Objective: Little research exists on diabetes self-care management (DSCM) in Arab populations. We examined the contribution of health belief constructs, socioeconomic position (SEP) and clinical factors (glycated haemoglobin [HbA1C] level, type of diabetes treatments, and receiving professional guidance) to DSCM among Arab patients in East Jerusalem with type 2 diabetes. Method: Using a structured questionnaire, we conducted face-to-face interviews with a random sample of 230 patients with type 2 diabetes in a large diabetes clinic. DSCM included engagement in any of the following in the last week: physical activity, consumption of low-fat and low-sugar diet, self-monitoring of blood glucose, medication uptake and foot care. We obtained HbA1C levels from the clinic’s patient registry. We used linear regression to examine the contribution of health beliefs, SEP and clinical factors to explaining DSCM. Results: Adherence to DSCM was low. Most patients (84.8%) were physically inactive, 64.3% did not consume a low-fat or low-sugar diet (46.5%) and 51% did not self-monitor blood glucose. However, medication adherence (95.7%) and foot care were high (77.4%). About 71% of participants had high HbA1C (>7.0%). In the multivariate analysis, total DSCM scores were higher among patients with low financial barriers, high perception of the benefits of DSCM and higher self-efficacy. Patients using oral medication (vs insulin) had significantly lower DSCM scores. Conclusion: Among Arab patients with diabetes, more interventions are needed to encourage DSCM, specifically in areas of lifestyle (diet and physical activity). Patients’ financial barriers, benefits of DSCM and patient self-efficacy should be emphasised.

Abstract Physical examinations in childhood and adolescence have been recommended by various professional organizations. In order to assess the value of periodic physical examinations in identifying previously undetected conditions, we analyzed the results of school screening examinations of approximately 25,000 Israeli students. Methods: Entire student populations in the 1st, 5th, 7th, and 10th grades in the Tel Aviv-Yafo public school system were offered physical examinations during the 1996–1997 and 1997–1998 school years. Nine physicians performed these examinations. Referrals to the primary care physician were made for abnormal findings. The frequencies of the leading referrals were determined, and comparisons were made according to gender and grade. Results: A total of 24,846 students were examined. The overall referral rate was 7.8 per 100 examinations. Leading referrals included “overweight”, “heart murmur”, and “spinal structural abnormalities” at all grade levels, and “nevi” in grades 5, 7, and 10. Referral rates increased between various grade levels for “spinal structural abnormalities”, “nevi”, and “varicocele”, and decreased for “short stature” and “overweight”. Of the 196 diagnoses documented after referral, 182 (93%) fell into three categories, namely, spinal, hernia and scrotal, and short stature. Conclusions: A wide range of physical findings were detected or referred at each of the grade levels in this large population of schoolchildren. Many of these were triggers for preventive health counseling, while approximately 1% of the examinations yielded important findings requiring intervention. These results provide a measure of justification for the American Academy of Pediatrics’ recommendations for periodic physical examinations in childhood and adolescence.

Trials assessing the effectiveness and safety of the Atkins diet for weight loss in obese diabetic patients are limited and adherence is problematic. The current trial compared an Atkins-like diet to a conventional ADA-recommended diet over a one year period. 52 type 2 diabetes patients, aged 35–75, BMI 30–39.9 kg/m2, HbA1c > 7%, treated by diet or oral medication, were initially placed on a DASH diet for one month, then randomly assigned to a modified Atkins diet (ATK) with unrestricted calorie intake or a standard American Diabetes Association (ADA) calorie-restricted diet. Weight, fasting blood glucose, lipid profile, blood pressure, and microalbuminuria were measured at baseline and after 1.5, 3, 6 and 12 months, and compliance with the diets was assessed. Similar weight loss and decrease in HbA1c were observed in both groups. Improvement in glycemic control and cardiovascular risk factor levels accompanied the modest weight reduction, with no significant between-group differences. ATK was not associated with untoward renal effects. Substantial drop-out in both groups was noted. There was no statistically significant advantage in terms of weight loss or glucose control for the Atkins-like diet. Adherence to a very low carbohydrate diet in a population accustomed to a Mediterranean-type diet rich in fruits and vegetables was modest, thus restricting its applicability to selected obese diabetes patients.

BACKGROUND: Positive direct antiglobulin tests (DATs) have been associated with both autoimmunity and lymphoproliferative disorders. However, it is unknown whether DAT+ in healthy blood donors is associated with an increased risk of malignancies.STUDY DESIGN AND METHODS: In the current study, all blood donors with DAT+ samples were identified during the years 1999 through 2003 through the Magen David Adom National Blood Services in Israel. This study compared the risk of cancer among 586 DAT+ and 2344 DAT− donors who were matched according to sex, age, and year of donation. The risk of cancer in DAT+ donors was also compared to expected rates in the general Israeli population. Cancer was ascertained through the Israel Cancer Registry.RESULTS: Malignancies occurred among 17 (2.9%) of the DAT+ and 27 (1.2%) of the DAT− blood donors; of these, 3 donors in the DAT+ group were diagnosed with hematopoietic malignancies within 12 months of their donation. Even after excluding these early cases, the relative risk of developing cancer was 2.14 (95% confidence interval [CI], 1.13‐4.10) comparing DAT+ with DAT− donors, while the relative risk for hematopoietic cancer was 8.3 (95% CI, 1.5‐43.2). Comparing DAT+ blood donors with the general population, the standardized incidence ratios (observed/expected cases) were elevated at 2.11 (95% CI, 1.15‐3.54; p = 0.16) for all malignancies and 8.03 (95% CI, 2.2‐20.6; p = 0.003) for hematologic malignancies.CONCLUSION: There is evidence of a significantly increased risk of cancer, especially hematologic malignancies, among blood donors with a positive DAT even within a short follow‐up period.

Data on the effect of contraceptive methods, other than the condom, on HIV acquisition is not clear. The aim of this study was to describe hormonal contraceptive use, sexual behaviour and HIV prevalence among women in Cameroon in order to provide baseline information for future analytical studies.

OBJECTIVES:Few population-based data exist on the incidence and prognosis of hairy cell leukemia (HCL). Our objectives were to study the effect of socio-demographic factors on this rare disease and the risk of second malignancies occurring in HCL patients.METHODS:We measured crude and age-adjusted incidence rates of HCL based on reporting to the Israel Cancer Registry (ICR) 1991-2001. Using Kaplan-Meier and multivariate analysis, we assessed survival by gender, ethnicity and geographic region. We ascertained additional primary tumors reported in this population and calculated standardized incidence ratios (SIRs) for tumors reported after the diagnosis of HCL.RESULTS:The ICR registered 147 cases of HCL among males and 34 in females between 1991 and 2001. Age-adjusted incidence rates were 1.62/10(6)/yr for women and 7.97/10(6)/yr for men, with rates 1.5 times higher in Jewish than in non-Jewish (mainly Arab) men. Mean overall survival also differed by ethnicity. In a multivariate model, increasing age at diagnosis (P < 0.001), as well as Arab origin (P = 0.008) were associated with poorer survival but gender did not significantly affect the survival after controlling for age and ethnicity. Other primary malignancies were reported in 20 (11%) individuals, with a predominance of genito-urinary tumors (65%) among males. Secondary genito-urinary tumors were significantly increased above the expected population rates (SIR 3.23, 95% confidence interval: 1.39-6.36, P = 0.008).CONCLUSIONS:In the Israeli population, age and ethnicity were associated with prognosis of HCL. Variations in disease characteristics, stage of disease at diagnosis or differential access to treatment may contribute to these findings. Patients with HCL appear to be at increased risk for genito-urinary malignancies.

Background: Dead Sea climatotherapy is highly effective in the treatment of psoriasis. However, its potential side effects, especially the risk of skin cancer, are unclear.Objective: We sought to determine the prevalence of solar damage and skin cancer among patients with psoriasis who underwent Dead Sea climatotherapy compared with control patients.Methods: This Multicenter controlled cross-sectional study was carried out Lit the Dead Sea Solarium Clinic and outpatient clinics of the participating centers. A total of 1198 participants (460 patients with psoriasis and 738 control patients) aged 20 to 70 years were included. A standard questionnaire including demographic parameters and sun exposure habits was administered to all participants. Patients were questioned about previous psoriatic treatments and climatotherapy at the Dead Sea. All participants underwent a structured physical examination of the skin. We compared the prevalence of solar damage for patients with psoriasis and control patients and assessed the extent of photodamage among patients with psoriasis according to exposure time at the Dead Sea in univariate and multivariate analyses.Results: Elastosis (P < .001), solar lentigines (P = .03), poikiloderma (P < .001), and facial wrinkles (P < .001) were significantly more common among patients with psoriasis compared with control patients and showed a dose response with increased Dead Sea exposure time. Self-reported previous skin cancers were more common in control patients compared with patients with psoriasis (8.2% vs 3.5%, P = .002), however, the prevalence of non-melanoma skin cancer on examination did not differ between the two groups. No cases of malignant melanoma were detected in either group.Conclusions: Dead Sea climatotherapy is not associated with an increased risk of malignant melanoma or nonmelanoma skin cancer for patients with psoriasis in Israel. However, UV exposure at the Dead Sea may play a role in the development of solar damage.

In the printed article, the authors regret a number of errors. These are now corrected below:In line 7 of the Abstract ∼670,000 person years [the person time for ages 25–74 years in the full study population] should be 399,000 person years [for ages 35–64].In Table 1, the 28-day case fatality for women aged 25–34 was 47% (not 42%). The age-adjusted rates are correct. Clarification: The rates in Table 1 are the average of the annual rates for 1995–1997.In Table 2, in the rows presenting In-hospital care with thrombolytic medications, the median for MONICA men was 44% (not 4%) and for women was 35% (not 4%).Clarification: The thrombolytic percentages for Jerusalem represent early revascularization as they include primary percutaneous coronary intervention (PCI), 3% in men and 5% in women. Excluding primary PCI, the Jerusalem thrombolytic ranking becomes 11/21 for men and is unchanged (11/20) for women.As the correct data were used in the analyses, the findings and the integrity of the paper are unaffected. In the printed article, the authors regret a number of errors. These are now corrected below: In line 7 of the Abstract ∼670,000 person years [the person time for ages 25–74 years in the full study population] should be 399,000 person years [for ages 35–64]. In Table 1, the 28-day case fatality for women aged 25–34 was 47% (not 42%). The age-adjusted rates are correct. Clarification: The rates in Table 1 are the average of the annual rates for 1995–1997. In Table 2, in the rows presenting In-hospital care with thrombolytic medications, the median for MONICA men was 44% (not 4%) and for women was 35% (not 4%). Clarification: The thrombolytic percentages for Jerusalem represent early revascularization as they include primary percutaneous coronary intervention (PCI), 3% in men and 5% in women. Excluding primary PCI, the Jerusalem thrombolytic ranking becomes 11/21 for men and is unchanged (11/20) for women. As the correct data were used in the analyses, the findings and the integrity of the paper are unaffected. Myocardial infarction occurrence in Jerusalem: a Mediterranean anomalyAtherosclerosisVol. 178Issue 1PreviewThe Jewish population of Israel consumes a diet rich in polyunsaturated fatty acids with a relatively low proportion of saturated fat, has a small alcohol intake and a lipid profile characterized by low HDL-cholesterol and high lipoprotein(a) (Lp(a)). It is therefore of interest to compare occurrence rates of coronary heart disease (CHD) with those elsewhere. Full-Text PDF

Background: In Israel, preventive services for mothers and children are provided mainly by the Ministry of Health through a network of Maternal and Child Health clinics, and partly by municipalities and health maintenance organizations. Utilization of the MCH clinics for prenatal care has declined during the last decades.Objective: To study the utilization and satisfaction with prenatal care services following the introduction of the National Health Insurance Law.Methods: The study population comprised a national sample of Jewish and Arab women who were interviewed by telephone regarding the following: main service utilized for prenatal care, physician and nursing visits, satisfaction with care, and demographic and other characteristics, The response rate was 92% among Jewish women and 88% among Arab women.Results: Twenty percent of the Jewish and 52% of the Arab women selected MCH clinics as the main service for prenatal care. The great majority of the study population attended the HMO services (clinics, independent physicians, women's health centers), while 7% of the Jewish and 4% of the Arab women visited a private clinic. The predisposing factors affecting the women's choice were educational level, ethnic group, religiosity, district of residence, and type of HMO. The mean number of physician visits was more than the eight visits recommended. Forty percent of the sample visited with three or more physicians at different services. More than 40% of the women had no appointment with a nurse, mainly those who chose the services of an HMO clinic, independent physician, or private physician. Satisfaction with the physician, nurse, and physical structure of the main service chosen for prenatal care was high.Conclusions: Since the majority of women preferred the HMO services, the merging of prenatal care with curative care provided by the HMOs has to be considered. Public health nurses should be integrated in the service, and their specific role needs to be defined.

UNLABELLED:Early detection is one of the aims of the surveillance by the preventive services in infancy.OBJECTIVES:This article presents the performance of screening for anemia in infancy, compliance with iron supplementation and treatment, screening for hearing, and abnormalities of the hip joint, and referral to ear, nose and throat (E.N.T.) and orthopedic specialists according to the screening results.METHODS:The sample consisted of Jewish and Arab women who gave birth during March 2000. Mothers were interviewed after the infants reached the age of 15-19 months (667 Jewish and 211 Arab). All the women utilized the preventive services of the Ministry of Health, municipalities or H.M.O's. Arab women from East Jerusalem utilized the services of non-governmental organizations (NGO's).RESULTS:A total of 61% of the Jewish and 86% of the Arab infants had a hemoglobin examination. Eighty-five percent of the Jewish and 75% of the Arab infants received iron as a supplement or treatment for anemia. The performance of hearing tests was 88% and 77%, respectively. Among the infants referred to E.N.T. no hearing loss was detected. Fourteen percent were not screened nor referred by the family physician/pediatrician. Among the self referrals, one child was detected with a hearing loss. Percent referrals to the orthopedic surgeon was higher among Jewish than Arab infants. Among those not examined through the preventive services, the rate of pathology detected by the orthopedic surgeon was higher than those referred.RECOMMENDATIONS:Findings highlight the need to improve the quality of screening and increase the percent of infants screened in the Arab and Jewish population, particularly those of the N.G.O.'s, with emphasis on high risk groups. Furthermore, efforts should be directed to define and recommend routines for detection of abnormalities of the hip joint, and integrate the procedures within the health services.

BACKGROUND:Prenatal care in Israel is established as a universal service, but the degree of compliance with care recommendations may vary with the healthcare provider or the characteristics of the population.OBJECTIVES:To study referral to and compliance with the performance of ultrasound, alpha-fetoprotein and amniocentesis and the factors associated with them in a national sample.METHODS:The sampling frame consisted of women who gave birth during March 2000. The sample included 1,100 Israeli Jewish and Arab women who resided in localities with over 50,000 and 20,000 inhabitants respectively. They were interviewed by phone 3 months after delivery.RESULTS:In both population groups 30% reported having seven or more ultrasounds during pregnancy. The performance of fetal body scans was relatively low. Factors associated with non-performance among Jewish women were: lower education, religiousness, and attending Mother and Child Health services as compared to all other services. Seventy-seven percent of Jewish women and 84% of Arab women reported that they had been referred for alpha-protein tests. For women aged 35 and over, 55% of Jewish women were referred for amniocentesis and 63% complied, whereas 39% of Arab women were referred but none complied.CONCLUSIONS:Ultrasound is almost universally performed among Jewish and Arab women, however fetal body scans, alpha-fetoprotein and amniocentesis (for women over the age of 35) are not. The reasons for the lower coverage may be due to under-referral and/or lack of compliance of the women, perhaps due to sociocultural barriers. In both population groups considerable out-of-pocket money is paid for the tests.

UNLABELLED:Preventive services for prenatal and child health care were established 85 years ago by Henrietta Szold, president of the Women's Zionist Organization of America. A network of 1200 Mother and Child-Care clinics (known as "Tipat Halav") has developed as a result of this initiative. Preventive services are provided by the Ministry of Health, municipalities and recently, by all four Health Maintenance Organizations (HMO's) in Israel.OBJECTIVES:To assess the utilization and satisfaction of preventive health services during infancy.METHODS:The sample consisted of Jewish and Arab women who gave birth during March 2000. A total of 667 Jewish and 211 Arab mothers were interviewed after their infants reached the age of 15-19 months. The response rate was 92% and 88% respectively.RESULTS:It was found that 96% of the Jewish women and 100% of the Arab women utilized "Tipat Halav" services. Preventive services were provided mainly by the Ministry of Health and municipalities, while HMO's provided service to 15% of the Jewish infants and 19% of the Arab infants. Nine percent of the infants were not, examined by a physician within the framework of the preventive service, but all infants had health supervision by a nurse. Overall, 25% of the Jewish infants and 32% of the Arab infants had 11 or more visits with the nurse. It was observed that mothers with a higher educational level and those with many children began the process of health supervision at a later stage and visited the clinic less frequently. The number of visits to all health services combined, from birth to 15-19 months, was 26 for Jewish and 28 for Arab infants, indicating over-utilization and dependence. However, the performance of hearing and vision tests was inadequate. Referral to orthopedics was 41% for Jewish and 11% for Arab infants. The level of satisfaction with the service was high, with scores mostly above 3.0 out of a maximum of a total of 4.0 points.CONCLUSIONS:The preventive services provided by the different agencies do not differ significantly except in the case of private physicians and voluntary organizations in East Jerusalem, which do not comply with the recommended routines.RECOMMENDATIONS:Our recommendations include raising the compliance and performance of screening tests and defining the policy of referral to orthopedic services. Furthermore, the clinics should provide more outreach to high-risk families in order to optimize their utilization of services and compliance.

BACKGROUND An increased prevalence of benign solar damage (eg, facial wrinkles) but not neoplastic lesions was observed among patients with psoriasis who were exposed to Dead Sea climatotherapy compared with controls. OBJECTIVES To compare the prevalence of actinic keratosis in psoriatic patients and controls and to assess whether known risk factors behave similarly in both groups. DESIGN Multicenter cross-sectional study. SETTING Dermatology clinics in 4 participating Israeli hospitals and at a Dead Sea clinic. PARTICIPANTS Adult subjects (n = 460) with plaque-type psoriasis were recruited from the Israel Psoriasis Association (volunteer sample) and from dermatology clinics (convenience sample). The control group (n = 738) consisted of nonimmunosuppressed patients attending these clinics for benign conditions unrelated to sun exposure, such as atopic or contact dermatitis. MAIN OUTCOME MEASURES Prevalence and distribution of actinic keratoses and odds ratios associated with skin, hair, and eye color and propensity or history of sunburn adjusted for age, ethnicity, and sun exposure. RESULTS Actinic keratoses were observed in 200 controls (27%) and 51 subjects (11%) (P<.001). This increased prevalence occurred in both sexes, participants aged 35 years or older, all ethnic groups, smokers, and nonsmokers. The anatomical distribution of lesions did not substantially differ between subjects and controls. In multivariate analysis, psoriasis conferred a protective effect (odds ratio, <1), as did dark skin, dark eyes, and a history of severe sunburn in childhood. However, significant interactions were observed between psoriasis and hair color as well as psoriasis and propensity to sunburn, whereby a linear association was observed for controls but not for patients with psoriasis. CONCLUSIONS Psoriasis confers protection against actinic keratosis. Hair color and propensity to sunburn exert differential effects among psoriatic patients and controls.

This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study’s approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.

BACKGROUND The study of disabilities, use of health services, and absenteeism of parents among 0- to 17-year-old residents of Jerusalem (n = 432) hospitalized for unintentional injuries. METHODS Telephone interviews with parents, 6 months after hospitalization. Disabilities among 4 to 17 year olds were measured by a 25-item scale derived from the International Classification of Impairments, Disabilities, and Handicaps and by limitations of activities. RESULTS Six months after the injury, limitations ranged from 8.3% (daily activities) to 19.4% (sport activities). About one in three presented at least one disability in the 25-item scale. All disabilities were present in higher proportions among adolescents. The more severe injuries whether to the head or other parts of the body presented higher percentages of disabilities. Burns and traffic crashes were associated with higher proportions of disabilities than other causes and with more frequent work absenteeism by their parents. CONCLUSION A relatively large proportion of children remain with long-term disabilities irrespective of cause and body part injured. Because the sequelae of injuries is multifaceted, rehabilitation should include coordination between health and other services.

Maternal anthropometry, expressed in terms of height, prepregnancy weight and weight gain during pregnancy was studied in 432 Israeli mothers who attended routinely the Hadassah Community Health Centre in Jerusalem, and delivered live births from 1990 to 1994. Among the variables studied, social class was positively associated to mother's height. From five curves fitted with gestational age and weight gain of each woman, a quadratic one was chosen to describe the weight gain pattern of the population. From the model, prepregnancy weight and the weekly rate of weight gain were calculated. Height was positively associated to the rate of weight gain. Gestational age at delivery and gender were the strongest predictors of birth weight, followed by height and rate of weight gain. Three patterns of weight gain were observed: concave, linear and convex. No one of the variables studied was related to the pattern of weight gain as determinant or consequence. Since not all the patterns follow the same shape, the interpretation of adequacy of weight gain at a certain gestational age by using available standards must be done carefully until further studies clarify the relationships between patterns of weight gain and pregnancy outcomes for this population. Prospective studies should be carried out in Israel to control for several factors influencing maternal anthropometry and pregnancy outcomes.

To analyze the effect of birth weight on weight, stature, and the Body Mass Index (BMI) at the ages of 6 and 14 years, 1,115 Jerusalem schoolchildren were studied. Correlations were low, but higher between birth and 6 years (range 0.10-0.31) than between birth and 14 years (range 0.04-0.20). The positive predictive values for the highest quartile of BMI at 6 and 14 years were 29.6 and 29.4% among boys, 31.4 and 33.0% among girls. They were highest for menstruating girls, 35.6 and 40.0%, respectively. These girls were already heavier at age 6 than other girls and bodys. Aanalysis of covariance showed that birth weight was consistently associated with weight, stature, and the BMI, while mother's origin, education and age, and the number of children in the family were not. Overall, the explained variance was low and decreased with age in both sexes. It was higher for stature than for weight, and was specially low for the BMI. © 1993 Wiley-Liss, Inc.

BACKGROUND:The aim was to determine the influence of the socioeconomic status of the family and the hygienic practices in the home on the prevalence of head lice infestation in children.METHODS:The study was carried out by analyzing the answers to a standardized epidemiological questionnaire given to parents of school children aged 4-17 in Bet Shemesh, a medium-sized urban town 25 km from Jerusalem.RESULTS:Of 3,000 questionnaires distributed, 958 (31.9%) were completed and returned. The majority of the children (72.4%) had been previously infested with lice. Half of them had other family members, mainly brothers and sisters, who had been infested in the past with lice. In 97.5% of the families the mother was responsible for examining the children for lice, and for carrying out treatment when infestation was present. An association was found between presence of lice infestation and mother's education, age of child, and frequency of shampooing, combing, and examination for lice. There was no association between infestation rates and mother's country of origin, crowding in the home, and the sharing of combs, brushes, hats, scarves, towels, and clothes.CONCLUSIONS:There is evidence that the incidence of lice infestation depends on the hygienic practices in the home rather than on the socioeconomic status of the family or sharing of personal articles among family members.