Israel Defense Forces Soldiers Research Articles

Predictors of combat training attrition in Israel Defense Forces soldiers.

Attrition from combat service carries significant organizational and personal ramifications, but predicting factors associated with attrition remains challenging. To evaluate medical and psychosocial factors associated with attrition from basic combat training (BCT) in the Israel Defense Forces (IDF). In addition, we identify subsets of the recruit population which exhibit certain trends in terms of medical corresponding with a high risk of attrition. A cross-sectional study of IDF combat trainees undergoing infantry BCT between 2012 and 2017. Data were collected from the soldiers' electronic medical and administrative records. We used multivariable logistic regression and the SAS® decision-tree tool to analyse key predictive factors for attrition. A total of 46 472 soldiers enlisted to BCT during the research period. The mean body mass index (BMI) was 21.8 (SD 3.54). The overall attrition rate was 10%. The following factors were associated with attrition from BCT: ethnicity (P < 0.01), BMI (P < 0.01), pre-enlisting motivation score (P < 0.01) and the number of mental health officer visits (P < 0.01). Using a decision-tree model, we found a high attrition rate among soldiers who had >5.2 to primary care physician visits (11% attrition rate versus 3%) or more than 11 sick leave days (59% versus 19%). This study sheds light on unique measures relating to attrition. Attrition is associated with several demographic and psychosocial factors. Early prediction of motivation and monitoring of healthcare utilization may enable early identification and focused interventions targeting soldiers at high risk for attrition. These findings need to be further translated into actionable directives and further investigations.

Factors associated with self-harm behaviors during military service in the Israel Defense Forces, rates of such behaviors and their outcomes

ABSTRACT The military environment involves stressful situations that may trigger or aggravate suicidal behaviors, such as suicide attempts (SAs), which significantly increase the likelihood of future suicide. This cross-sectional study aims to assess risk factors for severe SAs and non-suicidal self-injury (NSSI) among Israel Defense Forces (IDF) soldiers. Data were retrieved from an IDF computerized self-harm surveillance database and were based on the criteria of the Columbia Suicide Severity Rating Scale (C-SSRS) and the Suicide Attempt Self-Injury Interview (SASII). The cohort included all 1,238 occurrences of self-harm behavior, during 2017–2021. Other investigated variables included adjustment difficulty (AD, as per IDF definition) and psychiatric diagnosis (PD) as reported by mental health officers (MHOs) during recruitment. Higher rates of adjustment difficulties were found among soldiers who had conducted NSSIs. Higher rates of previous psychiatric diagnoses were found among individuals with SAs, and their risk of dying by suicide during military service was twice as high (OR = 2.356; p < .001). If the latter also served in a combat unit, the risk was almost fourfold (OR = .3.860; p < .001). The current study demonstrates a clear difference between IDF soldiers who conduct NSSI vs. those conducting SA with regard to adjustment difficulty (as per IDF definition) and PD.

Acceptance of Seasonal Influenza Vaccine Following COVID-19 Vaccination: A Survey among Israel Defense Forces Soldiers

Data regarding the contribution of COVID-19 vaccine rollouts to real-world uptake of influenza vaccination remains unclear. This cross-sectional survey-based study among Israel Defense Forces (IDF) soldiers aimed to assess the impact of the COVID-19 pandemic and specifically, previous COVID-19 vaccines uptake, on the intention to vaccinate for influenza during 2021–2022 season. Participants engaged in an online survey addressing vaccination history and current vaccine-related preferences. The survey was delivered prior to the initiation of the IDF’s annual influenza immunization campaign. A multinomial logistic regression model was applied to analyze factors correlated with unwillingness to receive influenza vaccine. Overall, 825 invitations to participate in the survey were distributed and the overall response rate was 78.5%. Among the 648 participants who replied (61.6% males, median age of 20 years), 51.9% were willing to receive the upcoming influenza vaccine. Factors associated with vaccine reluctance included being female, not receiving the previous season’s influenza vaccine, not having a previous diagnosis of COVID-19, and having decreased uptake of COVID-19 vaccines. Among participants not intending to receive an influenza vaccine, 50.3% stated that they are healthy and have no need for the vaccine and 36.2% stated they received too many vaccines over the previous year. The results of this study may suggest that influenza vaccination rates in the post-COVID-19 vaccine era may be reduced due to a perceived “vaccine saturation” phenomenon, owing to the density of COVID-19 vaccine administration. Future interventions such as campaigns related to maximizing influenza vaccination coverage should address repeated doses of COVID-19 vaccine administration.

Rapid Rollout and Initial Uptake of a Booster COVID-19 Vaccine Among Israel Defense Forces Soldiers.

The surge of breakthrough COVID-19 among fully vaccinated individuals has raised the prospects of booster dose administration. In Israel, concerns of waning immunity and dominance of the B.1.617.2 (delta) variant resulted in approval of a third-dose (booster) vaccination for the entire eligible population starting on August 29, 2021. This study aims to evaluate vaccine uptake for booster doses among a population of previously vaccinated individuals during a rapid rollout and to analyze socio-demographic characteristics associated with vaccine uptake. A cross-sectional study among Israel Defense Forces soldiers with high access to booster doses of BNT162b2. Subjects eligible for booster doses were voluntarily vaccinated at three vaccine sites constructed within soldiers’ bases. We analyzed associations between subjects’ socio-demographic characteristics and booster vaccine uptake at the culmination of vaccine rollout using logistic regression models. 1157 soldiers from an IDF brigade were eligible for third dose vaccination (received second dose > 5-months before rollout), with 978 (84.5%) receiving a third, booster dose during the study’s timeframe. Subjects’ median age was 20.5 (IQR 19.7–21.5) and 791 (68.4%) were male. Notable socio-demographic characteristics associated with increased vaccine uptake in a multivariable model included increased age (OR 1.16, 95% CI 1.02–1.31), high socio-economic status (OR 2.12, 95% CI 1.25–3.59) and female sex (OR 1.87, 95% CI 1.26–2.74). Below-average cognitive function score was associated with decreased vaccine uptake (OR 0.61, 95% CI 0.39–0.95). This study demonstrates that real-world vaccine hesitancy remains a major obstacle, even among a population previously acceptant to COVID-19 vaccines. Decreased uptake for vaccines may be associated with socio-demographic variables in-spite of high-access vaccine rollouts. Reasons for vaccine hesitancy among previously vaccinated individuals, along with the benefits of population-wide booster administration should be further investigated.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10935-022-00702-2.

Risk Factors Associated With Various Severities of Suicidal and Non-Suicidal Self-Harm Among Israel Defense Forces Soldiers-A Nested Case-Control Study.

Severe suicide attempt is a major risk factor for completed suicide. The aim of the present study was to focus on suicide behavior and timing to gain better understanding of these populations. The nested case-control retrospective study based on medical records of 246,866 soldiers, who demonstrated suicide attempts of varying severity, including death by suicide were compared with soldiers who did not demonstrate such behavior. Risk for death by suicide was associated with males, military seniority of less than 12 months. High frequency of visits with mental health care professionals was associated with being severe suicide attempters (SAs). Moderate suicide attempts were associated with being a male, visiting a primary care physician frequently, and belonging to one of the two latest immigrant groups in Israel (Ethiopians and former Soviet Union). Mild suicide attempts were associated with having a psychiatric diagnosis on the enlistment day, visiting a mental health care professional at high or average frequency, visiting a primary care physician at high or average frequency, being a male, and being born in the former Soviet Union. While the proportion of males demonstrating suicidal behavior was higher than the females', severe SAs were higher among females. There was a clear tendency of female suicide attempters at all levels to act toward the end of their military service. Although half of the SAs were females, their characteristics may be similar to those of the male SAs, contrary to the sex differences in suicide behavior among civilians.

Ten-year reduction in thoracic injury-related mortality among Israel Defense Forces soldiers

IntroductionThis study aims to describe injury patterns, prehospital interventions and mortality rates of combat-related thoracic injuries during the past decade among Israel Defense Forces (IDF) soldiers before and after implementation...

Combat-related ocular injuries in the Israel Defense Forces during the years 2013 to 2019.

Ocular injuries account for up to 13% of battle injuries, despite the implementation of advanced protective eyewear (PE). The aim of this study was to describe the extent of ocular injuries over the last years among Israel Defense Forces soldiers and to examine the change in PE policy introduced in 2013 and the effect of a high-intensity conflict on ocular injury characteristics. This retrospective registry-based analysis derived data from the Israel Defense Forces Trauma Registry and included soldiers who sustained combat-related ocular injuries between the years 2013 and 2019. Demographic data and injury characteristics of casualties, as well as information regarding the use of PE, were collected and analyzed. A total of 2,312 military casualties were available for this study; the incidence of combat-related ocular injuries was 8.9% (n = 113). Ocular injuries occurred among male soldiers (98.2%) with a mean ± SD age of 22.7 ± 4.6 years; mechanism of injury was penetrating in 59.3% of the casualties and blunt in 22.1% of the casualties, ocular injury was isolated in 51.3% of the casualties, and others sustained concomitant injuries including head (32.7%), upper extremity injury (17.7%), lower extremity (15.9%), torso (8.0%), neck (6.2%), and other (5.9%) injuries. Ocular injuries rate was similar among casualties who used PE (11.2%) and those who did not use PE (13.0%) while injured (p = 0.596). Rate of open globe injuries was 9.1% in casualties who used PE and 39.5% (p = 0.002) in casualties who did not. Eye protection may significantly reduce ocular injuries severity. Education of the combatants on the use of PE and guidance of medical teams on proper assessment, initial treatment, and rapid evacuation of casualties are needed to improve visual outcomes of the casualties further. Epidemiological study, level IV.

Primary Care Interventions to Address COVID-19 Vaccine Hesitancy Among Israel Defense Forces Soldiers

Vaccine hesitancy is an obstacle to achieving high vaccination rates for COVID-19. Current knowledge on vaccine uptake is mostly based on hypothetical intention to vaccinate surveys. We compared intention to vaccinate and real-world vaccine uptake among 511 soldiers in a military unit during an unrestricted, on-site COVID-19 vaccine rollout. Soldiers were offered group lectures, on-site consultations and primary care office visits, discussing concerns on vaccination with a primary care physician. Overall, 359 (70.3%) soldiers participated in the group lectures, 33 (6.5%) in on-site consultations and 19 (3.7%) attended primary care visits. Overall, 459 (89.8%) of 511 soldiers vaccinated for COVID-19. Of the 90 soldiers initially refusing, 38 (42.2%) had agreed to receive a vaccine. On-site COVID-19 vaccine rollout joined with primary care communication interventions may maximize vaccine uptake within a young-adult community. Future studies should evaluate the effectiveness of these efforts across different populations in a controlled and comparative manner.

The Association between Increased Body Mass Index and Overuse Injuries in Israel Defense Forces Conscripts

Objectives: To examine the association between body mass index (BMI) and overuse injuries (OI) among Israel Defense Forces soldiers, in different corps. Methods: Conscripts between 2003 and 2012, infantry, armored corps and intelligence corps (controls) were studied. OI data were taken from computerized patient records. The BMI was classified as underweight, low-normal (18.5–21.9), high-normal (22–24.9), overweight and obese. Multivariate analysis was performed using logistic regression. Results: There were 73,640 soldiers: 42,506 infantry, 20,781 armor and 10,353 intelligence. OI rates were 52.2, 51.6 and 27%, respectively. OI rate was directly proportional to BMI in all groups (relative risk compared to low-normal, underweight: 0.97, high-normal: 1.05, overweight: 1.11, obese: 1.19, p < 0.05 for all), increased height and younger age. By logistic regression, OI were significantly associated with training group, higher BMI, increased height, younger age, lower education, lower socioeconomic status and lower psychotechnical grading. Throughout the BMI range, each additional unit of BMI was associated with a 2% OI increase. Conclusions: Higher BMI was associated with a higher rate of OI in all groups. Therefore there is no point in differentially assigning recruits based on BMI.

Israeli Settler Colonialism in Context: Celebrating (Palestinian) Death and Normalizing Gender and Sexual Violence

Feminist Studies 45, no. 2/3. © 2019 by Feminist Studies, Inc. 541 Rabab Abdulhadi IsraeliSettler ColonialisminContext: Celebrating (Palestinian) Death and Normalizing Gender and Sexual Violence The fifty-one-day Israeli military assault on Gaza in the summer of 2014 resulted in the deaths of 2,251 Palestinians, including 551 children , as well as 11,231 injured and at least 500,000 displaced. This event destroyed infrastructure and the livelihoods of an already impoverished and vulnerable Palestinian population.1 As the Israeli military intensified its aerial and artillery bombardment, rhetoric employing sexualized , racist, Orientalist and Islamophobic tropes also intensified in Israeli public discourse. This included images on social media such as the portrayal of Gaza as a half-naked woman in a niqab with a caption calling on Israeli Prime Minister Netanyahu to rape her. Public banners sponsored by the City Council of Or Yehuda declared, “Israel Defense Forces soldiers, Or Yehuda’s residents are with you! Pound ‘their mothers ’ and return safely to your own mother!” At the completion of their two-year military service, Israeli men printed T-shirts that depicted a bullseye pointing at a pregnant Palestinian munaqqaba (a woman wearing a niqab) with the caption, “1 shot, 2 kills,” implying that the Israeli soldier can kill both the woman and her unborn child. Such violent 1. United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Occupied Palestinian Territory, “Key Figures on the 2014 Hostilities: Data Featured in the Report of the Independent Commission of Inquiry on the 2014 Gaza Conflict,” June 23, 2015, https://www.ochaopt.org/content /key-figures-2014-hostilities. 542 Rabab Abdulhadi Islamophobic discourse was not new to Israel nor exceptional among settler colonial regimes. However, the overt, public, and unapologetic audacity was new, especially when examined against Israel’s historically careful management of its public image, especially on the international stage.2 In this essay, I analyze this new climate of casually violent rhetoric , which includes Facebook and Twitter posts. This emerging discourse signals that the public space for oppositional expression in Israel has shrunk, turning it into even more of a police state—a reality that Indigenous Palestinians have experienced in both the past and present, but of which the majority of Ashkenazi Jewish Israelis are only recently becoming more aware.3 Since its inception in 1948, Israel has made the promotion of its image as an egalitarian and inclusive society a top national security priority . This task was historically assigned to the Israeli cabinet, Israel’s intelligence agencies—the Mossad and Shin Beit—as well as the Israeli military.4 More recently, Israel created the Ministry of Strategic Affairs and assigned experienced Mossad officials to the task.5 Furthermore, Israel’s Zionist supporters among US Republicans, Democrats, and the Christian right have raised tens of millions of dollars specifically to 2. David Reibstein, “Ido Aharoni: Why Brand Capital Is Part of National Security ,” Knowledge@Wharton Podcast, May 1, 2015, https://knowledge.wharton .upenn.edu/article/why-brand-capital-is-part-of-national-security. 3. By Indigenous, I refer to the totality of the Palestinian people, whether they became refugees after being expelled from their land by Zionist militias when Israel was founded in 1948 or they live under Israel’s colonial rule in the areas defined as such in 1948 and 1967. 4. Ali Abunimah, “Israel Using ‘Black Ops’ Against BDS, Says Veteran Analyst,” Electronic Intifada, September 5, 2016, https://electronicintifada.net/blogs /ali-abunimah/israel-using-black-ops-against-bds-says-veteran-analyst; Asa Winstanley, “Israel Reveals ‘Delegitimization Department’ to Spy on Boycott Activists,” Electronic Intifada, August 27, 2015, https://electronicin tifada.net/blogs/asa-winstanley/israel-reveals-delegitimization-department -spy-boycott-activists; Asa Winstanley, “Mossad Proxy Faked Violent Facebook Anti-Semitism,” Electronic Intifada, January 16, 2016, https://electronicintifada .net/blogs/asa-winstanley/mossad-proxy-faked-violent-facebook -anti-semitism; Jonathan Cook, “Did Banned Media Report Foretell of Gaza War Crimes?” Electronic Intifada, April 15, 2010, https://electronicintifada .net/content/did-banned-media-report-foretell-gaza-war-crimes/8788. 5. Itamar Eichner, “Government Creates Joint Program for Rapid BDS Response,” Ynetnews, December 29, 2017, https://www.ynetnews.com/articles/0,7340,L5063599 ,00.html. Rabab Abdulhadi 543 salvage Israel...

Evaluation of Suicide Risk Assessment Measures in an Israel Defense Forces Military Sample

ABSTRACTThe present study evaluates the psychometric properties of 4 commonly used measures of suicidal ideation and behaviors (Beck Scale for Suicide Ideation [BSS], Columbia-Suicide Severity Rating Scale [C-SSRS], Self-Harm Behavior Questionnaire [SHBQ], and Suicidal Behaviors Questionnaire—Revised [SBQ–R]) among a sample of Israel Defense Forces (IDF) soldiers. Measures were translated to Hebrew and completed by 65 active duty IDF soldiers who were recently hospitalized for at least 24 hours following a suicide attempt. Internal consistency and Pearson's r correlation analyses were conducted for all measures to test the reliability and validity of the measures. Findings support the reliability and validity of common suicide risk assessment measures among a sample of IDF soldiers. Instruments demonstrated acceptable-to-excellent internal consistency (αs = .72 to .93), save for the SBQ–R (α = .57). Further, all measures demonstrated associations as expected, suggesting convergent and divergent validity. The BSS, C-SSRS, and SHBQ can be reliably and validly used among IDF soldiers.

Olecranon Bursitis in a Military Population: Epidemiology and Evidence for Prolonged Morbidity in Combat Recruits.

Olecranon bursitis (OB) is a benign but disturbing condition that may adversely affect a military recruit's combat preparedness. This study was designed to assess incidence, risk factors, and associated medical burden of OB in the Israel Defense Forces. This is a retrospective study drawing on medical records of all Israel Defense Forces soldiers diagnosed as having OB between 2005 and 2015. OB was classified as septic and noninfectious. Crude incidence rates and duty-specific incidence rates were calculated. Medical burden was defined by the number of physician visits, referrals to orthopedic specialist consultations, duration of symptoms, and duration of pharmaceutical treatment. Demographic and occupational information (age, sex, height, weight, socioeconomic status, country of origin, type of military service, time of presentation to medical services) was used to identify risk factors for septic bursitis and longer duration of symptoms. Statistical analysis was performed in R statistical software. Risk factors were evaluated using the Chi-square test for categorical variables and Pearson correlation coefficients were used for continuous variables. The study was approved by the Israeli Defense Force IRB. A total of 2,692 soldiers were diagnosed with OB during the study period. The crude annual incidence rate of OB was 29/100,000 person-years (PY). Combat duty had an incidence of 97/100,000 PY, and noncombat duties had an incidence of 12/10,000 PY (p < 0.001). Female incidence (8.4/100,000 PY) was similar to male incidence (11/100,000 PY) in administrative duties (p = 0.54). More cases were diagnosed during summer and autumn than in other seasons (p = 0.016). Septic bursitis constituted 24% of all cases, was more frequent in combat soldiers (32%), and on average presented earlier in service than noninfectious OB (13 vs. 17 weeks since recruitment). The mean duration of symptoms was estimated at 17.58 weeks, with a mean of 1.75 physician visits per soldier. About 19% received a specialist referral. Origin from the former USSR was associated with a higher duration of symptoms (p = 0.012). Type of military service was the principal risk factor for OB, as indicated by a higher incidence of the disorder among combat compared to noncombat units, possibly the result of field training without protective gear and repetitive trauma to elbows. The greater number of diagnoses of OB during summer and autumn, when training is more intensive, support that explanation. Sex did not affect incidence of OB in administrative units. The medical burden appears to be relatively low, since most of the soldiers had only one physician visit. OB is highly prevalent in military compared to civilian populations. Outdoor training involving crawling is a probable explanation for the much higher rates among combat units and increased number of diagnoses during warm summer and autumn months. Prevention by use of protective gear seems to be the most promising intervention.

Utilization of Health Services by IDF Soldiers and Civilian Population at an Israeli HMO

Background: Over the past decades we have witnessed an increase in expenditure on health services in the various military systems. One of the ways to curb costs is by means of outsourcing. Based on this idea the Israel Defense Forces (IDF) promoted a project allowing soldiers to receive medical care from a nearby civilian HMO (Meuhedet). The medical basket provided to the soldiers is more extensive than that to civilians, furthermore the soldiers received all the health services they needed from the HMO without copayments. Objectives: The overall-objective of this study was to examine the consumption of medical services by conscript and standing army soldiers in comparison to that by the civilian population of similar age. Methods: A retrospective study comparing consumption of medical services between the population of soldiers and the civilian population. Populations and samples: The military population included 4530 IDF soldiers, who were ascribed to Meuhedet over the course of 2012. The civilian population included members of Meuhedet who do not have any disabilities. Data analysis: Using SPSS software, we used a comparison of averages test using the independent-samples T-test with a level of significance of 5%. Results: The military personnel tend to consume considerably more medical care than their civilian counterparts. Conclusion: In order to maintain the outsourcing of medical services for military personnel by the HMO, either the HMO’s revenue on their account must be higher or a system curbing their consumption of medical services must be put in place.

Intensified vmPFC surveillance over PTSS under perturbed microRNA-608/AChE interaction.

Trauma causes variable risk of posttraumatic stress symptoms (PTSS) owing to yet-unknown genome–neuronal interactions. Here, we report co-intensified amygdala and ventromedial prefrontal cortex (vmPFC) emotional responses that may overcome PTSS in individuals with the single-nucleotide polymorphism (SNP) rs17228616 in the acetylcholinesterase (AChE) gene. We have recently shown that in individuals with the minor rs17228616 allele, this SNP interrupts AChE suppression by microRNA (miRNA)-608, leading to cortical elevation of brain AChE and reduced cortisol and the miRNA-608 target GABAergic modulator CDC42, all stress-associated. To examine whether this SNP has effects on PTSS and threat-related brain circuits, we exposed 76 healthy Israel Defense Forces soldiers who experienced chronic military stress to a functional magnetic resonance imaging task of emotional and neutral visual stimuli. Minor allele individuals predictably reacted to emotional stimuli by hyperactivated amygdala, a hallmark of PTSS and a predisposing factor of posttraumatic stress disorder (PTSD). Despite this, minor allele individuals showed no difference in PTSS levels. Mediation analyses indicated that the potentiated amygdala reactivity in minor allele soldiers promoted enhanced vmPFC recruitment that was associated with their limited PTSS. Furthermore, we found interrelated expression levels of several miRNA-608 targets including CD44, CDC42 and interleukin 6 in human amygdala samples (N=7). Our findings suggest that miRNA-608/AChE interaction is involved in the threat circuitry and PTSS and support a model where greater vmPFC regulatory activity compensates for amygdala hyperactivation in minor allele individuals to neutralize their PTSS susceptibility.

Emotional regulation of mental pain as moderator of suicidal ideation in military settings

BackgroundIn the Israel Defense Forces (IDF) as well as in most armies throughout the world, the leading cause of death during peace-time is suicide. This study examines emotional regulation of mental pain as a contributor to suicidal ideation in soldiers. MethodsOne hundred sixty-eight IDF soldiers (aged 18–21years, 59% males) completed the following self-report questionnaires: Scale for Suicide Ideation (SSI); Orbach & Mikulincer Mental Pain Scale (OMMP); and Emotional Regulation of Mental Pain questionnaire. Participants were divided into 3 groups: soldiers who attempted suicide (AS group, n=58), soldiers under treatment by a mental health professional and reporting no suicidal behavior (PT group, n=58), and controls (C group, n=50). ResultsSuicide ideation, mental pain, and low emotional regulation were significantly higher in the suicidal group as compared to the two other groups (P<0.001). Mental pain was significantly related to more suicide ideation in soldiers with low ability to regulate mental pain (P<.001 for the interaction). ConclusionEmotional regulation of mental pain moderates the link between mental pain and suicide ideation. Soldiers with high mental pain and low regulation of mental pain exhibited higher suicidal ideation. These findings may assist in planning prevention programs in the army and similar settings.

Atopy as a risk factor for the development of asthma in young recruits

Objective: Asthma is one of the most common chronic diseases globally. Atopy, and especially allergic rhinitis (AR), was found as an important risk factor for asthma. The purpose of this study was to examine the association between different atopic parameters and military professions to the incidence of asthma. Methods: In a retrospective study, we included 128 591 Israel Defense Forces soldiers drafted between the mid-nineties to the early-2000s. We examined the incidence rates of asthma in relation to atopic background and to military profession. Results: The relative risk (RR) for the development of asthma in persons with a history of AR and the RR for asthma in atopics vs. nonatopics was 1.86 (95% CI: 1.57–2.21) and 1.73 (95% CI: 1.47–2.04), respectively. The RR for the development of asthma in persons with a history of AR was higher in Combat Units (CU) and Administrative and Driving units (ADU) (RR = 2.80; 95% CI: 2.09–3.76 and RR = 1.58; 95% CI: 1.19–2.12, respectively) than in Maintenance Units (MU) (RR = 1.27; 95% CI: 0.93–1.74). When comparing the risk for asthma amongst persons with AR, we found it lower in MU compared to ADU (RR = 0.65; 95% CI: 0.43–0.97). In atopics vs. non-atopics, the risk for asthma was higher in ADU as compared to other occupations. Conclusions: Atopy, particularly AR, is a risk factor for the development of new-onset asthma in young adults. Atopy has the highest significant effect in CU where the physical demands are higher.

Factors associated with visually assessed quality of movement during a lateral step-down test among individuals with patellofemoral pain.

Cross-sectional. To determine what physical measures are associated with visually assessed quality of movement among patients with patellofemoral pain (PFP). An altered movement pattern has been implicated as a risk factor for PFP. An understanding of physical measures associated with an altered movement pattern could potentially help guide prevention and management efforts in patients with PFP. Seventy-nine (40 women) Israel Defense Forces soldiers referred to physical therapy with a diagnosis of PFP were included. Movement pattern was assessed visually during a lateral step-down test and rated as "good" or "moderate," based on previously established criteria. Weight-bearing and non-weight-bearing ankle dorsiflexion (DF) range of motion (ROM); hip internal and external rotation ROM; and hip abduction, hip external rotation, and knee extension strength were also assessed. Differences in physical measures between those with good versus moderate quality of movement were assessed. Weight-bearing DF ROM was more limited among participants with a moderate quality of movement compared to those with a good quality of movement (P<.01). Among men, non-weight-bearing DF ROM was more limited in those with a moderate quality of movement as well (P<.01). In addition, quality of movement was associated with weight-bearing DF ROM for both women (r = -0.39, P = .01) and men (r = -0.46, P<.01), and with non-weight-bearing DF ROM for men (r = -0.66, P<.01). When the subgroup of participants who exhibited more than 25° of non-weight-bearing DF ROM was assessed, those with a good quality of movement displayed greater hip external rotator and knee extensor muscle strength compared with those with a moderate quality of movement (P<.01). Ankle DF ROM should be assessed when patients with PFP demonstrate a lower quality of movement during a lateral step-down test. Lower hip muscle strength may be associated with lower quality of movement among patients with relatively greater ankle DF ROM.

Effective abandonment: The neoliberal economy of violence in Israel and the Occupied Territories

Towards the end of 2012, a group of Israeli settlers and right-wing activists attacked an Israel Defense Forces (IDF) base on the West Bank. IDF soldiers and members of the Israeli Knesset had provided information to the attackers, who adopted a ‘bring it on’ tone that commentators described as echoing ‘civil war’. As the occupation blurs the categories of inside/outside, what we are witnessing is a challenge to the traditional distinction between politics and war. Accordingly, we are moved to think in terms of the distribution and variable intensities of violence, rather than to accept simple debates about either the absence or presence of war or the monopoly of violence. This article seeks to examine the evolving relationship between the state and society in the wake of the so-called Arab Spring through an investigation of the relationship between neoliberalism and sovereign violence. It argues that ‘price tag’ actions perpetrated in the Occupied Territories and Israel are the effect of a neoliberal organization of power characterized by a form of governing by non-intervention, where the abandonment of certain parts of society produces the desired containment of elements considered undesirable to the body politic. This article challenges Weber’s theory of state sovereignty as the monopoly of legitimate state violence, arguing instead that state apparatuses may in fact ‘outsource’ violence. We can understand this shift in the mode of operation of sovereignty by theorizing ‘society’ as the effect of warlike relations whereby particular tactics and strategies are employed as a way of organizing and policing forms of life necessary for the continuation of a particular body politic.

Trends in the epidemiology of cutaneous leishmaniasis in a young adult population in Israel: a long-term survey

The Israel Defense Forces (IDF) medical records offer a unique and valid 28-year view of the striking differences in cutaneous leishmaniasis (CL) seasonality patterns and incidence rates between the military and civilian sectors in Israel. To determine the annual epidemiology and seasonality trends of CL over the long term in the IDF. The database of the Epidemiology Section of the IDF Medical Corps was reviewed for all reported cases of CL (passive surveillance) from 1 January 1978 to 31 December 2006. The diagnosis of reported CL was based on the clinical presentation, relevant epidemiologic data, and, in most cases, microscopic visualization of the parasite. Polymerase chain reaction (PCR) confirmation of the parasite has been more routinely performed since 2003. Rates of CL were generally characterized by peaks every 10 years, until the last 10 years when a second peak occurred in the same decade. The average monthly rates varied from a low of 0.8 cases per 100,000 population in June to a high of 9.83 cases per 100,000 soldiers in December. The results of this study imply that we are currently in the midst of a re-emergence of CL in Israel, in particular among IDF soldiers. This increase warrants a change in the public health approach.

Gaps in Expectations among Clients of Secondary Medical Services in the Military System Compared with the Civilian System as a Satisfaction Index

The Israel Defense Forces Medical Corps operates a health network for Israel Defense Forces soldiers. Secondary medicine is included in the services to which soldiers are entitled. It is provided to military personnel through two parallel systems: within the Medical Corps specialists' clinics and through the auspices of a number of civilian hospital outpatient clinics. The military medical system, like the civilian medical system, is designed to serve its clientele. One of the indices for ascertainment of satisfaction with medical services is compatibility of client expectations with the service actually received. In this study, we present a gap index that demonstrates that there is gap in satisfaction among soldiers receiving secondary medical services from the military network compared with soldiers who receive secondary medical services from the civilian network. We designed a questionnaire administered to 1,532 soldiers and used 1,359 (89% response rate) for our analysis. The military system provides soldiers with services fully in synch with military regulations. Consequently, in most cases, there is a gap between soldiers' expectations from military medical service and the service they receive in practice-a phenomena that impairs soldier satisfaction. On the other hand, soldiers receiving medical services and treatment from the public civilian system receive, for the most part, service and treatment that meets or even exceeds their expectations because the system operates according to other regulations.