, endometriosis, cancer, and decreased fertility, sperm count and quality. Fetal exposure to EDCs is associated with increased rates of miscarriages, prematurity and low birth weight. There is likely no safe level of exposure to EDCs, with increasing evidence of trans-generational and epigenetic effects. There are several existing Israeli laws to reduce plastic use and waste. Taxes on single-use plastic (SUP) were recently cancelled. There are many gaps in regulatory standards for food-, beverage- and child- safe plastic. Existing standards are poorly enforced.</p><p><strong>Conclusion: </strong>Reduction in production and use of plastic, promotion of recycling and reduction of leaching of toxic additives into our food and beverages are essential policy goals. Specific recommendations: Periodic monitoring of MNP in bottled beverages, food, indoor air; Strengthen enforcement of standards for food-, beverage-, and child-safe plastic; Renew tax on SUPs; National ban on SUP at public beaches, nature reserves and parks; Ban products manufactured with MNP; Increase research on sources and health outcomes of exposure to MNP and EDCs.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"44"},"PeriodicalIF":3.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11385141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298397","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}