Voluntary dehydration among elementary school children residing in a hot arid environment.

BACKGROUND: Voluntary dehydration is a condition where humans do not drink appropriately in the presence of an adequate fluid supply. This may adversely affect their physical and intellectual performance. The present study aimed to describe the prevalence of voluntary dehydration among elementary school children of different ethnicities and countries of birth. METHODS: Four hundred and twenty-nine elementary school children, aged 8-10 years, from four subpopulations (Israeli-born Jewish and Bedouin-Arab children, and immigrant children who recently arrived to Israel from Eastern Europe and from Ethiopia) were studied. The level of dehydration was determined by noontime urine osmolality, from samples taken over 1 week in mid-summer. Urine osmolality <500 mOsmol kg(-1) H(2)O was considered to be an appropriate level of hydration. RESULTS: Mean urine osmolality was 862 +/- 211 mOsmol kg(-1) H(2)O. Osmolality above 800 mOsmol kg(-1) H(2)O was detected in 67.5% of the urine samples; among these, 25% were above 1000 mOsmol kg(-1) H(2)O. The most dehydrated group was that of Israeli-born Jewish children, whereas the Bedouin-Arab children were the least dehydrated. CONCLUSIONS: A high proportion of children who reside in a hot and arid environment were found to be in a state of moderate to severe dehydration. Bedouin ethnicity was associated with better hydration, whereas Israeli-born Jews were most severely dehydrated. Educational intervention programmes promoting water intake should start in early childhood and continue throughout life.

Repeated fasting and refeeding with 20:5, n-3 eicosapentaenoic acid (EPA): a novel approach for rapid fatty acid exchange and its effect on blood pressure, plasma lipids and hemostasis.

Twenty hypertensive subjects participated in three clinical trials of 13 days each, to examine the effects of Alsepa fish oil [20:5, n-3 eicosapentaenoic acid (EPA) 180 mg, and 22:6 n-3 docosahexaenoic acid (DHA) 120 mg] on n-3 for n-6 polyunsaturated fatty acids (PUFA) exchange on serum phospholipids, blood pressure (BP), triglycerides (TG) and primary hemostasis. After 13 days, plasma phospholipids showed an increase in sigma n-3 (EPA and DHA) from 2.0 to 5.9% (P < 0.01), and a decrease in sigma n-6 (arachidonic acid and linoleic acid) from 29.8 to 22.6% (P < 0.01). A concomitantly significant reduction in systolic BP (SBP) (158.7 +/- 23.8 mm Hg to 146.5 +/- 17.0 mm Hg, P = 0.04), and diastolic BP (DBP) (80.8 +/- 8.4 mm Hg to 72.9 +/- 14.9 mm Hg, P = 0.04) as well as a significant decrease in platelet adhesion and aggregation on extra cellular matrix measured as a percentage of surface coverage (11.9 +/- 4.8% to 4.2 +/- 3.2%, P = 0.0001) was observed. In addition, a significant reduction in baseline dependent TG was observed; the higher the baseline level TG, the more pronounced the reduction (average 159.2 +/- 74.6 mg% to 108.0 +/- 46.1 mg%, P = 0.001). No change was observed in total cholesterol, high and low density lipoprotein (HDL, LDL), platelet and fibrinogen. Repeated fasting and refeeding with fish oil facilitated plasma exchange of n-3 for n-6 PUFA, improved BP, clinical metabolic parameters and lowered platelet reactivity in the vessel wall (primary hemostasis). In severe and life-threatening situations, the beneficial effects of fish oil should be considered for rapid exchange of n-3 for n-6 PUFA. In this study we describe a novel approach for rapid fatty acid exchange by fasting/refeeding with fish oil supplementation, as well as improved BP, plasma lipids and primary hemostasis. Further research is required on the therapeutic use of fish oils and the physiological mechanisms involved in fatty acid exchange.

Physical and psychological well-being among immigrant referrals to colonoscopy.

The association between immigration and well-being was studied in 2 groups of referrals to colonoscopy in the Negev region of Israel: Eastern Europe born (n = 278) and Israeli born (n = 70). The findings of this study suggest that the first 3 years after migration are associated with inferior physical and psychological well-being, and, to a lesser degree, with poorer family functioning and limited social interactions. The differences between immigrants and Israeli born tended to fade away as years went by, and the most veteran immigrants, those who immigrated more than 40 years prior to the study, scored best on most physical and psychological well-being indicators. Findings are discussed in terms of a life events approach and in terms of Israeli immigration regulations and absorption policy.

Clitoral and penile sizes of full term newborns in two different ethnic groups.

Standards of penile and clitoral sizes are useful for diagnosis of genital abnormalities. In order to verify whether ethnicity has an effect on the size of external genitalia in newborns, 570 full term infants, Jews (221) and Bedouins (349), at the neonatal department of the Soroka Medical Center were examined. Clitoral length, the distance between the center of the anus to the fourchette (AF) and the distance between the center of the anus and the base of the clitoris (AC) were measured, and the AF/AC ratio was calculated for the females. Penile length was measured in the males. Significant differences in clitoral length (12.6%) between the Jewish group (5.87 +/- 1.48 mm) and the Bedouin group (6.61 +/- 1.72 mm) (p < 0.01) and in the ratio of AF to AC between the two ethnic groups (p < 0.01) were found. To the best of our knowledge, our study is the first to report ethnic differences in genital sizes of newborns.

Physicians' attitudes toward litigation and defensive practice: development of a scale.

The authors' threefold purpose in this article was to (a) propose a model of the relationship between the emotional aspects of physicians' attitudes to medical errors (e.g., fear of litigation) and their functional consequences (e.g., tendency to defensive practice); (b) develop a measure of some of these attitudes; and (c) provide empirical support for some of the relationships in the model. Medical students and physicians responded to a questionnaire concerning their attitudes toward uncertainty and medical error. The dependent variables were two dimensions of attitudes to uncertainty ("reluctance to disclose uncertainty" and "stress from uncertainty") and four dimensions of attitudes to medical error ("fear of litigation," "support for self-regulation," "tendency to defensive practice," and "self-disclosure of errors"). Stress from uncertainty correlated with fear of malpractice litigation and defensive practice. They concluded that interventions that aim to increase physicians' tolerance of uncertainty may also reduce their fear of malpractice litigation and their tendency to defensive practice.

Patients' preferences for participation in clinical decision making: a review of published surveys.

Models of doctor-patient relations vary between "paternalistic" and "informative." The paternalistic model emphasizes doctors' authority; alternative models allow patients to exercise their rights to autonomy. Published surveys indicate that most patients want to be informed about their diseases, that a proportion of patients want to participate in planning management of their illnesses, and that some patients would rather be completely passive and would avoid any information. The severity of the patients' conditions, and their being older, less well educated, and male are predictors of a preference for the passive role in the doctor-patient relationship, but demographic and situational characteristics explain only 20% or less of the variability in preferences. The only way a physician can gain insight into an individual patient's desire to participate in decision making is through direct enquiry. The ability to communicate health-related information and to determine the patients' desire to participate in medical decisions should be viewed as a basic clinical skill.

[Long-term weight changes after Roux-en-Y gastric bypass for morbid obesity].

100 patients were followed for 6-9 years after Roux-en-Y gastric bypass for morbid obesity. They were randomly selected from 600 patients operated on between 1980-85. Their initial weight averaged 118 +/- 16 kg, which was 196 +/- 25% of their ideal body weight. They reached their lowest weight during an average of 15.5 months after surgery, at which time 37% were at their ideal weight, 42% were 110-130% of their ideal weight and 21% were 131-192% of their ideal weight. 90% had lost more than 50% of their excess weight. 24% had lost all their excess weight or even more, which could jeopardize nutritional status. Longer follow-up of 6-9 years showed weight gain, with 24% having become morbidly obese again, 74% having lost more than 50% of their excess weight and only 7% having lost all their excess weight. We conclude that Roux-en-Y gastric bypass induces long term weight loss and largely prevents return of morbid obesity, as long as 6-9 years after surgery.

[Hirschprung's disease in the Negev].

We treated 65 children with proven Hirschprung's disease between 1970-1992. After definitive surgery, 35 were over 10 years of age and 13 were over 18. The male:female ratio was 4:1. All but 3 were born full-term. 44% were of Bedouin origin, with a higher prevalence in 3 families of 2 tribes. 38 (58%) were diagnosed in the neonatal period: by barium enema and rectal muscle biopsy in 42 (65%), and by barium enema alone in 23 (35%). In the latter the diagnosis was verified by intra-operative biopsy. Severe constipation, intestinal obstruction or enterocolitis were the presenting features. 19 associated anomalies were found in 12 children, but none was life-threatening; 5 (8%) had cardiac anomalies; none had Down's syndrome. The rectosigmoid colon was the most common aganglionic segment involved (only 1 had total colonic aganglionosis). 7 of the 8 with short segment involvement responded well to posterior rectal myectomy. 55 patients had an abdominoperineal pull-through: 48 by Swenson's procedure and 5 by the Soave and 2 by the Duhamel modifications. In 43 a protective colostomy was performed at the end of the procedure. 53 had complete diversion colostomy at the time of initial diagnosis (neonatal and early infancy). There was no intra- or immediate post-operative death. 1 patient died 2 months after operation of complications following enterocolitis and total parenteral nutrition. 2 died a few hours after admission of severe sepsis due to enterocolitis before operation was possible. There were early postoperative complications in 11% of the 151 operations, mostly minor wound infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Fine particles and meteorological conditions are associated with lung function in children with asthma living near two power plants.

Fine particles are thought to pose a risk to health, especially for vulnerable groups such as children with asthma. These children are also known to be affected by meteorological and seasonal changes. We assessed the association between air pollution and lung function via peak expiratory flow (PEF), controlling for seasonal changes, meteorological conditions and personal physiological, clinical and sociodemographic measurements, in a panel of schoolchildren with asthma living near two power plants in Israel. Two hundred and eighty-five children with confirmed asthma performed PEF tests and completed a respiratory symptoms diary twice a day. Particulate matter <10 microm in diameter (PM10), particulate matter <2.5 microm in diameter (PM2.5) and meteorological conditions were measured at six fixed stations. Data were analysed using time series analysis-generalized linear model and generalized estimating equations. The models were built under the assumption that any health outcome belongs to a multivariate hierarchical system and depends on meteorological, geophysical and sociocultural variables and pollution factors. No significant differences were found in the demographic (age, gender, mean parental education level, parental smoking habits, place of birth and housing density), physiological (body mass index) and clinical factors (illness severity) between the communities participating in the study. A significant direct effect of PM2.5 on the PEF was found in Ashdod (P=0.000). In Sderot, this effect was through an interaction between PM10 and the sequential day of the year (P=0.000). The main conclusion of this study is that children with asthma are at risk from air pollution and geophysical conditions. Policy makers should take these results into consideration when setting thresholds for environmental protection.

Hospitalized patients' satisfaction with caregivers' conduct and physical surroundings.

The study examined the relative contribution of caregivers' conduct and physical conditions of the hospital setting to patients' global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a population of 360,000 in southern Israel. Patients were interviewed using a structured questionnaire. Inclusion criteria were patients over 17 years of age, fluency in Hebrew, and hospitalization in the internal medicine wards for 24 hours or more. The dependent variable was "global satisfaction." The independent variables were "satisfaction with caregivers' conduct," "satisfaction with physical surroundings and conditions," and "self-assessment of health." The three independent variables accounted for 36.8% of the variation in patients' satisfaction with care, of which 87% relate to "satisfaction with caregivers' conduct." In conclusion, hospital patients value the caregivers' conduct more than the physical environment.

Evaluation of primary health services: the provider perspective.

This study proposes a strategy for the evaluation of the quality of primary health services based on the provider's satisfaction with the service. In the area of health sciences only a few studies have inquired into the factors contributing to provider satisfaction. The present study tested the hypothesis that expectation regarding availability of services as well as the self-image as a provider of care and the assessment of a provider-patient relationship are major determinants of provider satisfaction. This hypothesis is derived from job satisfaction studies as well as from research on patient satisfaction. All general physicians, pediatricians, nurses, pharmacists and administrators working in 17 primary clinics in Israel were interviewed, in their clinics, by appointment (n = 147), using structured questionnaires which were especially designed for this study. Seventy-four percent of the team members stated that they were "satisfied" or "very satisfied" with the service they provide in the clinics. Overall satisfaction was significantly lower among doctors and pharmacists. The most important predictor of satisfaction is the assessment of adequacy of time devoted to patients. Only one third of the team members stated that the amount of time devoted for examination, treatment or conversation is as great as they would wish. The finding suggests that team members understand that the lack of availability of services and equipment, and lack of opportunities to meet with peers, as well as alien and cold relationships with patients, are all likely to bring about deterioration in their normative professional behavior.

Self-rated health among the elderly. A comparative analysis of health status measures, leisure activities and social contacts in age/sex groups.

A comparative analysis of self-rated health (SRH) by demographic characteristics, health status measures, leisure activities and social contacts was performed in four age/sex groups of elderly. The relative contribution of each group of variables to the explained variation in SRH was assessed using multiple regression analyses. A stratified sample drawn in an Israeli city led to 606 structured home interviews. The results show that: 1) for all groups the strongest correlates with SRH are health status measures, 2) for all groups the weakest correlates with SRH are demographic variables, 3) a significant relationship is found between SRH and age at immigration only for younger males, and 4) the explanatory power of social contacts and leisure activity variables varies significantly among the different groups. These factors explain relatively more of SRH in the younger age groups, and especially among younger males. Such findings suggest careful analyses of concepts in different socio-demographic groups for theoretical reasons and for purposes of planning health promotion community programs.

Coping with health services disruption. Perceiving need and utilizing available services during a doctors' strike.

This study examined utilization of health services during a 118-day doctors' strike. A total of 1,663 members of 423 families were home-interviewed 1 month after the beginning of the strike. A total of 39% (649 people) perceived a subjective need for health care at least once during the month preceding the interview. A total of 813 episodes of "need" were recorded. Forty-six percent of those with perceived "need" sought medical care in all episodes of need, 6% in some episodes, and 49% sought no medical advice for any of their morbidity episodes. It was found that the socioeconomic status made a major contribution to the variation in the proportion of met needs. The relevance of socioeconomic status was supported by the finding that financial constraints were the most frequently cited reason for not utilizing services. The proportion of the subjectively perceived unmet needs for medical care was lower among people from the higher socioeconomic strata.

Gross intellectual impairment among non-institutionalized elderly: difficulties in assessment and risk factors.

Quality of life of both the aged person and his relatives depends, to a large extent, on the capacity of the old person to think and to remember. In an attempt to assess the intellectual capabilities (InC) of the elderly and to identify risk factors associated with intellectual impairment (InI), a community study was carried-out. The study population was ethnically heterogeneous and comprised of a high percentage of immigrants and of people who had never attended school. Some methodological issues related to studying InC of a population with these characteristics are discussed. A stratified random sample of non-institutionalized individuals aged 65+ years was home interviewed using a short, portable questionnaire which can be used by non-professional interviewers. The research tool is comprised of 10 questions which check time and place orientation as well as short and long term memory. Although the validity of the questionnaire needs further study, some conclusions can be drawn. Approximately 16% of the subjects failed to answer correctly at least 5 of the 10 questions. People over 75 years old, single persons, those with low education and low environmental stimulation were identified as high risk groups for InI, as defined in our study. Functional limitation, such as immobility, dependence in daily functions and hearing deprivation seem to affect the InC of the aged, especially of the less educated people. Such findings may suggest the need to plan community-oriented prevention programs for the sake of the growing population of the aged in western countries.

Tolerance of uncertainty of medical students and practicing physicians.

BACKGROUND: Tolerance of uncertainty is believed to be an important attribute of practicing physicians. This study attempts to (1) estimate how medical students perceive physicians' tolerance of uncertainty and (2) measure the tolerance of uncertainty of practicing physicians. RESEARCH DESIGN: Cross-sectional. SETTING AND SUBJECTS: Medical students (n = 113) and practicing physicians (n = 151) at the Faculty of Health Sciences, Ben-Gurion University, Israel. MEASURES: A self-administered, Hebrew version of an instrument developed in the United States. INDEPENDENT VARIABLES: Age, gender, seniority (year of study for students or years in practice for physicians), country of birth for students or of graduation for physicians, and physicians' specialty. DEPENDENT VARIABLES: Two dimensions, which were identified by factor analysis: reluctance to disclose uncertainty and stress from uncertainty. RESULTS: The estimates of physicians' stress from uncertainty by first-year students aged <22 years were higher than those by first-year students aged > or =22 years. There were no significant differences in the way junior and senior medical students perceived physicians' tolerance of uncertainty. Stress from uncertainty was higher in female physicians (P = 0.028) and in graduates of the former Soviet Union (P = 0.044) than among male physicians and Israeli graduates, respectively. Reluctance to disclose uncertainty was higher among graduates of the former Soviet Union (P = 0.003) and among psychiatrists (P = 0.021) than among Israeli graduates and other specialties, respectively. CONCLUSIONS: The reliability and factor structure of the instrument were replicated. The previously reported differences in tolerance of uncertainty between women and men and between local and foreign graduates were confirmed. Physicians' tolerance of uncertainty appeared to be higher than that attributed to them by students. The expected age-related differences in perception of clinical uncertainty were not detected between junior and senior medical students.

Obesity among Jewish and Bedouin secondary school students in the Negev, Israel.

BACKGROUND: Obesity, which is a common problem, may be associated with many pathological conditions. In this study we compare the prevalence of obesity among Jewish and Bedouin 11th and 12th grade students. METHODS: Five secondary schools were chosen in the Beer Sheva region. The health charts of school infirmaries of all 512 students attending high classes were reviewed. Birth weight, and weight at ages 6-7, 14-15, and 17-18 were abstracted together with height at 17-18 y, as these data were available to us. Triceps skinfold thickness measurements (TST) were made in a subsample of 243 students. Obesity was defined by comparing the individual weight and height (W-H) and the TST to standard norms for age and sex. RESULTS: The differences between the prevalence rates of obesity among Jewish and Bedouin students were not significant (13.7% vs. 11.0%; 9.9% vs. 6.2%, using the W-H and the TST methods, respectively). Obesity at the ages 6-7 and 14-15 is a significant risk factor for obesity at 17-18 y. (RR = 5.8 and 12.1 respectively with 95% CI = 4.0-12.7 and 7.0-21.9, respectively). No significant differences were found between the rates of obesity obtained by the W-H and the TST methods (13.3% vs. 8.6%).