Dorit Nitzan

Purpose Anxiety is often studied at the individual level, with societal and environmental effects remaining under-researched. This study examines the impact of national security instability on short-term anti-anxiety medication purchases in Israel. Methods A retrospective cohort study using electronic medical records from an Israeli health fund covering over 2.6 million people, spanning January 1, 2006 to July 31, 2024. We assessed the association between ‘military operations’, the ‘Second Lebanon War’ and the ‘October 7th War’ and the incidence of short-term benzodiazepine purchases (a proxy for acute anxiety or stress responses prompting pharmacological treatment), differentiating first-ever from repeated purchases. Results 1,142,641 members aged 21 or older contributed 12,027,931 person-years at risk. The risk of first-time benzodiazepine purchases was 28% higher during military operations (95% CI: 1.21–1.34) and 44% higher during the Second Lebanon War (95% CI: 1.27–1.62). The October 7th war was the most significant armed conflict associated with an increased risk of short-term benzodiazepine treatment initiation over 19 years, at a 317% increase (95% CI 3.97–4.38). Unlike other conflicts, residential region did not influence anxiolytic patterns following October 7th. Conclusions Armed conflicts significantly influence anxiolytic use in Israel, with the recent war having the most pronounced effect. These findings underscore the need for emergent mental-health interventions during crises and long-term resilience approaches to prevent dependency.

Background: Israel established the Medical Volunteers for Israel (MVFI) registry to rapidly recruit, license, and integrate international physicians into its health system during emergencies. This study evaluates the registry’s design, implementation, and operational outcomes. Methods: A narrative synthesis of registry data was conducted using the MFVI dataset from October 2023 to August 2025. Quantitative analysis characterized physician demographics, specialty distribution, licensing status, and deployment outcomes. A standardized review of hospital needs assessment and licensing protocols was performed to detail the system’s replicability. Results: The registry enrolled 7,032 international physicians from over 50 countries, with 59% originating from the United States. High-demand specialties included anesthesiology (23% of deployed), emergency medicine (23%), and trauma surgery (12%). Of those registered, 453 physicians were successfully deployed to fill acute staffing gaps. Deployment occurred through a novel, hospital-specific temporary licensing mechanism that bypassed the traditional multi-month observation requirements for senior physicians entering the Israeli workforce. The process, designed to be efficient and similar to that for temporary licenses for visiting specialists, was intended to accelerate approvals and reduce bureaucracy. Although it was finalized before Oct 7, 2023, for earthquake preparedness, recruitment, and final approval occurred only after that date. Conclusions: The MFVI registry demonstrates that a government-led, need-based integration of international medical personnel is an effective strategy for sustaining healthcare operations during emergencies. While successful in bridging staffing gaps, the model requires robust pre-deployment orientation to overcome language and system barriers. By embedding expertise directly into national infrastructure, this approach offers a scalable alternative to traditional parallel aid models such as emergency medical teams and field hospitals.

Background: This study examines Israel’s food system’s security, sovereignty, resilience, and sustainability using the Mediterranean Diet (MD) lens. The current global context, marked by supply chain disruptions, climate change impacts, and geopolitical tensions, highlights the critical importance of resilient food systems. We analyzed Israel’s food system using FAO Food Balance Sheets (FBS) (2010–2020 trends) and Israel Central Bureau of Statistics (CBS) production and trade data (2021) to assess food availability, import dependency ratios (IDR), and alignment with Mediterranean Diet guidelines. Methods: A literature search was conducted using PubMed, Semantic Scholar, EBSCO Discovery, and Google Scholar, aiming to agree on the food-based guidelines of MD and their impact on health outcomes. Studies from the past 10 years with the keywords “Mediterranean diet” and “meta-analysis” were included. The Israeli agricultural production data from 2010 to 2020 were drawn from the Central Bureau of Statistics (CBS). Import dependence was calculated by converting product quantities from tonnes to grams per person per day (annual quantity × 10 million people ÷ 365 days). Results: Israel demonstrates significant import dependency across critical food groups, with 90% of cereals, 87% of fish, 82% of nuts, and 65% of added fats sourced internationally. While nearly self-sufficient in poultry and dairy, chickens and cows grown in Israel depend on imported feed. Moreover, the country’s food supply significantly deviates from the MD recommendations. Notably, there is an undersupply of nature-based proteins, including legumes. Conclusion: The results emphasize the advantages of shifting towards more locally produced, plant-based food and feed, especially in nature-based proteins. Embracing an MD-aligned food system would concurrently tackle the challenges of public health, food security, resilience, and environmental sustainability. These findings hold global significance for countries confronting similar issues in reconciling nutritional recommendations with food security needs. Future strategies should concentrate on policy reforms, agricultural investments, and public involvement to strengthen Israel’s food sovereignty and nutritional landscape.

Objective: The pandemic exposed global inequities in terms of health system capacities and vaccination coverage. This study evaluated the relationship between countries’ preparedness and COVID-19 vaccination rates. Methods: In this ecological study, we gathered global pre-pandemic data on country-level States Parties Self-Assessment Annual Reporting (SPAR) and universal health coverage (UHC) indexes. We then analyzed their relationship with COVID-19 vaccination rates in 2021–2022, using bivariate and multivariate analyses, including confounders, such as the country’s income classification and population demographics. Findings: The mean vaccination rates increased from 32.2% in October 2021 to 51.2% by August 2022. The UHC and SPAR indexes showed strong positive correlations with vaccination rates (r = 0.76 and r = 0.66, respectively, p < 0.001). In regard to the multivariate analyses, both the UHC (B = 0.81, 95% CI: 0.56–1.06) and SPAR (B = 0.34, 95% CI: 0.19–0.49) indexes remained significant predictors of vaccination rates, even after adjusting for country income level, with their influence strengthening over time, while income level effects diminished. Conclusions: This study underscores the critical importance of preparedness efforts, as gauged by the SPAR and UHC indexes, in shaping the effectiveness of COVID-19 vaccination responses globally. Strengthening preparedness measures is important for optimizing vaccination strategies and achieving broader immunization coverage targets.

Background and aim: Public health and social measures (PHSM) are critical aspects of limiting the spread of infections in pandemics. Compliance with PHSM depends on a wide range of factors, including behavioral determinants such as emotional response, trust in institutions or risk perceptions. This study examines self-reported compliance with PHSM during the COVID-19 pandemic in the Federation of Bosnia and Herzegovina (FBIH). Materials and methods: We analyze the association between compliance and behavioral determinants, using data from five cross-sectional surveys that were conducted between June 2020 and August 2021 in FBIH. Quota-based sampling ensured that the 1000 people per wave were population representative regarding age, sex, and education level based on the data from the latest census in Bosnia and Herzegovina. One-way analysis of variance (ANOVA) was used to identify significant changes between studies on determinants and PHSM measures. Regression was used to find relations between behavioral determinants and PHSM. Results: Participants reported strong emotional responses to the rapid spread of the virus and its proximity to them. Risk perception was spiking in December 2020 when rates of infection and death were particularly high. Trends in policy acceptance were divergent; participants did not rate PHSM as exaggerated, but perceived fairness was low. Trust in institutions was low across all waves and declined for specific institutions such as the health ministry. In five wave-specific regression analyses, emotional response (β_min/max = .11*/.21*), risk perception (β_min/max = .06/.18*), policy acceptance (β_min/max = .09/.20*), and trust in institutions (β_min/max = .06/.21*) emerged as significant predictors of PHSM. Conclusions: This study contributes to the body of research on factors influencing compliance with PHSM. It emphasizes the importance of behavioral monitoring through repeated surveys to understand and improve compliance. The study also affirms the impact of public trust on compliance, the risk of eroding compliance over time, and the need for health literacy support to help reinforce protective behaviors.

Background: Exposures to stress and traumatic events plays a significant role in triggering or precipitating anxiety. Nonetheless, these are often examined at the individual level, while societal-environmental exposures and their association with anxiety disorders are under-researched, especially in the Israeli context. This study leverages 19 years of longitudinal data from a large healthcare organization to examine the impact of national security instability on short-term anxiolytic purchases in Israel. Methods: We conducted a retrospective cohort study using electronic medical records of over 1.1 million individuals from 2006 to 2024, examining rates of first-time and renewed use of anxiolytic medications of the benzodiazepines group during periods of armed conflict, including military operations and wars. Cox proportional hazards models were used to assess associations, adjusting for confounders such as age, sex, socioeconomic status, socioreligious sector, residence and previous psychiatric treatment. Results: The risk for first purchase of an anxiety-relief short terms medication during military operations was 28% higher (HR 1.28, 95% CI: 1.21-1.34) compared to periods of relative national stability, after adjustments, and 44% higher during the Second Lebanon War (HR 1.44, 95% CI 1.27-1.62). The events of October 7 ^th were the most significant armed conflict increasing the risk for anxiety-related reaction necessitating treatment throughout the 19-years follow-up, with individuals at 317% increased risk for treatment initiation compared to periods of relative national stability (HR 4.17, 95% CI 3.97-4.38). Alongside a baseline increased risk for initiating anti-anxiety treatment, women experienced an additional elevated risk for anxiolytic therapy during times of national security threats, with 26% additional increased risk during military operations and an 81% increased risk following the events of October 7th. Residents of northern Israel had an increased risk of purchasing anxiolytics during the Second Lebanon War (HR 1.39, 95% CI: 1.12-1.72), while during military operations it was the residents of southern Israel who faced an increased risk for anxiolytic usage, with an HR of 1.18 (95% CI: 1.05-1.33). Conversely, the residential region did not significantly influence anti-anxiety treatment patterns following October 7th among residents of southern or northern Israel, compared to individuals living in central Israel, indicating a broader national impact beyond regional differences. Conclusions: National armed conflicts significantly influence anxiolytic medication use in Israel, with the October 7th war showing the most pronounced effect. These findings highlight the need for comprehensive mental health interventions during times of national crisis, focusing on both short-term relief and long-term mental health support to prevent dependency and improve mental health outcomes in the wake of national crises.

On October 7, 2023, Hamas terrorists attacked people in their homes, fields, and at a music festival in Israeli communities near the border with Gaza. More than 1,145 men, women, and children were killed, about 1,800 wounded were evacuated to hospitals in the country, and 253 infants, children, women, elderly, and men were abducted. This mass casualty incident (MCI) was the start of a war that is still ongoing. The Israeli medical system, which faced an overwhelming first 24 h, continues to take care of casualties, including those who are injured by missiles that target Israeli residential areas.Israel has a well-established trauma system, and as a result of the experience gained in this war, the system merited review. This was the topic of a meeting of leaders of the Israeli healthcare system, and it forms the basis of this report. The meeting and report provide a platform for presenting the trauma system management during the war, highlighting the strengths of the system as well as its challenges and lessons learned. The participants also brainstormed and discussed possibilities for future improvements.