1
|
Abu-Quider A, Asleh M. Ethnic and socioeconomic disparities in survival of children and adolescents with CNS tumors in Southern Israel. Neurooncol Pract 2022; 9:441-448. [DOI: 10.1093/nop/npac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study sought to evaluate survival of pediatric and adolescent patients with central nervous system (CNS) cancer in southern Israel, outline disparities between ethnic and socioeconomic groups (Bedouin Arabs compared to Jews) and evaluate the role of socioeconomic status (SES) in ethnic disparities.
Methods
A retrospective study was conducted among 91 patients aged one to 20 years, who were diagnosed with CNS tumors between 2001 and 2017, and followed-up through 2020. Ethnic differences in survival were measured by age, sex, stage, histology and SES. One and 3-year survival rates were calculated. Multivariable regression analysis was used to estimate adjusted ethnic differences in survival rates.
Results
Ethnic differences in survival existed within all studied variables. All Bedouin patients lived in low SES settlements (All Bedouin settlement in Southern Israel are ranked in lower socioeconomic deciles). Twenty-eight patients had medulloblastoma. Seven (25%) presented with leptomeningeal disease or distant metastases. Medulloblastoma molecular subgroups were not assessed for logistic reasons. Three-year overall survival of Bedouins was 50% compared to 92.3% for Jews. Adjusted risk of death at 3 years was significantly higher for Bedouin patients (aHR 3.36, 95% CI 1.41–7.98, P = .006).
Conclusions
We conclude that Bedouin children with CNS tumors have significantly lower survival rates compared to Jewish children, and SES seems to play a major part in these disparities. Factors influencing these disparities should be addressed and public health interventions to eliminate these disparities should be developed.
Collapse
Affiliation(s)
- Abed Abu-Quider
- Pediatric Hemato-Oncology Department, Saban Pediatric Medical Center, Soroka University Medical Center , Israel
| | - Mahdi Asleh
- Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| |
Collapse
|
2
|
Rotenberg DK, Stewart-Freedman B, Søgaard J, Vinker S, Lahad A, Søndergaard J. Similarities and differences between two well-performing healthcare systems: a comparison between the Israeli and the Danish healthcare systems. Isr J Health Policy Res 2022; 11:14. [PMID: 35227304 PMCID: PMC8883018 DOI: 10.1186/s13584-022-00524-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/16/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Denmark and Israel both have highly rated and well-performing healthcare systems with marked differences in funding and organization of primary healthcare. Although better population health outcomes are seen in Israel, Denmark has a substantially higher healthcare expenditure. This has caused Danish policy makers to take an interest in Israeli community care organization. Consequently, we aim to provide a more detailed insight into differences between the two countries’ healthcare organization and cost, as well as health outcomes.
Methods
A comparative analysis combining data from OECD, WHO, and official sources. World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) statistics were used, and national official sources were procured from the two healthcare systems. Literature searches were performed in areas relevant to expenditure and outcome. Data were compared on health care expenditure and selected outcome measures. Expenditure was presented as purchasing power parity and as percentage of gross domestic product, both with and without adjustment for population age, and both including and excluding long-term care expenditure.
Results
Denmark’s healthcare expenditure is higher than Israel’s. However, corrected for age and long-term care the difference diminishes. Life expectancy is lower in Denmark than in Israel, and Israel has a significantly better outcome regarding cancer as well as a lower number of Years of Potential Life Lost. Israelis have a healthier lifestyle, in particular a much lower alcohol consumption.
Conclusion
Attempting to correct for what we deemed to be the most important influencing factors, age and different inclusions of long-term care costs, the Israeli healthcare system still seems to be 25% less expensive, compared to the Danish one, and with better health outcomes. This is not necessarily a function of the Israeli healthcare system but may to a great extent be explained by cultural factors, mainly a much lower Israeli alcohol consumption.
Collapse
|
3
|
Kalfon L, Baydany M, Samra N, Heno N, Segal Z, Eran A, Yulevich A, Fellig Y, Mandel H, Falik-Zaccai TC. Congenital Hypotonia: Cracking a SAGA of consanguineous kindred harboring four genetic variants. Mol Genet Genomic Med 2021; 10:e1849. [PMID: 34970863 PMCID: PMC8801141 DOI: 10.1002/mgg3.1849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We aimed to determine the molecular and biochemical basis of an extended highly consanguineous family with multiple children presenting severe congenital hypotonia. METHODS Clinical investigations, homozygosity mapping, linkage analyses and whole exome sequencing, were performed. mRNA and protein levels were determined. Population screening was followed. RESULTS We have identified a novel nonsense variant in NGLY1 in two affected siblings, and compound heterozygosity for three novel RYR1 variants in two affected sisters from another nuclear family within the broad pedigree. Population screening revealed a high prevalence of carriers for both diseases. The genetic variants were proven to be pathogenic, as demonstrated by western blot analyses. CONCLUSIONS Revealing the genetic diagnosis enabled us to provide credible genetic counselling and pre-natal diagnosis to the extended family and genetic screening for this high-risk population. Whole exome/genome sequencing should be the first tier tool for accurate determination of the genetic basis of congenital hypotonia. Two different genetic disorders within a large consanguineous pedigree should be always considered.
Collapse
Affiliation(s)
- Limor Kalfon
- Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| | - Meirav Baydany
- Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar Ilan, Safed, Israel
| | - Nadra Samra
- Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar Ilan, Safed, Israel
| | - Nawaf Heno
- Department of Pediatrics, Galilee Medical Center, Nahariya, Israel
| | - Zvi Segal
- Department of Ophthalmology, Galilee Medical Center, Nahariya, Israel
| | - Ayelet Eran
- Neuroradiology, Rambam Health Care Campus, and Technion Faculty of Medicine, Haifa, Israel
| | - Alon Yulevich
- Department of Pediatric Surgery, Galilee Medical Center, Nahariya, Israel
| | - Yakov Fellig
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hanna Mandel
- Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| | - Tzipora C Falik-Zaccai
- Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar Ilan, Safed, Israel
| |
Collapse
|
4
|
Bittles AH. Population structure and inherited genetic disorders in the Bedouin of the Negev. J Community Genet 2019; 11:11-12. [PMID: 31346959 DOI: 10.1007/s12687-019-00432-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- A H Bittles
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6027, Australia. .,Centre for Comparative Genomics, Murdoch University, Perth, WA, 6051, Australia.
| |
Collapse
|
5
|
Reis S, Glick SM, Urkin J, Gilbey P. The medical education system in Israel. Lancet 2017; 389:2570-2574. [PMID: 28495113 DOI: 10.1016/s0140-6736(17)30822-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Shmuel Reis
- The Center for Medical Education, The Hebrew University Hadassah Medical School, Jeruslem, Israel
| | - Shimon M Glick
- Moshe Prywes Center for Medical Education, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Soroka University Medical Center, Beer Sheva, Israel.
| | - Jacob Urkin
- Moshe Prywes Center for Medical Education, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Peter Gilbey
- Bar Ilan University Faculty of Medicine in the Galilee, Safed, Israel
| |
Collapse
|
6
|
Rubin L, Belmaker I, Somekh E, Urkin J, Rudolf M, Honovich M, Bilenko N, Grossman Z. Maternal and child health in Israel: building lives. Lancet 2017; 389:2514-2530. [PMID: 28495101 DOI: 10.1016/s0140-6736(17)30929-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 01/12/2023]
Abstract
Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development. Israel has already exceeded the developed regions' Sustainable Development Goal 2030 targets for maternal mortality, neonatal mortality, and mortality in children younger than 5 years in all population groups. Yet these accomplishments are marred by Israel's high prevalence of child poverty (more than 30%), particularly among Arabs (63%) and ultra-Orthodox Jews (67%). Although infant mortality has improved in all subpopulations since Israel was founded in 1948, infant mortality among Arabs is still more than twice as high as among Jews. To address these disparities in health, the Israeli Ministry of Health has created a special division and has funded an intervention programme to reduce the infant mortality among Bedouin Arabs. Other interventions include targeted and culturally appropriate health-care programmes and services for communities with a high number of at-risk children and young adults, dental health service for all children up to 15 years, and improved collaboration between health, education, and welfare services. The challenges faced by the Israeli health-care system include a growing trend towards medicalisation of prenatal care, ensuring staff are trained to treat developmental, behavioural, and psychosocial issues in children and their families, securing sustainable funding for health promotion and injury prevention programmes, expanding and improving the coordination of services for children with special needs or who are at risk, and programme assessment. Ensuring adequate funding for dedicated, preventive paediatric care and taking action on a nationwide scale to reduce child poverty are essential for maintaining health gains in children. In this Series paper, we describe the health indices, highlight disparities, and discuss the challenges in delivering and maintaining maternal and child health care in Israel.
Collapse
Affiliation(s)
- Lisa Rubin
- Department of Maternal and Child Health, Public Health Service, Ministry of Health, Jerusalem, Israel; School of Public Health, University of Haifa, Haifa, Israel.
| | - Ilana Belmaker
- Division of Health in the Community, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eli Somekh
- Wolfson Medical Center, Holon, Israel; Tel Aviv University School of Medicine, Tel Aviv, Israel; Israel Pediatric Association, Tel Aviv, Israel; European Paediatric Association-Union of National European Paediatric Societies and Associations, Berlin, Germany
| | - Jacob Urkin
- Division of Health in the Community, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Mary Rudolf
- Department of Population Health, Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel; Department of Paediatrics and Child Health, University of Leeds, Leeds, UK
| | - Mira Honovich
- Department of Maternal and Child Health, Public Health Service, Ministry of Health, Jerusalem, Israel
| | - Natalya Bilenko
- Sub District Health Office, Ashkelon District, Ministry of Health, Ashkelon, Israel; Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Zachi Grossman
- Maccabi Health Services, Tel Aviv, Israel; Israel Pediatric Association, Tel Aviv, Israel; Israel Pediatric Research in Office Setting Network, Tel Aviv, Israel
| |
Collapse
|