
==== Front
Sci Rep
Sci Rep
Scientific Reports
2045-2322
Nature Publishing Group UK London

39256603
72332
10.1038/s41598-024-72332-z
Article
Exploring ethnic disparities in pediatric molluscum contagiosum in Southern Israel
https://orcid.org/0000-0003-1728-409X
Andre Nicolas 1
Jurban Eman 2
Alyagon Adva 1
Moscovici Khen 3
https://orcid.org/0000-0001-6646-9061
Horev Amir amirhr@clalit.org.il

14
1 https://ror.org/05tkyf982 grid.7489.2 0000 0004 1937 0511 Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
2 grid.412686.f 0000 0004 0470 8989 Pediatric Department, Soroka University Medical Center, Be’er Sheva, Israel
3 https://ror.org/0213tsk84 grid.477498.1 0000 0004 0454 4267 Department of Psychiatry, Maayenei Hayeshua Medical Center, Bnei Brak, Israel
4 grid.412686.f 0000 0004 0470 8989 Pediatric Dermatology Service, Soroka University Medical Center, Hanesiim St., 84101 Be’er Sheva, Israel
10 9 2024
10 9 2024
2024
14 2113912 4 2024
5 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Molluscum contagiosum (MC) is a common skin infection affecting children globally, including in Israel, which has a diverse population comprising mainly Jews (73.2%) and Arabs (21.1%). Despite documented disparities in various diseases between these groups, research on differences in dermatological care is scarce. This study aimed to investigate MC as a potential differentiator between Arab and Jewish children. A retrospective analysis of MC cases among children (0–18 years) from 2013 to 2022 was performed at Soroka University Medical Center, a tertiary hospital serving over a million patients. 615 patients participated in our study, with 95.2% Jewish and 4.8% Arab. Both groups showed similar characteristics in lesion quantity (P  =  0.535), diameter (P  =  0.341), inflammation markers, and lesion location. Additionally, management, treatment response, and outcomes were found to be similar between the two groups. In conclusion, the Arab representation in the study was disproportionately low compared to their population in the area. While Jewish patients may rely more on medical specialists, we believe Arabs may prefer self-management practices, such as the use of traditional medicine, possibly hindering effective physician-led care. Understanding such disparities could improve dermatological care by tailoring approaches to diverse populations.

Keywords

Delivery of health care
Dermatology
Global health
Molluscum contagiosum
Traditional medicine
Subject terms

Health care
Skin diseases
issue-copyright-statement© Springer Nature Limited 2024
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pmcIntroduction

Molluscum contagiosum (MC) is a prevalent skin infection affecting children aged 0–16, with a global prevalence ranging from 5 to 11.5%1. The decision to treat MC has been historically debated due to its self-limiting nature and limited improvement with therapy2. However, the infection often presents with tender, crusted, erythematous lesions, raising concerns about bacterial infection3. Consequently, medical intervention is justified to ensure that these signs of inflammation represent the host response, facilitating the resolution of the viral disease rather than bacterial superinfection3.

Israel is home to a diverse range of ethnic groups, with Jews comprising approximately 73.2% of the total population and Arabs constituting around 21.1% of the population4. Recent publications emphasize notable health inequalities between the Jewish and Arab populations. Despite having access to one of the most proficient healthcare systems globally, the Arab population reportedly experiences a shorter life expectancy and markedly poorer health outcomes compared to their Jewish counterparts5. Treister-Goltzman et al. identified women in the Arab population as a risk factor for severe anemia6, and Savitsky et al. demonstrated that Arab women had a significantly lower probability of benefit entitlement due to mental illness within 2 years after childbirth7. Furthermore, Southern et al. demonstrated that Arab children tend to have a higher recent usage of antibiotics compared to Jewish children8. Finally, Cohen et al., who investigated resilience levels among Jewish and Arab Israeli citizens amidst the COVID-19 outbreak, found that Arabs reported elevated distress levels and diminished individual and community resilience when compared to their Jewish counterparts9.

Nonetheless, the Arab community, notably in the southern Israel district, has demonstrated a greater willingness to engage with public health initiatives. This is evident in their higher compliance with routine vaccination programs for school-aged children10. Specifically, Shahbari et al. found that Arab mothers were more likely to embrace both Human Papillomavirus and Influenza vaccinations11. Additionally, Forer et al. suggested that Arabs exhibited higher adherence to varicella vaccination compared to Jews12. Despite existing healthcare disparities in access between Arabs and Jews, the active participation of Arabs in healthcare can be viewed as a sign of trust in health systems, as discussed more globally by Tal et al. in their paper13.

Despite numerous manuscripts focusing on the disparity of these two groups regarding vaccines and certain pathologies14,15, extremely limited research exploring disparities in dermatological care between Arabs and Jews can be found in the literature. In two comprehensive manuscripts, Kridin et al. delve into the differing epidemiology of pemphigus16 and bullous pemphigoid17, highlighting distinctions between the two groups. More research exploring dermatological conditions within the Arab and Jewish populations is needed. Closing this gap would help raise awareness about dermatological care, not only in the Israeli healthcare system, but in all countries with diverse populations by optimizing resource utilization to enhance care across them.

Here, we provide new insights by examining molluscum contagiosum as a potential factor distinguishing between the two groups. By deepening our understanding of the variations in this prevalent skin infection among Arabs and Jews, and identifying potential health disparities in molluscum care between these populations, we aim to inform healthcare organizations and delivery, ensuring appropriate care for a broader population.

Materials and methods

This study was conducted at the pediatric dermatology clinic of Soroka University Medical Center (SUMC), a university-affiliated referral center in Southern Israel that directly serves a population of 600,000 and functions as a tertiary hospital for over 1 million people. The data was extracted from the medical records of patients at SUMC, and the study was carried out under the approval of the Soroka Medical Center’s Institutional Review Board (IRB) with the reference number SOR-0305-21.

A retrospective analysis was performed on all cases of children (aged 0–18) diagnosed with molluscum contagiosum (MC) between 2013 and 2022. The inclusion criteria comprised individuals who received assessment or treatment for MC lesions at the pediatric dermatology clinic in SUMC during this period, while those aged 18 years and older and those not evaluated at the clinic were excluded. Initial data collection included demographic information such as age, ethnicity, gender, and age at MC diagnosis. Subsequently, various parameters related to MC lesions were examined, covering aspects like location, number, size, and the presence of erythema, ulceration, pruritus, or purulence. Treatment details and associated outcomes, such as hypopigmentation, hyperpigmentation, and scarring, were also analyzed, along with the number of clinic visits to assess resistance or reinfection. Evaluation criteria for treatment response involved a reduction in lesion size by at least 50%, absence of scarring, and clinical improvement, as documented by the treating physician. Clinical improvement parameters extended beyond alterations in lesion size and scarring to encompass changes in induration, ulceration, and erythema. Recurrent visits due to MC complaints were also assessed after excluding individuals who did not receive any treatment, aiming to mitigate any bias in visit frequency for patients scheduled for routine follow-ups at the office but not receiving treatments.

All treatments within the study were classified into two groups: MC treatments (Curettage, topical retinoids, Fluorouracil with Salicylic acid, Imiquimod, Podophyllotoxin, Trichloroacetic acid, and Liquid Nitrogen) and supportive treatments (topical and systemic steroids and antibiotics).

Descriptive statistical univariate analyses were conducted using JASP. Normality was assessed, when applicable, through Shapiro–Wilk tests. Distinctions between Jews and Arabs were examined using two-tailed chi-square tests or Mann–Whitney tests, when relevant. The threshold for statistical significance was set at P < 0.05.

Results

615 children participated in the study. On average, the children in our sample were 7.9 years old, and 51.8% were male. Among the participants, 95.2% identified as Jewish, with the remaining 4.8% identifying as Arabs. Our evaluation revealed no disparity in age and gender between Arab and Jewish patients with MC. Furthermore, no distinction was observed in atopic dermatitis prevalence between the two groups. Table 1 provides a summary of the demographics of our cohort.Table 1 Demographic characteristics of children with molluscum contagiosum (MC).

Demographic	Data	
 Total Children (N)	615	
 Average Age (mean)	7.9 years	
Gender (%)	
 Male	51.8%	
 Female	48.2%	
Ethnicity (%)	
 Jewish	95.2%	
 Arabs	4.8%	

Our assessment of differences in various lesion characteristics among Jewish and Arab MC patients revealed predominantly similar findings. Arab and Jewish patients with molluscum exhibited comparable quantities of lesions (P  =  0.535), similar lesion diameters (P  =  0.341), as well as similar levels of inflammation markers, including erythema (P  =  0.089), itchiness (P  =  0.397), ulceration (P  =  0.344), and purulence (P  =  0.620). Additionally, no significant difference was found in the distribution of lesions across different body locations between the two groups, such as on the cheeks (P  =  0.298), eyelids (P  =  0.903), trunk (P  =  0.616), and upper limbs (P  =  0.143). However, Jews exhibited significantly more lesions on the lower limbs compared to Arabs (P  =  0.031, Table 2).Table 2 Comparison of key molluscum lesion characteristics between Arabs and Jews.

Characteristics	Arabs	Jews	P-value	
Lesion Quantity (median)	5	10	0.535	
Lesion Diameter in mm (median)	3.5	5	0.341	
Atopic Dermatitis	2 (6.90%)	79 (13.62%)	0.298	
Lesion on Cheeks	8 (34.78%)	125 (24.46%)	0.263	
Lesion on Eyelid	5 (21.74%)	108 (20.69%)	0.903	
Lesion on the Trunk	15 (51.72%)	319 (56.46%)	0.616	
Lesion on Upper Limbs	5 (17.24%)	165 (29.95%)	0.143	
Lesions on Lower Limbs	6 (20.69%)	226 (40.79%)	0.031	
Ulceration (N)	5 (20.00%)	64 (13.33%)	0.344	
Purulence (N)	5 (20.00%)	82 (16.23)	0.620	
Itchiness (N)	7 (28.00%)	103 (20.89%)	0.397	
Erythema (N)	19 (70.37%)	287 (53.64%)	0.089	

In regard to treatments, Arabs and Jews showed similar responses concerning the utilization of MC-specific or nonspecific treatments (P  =  0.630 and P  =  0.631, respectively). There was no discernible disparity in the overall treatment response between the two groups (P  =  0.323), nor in the reduction of ulceration (P  =  0.985), itchiness (P  =  0.996), or erythema (P  =  0.900) post-treatment. Additionally, neither group exhibited a higher incidence of residual scarring (P  =  0.740), hypopigmentation (P  =  0.317), hyperpigmentation (P  =  0.540), or recurring MC-related complaints (P  =  0.816) following treatment (Table 3).Table 3 Comparison of treatment characteristics between Arabs and Jews.

Characteristics	Arabs	Jews	P-value	
Use of MC specific treatments	1 (3.45%)	32 (5.53%)	0.630	
Use of non-specific treatments	22 (75.86%)	414 (71.75%)	0.631	
Overall response to treatments	5 (50%)	130 (65.33%)	0.323	
Response to treatments

Reduction in ulceration

	2 (22.22%)	36 (28.13%)	0.985	
Response to treatments

Reduction in itchiness

	3 (37.5%)	59 (37.58)	0.996	
Response to treatments reduction in erythema	3 (30%)	47 (31.33%)	0.900	
Residual scarring	1 (12.5%)	25 (17.01%)	0.740	
Hypopigmentation	0 (0%)	16 (11.12%)	0.317	
Hyperpigmentation	0 (0%)	8 (27.59%)	0.540	
Recurrent MC complaints	17 (60.71%)	356 (62.90%)	0.816	

Discussion

In a setting where research data on global health within the dermatological field is lacking, our retrospective study investigated variances in MC characteristics and treatments between Arab and Jewish populations. Our findings indicate that while Arabs and Jews exhibit comparable lesion traits and are generally treated similarly, less than 5% of our study group comprised Arabs, despite our medical center being situated in an area where most Arabic Bedouins reside.

Our findings are notable, revealing a significantly lower representation of Arabs in contrast to other studies examining health disparities between Arabs and Jews across different fields. For instance, in Kalter-Leibovici et al.'s investigation on diabetes, Arabs constituted approximately 50% of their study population18, while Gotsman et al. reported over a quarter of their cohort being Arab19. Similarly, studies on breast cancer in Arabs compared to Jewish women exhibited a similar pattern20. Moreover, Kridin et al. found comparable proportions of Arab patients in their dermatological studies16,17. The disparity in Arab representation compared to Jewish individuals at our hospital is intriguing, especially considering that Kridin et al. show that they seem to seek specialist care, including dermatological consultations, but do not present to us through referrals from their primary care physicians.

In their study on disparities in healthcare utilization among Jews and Arabs in Israel, Baron-Epel et al. documented patterns of healthcare consultation among Arabs, including reduced utilization of specialist care, increased reliance on family physician care, and higher rates of hospitalizations21. These authors discussed potential factors contributing to the underutilization of healthcare services by Arabs, such as cultural norms and behaviors, as well as possible differences in access and quality of care21. While previous studies on disease disparities between Jews and Arabs have shown a lower proportion of Arabs compared to Jews, our population's even lower representation is compelling and cannot be solely attributed to difficulties in accessing care, considering that all Israeli citizens have unrestricted access to contemporary healthcare services.

Alternatively, one might consider that Jews could be particularly attentive to skin conditions, as observed by Rozani in older populations seeking dermatology care (18.9% of Jews vs. 8.5% of Arabs, P < 0.001)22. Despite MC being a self-limiting disease that does not typically necessitate the same clinical attention as other dermatological conditions such as pemphigus vulgaris or psoriasis, Jewish patients comprised nearly all of the individuals in our cohort. This could be attributed to a higher utilization of specialist services and a less optimal utilization of family physicians among Jews, as already considered in another study investigating disparities in healthcare service utilization between Jews and Arabs in Israel21.

Interestingly, Jews and Arabs exhibited no discernible differences in the clinical characteristics of their molluscum infection. They displayed identical lesion diameters, numbers of lesions, inflammation markers, and overall distribution of lesions throughout the body, except for a higher number of lesions on the lower limbs among Jews. Equally intriguing is the observation that these two groups received similar treatment and demonstrated comparable recurrence rates of complaints following treatment. These findings suggest that both Jews and Arabs receive equitable care when seeking consultation for MC, and no specific emphasis should be placed on either group regarding lesion presentation, as they appear to be uniform.

However, while cultural disparities in healthcare utilization and limited access to healthcare may influence our findings, other factors could also contribute to the limited representation of Arab patients in our clinic. The prolonged duration and visibility of MC lesions, along with the potential for virus transmission, can induce psychosocial distress, stigma, and anxiety for both patients and caregivers, as demonstrated by Olsen et al.23 We believe that this holds true regardless of ethnicity, as similar effects have been documented in other skin disorders in Arabic countries, such as psoriasis24. Therefore, while Arabs may indeed have trust in healthcare practitioners, they may perceive the severity of MC differently, even after being referred from a family physician to a dermatologist. As discussed in a questionnaire-based study by Yosef et al., Arab Israelis tend to report lower illness perception and lower subjective morbidity compared to Jews or immigrants from the former Soviet Union (OR = 0.34, P < 0.0001)25. Consequently, Arabs might prefer a more observational approach in managing self-limited disorders such as MC. However, Arabs may also be more prone to the adoption of certain traditional practices affecting the self-management of illnesses26. As such, the literature extensively documents that Arabs exhibit a notable preference for alternative medicine, particularly herbal remedies, compared to Jews27,28. This inclination is observed across various Middle Eastern countries where research highlights the widespread use of alternative medicine for dermatological disorders among Arabs. For instance, one study investigated the efficacy of fig tree latex therapy on warts29, while another discussed the role of herbal infusions, ointments, and capsules in the self-management of psoriasis30. This suggests a need for physicians to adopt a distinct approach in managing dermatological conditions in the Arab population, along with enhanced patient education on skin care, even for benign lesions.

Our study exhibits several notable strengths. Firstly, our patients underwent evaluations at a solitary center under the care of a board-certified pediatric dermatologist, thus reducing the likelihood of discrepancies in the interpretation of skin lesions across different assessors. Secondly, the retrospective design of our study enabled investigation into ethnic variations in molluscum lesions. However, our study also has limitations. Since our population primarily consists of Arabic Bedouins, this subgroup of Arabs may exhibit distinct behaviors compared to Arabs residing in the northern regions of the country. Consequently, the generalizability of our findings to the broader population might be limited. Additionally, the underrepresentation of the Arab population, combined with the overrepresentation of the Jewish population, may introduce a bias into the data analyses of our study. Thus, larger studies involving a more extensive population are necessary to validate our conclusions. Finally, our retrospective analysis limits our ability to fully explore the reasons behind the underrepresentation of the Arab population in our cohort. To better explain our findings, more research, notably questionnaire-based studies with a qualitative component, is needed.

In summary, our study examined disparities between Arabs and Jews concerning MC, revealing no significant distinctions in the clinical characteristics of lesions or their management by physicians. Nonetheless, it is noteworthy that less than 5% of our study cohort comprised Arabs despite a considerably larger Arab population residing in our vicinity. While Jews might overuse medical specialists, we posit that the Arab population may require a different approach, as they are inclined toward self-management practices, notably traditional medicine, that could potentially hinder effective physician-led care.

Author contributions

Amir Horev: Conceptualization (lead); Review and editing (equal); administrative support (lead) and provision of study materials and patients (lead). Chen Moskovich: software (lead), formal data analysis (lead), review and editing (equal). Adva Alyagon: Conceptualization (equal); Eman Jurban: Collection and assembly of data (equal); writing – review and editing (equal). Nicolas Andre: Writing – original draft (lead), data analysis and interpretation (lead), writing – review and editing (equal).

Funding

No funding was received for this study.

Data availability

All data may be available upon request to the corresponding author.

Competing interests

The authors declare no competing interests.

Ethical approval

Approval from Soroka Medical Center’s institutional review board was obtained prior to the study which complied with the 1964, 1975 and 2013 revisions of the Helsinki Declaration (approval number SOR-0305-21). No informed consent needed to be obtained due to the retrospective nature of our study, as stated by the institutional review board.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. Olsen JR Gallacher J Piguet V Francis NA Epidemiology of molluscum contagiosum in children: A systematic review Fam Pract. 2014 31 2 130 136 10.1093/fampra/cmt075 24297468
Olsen, J. R., Gallacher, J., Piguet, V. & Francis, N. A. Epidemiology of molluscum contagiosum in children: A systematic review. Fam Pract. 31(2), 130–136 (2014).24297468 10.1093/fampra/cmt075
2. Meza-Romero R Navarrete-Dechent C Downey C Molluscum contagiosum: An update and review of new perspectives in etiology, diagnosis, and treatment Clin. Cosmet. Investig. Dermatol. 2019 30 12 373 381 10.2147/CCID.S187224
Meza-Romero, R., Navarrete-Dechent, C. & Downey, C. Molluscum contagiosum: An update and review of new perspectives in etiology, diagnosis, and treatment. Clin. Cosmet. Investig. Dermatol. 30(12), 373–381 (2019).10.2147/CCID.S187224
3. Butala N Siegfried E Weissler A Molluscum BOTE sign: a predictor of imminent resolution Pediatrics. 2013 131 5 e1650 1653 10.1542/peds.2012-2933 23545377
Butala, N., Siegfried, E. & Weissler, A. Molluscum BOTE sign: a predictor of imminent resolution. Pediatrics. 131(5), e1650-1653 (2013).23545377 10.1542/peds.2012-2933
4. Latest Population Statistics for Israel [Internet]. [cited 2024 Feb 15]. Available from: https://www.jewishvirtuallibrary.org/latest-population-statistics-for-israel
5. Tanous O Asi Y Hammoudeh W Mills D Wispelwey B Structural racism and the health of Palestinian citizens of Israel Glob. Public Health. 2023 18 1 2214608 10.1080/17441692.2023.2214608 37209155
Tanous, O., Asi, Y., Hammoudeh, W., Mills, D. & Wispelwey, B. Structural racism and the health of Palestinian citizens of Israel. Glob. Public Health. 18(1), 2214608 (2023).37209155 10.1080/17441692.2023.2214608
6. Treister-Goltzman Y Peleg R Biderman A Anemia among Muslim Bedouin and Jewish women of childbearing age in Southern Israel Ann. Hematol. 2015 94 11 1777 1784 10.1007/s00277-015-2459-z 26211919
Treister-Goltzman, Y., Peleg, R. & Biderman, A. Anemia among Muslim Bedouin and Jewish women of childbearing age in Southern Israel. Ann. Hematol. 94(11), 1777–1784 (2015).26211919 10.1007/s00277-015-2459-z
7. Savitsky B Radomislensky I Frid Z Gitelson N Glasser S Hendel T Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study Isr. J. Health Policy Res. 2020 9 1 63 10.1186/s13584-020-00407-z 33168058
Savitsky, B. et al. Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study. Isr. J. Health Policy Res. 9(1), 63 (2020).33168058 10.1186/s13584-020-00407-z
8. Southern J Roizin H Daana M Rubin C Hasleton S Cohen A Varied utilisation of health provision by Arab and Jewish residents in Israel Int. J. Equity Health. 2015 7 14 63 10.1186/s12939-015-0193-8
Southern, J. et al. Varied utilisation of health provision by Arab and Jewish residents in Israel. Int. J. Equity Health. 7(14), 63 (2015).10.1186/s12939-015-0193-8
9. Cohen O Mahagna A Shamia A Slobodin O Health-care services as a platform for building community resilience among minority communities: An Israeli Pilot Study during the COVID-19 Outbreak Int. J. Environ. Res. Public Health. 2020 17 20 7523 10.3390/ijerph17207523 33081120
Cohen, O., Mahagna, A., Shamia, A. & Slobodin, O. Health-care services as a platform for building community resilience among minority communities: An Israeli Pilot Study during the COVID-19 Outbreak. Int. J. Environ. Res. Public Health. 17(20), 7523 (2020).33081120 10.3390/ijerph17207523
10. Yitshak-Sade M Davidovitch N Novack L Grotto I Ethnicity and immunization coverage among schools in Israel Ethn. Health. 2016 21 5 439 451 10.1080/13557858.2015.1068281 26304468
Yitshak-Sade, M., Davidovitch, N., Novack, L. & Grotto, I. Ethnicity and immunization coverage among schools in Israel. Ethn. Health. 21(5), 439–451 (2016).26304468 10.1080/13557858.2015.1068281
11. Shahbari NAE Gesser-Edelsburg A Davidovitch N Brammli-Greenberg S Grifat R Mesch GS Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel Int. J. Equity Health. 2021 20 1 201 10.1186/s12939-021-01523-1 34493294
Shahbari, N. A. E. et al. Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel. Int. J. Equity Health. 20(1), 201 (2021).34493294 10.1186/s12939-021-01523-1
12. Forer E Yariv A Ostrovsky D Horev A The association between varicella vaccination and herpes zoster in children: A semi-national retrospective study J. Clin. Med. 2023 12 13 4294 10.3390/jcm12134294 37445329
Forer, E., Yariv, A., Ostrovsky, D. & Horev, A. The association between varicella vaccination and herpes zoster in children: A semi-national retrospective study. J. Clin. Med. 12(13), 4294 (2023).37445329 10.3390/jcm12134294
13. Tal O Ne’eman Y Sadia R Shmuel R Schejter E Bitan M Parents’ attitudes toward children’s vaccination as a marker of trust in health systems Hum. Vaccines Immunother. 2021 17 11 4518 4528 10.1080/21645515.2021.1971472
Tal, O. et al. Parents’ attitudes toward children’s vaccination as a marker of trust in health systems. Hum. Vaccines Immunother. 17(11), 4518–4528 (2021).10.1080/21645515.2021.1971472
14. Blumenfeld O Dichtiar R Shohat T Israel IDDM registry study group (IIRSG). Trends in the incidence of type 1 diabetes among Jews and Arabs in Israel Pediatr. Diabetes. 2014 15 6 422 427 10.1111/pedi.12101 24283719
Blumenfeld, O., Dichtiar, R. & Shohat, T. Israel IDDM registry study group (IIRSG). Trends in the incidence of type 1 diabetes among Jews and Arabs in Israel. Pediatr. Diabetes. 15(6), 422–427 (2014).24283719 10.1111/pedi.12101
15. Leibovici V Koran LM Murad S Siam I Odlaug BL Mandelkorn U Excoriation (skin-picking) disorder in adults: A cross-cultural survey of Israeli Jewish and Arab samples Compr. Psychiatry. 2015 58 102 107 10.1016/j.comppsych.2014.12.008 25682319
Leibovici, V. et al. Excoriation (skin-picking) disorder in adults: A cross-cultural survey of Israeli Jewish and Arab samples. Compr. Psychiatry. 58, 102–107 (2015).25682319 10.1016/j.comppsych.2014.12.008
16. Kridin K Zelber-Sagi S Khamaisi M Cohen AD Bergman R Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region J. Am. Acad. Dermatol. 2016 75 5 925 930 10.1016/j.jaad.2016.06.055 27614531
Kridin, K., Zelber-Sagi, S., Khamaisi, M., Cohen, A. D. & Bergman, R. Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region. J. Am. Acad. Dermatol. 75(5), 925–930 (2016).27614531 10.1016/j.jaad.2016.06.055
17. Kridin K Bergman R Ethnic variations in the epidemiology of bullous pemphigoid in Israel Int. J. Dermatol. 2018 57 1 34 39 10.1111/ijd.13813 29090462
Kridin, K. & Bergman, R. Ethnic variations in the epidemiology of bullous pemphigoid in Israel. Int. J. Dermatol. 57(1), 34–39 (2018).29090462 10.1111/ijd.13813
18. Kalter-Leibovici O Chetrit A Lubin F Atamna A Alpert G Ziv A Adult-onset diabetes among Arabs and Jews in Israel: A population-based study Diabet. Med. J. Br. Diabet. Assoc. 2012 29 6 748 754 10.1111/j.1464-5491.2011.03516.x
Kalter-Leibovici, O. et al. Adult-onset diabetes among Arabs and Jews in Israel: A population-based study. Diabet. Med. J. Br. Diabet. Assoc. 29(6), 748–754 (2012).10.1111/j.1464-5491.2011.03516.x
19. Gotsman I Avishai-Eliner S Jabara R Zemora Z Shauer A Lotan C Ethnic disparity in the clinical characteristics of patients with heart failure Eur. J. Heart Fail. 2015 17 8 801 808 10.1002/ejhf.285 25994423
Gotsman, I. et al. Ethnic disparity in the clinical characteristics of patients with heart failure. Eur. J. Heart Fail. 17(8), 801–808 (2015).25994423 10.1002/ejhf.285
20. Zidan J Sikorsky N Basher W Sharabi A Friedman E Steiner M Differences in pathological and clinical features of breast cancer in Arab as compared to Jewish women in Northern Israel Int. J. Cancer. 2012 131 4 924 929 10.1002/ijc.26431 21918975
Zidan, J. et al. Differences in pathological and clinical features of breast cancer in Arab as compared to Jewish women in Northern Israel. Int. J. Cancer. 131(4), 924–929 (2012).21918975 10.1002/ijc.26431
21. Baron-Epel O Garty N Green MS Inequalities in Use of Health Services among Jews and Arabs in Israel Health Serv. Res. 2007 42 3 Pt 1 1008 1019 10.1111/j.1475-6773.2006.00645.x 17489901
Baron-Epel, O., Garty, N. & Green, M. S. Inequalities in Use of Health Services among Jews and Arabs in Israel. Health Serv. Res. 42(3 Pt 1), 1008–1019 (2007).17489901 10.1111/j.1475-6773.2006.00645.x
22. Rozani V Ethnic differences in socioeconomic and health determinants related to self-rated health status: A study on community-dwelling Israeli jews and arabs in old age Int. J. Environ. Res. Public Health. 2022 19 20 13660 10.3390/ijerph192013660 36294239
Rozani, V. Ethnic differences in socioeconomic and health determinants related to self-rated health status: A study on community-dwelling Israeli jews and arabs in old age. Int. J. Environ. Res. Public Health. 19(20), 13660 (2022).36294239 10.3390/ijerph192013660
23. Olsen JR Gallacher J Finlay AY Piguet V Francis NA Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: A prospective community cohort study Lancet Infect. Dis. 2015 15 2 190 195 10.1016/S1473-3099(14)71053-9 25541478
Olsen, J. R., Gallacher, J., Finlay, A. Y., Piguet, V. & Francis, N. A. Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: A prospective community cohort study. Lancet Infect. Dis. 15(2), 190–195 (2015).25541478 10.1016/S1473-3099(14)71053-9
24. Dimitrov D Matusiak Ł Szepietowski J Stigmatization in Arabic psoriatic patients in the United Arab Emirates—A cross sectional study Adv. Dermatol. Allergol. Dermatol. Alergol. 2019 36 4 425 430 10.5114/ada.2018.80271
Dimitrov, D., Matusiak, Ł & Szepietowski, J. Stigmatization in Arabic psoriatic patients in the United Arab Emirates—A cross sectional study. Adv. Dermatol. Allergol. Dermatol. Alergol. 36(4), 425–430 (2019).10.5114/ada.2018.80271
25. Yosef Y Kiderman A Chinitz D Lahad A The landscape of medical care consumption in Israel: A nationwide population cross-sectional study Isr. J. Health Policy Res. 2022 10 11 38 10.1186/s13584-022-00542-9
Yosef, Y., Kiderman, A., Chinitz, D. & Lahad, A. The landscape of medical care consumption in Israel: A nationwide population cross-sectional study. Isr. J. Health Policy Res. 10(11), 38 (2022).10.1186/s13584-022-00542-9
26. Arabiat D Whitehead L Jabery ALM Hamdan-Mansour A Shaheen A Abu Sabbah E Beliefs about illness and treatment decision modelling during ill-health in arabic families J. Multidiscip. Healthc. 2021 14 1755 1768 10.2147/JMDH.S311900 34267524
Arabiat, D. et al. Beliefs about illness and treatment decision modelling during ill-health in arabic families. J. Multidiscip. Healthc. 14, 1755–1768 (2021).34267524 10.2147/JMDH.S311900
27. Ben-Arye E Lev E Keshet Y Schiff E Integration of herbal medicine in primary care in Israel: A Jewish-Arab cross-cultural perspective Evid.-Based Complement. Altern. Med. ECAM. 2011 2011 401395 10.1093/ecam/nep146
Ben-Arye, E., Lev, E., Keshet, Y. & Schiff, E. Integration of herbal medicine in primary care in Israel: A Jewish-Arab cross-cultural perspective. Evid.-Based Complement. Altern. Med. ECAM. 2011, 401395 (2011).10.1093/ecam/nep146
28. Keshet Y Popper-Giveon A Integrative health care in israel and traditional arab herbal medicine: When health care interfaces with culture and politics Med. Anthropol. Q. 2013 27 3 368 384 10.1111/maq.12049 24248993
Keshet, Y. & Popper-Giveon, A. Integrative health care in israel and traditional arab herbal medicine: When health care interfaces with culture and politics. Med. Anthropol. Q. 27(3), 368–384 (2013).24248993 10.1111/maq.12049
29. Bohlooli S Mohebipoor A Mohammadi S Kouhnavard M Pashapoor S Comparative study of fig tree efficacy in the treatment of common warts (Verruca vulgaris) versus cryotherapy Int. J. Dermatol. 2007 46 5 524 526 10.1111/j.1365-4632.2007.03159.x 17472688
Bohlooli, S., Mohebipoor, A., Mohammadi, S., Kouhnavard, M. & Pashapoor, S. Comparative study of fig tree efficacy in the treatment of common warts (Verruca vulgaris) versus cryotherapy. Int. J. Dermatol. 46(5), 524–526 (2007).17472688 10.1111/j.1365-4632.2007.03159.x
30. Ben-Arye E Ziv M Frenkel M Lavi I Rosenman D Complementary medicine and psoriasis: Linking the patient’s outlook with evidence-based medicine Dermatology. 2003 207 3 302 307 10.1159/000073094 14571074
Ben-Arye, E., Ziv, M., Frenkel, M., Lavi, I. & Rosenman, D. Complementary medicine and psoriasis: Linking the patient’s outlook with evidence-based medicine. Dermatology. 207(3), 302–307 (2003).14571074 10.1159/000073094
