עמוד בית
Sun, 26.06.22

June 2021 ............................ (Issue 50)

Articles and Reviews
Reoot Cohen-Koren, MA, Dror Garbi, MA, Shirley Gordon, PhD, Nirit Yavnai, DMD, MPH, Yifat Erlich Shoham, MD, MHA, Leah Shelef, PhD
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Introduction: While participating in rescue missions, combat military flight engineers are exposed to the distressing sights, sounds, and smells of casualties. Such exposure increases their vulnerability to emotional distress, including PTSD. The aim of this cross-sectional study is to examine the link that seniority in service and exposure to casualties during rescue missions have to psychological distress.

Methods: The study was conducted among the helicopter squadrons in the Israeli Air Force. Five self-reported questionnaires were administered: post-traumatic stress symptoms (PCL), psychological distress (OQ45), Maslach Burnout Inventory (MBI), self-efficacy, and social support (MPSS). 112 flight engineers participated in the study, the vast majority of whom were male (99.1%). The average age was 39.32 (SD = 8.75). Half of the participants had been serving over 20 years as flight engineers, and a quarter had been serving between ten and nineteen years.

Results: The GLM analysis revealed that greater seniority and participation in fewer rescue missions that included exposure to fatalities (1-3) are predictors of post-traumatic symptoms. Seniority of 10-19 years of service and an exposure to fatalities (1-3 instances) during rescue missions were found to be predictors of psychological distress. Finally, while exposure to fatalities (1-3) predicted burnout, seniority was not found to be a predictor variable.

The participants in the present study did not report symptoms that met the
definition of post-traumatic stress disorder. Yet, there are two groups that require
specific attention, flight engineers who have been serving for 10-19 years and those
who have participated in 1-3 rescue missions that included exposure to fatalities.
Dorit Tzur, MSc, Ehud Levitin, MA, Shai Herzberger, MD, Sharon Ohayon-Cohen, MD, Yuval Ran, MD
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Background: The COVID-19 pandemic broke out in December 2019 and has been spreading all over the world since mid-February 2020. In the age of technology and digitization, the application of mathematical models of measures being implemented and monitoring morbidity is one of the most prominent measures implemented all over the world to predict, prepare for, and prevent morbidity and mortality.

Objective: To examine trends in COVID-19 morbidity in the IDF and build a model for predicting morbidity among soldiers.
Methods: Coronavirus morbidity data in Israel were collected daily from the Ministry of Health website and from the IDF. The prediction algorithm was based on the Neural Network model. The product of the model is the daily average prediction of the number of new COVID-19 cases in the IDF in the next 7 days. The average daily difference )in absolute value( between the prediction and the number of actual confirmed cases during the training period was 10, and during the test period – only 6.8.
Conclusions: Data indicate that the morbidity trend in the IDF is similar to the trend among
civilians, except in January 2021. It is possible the similarity of the trends can be
attributed to the fact that most IDF bases are “open bases”, thus soldiers and
civilians’ chances of exposure to the virus are similar. We believe that statistical
and mathematical models for predicting coronavirus morbidity can be developed
on the basis of machine learning methods, provided there is a sufficient learning
period of the trends.
Summary: We recommend continued investment in the development of statistical and
mathematical models for the study of morbidity in the IDF, to predict outbreaks
and unusual events
Leah Shelef, PhD, Ishai Nir, MD, Lucian Tatsa-Laur, MD, MBA, Niv Gold, MD, Ariel Ben Yehuda, MD
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Introduction: A study on the effectiveness of the IDF's suicide prevention program (SPP) that was published in 2016 has shown the hazard ratio for the SPP's exposure effect on time elapsed until death by suicide to be 0.476 (95% CI = 0.37-0.60, p <0.001). This finding culminates in a 47% reduction in the suicide rate. Other calculated variables showed that the most significant reduction was for Israel-born males, of high socioeconomic status, with high intelligence scores, who served in combat units. The current study's aim was to further investigate the SPP's effect over a wider range of years and to examine possible demographic changes in soldiers who died by suicide after its implementation.
Methods: The study was a nested case-control retrospective study based on data gathered from 1992 to 2016, which includes 1,462,882 soldiers who finished mandatory service and 491 soldiers who died by suicide. Those were divided into before and after SPP's implementation.
Results: Multivariate analysis showed demographic changes in those who died by suicide. Before the SPP's implementation, risk factors for suicidality were being male, serving in combat or combat support, Ethiopian origin, and Druze religion. The SPP caused a relative decrease in suicidality for males (compared to females), for combat support soldiers and for Druze soldiers. Ethiopian origin and psychiatric conditions, however, became more prominent as risk factors.
Conclusion: The SPP is generally effective, but it benefits some demographic sub-groups
more than others.
JIMM in English- Articles
Noam Protter, DMD, Yael Arbel, DMD, Tarif Bader, MD, Noam Fink, MD
The COVID-19 pandemic reached the Israel Defense Forces in the beginning of March 2020, and an urgent need to detect cases arose. Within a week, the IDF’s Medical Corps retrofitted its forensic laboratory to perform SARS-CoV-2 rt-PCR tests. Multiple sites were deployed to perform the tests, including a mobile unit that performed them at the bedside of non-ambulatory soldiers. This report will describethe process of this unique effort.
Gabriela Kleinerman, DVM, PhD, Sivan Melloul, DVM, Alon Abramovich, MD, Sagi Gavriel, PhD, Lavie Haim, DVM
Rickettsiosis is an important vector-borne infection of humans in Israel. In the IDF, an average incidence of 3.3 cases per 100,000 soldiers is reported annually (5.5 times higher than in civilians). We applied the "One Health" approach to address a murine typhus case in a reserve soldier who was infected during a field training, for: the purpose of risk assessment and determination of preventative measures for future Rickettsiosis infections. A multidisciplinary team from the IDF Medical Corps evaluated the area and collected ticks and fleas from the vegetation and a Meriones tristami gerbil. Out of the 21 ticks collected, one contained Rickettsia typhi-DNA, making this the first report of a Rhipicephalus sanguineus tick harboring typhus group Rickettsial DNA in Israel. None of the 15 fleas were infected. Due to the low prevalence of Rickettsia infection in the ticks and the fact that they were only found in a small area of the military base, it was decided to carry out training of recruits as planned and not implement pest control. Several measures were taken to prevent the occurrence of new cases of Rickettsiosis, such as: use of insect repellent, examination of the soldiers for presence of tick and flea bites at the end of the training, and antibiotic prophylactic antibiotic if arthropod bites were found.
The multidisciplinary approach used in this study resulted in a valuable exchange of capabilities, necessary for preventive science-based decision making concerning an area which is an important military training site and naturally protected.
Shlomi Ritz, DMD, Galit Almoznino, DMD, MSc MHA, MPH, Lee Slutzky Ritz, MD, Noam Protter, DMD
The outbreak of the COVID-19 pandemic caused changes in all aspects of daily life, including adjustments in dental work. The COVID-19 vaccine was rapidly approved, provoking hesitations among the general public as well as dental staff. The aim of this study is to assess the views and beliefs of IDF dental staff regarding COVID-19 and its vaccine
Methods: A questionnaire was sent to all IDF dental staff during the first week of January 2021. 219 participants replied. The questionnaire consisted of both demographic data and Likert scale phrases.
Results: General dental practitioners, dental specialists, dental hygienists, and dental assistants responded. Men were vaccinated at a higher rate than women, this is possibly explained by the finding that women were more concerned about the vaccine’s safety in terms of future fertility. The younger population was more apprehensive about short and long-term effects of the vaccine. Dental assistants and hygienists showed greater concerns regarding the safety of the vaccine and felt that dental activity should be limited to emergency treatment.
Discussion: The main difference in vaccination rates observed between groups can be attributed to concerns about future fertility and age differences. In addition, it may be associated with the responders’ education and exposure to media publications.
Limitations: Responders from the younger age groups, as well as women, consisted mostly of dental assistants and hygienists, which may be a confounding factor.
Conclusions: This study shows a difference in attitudes towards the COVID- 19vaccine and its safety, as well as compliance with vaccination among IDF dental staff. In addition, the study emphasizesthe importance of addressing younger crowds in the proper manner in order toimprove vaccination compliance.
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