Ongoing Projects at NEHRI
Environmental exposures related to cancer morbidity
In this study, Novack et al. will estimate the annual incidence rate of cancer in the Negev during 2001-2024 and cumulative for the entire period, by types of cancer, by gender and age. They will also estimate the contribution of environmental (pollution, climate, solar radiation, proximity to hazardous areas) and demographical factors to cancer development.
In the ecological set-up the new cancer cases will be mapped based on the patients' residence address, providing a spatial gradient to exposure factors and area-specific cancer morbidity. In a case-control set-up we will evaluate the extent of an individual exposure to pollutants and meteorological conditions prior to the disease onset, as well as individual factors potentially related to the disease.
Human biomonitoring: National Survey - stage 2
This investigation is an extention of our initial study performed among blood donors who donated blood during two consecutive years 2020-2022. In all, close to 4800 samples were collected and 911 of these were tested by the National Laboratory of Public Health for arsenic (As), cadmium (Cd), chromium (Cr) and lead (Pb) (Hassan et al, 2020, Hassan et al, 2023a, Hassan et al, 2023b).
In the new analysis, 2,000 blood samples will be tested, primarily sampled from non-urban areas. The findings will complete to the full picture on metals' concentrations in the general population of the Israeli residents.
We will search for sources of metals contamination in the form of hazardous industries in case of any systematically elevaled levels of metals detected in spatial clusters.
We also hope to follow the physiopathological pathway from ambient external exposure, to internal dose (heavy metals in blood), to biological effect, by testing blood samples for changes in 80HdG. This last analysis will serve to indicate changes to donor DNA as a result of oxidative stress.
Finally, we will perform an ecological study to assess any correlation between exposure to ambient pollution and morbidity.
Collaboration of MDA Blood Services, national public health laboratory and SUMC researchers.
Trajectories of adaptation to climate change, by immigration status and country of origin
The world is getting hotter and some of the changes are unfortunately nether preventable nor reversible. A human body has a remarkable ability to adapt to a new environment. Understanding biological coping mechanisms might accelerate development of new ideas on how the humanity can adapt, survive and prosper under the changing climate conditions. We suggest taking an advantage of the Negev region population and climate settings. The region is known for its extreme meteorological conditions and frequent dust storms and population of 750,000 comprising large fraction of immigrants (30%) from regions with a colder climate from 1990s-wave (former-USSR) or hot climate from Ethiopia, genetically-native population of Bedouin-Arabs (30%) and Israeli-born. This sets ideal conditions for "natural experiment" on climate change and human endurance and adaptation, as a function of time since immigration.
In the proposed study we will analyze the temporal trends of climate-related morbidities in ethnic subgroups. Specifically, we will (1) estimate the impact of heat and dust on the hot climate naïve populations (immigrants) as compared to Israeli-born subgroups; (2) identify populations suffering the most from temperature fluctuations/heat waves and dust storms; (3) define the risk function of temperature and dust exposure within subgroups. For this initial study, we will focus on short-term effects of climate on birth outcomes and morbidity from cardiovascular and respiratory disorders.
The study population will comprise patients attending emergency department or hospitalized in Soroka hospital, the only hospital serving the Negev population. We will focus on the adaptation abilities to environment, based on comparison of immigration cohorts and country of origin. Our findings will reveal a possible trajectory of adaptation to changing meteorological conditions, and identify susceptible populations where an intervention is warranted.
At the second stage, the study will be extended to the national survey within the Clalit patients.
Effects of environmental exposure on patients with autoimmune rheumatic diseases
The aim of the project is to investigates the impact of environmental factors—temperature, humidity, UV radiation, and air pollution—on disease activity in patients with autoimmune rheumatic diseases (ARD) such as rheumatoid arthritis, systemic lupus erythematosus, and gout. Using both retrospective and prospective analyses, the research examines correlations between environmental exposures and ARD-related health outcomes, including healthcare utilization and inflammatory markers. The findings aim to inform preventive strategies and improve disease management for climate-sensitive ARD patients.
Relationship between crop flowering and allergies
Agriculture in Israel has played an important role in the development and economy in the country, despite its arid climate and challenging environment. The main crops that grow in Israel, particularly in the Negev, are olives, dates, pomegranates, and grapes.
Despite the fact that agriculture has been a major presence in Israel for decades, we have much to learn about the industry's health implications for residents, such as the crop-related airborne allergens that are major triggers for Allergic Airway Disease (AAD). With the climate change crises, incidences of AAD and related ED visits are expected to increase, as higher temperatures, high wind speeds, and low humidity increase pollen release. We hypothesize that there is a temporal association between crop flowering and higher rates of allergy-related ED visits and allergy medication purchases.
Relationship between desalination, iodine, and health implications
Water scarcity is a growing concern worldwide. Israel is a country that has been facing a water crisis for decades due to its geographic location in a semi-arid region with a growing population and limited natural water resources. In response to this challenge, Israel has implemented a comprehensive water management system that includes desalination, water reuse, and efficient irrigation practices.
Israel's reliance on desalinated water has significantly increased in the last few years, making Israel the world's leader in desalination technology, producing over 600 million cubic meters of water annually. Today, desalinated water accounts for nearly 85-90% of Israel's domestic water consumption, highlighting its vital role in ensuring the country's water security.
Desalination of water may come at a price. The natural sources of water are typically enriched with microelements, some of which are essential for human health, such as magnesium, calcium, iodine, and potassium. Lack of iodine, specifically, is associated with thyroid diseases.
Temperature variability, air pollution, and birth outcomes in a changing climate: epidemiological innovation contrasting populations in southern Israel.
This a population-based study aimed to assess the possible impact of temperature variability on birth outcomes. The researchers will analyze all births taking place in Soroka Medical Center between 2003-2021. The meteorological conditions will be verified based on maternal addresses and meteorological stations in the Negev.
The effects of urban microclimate variability and global climate change on heat-related cardiovascular outcomes in the semi-arid environment of southern Israel
This study has being conducted in Southern Israel and is aimed to estimate the association between ambient air temperature and cardiovascular outcomes at an individual level. Temperature exposure will be evaluated in terms of mean and extreme temperature exposure and in terms of variability of exposure to temperature during specific time-windows. We will assess the incidence of acute coronary syndrome, ischemic stroke and cardiac death. We will investigate the effects of various (short- and long-term) time-windows of temperature exposure.
Impact of dust origin on respiratory and cardiovascular diseases hospital admissions
Previous research suggests that aerosols and dust can act as effective mechanisms to spread microbes, likely having a negative impact on human health. Further, it is apparent that the specific types of bacteria carried on aerosols can vary based upon the origin of the dust and the trajectory it has taken. Here, we build upon the research of Gat et al. (2017) to determine if varying source regions and pathways of dust result Using a methodology consistent with previous literature, we determine specific “dust days” in Be’er Sheva, Israel from 2000 through 2015 using half-hourly PM10 data obtained from a monitoring station in Be’er Sheva and thoroughly quality controlled by the Technion Center of Excellence in Exposure Science and Environmental Health Air Pollution Monitoring Database. Using the HYSPLIT model on dust days, we calculate 72-hour back trajectories for 0, 200, and 500m above ground level to determine both the origin of the dust and path it has taken prior to its arrival in Be’er Sheva. We group the trajectories into distinct clusters to allow for the comparison between various dust origin regions and pathways with human health.
Epilepsy exacerbations and air pollution in Israel: A Case-Crossover study
Epilepsy is a common, serious, chronic neurological disorder that affects ~65 million people worldwide. It is characterized by recurring seizures that can severely impact the quality of life and increase the risk of injury and mortality.
This study attempts to evaluate the effect of daily changes in particulate and gaseous air pollution on seizure related Emergency Department visits and hospitalizations of epilepsy suffering patients and analyze the factors contributing to air pollution vulnerability and
air pollution resilience.
For each event, short-term exposure to ambient air pollutants during the hazard period will be compared to control periods within the same
individual to assess the transient effect of air pollution.
Clinical and Sub-Clinical Outcomes in Primary Care Settings across the Temperature Scale
Primary care is usually the first point of contact for patients with the health system. This makes it ideal for detecting the first clinical or even sub-clinical effects of ambient temperatures and an excellent place for prevention and intervention in many cases.
This is a time-stratified case-crossover study that uses aggregated healthcare data from Clalit health systems and regional daily environmental data. This advanced study design was recently used to analyze associations between temperature and various aggregate outcomes, as it combines advantages from the two traditional methods of time series analyses and individual-level case-crossover studies. In short, this design uses the daily variability of the absolute incidence of the selected outcome (e.g., number of visits) and the relevant exposure to examine the associations between them.
The study period is stratified into non-overlapping strata, defined as week-of-day, within-month, and year. Each calendar day during the study period is compared to all other days in its stratum so that weekday, season, and time trends are controlled as part of the study design. Another advantage of this design is its ability to ignore days without any events, making it useful also for less common outcomes. For non-event data, such as numeric lab results, statistical measures of their daily distribution will be analyzed instead of count data, as described below.
This analytic approach uses the entire population’s data without requiring informed consent or active cooperation from patients. Moreover, this design is not susceptible to confounding by individual characteristics. Using aggregate data simplifies privacy issues and eases institutional review board (IRB) permissions and data extraction processes. It also minimizes research costs since the data used is already collected routinely. Ethical permission will be sought from Clalit.
Myasthenia Gravis exacerbations and air pollution in Israel
Myasthenia gravis (MG) is a long-term neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness.
Long-term exposure to air pollution has been found to be associated with higher risk of developing autoimmune diseases, and short-term exposures are associated with exacerbations in such diseases.
This study will evaluate the effect of daily changes in ambient
temperature, particulate and gaseous air pollution on Emergency Department visits and hospitalizations of patients suffering from Myasthenia Gravis.
Effect of Wars and National disasters on blood donations and safety of donated blood
In this study we characterize patterns of blood donation in Israel during peacetime and national disasters and investigated the safety of blood supply to hospitals and to the army. We compare our findings during the 2023-2025 war in Israel to the aftermath of the September 11th, 2001 attacks in the US.
We investigate the patterns, the amount of blood units donated and characteristics of donors during the 30 days before and after the start of war Iron Swords and during the relative peacetime in Israel (October, 2022).
We also investigate the prevalence of infectious diseases in donated blood and compare our results to results of US blood donors in 5 blood centers across the country, responding to the 9/11 attacks.
Circadian Light (CL) and Health Outcomes in Hospitals in Israel
Hospitalization exposes the occupants of hospital buildings to numerous indoor environmental pollutants and stressors (e.g. density, noise, night lighting and poor ventilation, as well as biological pathogens). Vulnerable populations may also be particularly susceptible to indoor environmental stressors because of functional and behavioral limitations, which might significantly reduce their access to nature.
This study will assess the impact of ambient daylight levels on clinical recovery metrics in an internal medicine department. Using statistical methods, we will analyze historical patient data and look for a correlation between distance from the window (as
a proxy for exposure to daylight) and time to defervescence as
an indicator for health benefits.
Effect of Extreme Ambient Temperature on Health in Working-Age Adults
Among general population experiencing heatstroke
In this study, we will compare exposure to meteorological conditions up to 7 days prior to a heatstroke with exposure prior to days without heatstroke (case-crossover design, patient-based analysis).
Likewise, we will investigate the temporal association between meteorological conditions and incidence of heatstroke events in Israel, by seasons, geographical regions and in subgroups of healthy population and chronic patients (time series design, ecological data analysis).
Among chronic patients
We will explore the temporal variability of clinical outcomes as a function of meteorological conditions within up to 7 days preceding those events (event of death, ER visits, etc) over the course of the study period 2001-2024. We will investigate the repeated laboratory and clinical measurements of chronic patients as a function of meteorological conditions prior to those measurements.
Sustainable Anesthesia: Identifying Opportunities for Greenhouse Gas Emission Reduction in the Surgical Setting
There is an increased interest in the climate impacts of anesthetic gases stemming from two primary factors. First, anesthetics have a high carbon footprint and contribute to the total carbon footprint of healthcare around the world. Second, certain potent anesthetic greenhouse gases (GHG) can be easily and safely replaced by other
options that are currently in clinical use.
Our goals in this study are to (1) describe the types and estimate quantity of anesthesia gases used in surgical theaters in SUMC; (2) explore factors that contribute to the usage of anesthetic gases, including the surgery properties and surgical teams; (3) estimate the stands and beliefs of the medical personnel with respect to
anesthesia in their clinical practice.
Environmental Exposures and Their Influence on Susceptibility to Upper Respiratory Tract Infections in Children with Asthma
This nationwide study investigates how environmental exposures influence the risk of upper respiratory tract infections (URTIs) among children with asthma. Using electronic medical records from Clalit Health Services and data from national environmental monitoring stations across Israel, the study links clinical outcomes with environmental conditions such as air pollution and meteorological factors to identify exposure-related risks for pediatric asthma patients.
