Paula Feder-Bubis

Punctuated Equilibrium and Path Dependency in Coexistence: The Israeli Health System and Theories of Change

Israels enactment of national health insurance was clearly a breakthrough. However, other aspects of reform that were supposed to be implemented simultaneously were stymied, in particular, the conversion of government hospitals to independent trusts and removing the Ministry of Health from the direct provision of services such as mental health and long-term care. This article explores how punctuated equilibrium and path dependency coexist in the Israeli case. In doing so, it examines the relevance of concepts provided by various theories of social and institutional change. Aside from path dependency and punctuated equilibrium, we discuss other notions derived from related theories, such as political leadership and the role of ideas. Applying these theories to the Israeli case helps better understand the coexistence of punctuated equilibrium and path dependency.

Laypersons' views of material incentives for enhancing colorectal cancer screening†

Colorectal cancer (CRC) early detection improves health outcomes; screening programmes invest efforts in initiating invitations to target populations to be tested. Enhanced adherence is essential for reduction of morbidity and mortality. Participation rates in Israel are still relatively low.

Emergency situations and deaf people in Israel: Communication obstacles and recommendations

The absence of the ability to hear sounds in deaf people is an obstacle to optimal communication in a predominantly hearing world. Emergency situations harbor sufficient challenge for the hearing person and pose even greater barriers for the deaf and hard of hearing. During disasters and emergency situations, deaf people have great difficulty in obtaining and sharing information, increasing their dependence on others. This article focuses on the experience of deaf people during a period of security threat, when missiles from the Gaza strip were aimed at the civilian population in Southern Israel, in 2009. The aim of this article is to illustrate the complexities that deaf citizens experienced, and describe their coping mechanisms. A qualitative study including 15 heterogeneous-background Deaf participants interviewed by a researcher that belongs to the deaf community using a multiple-method facilitated questionnaire. Data was analyzed using grounded theory methodology principles. Main categories that arose from data analysis were communication problems during emergencies, the pager as a questionable warning device about emergencies (due to timing and content/context issues of its use), and the implications of the location of deaf people at time of emergency. Various channels for conveying information should be examined and created in order to maximize the heterogeneous deaf communitys ability to receive vital information during an emergency. Professional sign language interpreters are necessary during emergencies, helping to reduce both dependence on informal sources (such as family members, including minors, friends, neighbors, by-standers) and risk. The development of new technologies may bear potential help for deaf persons during emergencies. Being a socio-linguistic minority, it is recommended to ensure these technologies will be accessible to the whole deaf community.

Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis.

Background Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. Objective This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.

Religious Leaders’ Opinions and Guidance Towards Oral Health Maintenance and Promotion: A Qualitative Study

Religions emphasize the supreme value of life. However, potential or concrete conflicts of perception between dictates of faith and science often present an inescapable dilemma. The aim of this qualitative research was to examine the views of spiritual and religious leaders towards general and oral health issues. A total of 11 eminent Jewish spiritual and religious community leaders were purposively chosen. They were interviewed using a semi-structured questionnaire. The verbatim transcriptions of the interviews were analysed in the spirit of grounded theory, using qualitative data analysis software. Open, axial, and thematic coding served to build categories and themes. Analysis of participants’ perspectives reflected that they, based upon Jewish theology, attributed high importance to primary prevention at both personal and community levels. Religious and orthodox people were depicted as being motivated towards maintaining oral health behaviours due to a sense of obligation to follow religious edicts, strong social support, and elevated perceived spiritual levels. We offer a theoretical model that can explain the potential high motivation among these communities towards implementing positive general and oral health behaviours. Religiosity may be regarded as an example of a psycho-social health determinant, encompassing spiritual belief (“psycho”) and social support (“social”) components.

The health of deaf people

2238 www.thelancet.com Vol 379 June 16, 2012 3 Untch M, Fasching PA, Konecny GE, et al. Pathologic complete response after neoadjuvant chemotherapy plus trastuzumab predicts favorable survival in human epidermal growth factor receptor 2–overexpressing breast cancer: results from the TECHNO trial of the AGO and GBG study groups. J Clin Oncol 2011; 29: 3351–57. 4 Guiu S, Gauthier M, Coudert B, et al. Pathological complete response and survival according to the level of HER-2 amplifi cation after trastuzumabbased neoadjuvant therapy for breast cancer. Br J Cancer 2010; 103: 1335–42. 5 Dowsett M, Procter M, McCaskill-Stevens W, et al. Disease-free survival according to degree of HER2 amplifi cation for patients treated with adjuvant chemotherapy with or without 1 year of trastuzumab: the HERA trial. J Clin Oncol 2009; 27: 2962–69. Authors’ reply In reply to Tetsuji Fujita, the incidence and prognostic eff ect of pathological complete response does vary between the diff erent intrinsic subtypes of breast cancer. In HER2positive breast cancer, two large randomised studies have shown that pathological complete response correlates with disease-free survival in patients treated with anti-HER2 therapy. Additional information is expected from the NeoALTTO study once the disease-free survival data become available. On the other hand, the NASBP B27 study included a global breast cancer population, so its fi ndings might not apply specifi cally to HER2-positive breast cancer. The mentioned correlation between levels of HER2 amplifi cation and pathological complete response, although interesting, is from a small retrospective sample without a validated HER2 amplifi cation cutoff . In the HERA trial of adjuvant trastuzumab, there was no diff erence in trastuzumab benefi t according to either copy number or HER2 ratio in 3401 patients. In summary, we maintain our belief that pathological complete response is likely to be an early indicator of benefi t of HER2targeted agents in neoadjuvant studies. Katya Brede-Hekimian addresses some issues similar to those of Fujita. Additionally, the reason why some tumours relapse after a pathological complete response is achieved might be explained on the basis of as yet unknown biological determinants of metastasis, the presence of a high systemic tumour burden before the start of therapy, tumour heterogeneity, and the existence of local host conditions that might favour the regrowth of tumours in certain metastatic niches. The observation that the higher pathological com plete response rate seen in the combination group did not result in a higher rate of breastconserving surgery deserves careful analysis. At fi rst glance, even in patients with a complete radiological response, the proportion of patients that underwent a mastectomy was high. We are currently analysing the reasons for this apparent discordancy and we do not believe that it is related to patients’ preferences alone. Finally, we agree that the patients who do not achieve a pathological complete response have a worse prognosis and that the potential implications of the lack of such a response have to be explained to all patients who receive neoadjuvant therapy, taking into consideration the tumour subtype, the administered therapy, the duration of therapy, and the planned postoperative (adjuvant) therapy. Additionally, the launch of clinical studies with novel antiHER2 treatments is currently being considered in patients with HER2positive tumours who do not achieve a pathological complete response with conventional anti-HER2 therapy.

New sign language new(S): the globalization of sign language in the smartphone era

Abstract Languages are dynamic and change over the years. Changes in sign languages have been usually initiated to accommodate the needs of the local Deaf community. With the increase in smartphone use, sign languages are influenced not only by the local Deaf community, but also by foreign Deaf people on the other side of the screen, regardless of their location. Smartphones influence the sign language itself and the Deaf community by connecting different communities of Deaf people through messages, shared information and experiences, and news delivery. The popularity of this technology among Deaf communities is a social phenomenon emerging from Deaf people themselves. Smartphones may promote the globalization of sign language, shortening distances between Deaf communities around the world.

Lessons learned from the 2009–2010 H1N1 outbreak for the management of the 2013 silent polio outbreak

BackgroundThe Israeli Ministry of Health (MoH) encountered two substantial outbreaks during the past decade: the H1N1 swine flu outbreak during 2009–2010 and the silent polio outbreak during 2013. Although both outbreaks share several similar characteristics, the functioning of the Israeli MoH was different for each case. The aim of this study was to identify factors that contributed to the change in the MoH response to the polio outbreak in light of the previous 2009–2010 H1N1 outbreak.MethodsWe conducted a qualitative research using semi-structured interviews with 18 Israeli policymakers from the MoH, relevant specialists and politicians. Each interview was transcribed and a thematic analysis was conducted independently by two researchers.ResultsThree main themes were found in the interview analysis, which reflect major differences in the MoH management policy during the polio outbreak. 1) clinical and epidemiological differences between the two disease courses, 2) differences in the functioning of the MoH during the outbreaks, 3) differences in the risk communication strategies used to reach out to the local health community and the general public. Most interviewees felt that the experience of the 2009–2010 H1N1 outbreak which was perceived as unsuccessful, fueled the MoH engagement and proactiveness in the later polio outbreak.ConclusionThese findings highlight the importance of learning processes within health care organizations during outbreaks and may contribute to better performance and higher immunization rates.