Ongoing Projects at NEHRI
Environmental exposures related to cancer morbidity
In this study, the NEHRI team will estimate the annual incidence rate of cancer in the Negev and for the entire Israel 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.
Analysis is performed separately for cancer morbidity in adults and in children.
The study is led by Ismael Massalha, Miri Ben Harush, Yotam Eshel and Lena Novack, with data analysis conducted by Nitzan Sagie and Kineret Grant-Sasson.
Human biomonitoring: National Survey - stage 2
This investigation is an extension of our initial study performed among blood donors who donated blood during two consecutive years 2020-2022. In that study, 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, 1,100 additional samples will be tested, primarily sampled from non-urban areas, which will add up to 2000 blood samples in donors in Israel. 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 elevated levels of metals detected in spatial clusters.
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.
The research is conducted by Kineret Grant-Sasson as part of her PhD thesis, and supervised by Lena Novack and Tamar Wainstock.
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. To explore the capability of a human body to adapt, we suggest taking an advantage of the climate settings in the Negev, known for its extreme meteorological conditions and frequent dust storms, and also its unique population. The Negev population is close to 750,000 residents 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 study we analyze the temporal trends of climate-related morbidities in ethnic subgroups. Specifically, we (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. In this initial study, we are focusing on short-term effects of climate on birth outcomes and morbidity from cardiovascular and respiratory disorders.
The study population comprises patients attending emergency department or hospitalized in Soroka hospital, the only tertiary 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.
The study is led by Victor Novack, with research conducted by Adi Shiloh as part of her PhD thesis.
Effects of environmental exposure on patients with autoimmune rheumatic diseases
The aim of the project is to investigate 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. The study is led by Iftach Sagi, with data analysis support provided by Yuval Arnon.
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.
The study is led by Boomie Ben-Sheleg and Lena Novack, with data analysis support provided by Ilan Libes.
Desalination, Drinking Water Mineral Content, Pollutants, and Associated 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. Today, desalinated water accounts for more than half 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.
Comparing anthrogenic and non-anthropogenic particulate matter in Tel Aviv
This study examines the association between exposure to dust storms—distinguishing between amorphous and crystalline particle composition—and exacerbations of cardiovascular and respiratory diseases. Using a retrospective cohort design, it links high-resolution environmental data from Lidar monitoring with large-scale electronic health records from Clalit Health Services (2019–2024). The project applies complementary time-series and case-crossover approaches to evaluate both immediate and delayed health effects of dust exposure. A key innovation is the focus on particle composition rather than standard PM metrics, aiming to identify differential health impacts of distinct dust types.
The study is led by Alexandra Chudnovsky (Tel-Aviv University) and Lena Novack, with research conducted by Yuval Arnon as part of his MPH thesis.
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.
The study is led by Gal Ifergane, with research conducted by Uri Reshef Levi.
Clinical and Sub-Clinical Outcomes in Primary Care Settings across the Temperature Scale
Primary care is often the first point of contact within the healthcare system, making it a valuable setting for identifying early clinical and even subclinical effects of ambient temperature, as well as for guiding prevention and intervention efforts.
In this study the researchers examine the association between daily temperature variations and healthcare utilization, using large-scale data from Clalit Health Services alongside regional environmental data. By comparing patterns in health outcomes across similar time periods, the study evaluates how short-term changes in temperature relate to variations in primary care visits and related measures. The approach leverages population-level data while minimizing bias from individual-level differences.
This project is led by Raanan Raz (Tel Aviv University) and conducted by his research team in collaboration with NEHRI and the data unit of Soroka Clinical Research Center.
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.
In this study we 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.
The study is led by Gal Ifergane, with research conducted by Uri Reshef Levi.
Circadian Light 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 behavioural 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 analyse 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.
This study is led by Lior Zeller and Evyatar Erell, with research conducted by Uri Reshef Levi.
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.
The study is led by Lena Novack, with data analysis conducted by Uri Reshef Levi.
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.
In this study we (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.
The study is led by Yair Benyamin, with data analysis conducted by Uri Reshef Levi and Naama Schor.
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 paediatric asthma patients.
The data analysis is the study is performed by Nitzan Sagie.
Environmental and Health Impacts of Industrial Pollution in Mishor Rotem: A Multidisciplinary Study of Phosphogypsum Dispersion
Mishor Rotem, located in Israel’s Negev region, is a major industrial zone that hosts several polluting industries, including the Rotem Amfert chemical plant. One of the most significant environmental byproducts of this activity is phosphogypsum, a waste material generated during the production of phosphate fertilizers.
This research aims to fill that gap through a combination of retrospective epidemiological analysis and biological monitoring of individuals living in the proximity of the industrial area or exposed to the site pollution by air or water routes.
