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עמוד בית
Wed, 29.05.24

March 2021 (Issue 49)

Articles & Reviews
Shachar Shapira, MD, MHA, MA, Eva Avramovich, MD, MPH, Ilana Gens
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This article reviews the existing data and experience regarding health promotion.
We describe different approaches and strategies in both the civilian and the
military system.
Health promotion is the field of disease prevention and well-being improvement.
This new definition represents an ancient approach that was mentioned by
Hippocrates and integrated in the health principles of the Rambam. It consists of
three levels of disease prevention: primary prevention which mitigates risk factors,
secondary prevention by early disease detection, and tertiary prevention which is
centered around the reduction of complications.
To better gauge the preferred health promotion strategy, we reviewed the actions
taken by several countries and foreign militaries, which in some cases can be
viewed as excessive or inappropriate.
Despite significant developments, in the IDF as well as Israel at large, the
breakthrough that can result in a conceptual change has yet to occur. A holistic
approach, higher level of primary prevention, establishment of research database
and effective influence by commanders are all needed to create real change.
Utilizing a strategic model for health promotion is the key element. Linking health
promotion with improved operators’ capabilities, utilizing the opportunity created
by the COVID-19 pandemic as a disease that highlights the importance of health
maintenance and improvement, and the increased influence of caregivers in
their units – all are contributing factors that create improved conditions for the
advancement of health promotion, and thus for fulfilling the moral and professional
obligation of the IDF Medical Corps.

Keywords: Health Promotion, Prevention, Policy, Public Health
Amir Lipman, MA, Leah Shelef, PhD, Shirley Gordon, PhD, Shachar Shapira, MD, MHA, MA, Dror Garbi, MA
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Introduction: In many units in the Israel Defense Forces (IDF), soldiers are required
by their position to maintain the secrecy of certain classified information. This
study aimed to examine the association between personality traits and mental
distress following exposure to classified information.
Methods: The study population included 27 male soldiers in active service in
a classified Air Force unit, who by the nature of their position are required to
maintain secrecy. The study examined personality traits using the NEO Personality
Inventory-Revised questionnaire (NEO PI-R). Mental distress was assessed using
the State-Trait Anxiety Inventory for anxiety, the Beck Depression Inventory for
depression, the Mental Health Inventory (MHI) for general well-being, and the
Patient Health Questionnaire for somatization. An additional questionnaire, which
was created specifically for the present study and examines the distress and
discomfort of keeping the secrecy of classified information, was also used.
Results: Findings show that after the secret-keeping requirement was imposed
on participants, the lower the levels of a participant’s NEO PI-R facets of
“conscientiousness” and “agreeableness”, the worse the mood he reported. The
soldiers with low levels of these facets were also more preoccupied with the
idea of knowing the secret and the obligation to keep it to themselves. Additional
findings demonstrated that the more introverted an individual, the more difficulty
he experiences in keeping the secret from friends and family who are not privy to
it. In mandatory polygraph tests administered routinely to these soldiers, it was
revealed that the more neurotic the soldier’s personality, the more he fears the
polygraph tests. Similarly, the higher the level of neuroticism, the more difficult it
is to keep the secret. Finally, it was found that the lower the level of the “openness
to experience” facet, the stronger the sense of loneliness.
This study found an association in soldiers between personality traits, distress,
and the requirement to maintain a secret. Additionally, an association was found
between secret-keeping and symptoms of distress, anxiety and depression.
Limitations – the small sample size and the invalidity of the questionnaire on
distress and discomfort of keeping the secrecy of classified information, limited
the establishment of causal relationships.

Keywords: classified information, secret, soldiers, depression, anxiety, personality traits.
Leah Shelef, PhD, Elad Kimchi, MD, Ayala Haker, PhD
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Background: Previous suicide attempts significantly amplify the risk of suicide.
Early detection of suicide risk may save lives.
Objective: Presentation of the characteristics of the suicidal soldier in the Air Force
in comparison with the rest of the IDF.
Methods: Sociodemographic, psychological, and military variables were compared
based on three descriptive surveys conducted in the Israeli Air Force (IAF).
Results: Regarding suicide, between 2002 and 2012, 27 IAF soldiers committed
suicide (81% male). The cases were evenly distributed throughout the three years
of an individual’s military service. Military mental health services had treated 37%
of all IAF suicides in the studied years. There were no suicides among pilots.
As for suicide attempts, in 2005-2006, 117 soldiers were found to have injured
themselves, 65% of whom were male. The average point in time when the injuries
occurred was 11 months into the service. Among soldiers who injured themselves,
46% worked in various army administration jobs and 18% were in different stages
of training (apprenticeship + courses). Of the participants, 45% did not seek mental
health services in their units. For 81% of the soldiers who self-injured, their selfinjury
was the first such occurrence. The purpose of the self-injury was to express
distress and a need for attention. In the years mentioned above, there were no
known suicide attempts by pilots.
Conclusions and Recommendations:
In the IDF, despite the differences between the branches in terms of service, military
designation, and profession, no differences were found in the characteristics of
soldiers committing or attempting to commit suicide in the Air Force compared
to the other branches. Although not conclusively proven, it emphasizes the need
to construct the profile of a suicidal soldier in the Air Force compared to soldiers
from other branches, especially in terms of the stage of their service in which the
suicide or suicide attempt occurred. These differences, if there are any, may have a
critical impact on the focus of suicide prevention efforts.

Keywords: suicides, military service, soldiers, pilots.
Michael Solomonov, DMD, Dan Henry Levy, DMD MSc, Gabriel Batashvili, DMD, Liran Levin, DMD, FRCD(C), FIADT, FICD, Yehuda Zadik, DMD, MHA
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Traumatic dental injuries (TDIs) are common in the military population, among
both combatants and non-combatant soldiers. In cases of TDI, and especially in
the case of tooth avulsion, proper and prompt initial treatment is crucial to the
prognosis of the tooth, in addition to the patient's comfort. This article presents
military health care providers with the updated guidelines of the International
Association of Dental Traumatology for the initial treatment of cases of TDI,
with an emphasis on emergency treatment in case of dental avulsion.

Keywords: dental trauma, military dentistry, military medicine.
Eyal Fruchter, MD
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Suicide is a preventable death. Suicide is one of the leading causes of death in
armies, and is correlated with aspects such as gender (it is more common among
men), young age, traumatic experiences and stressful situations. Suicide prevention
is possible and must include multi-dimensional approaches, which are key in
lowering the suicide rate. Lessons learned from past American Air Force studies
emphasize the need for continuous activity and updates of these programs in order
to keep them "fresh".
The IDF suicide prevention program is now in its 11th year with a proven success of
lowering the suicide rate by 57% in comparison to the years before the program was
launched. Like all good programs, it requires continuous learning and updating. The
article presented in this journal, "Suicides and Suicide Attempts Among Soldiers
and Pilots in the Air Force", is an effort to advance this cause, focusing on specific
demographics in terms of their psychological, social and military aspects.

Keywords: suicide, soldiers, suicide prevention.
Pavel Kotlarsky, MD, Karina Dorfman, MD, Elad Apt, MD, Ido Stahl, MD, Edward Kalif, MD, Yaniv Keren, MD
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Background: Fractures of finger phalanges are the most common injury to the
skeletal system. There is a wide variability of injury patterns and digit involvement.
This variability might be explained by the different mechanisms of injury, which
are related to the occupation and age of the patients in each study population.
Self-inflicted injuries have been observed in armed forces personnel worldwide,
motivated by secondary gain and malingering.
Objective: This study was designed to characterize phalangeal fractures among
Israeli conscripts.
Materials and Methods: We conducted a retrospective analysis of adult patients
who were admitted to our Emergency Department (ED) with isolated hand digital
injuries in 2012-2013. A descriptive analysis of the data collected from case files
was performed.
Results: 1028 patients were admitted to the ED due to digital injury, 45.7% of whom
were conscripts. 92.6% suffered from a single finger injury. Out of all single finger
injuries, the 5th finger was found to be the most common (61% among conscripts
vs. 18% among civilians). Among soldiers, 43% of the injuries occurred due to
an external object and 40% due to a slammed door (among civilians, 63% and
17% respectively). Sunday admissions were the most frequent among military
personnel and accounted for 25.7% of all admissions, compared to only 14.8% in
the civilian population.
Conclusions: Conscripts and civilians have different patterns of finger injury.
Conscripts have significantly higher incidence of 5th finger injury, left hand side
involvement, injuries during the weekend, nighttime admissions and a history of
hands being slammed by doors. The high incidence of injuries in conscripts while
off duty raises the suspicion of self-inflicted injury.

Keywords :finger fractures, self-inflicted injury, soldiers, fractures, malingering.
Tomer Talmy, MD
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Full Text Online

Large-scale administration of a safe and effective COVID-19 vaccine is imperative
for changing the trajectory of the pandemic. Public acceptance of a vaccine
is a key determinant of our ability to reach the herd immunity threshold. An
anonymous, web-based survey was administered to soldiers in an Israel Defense
Forces (IDF) special forces unit. Of 318 respondents, 199 (62.6%) responded “Yes”,
72 (22.6%) responded “No” and 47 (14.8%) responded “Unsure” to the question of
whether they intend to receive the vaccine. Combat service was found to have a
significant correlation with the above responses. Reasons for concern centered
around the safety profile of the vaccine. Advocacy measures aiming to dispel
misinformation and better inform the military population along with the general
public are crucial for attaining maximum acceptance of COVID-19 vaccines.

Keywords: COVID-19, SARSCoV-2, vaccine survey, military.
Amit Rimon Yuval Haviv
The stigma associated with mental illness and seeking help for this distress in the military. Evidence was examined
On the public stigma regarding mental disorders. They identified that in general the public holds
Negative stereotypes about people with psychological problems, which leads to potential discrimination
Towards them. Internalizing these social norms leads to self-stigma, to low self-esteem
And a decrease in motivation to seek help. Even if soldiers want to ask for help in the face of psychological difficulties,
Obstacles to mental health care may prevent them from seeking the help they need. This list is suggested
A comprehensive model that illustrates how the stigma surrounding mental health problems may prevent soldiers from receiving help.
Also, a number of possible interventions to reduce the stigmas in the military are proposed here.
Amit RImon Yuval Haviv
The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States
United States. Papillomavirus is involved in 99% of cervical cancers and in 90%
From cases of rectal cancer in men and women (about 60 diagnoses per year in Israel
In addition, after infection, the virus may be involved in genital warts. this
A disease that affects 20,000 sexually active adults at any given time .
The Center for Disease Control, which advises on vaccine issues (ACIP), has recognized the potential benefits
Existing in the vaccine young men between the ages of 11 or 12 to 21 years of age. Maximum age for vaccination
Extended to age 26 for men having sex with men and transgender people in countries
United. In Israel, the 9GADSIL vaccine is recommended for women and men aged 26-9.
Despite these recommendations, vaccination of young men is currently limited by variables
Many, which concern both patients and medical staff. The authors requested
Draw these variables, as far as the U.S. Air Force is concerned, with a view
To guide future interventions.
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