עמוד בית
Sun, 26.06.22

June 2020 - Corona II ...................... (Issue 46)


Introduction
Chief Editor - Prof. Adi Leiba
Articles
Shirley Gordon, Dror Garbi, Shahar Ben Bassat, Shachar Shapira, Leah Shelef
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Background: Waiting for the results of the COVID-19 test forces upon a person the realization that they may be ill and die as a result. This kind of thought is usually absent from daily life. The uncertainty involved with waiting for the COVID-19 test results usually causes concern, which in some people may result in significant anxiety. The purpose of the present survey was to examine the level of emotional distress among Air Force members waiting for the COVID-19 test results.

Method: The source of the data used in this survey was the Aero-Medical COVID-19 center’s database. Participation in the survey was on volunteer basis. Each participant received an online questionnaire that included questions on the following topics: type of isolation prior to being tested (i.e. home, in the military unit, in a military inpatient facility and a group tested for silent carriers of the virus), COVID-19 clarification status (i.e. awaiting testing, tested, etc.), self-evaluation health questionnaire, level of mental distress, and fear category. In addition, the survey included the Generalized Anxiety Disorder (GAD) questionnaire.

Results: The survey included 284 participants, 62% (176) of whom were male and 42% (119) were career soldiers. The age range was 18.0 – 50.0 years (m=24.3; SD 7.61). Regarding testing, 45.8% (130) of the participants had been tested already and were found negative for Covid 19. More than 50% were still waiting for testing or for test results. The degree of distress of the group that was isolated at home was high compared to the group isolated in the military medical facility. However, the highest level of distress was observed in a group that was not isolated (a group tested for silent carriers of the virus). The level of distress and anxiety among women was higher compared to men. The level of distress was also found to be higher among soldiers in compulsory service than among career soldiers and among the enlisted soldiers compared to officers. Finally, administrators and technical officers demonstrated higher levels of anxiety and distress compared to the combat soldiers.

Discussion and Conclusions: The findings indicate that the isolation environment provided in the military facility seems to have had a beneficial effect on the soldiers’ mental state, as compared to home isolation. This surprising effect may be due to the fact that isolation at a military facility removes the fear of infecting one’s family members. If there will be a second wave the benefits of home isolation should be considered. The high level of distress found among women and compulsory service soldiers is supported by the latest research findings in Israel and around the world. The combination of a number of stressors like military job, marital and financial status, etc., may increase the likelihood of distress. These populations should, therefore, be monitored proactively by medical and mental health professionals while awaiting test results.

Keywords: COVID-19; Mental health officers; Military; Stress.
Meital Abadi, Harry Chweidan, Stav Bekker, Avi Shemesh, Ma'ayan Paz, Dana Bloch, Lev Vinogradsky, Noam Protter
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Background: The COVID-19 virus, which first appeared in December 2019, was declared a global emergency. Health care workers and dentistry staff are at high risk of exposure to the SARS-CoV-2 due to the characteristics of their profession. Therefore, in order to reduce the spread of the disease, various restrictions were published, including a directive prohibiting elective dental treatment and providing dental emergency treatments only.

Objective: The first aim of the study was to examine the compliance of dental clinics in the Israel Defense Forces (IDF) dental unit to published protocols. The second purpose of the study was to examine whether there is a correlation between the professional seniority and level of expertise, to the level of knowledge among the dentists regarding the virus and the disease, and whether this impacted the clinical decision making by the dentists.

Methods: The study was based on a digital questionnaire sent to 150 dentists in the IDF dental unit. The questionnaire collected information regarding their level of expertise, Seniority in the profession, knowledge of the COVID-19 pandemic, the compliance to the protocols published by the IDF dental unit regarding clinical procedures and decision making in theoretical clinical cases. After the data collection, the correlation between level of expertise, level of knowledge about the virus and disease and clinical decision-making was examined.

Results: A total of 111 dentists responded to the questionnaire (74% compliance). It was found that the absolute majority of respondents comply with the published protocols. A negative correlation between professional seniority among general practitioners and level of knowledge regarding the COVID-19 pandemic was found, and a positive correlation between the level of expertise and the level of knowledge regarding the pandemic was found. As for clinical decision making in the various cases presented, it was found that as knowledge about the pandemic increased, better clinical decisions are made.

Conclusions: The mechanism of disseminating protocols to the dentistry system should be done directly and in various forms of media while monitoring in order to verify compliance with the implementation of the protocols.
In addition, increasing knowledge among dentists is essential for ensuring proper clinical decision making while reducing the spreading of the virus among caregivers and patients.

Keywords: COVID-19 epidemic; Dentist; Clinical decision making.
Dan Nemet, Felix Lotan, Diana Vinitsky–Hertzog, Olga Polyakov
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Background: Major urban search and rescue disasters ose a significant medical challenge due to the nature of injuries, the diverse populations involved, the limitations of the treatment capability and the continuous danger. The Israeli National Rescue Unit (INRU) of the Home Front Command (HFC) participated in many disaster events in Israel and abroad and gained extensive experience in the medical treatment at destruction sites. In recent years, the HFC has been cooperating with international rescue units, including the US National Guard. The need to internationally share knowledge and training led to a joint search and rescue medicine course.

Objective: To evaluate the first international search and rescue medicine course, led by HFC, in the United States.

Methods: Retrospective research, based on feedback questionnaires on the medical and training aspects of the course.

Results: 21 First responders participated in the course. The course led to a significant improvement in a search and rescue medicine knowledge test (pretest 72, posttest 83, p=0.0048). The training contributed significantly to improvement of knowledge and ability to treat the injured in destruction scenarios. The trainees reported that the course training had improved their skills (21/21), it matched their level of knowledge (21/21) and that an improvement was achieved in performing skills, medical procedures and in team work on the destruction site.

Conclusions: The international Search and Rescue Medicine course improved the knowledge, skills, and treatment capabilities of trained medical teams. The course may serve as the basis for international training collaboration and improve international cooperation in the catastrophic events.

Keywords: Search and rescue medicine; International collaboration; Structural collapse.
Shirley Gordon, Dror Garbi, Shahar Ben Bassat, Shachar Shapira, Leah Shelef
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Background: Unlike war, for which the military is expected to be prepared, dealing with the COVID-19 outbreak required a changed approach and adjustment.

Objective: The current study aims to identify and analyze the challenges faced by Israeli Air Force (IAF) career personnel and allow the IAF command to devise ways to meet their unique needs.

Method: A survey was conducted of the challenges reported by 711 (mean age 31.5; SD 11.0) IAF career personnel, during the first wave of the COVID-19 pandemic. The participants completed a questionnaire that dealt with unique challenges (personal, family and command). The answers of 550 participants (77.35%) were compared.

Results: Of 550 respondents, 54% reported low mood and irritability, 44% reported a constant feeling of anxiety or fear of being infected, and 29% reported having trouble sleeping. Most of them (66%) were concerned about infecting their family with COVID-19. The shift from normal work conditions to an unfamiliar capsule configuration concerned 58% of respondents. Functional continuity worried 55% of respondents. Trouble managing subordinates worried 50% of the participants. Of the three types of challenges analyzed (personal, family, and command), the command challenge was the only one where the personal variables (military role, rank, and marital status) made no difference. Finally, about 30% of the respondents admitted that they needed professional support, but 21% of that group said they felt uncomfortable consulting a professional.

Conclusions: The difficulty felt by commanders regarding their responsibilities was similar among all the involved participants, regardless of all the other examined variables.

Keywords: COVID-19; Israeli Air Force; Quarantine; Capsule Reverse Isolation.
Reviews
Nili Borochov Greenberg, Judith Shaham, Asher Pardo, Israel Shreibman, Nathan Amit, Yael Sahar Kostis, Raz Dekel, Irene Diamant, Meir Sharabani, Haim Cohen
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Background: Due to the ongoing 2019–20 pandemic caused by SARS‑CoV‑2, only essential workers were instructed to continue working. In the full article we present recommendations on the appropriate protection means required for essential employees, according to their risk, which were written by a committee of the National Council for the Worker’s Health, a body that regularly advises the Ministry of Health.

Objectives: Minimizing the SARS-CoV-2 infection rate among essential workers by applying occupational hygiene means.

Methods: We have used the official Israeli government definition of an essential worker. The essential workers were rated by their level of risk of exposure to the virus at work using various parameters: Ways of transmitting the virus, WHO and OSHA recommendations for protective distance between people (over 2 meters); Short exposure duration of contact which is considered a brief contact (ranged 15-30 minutes) was adopted to reflect an additional protective parameter for exposure.

Results: Depending on the level of risk of infection in various workplaces, the personal protective measures recommended according to the rated risk of exposure: Very high-risk jobs – N95 respirator (FFP2), gloves, face shield and disposable coverall with integrated cap; High-risk jobs – N95 respirator (FFP2), gloves and face shield; Medium risk jobs – N95 respirator (FFP2) and gloves; Low risk jobs – shall be protected in accordance with the Israeli Ministry of Health guidelines of the general public, unless their regular work requires the use of personal respiratory protective equipment. Conclusions: Employers and employees who follow the guidelines formulated in this paper are expected to reduce exposure to the SARS-CoV-2 virus.

Keywords: SARS-CoV-2; COVID-19; Occupational health risk; Protective measures; Disinfectants.
Clinical Challenge : Answer
Dr. Amitai Elkayam
The answer for the clinical image from issue 43
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