Socioeconomic status and vaccine coverage during wild-type poliovirus emergence in Israel.

In August 2013, a nationwide vaccination campaign with bivalent oral polio vaccine (bOPV) was initiated after isolation of wild-type poliovirus type 1 (WPV-1) in routine sewage surveillance in Israel. The campaign started in the Southern district and later extended to the entire country. This study examined the association between socioeconomic status (SES), and compliance with bOPV vaccine during the campaign. Nationwide data relating to SES by geographical cluster were correlated with vaccine coverage rates in the same areas. All analyses were conducted separately for Jews and Arabs. Coverage with the bOPV vaccination campaign in the Arab population (92·4%) was higher than in the Jewish population (59·2%). This difference was consistently present in all SES clusters. In the Jewish population there was an inverse correlation between SES and vaccination coverage rates (R = -0·93, P < 0·001). Lower vaccination coverage with supplemental vaccine activities in higher SES groups is a challenge that needs to be addressed in future public health events and emergencies in order to achieve satisfactory protection rates for the public.

Like mother like daughter: low birth weight and preeclampsia tend to reoccur at the next generation.

BACKGROUND: Low birth weight and preeclampsia are both adverse pregnancy and delivery outcomes, with possible influence on future health status. Previous studies have shown that intergenerational factors may be important prognostic information in evaluating women prior to or after conception. Our objective was to evaluate the role of intergenerational factors on the incidence of preeclampsia and low birth weight (LBW). METHODS: A retrospective population-based study was conducted. Perinatal information was gathered from 2311 familial triads, comprising mothers (F1), daughters (F2), and children (F3). All births occurred in a tertiary medical center between 1991 and 2013. A multivariate generalized estimating equation logistic regression model analysis was used to study the association between LBW and preeclampsia across generations while controlling for confounders and for clusters of families in the database. RESULTS: A total of 1490 in F1, 1616 in F2, and 2311 in F3 were included. LBW in mothers (F2), adjusted for possible confounders, was found to be a significant predictor for LBW in offspring (OR = 1.6, 95% CI 1.02-2.6, p = .043). Likewise, preeclampsia was also noted as a significant intergenerational factor following adjustments for possible confounders (OR = 2.9, 95% CI 1.4-5.8, p = .004). CONCLUSIONS: Maternal LBW and preeclampsia are both independent risk factors for recurrence in the next generation.

Depressive symptoms and risk for malnutrition among hospitalized elderly people.

OBJECTIVES: To explore the association between depressive symptoms and risk for malnutrition in hospitalized elderly people. METHODS: 195 hospitalized medical patients older than 65 years of age were studied in a cross-sectional design. Depression was assessed by 30-item Geriatric Depression Scale (GDS), nutritional status was evaluated by the Mini-Nutritional Assessment (MNA). Eating and digestive problems were assessed using selected items of Nutrition Risk Index (NRI), cognitive and functional status by Folstein and Barthel indices respectively; demographic data, diagnoses and medications were obtained from medical records. RESULTS: The prevalence of depression in the studied population was 28%. MNA scores were significantly lower among depressed patients as compared with non-depressed (22.86 vs. 24.96, p < 0.001), indicating a higher risk for undernutrition among depressed persons. After controlling for age, cognitive status, functional ability, and number of illnesses, undernutrition was significantly associated with depression (OR = 2.23; 95% CI: 1.04-4.8). CONCLUSIONS: Nutritional risk is associated with depression in aged inpatients. Close case management of the elderly hospitalized patients that include assessment and treatment for both disorders may be beneficial.

[Incidence and predictors of atrial fibrillation after coronary artery bypass grafting in the Negev--are we different from the rest of the world?].

BACKGROUND: Atrial fibrillation (AF) remains a common problem after coronary artery bypass grafting (CABG). AF increases the risk for stroke and is associated with increased length of hospitalization and mortality. AIM: This study aimed to determine incidence, timing and predictors of post CABG AF in a prospectively evaluated cohort of patients undergoing CABG in the Negev. METHODS: Preoperative clinical data, intraoperative, intensive care and postoperative events including AF episodes were prospectively evaluated in 156 consecutive patients undergoing CABG during a nine month period ending on July 2003. RESULTS: Mean age was 64.9 years (SD = 9.7, range 41 - 84 years); 76.3% (119) were male. The in-hospital mortality was 1.2% (2 patients). The incidence of AF was 32.1% (50), with 40% of the AF episodes occurring on the second postoperative day (range 1-6 days). Univariate analyses identified the following variables as risk factors for AF: female gender, older age, ethnic origin, BMI > 30, hypertension, dyslipidemia, pre CABG nitrate, Ca blockers and furosemide treatment, left atrial diameter, renal failure and post CABG respiratory complications (p <0.05). By multivariate analysis, three variables were identified as independent predictors: BMI>30 (odds ratio 2.4; 95% CI 1.2-4.8); Sephardic Jews (OR 11.2; CI 1.0-114); enlarged left atrium (OR 4.6; CI 1.5-14.1). CONCLUSIONS: Consistent with previous studies, enlarged left atrium was a predictor of post CABG AF. In addition ethnic origin (Sephardic Jews) and BMI> 30 were also found to be important predictors of post CABG AF. In comparison with other studies, we not found moderate differences in outcomes and mortality in population that underwent CABG in the Negev in comparison to studies of the world.

[Trends and characteristics of diabetes-related lower limb amputations in the Negev, 1996-1999].

BACKGROUND: The loss of a lower limb because of diabetic foot problems such as infections is an important complication of diabetes mellitus. The goals of this study were: (1) to examine trends in incidence of diabetic-related lower limb amputations in the Negev, (2) to describe the clinical characteristics of patients who underwent amputations in the Soroka University Medical Center and (3) to estimate in-hospital mortality and its predictors. METHODS: This study included all diabetic patients who underwent non-traumatic lower limb amputation in the Soroka Hospital during the period 1996-1999. The computerized hospitalization files and surgery logs during the study period were reviewed for ICD-9 diagnoses of diabetes and amputations. For each patient, hospitalization records were abstracted and data on socio-demographic and clinical characteristics were collected. RESULTS: During the study period 411 amputations were performed on 250 diabetic patients (1.6 amputation/person). The estimated mean annual incidence rate of lower limb amputations in the Negev was 5 per 1000 diabetic patients, 27.3 per 100,000 total population, and 45 per 100,000 adults above 18 years of age. The mean age was 68 (SD +/- 11.4) years. The most frequent types of surgery were standard below-knee amputation. Fourteen percent of patients died during hospitalization. Systolic blood pressure, white blood count and serum creatinine at admission were independent predictors of in-hospital mortality. CONCLUSIONS: The incidence of lower limb amputation in the Negev is similar to that reported in other countries. Interventions directed to early detection of diabetic foot problems may have an impact on the reduction of lower limb amputations and related mortality.

[Reporting maternal behavior during diarrhea in Bedouin children].

Diarrhea is still a major cause of morbidity and mortality among children in developing countries. The Bedouin population of southern Israel is in transition from a nomadic to a settled life-style. We examined maternal knowledge and reported behavior when their children had diarrhea. Mothers defined diarrhea as the passing of 4-5 stools per day. The most frequent signs of the illness were an increased number of watery stools with changes in either color or form. The most frequent symptom that prompted mothers to seek medical aid was blood in the stool. All mothers reported increasing fluid intake in their children during diarrhea, and most reported giving herbal tea. About half of the women avoided milk products and used special foods for the treatment of diarrhea. A quarter of the women reported stopping or decreasing the frequency of breast feeding during diarrhea. Reported cessation of breast feeding during diarrhea was associated with changing to special foods, and failure to note the onset of diarrhea or to recognize signs of dehydration. The withdrawal of breast feeding during episodes of illness and diarrhea is related to lack of knowledge regarding diarrhea. These data indicate that even in this population, with free access to preventive and curative medical care, there should be greater efforts to educate mothers to detect diarrheal disease and to maintain breast feeding during the diarrhea.

[Specialty clinics--gain or loss?].

We evaluated the significance of first visits to our pulmonary clinic with regard to diagnosis and treatment by reviewing records of 287 new referrals by medical care providers (Sept. 1998-Feb. 1999). At the first visit the diagnosis was changed in 30%, and treatment in 40%. These are minimal figures because evaluation had not been completed nor the diagnosis determined in all cases, while further investigation and follow-up continued. In light of these findings, we believe that recent pressure on primary care physicians to avoid referrals to specialty clinics would result in short-term savings, but in the long term, would increase expenses and diminish quality of care. It is important to consider ways to maximize the interaction between the primary care physician and the specialist to maintain quality of care and decreases costs.

[Prevalence and characteristics of myocardial infarction, diabetes and hypertension in the adult Jewish population: results from the Negev Nutritional Study].

BACKGROUND: Monitoring the prevalence of chronic conditions such as chronic heart disease, diabetes and hypertension in adult populations is essential for health services planning and identification of populations at high risk. OBJECTIVES: To describe the prevalence of self-reported conditions such as myocardial infarction, diabetes mellitus and hypertension in the Jewish Negev population and the patterns of use of health services and dietary behavior of persons suffering from these conditions. METHODS: A random proportional geographic cluster sample of the adult Jewish population (n = 1159, age 35+) from the Negev area was interviewed at home between 1998 and 1999. The interview included questions regarding chronic conditions, patterns of health services use and dietary behavior. RESULTS: Men had twice the prevalence of myocardial infarction and underwent more invasive cardiac procedures than women. The highest prevalence of myocardial infarction and hypertension were found in Central- and Eastern European-born persons while the highest prevalence of diabetes was found in Western-born participants. Of the participants < 61 years of age, 19% reporting diabetes and 33% reporting hypertension did not use medication and were not adhering to an appropriate diet. Thus, one-third of those with reported hypertension and 15% of those reported as diabetics were not adhering to any treatment. The prevalence reported in this study was higher than the national data. CONCLUSIONS: The data collected showed a higher prevalence of chronic diseases among the southern Israeli population as compared with the national data. Among people with chronic diseases, high percentages are not treated. The information reported here may help in the allocation of health services for the south of Israel and in the identification of populations at risk.

[Monthly rhythms of exacerbations and debuts of some diseases and sudden death]. / Mesiachnye ritmy obostrenii i debiutov nekotorykh zabolevanii i ostrovoznikaiushchikh smertel'nykh iskhodov.

A chronobiological analysis covering 355 adults and children with different diseases, cases of sudden deaths due to blood coagulation causes has revealed monthly hyper- and hypocoagulation periods. The hypercoagulation periods in which life-threatening thrombosis may occur were observed 8 days close to the new moon and 7 days after it as well as in the second phase of a monthly biorhythm. In the first phase of a monthly biorhythm there is a tendency to hemorrhage. In these days more attention should be given to patients who may develop hemorrhage to prevent threat to their life and sudden death.

Maternal weight misperceptions and smoking are associated with overweight and obesity in low SES preschoolers.

OBJECTIVES: To identify modifiable risk factors for obesity among low socioeconomic status (LSES) children. METHODS: Cross-sectional data were obtained from 238 4-7-year-old children and 224 mothers from LSES preschools. Anthropometric measurements were obtained; mothers were interviewed about sociodemographic characteristics, health behaviors, perceptions and beliefs. RESULTS: The combined prevalence of overweight and obesity (OWOB) among children was 29.8% based on the new World Health Organization (WHO) growth standard. Prevalence of OWOB (body mass index ≥25) among mothers was 51.8%. Mean age, sleeping hours, gender distribution and poverty level were similar between normal and OWOB children. Over 82% of mothers underestimated their child's weight status. Of the 62 OWOB children, 74.2% were perceived by their mothers as having 'normal weight' (NW) and 8% were perceived as 'thin'. Mothers perceived 67 out of 158 NW children (42.4%) as 'thin' (P<0.001). Mediation analysis indicated that 10% of the effect of maternal underestimation on child's OWOB may be mediated through child's daily sedentary hours (P=0.06). In a multivariable logistic-regression analysis controlling for maternal obesity, knowledge regarding breakfast's importance and child's daily sedentary hours, maternal underestimation of the child's weight status (odds ratio=7.33; 95% confidence interval (CI):2.41-22.37; P<0.0001) and parental smoking (odds ratio=3.25; 95% CI: 1.26-8.40; P=0.015) were the only significant factors associated with OWOB in LSES children. CONCLUSIONS: Maternal perception of child's weight status and parental smoking are associated with childhood OWOB among LSES children. These parameters can help identify children at risk for obesity. Maternal perception may be amenable to intervention.

Maternal knowledge and environmental factors associated with risk of diarrhea in Israeli Bedouin children.

Diarrhea is still a major cause of morbidity and mortality among children in developing countries. As it is due to multiple causative agents including viruses, bacteria and parasites, biological interventions are not currently available to markedly reduce incidence and severity. We examined maternal knowledge and reported behavior during diarrheal episodes, as well as environmental factors to determine their association with diarrhea. The children and mothers were from a Bedouin township in southern Israel, which has developed preventive and curative health care facilities. The Bedouin population in Israel is in transition from a nomadic to a settled life style. While almost all mothers exhibited good knowledge regarding food storage and prevention of diarrhea episodes in the children, the rate of illness in the children remained relatively high (two episodes per child year of observation). In a multivariate analysis, cessation of breastfeeding during diarrhea, child sleeping with siblings and lack knowledge about risk factors, were the major risk factors for illness with odds ratios (OR): 4.6, p = 0.02, 5.6, p = 0.03 and 1.7, p = 0.06, respectively. These data indicate that even in this population with free access to preventive medical care, greater efforts should be made to educate mothers regarding risk factor for diarrheal disease identification and the benefits of maintaining breastfeeding during diarrhea episodes.

A decade (1989-1998) of pediatric invasive pneumococcal disease in 2 populations residing in 1 geographic location: implications for vaccine choice.

During 1 decade (1989-1998), data on invasive pneumococcal disease were collected prospectively to assess the burden of disease among Jewish and Bedouin children in southern Israel and the potential reduction in illness that can be achieved by using conjugate vaccines. Data on 513 children <15 years old with bacteriologically proven invasive pneumococcal disease were obtained. Among Jewish and Bedouin children <5 years old, incidence rates were 45 and 139 cases per 100,000 child-years of observation, respectively. Jewish and Bedouin children differed in clinical manifestations, seasonal patterns of disease, serotype distribution, and antibiotic susceptibility rates. The potential coverage by 7-, 9-, and 11-valent conjugate vaccines is 41%, 67%, and 71%, respectively, for Jewish children and 22%, 63%, and 65%, respectively, for Bedouin children. The 9- and 11-valent pneumococcal conjugate vaccines have the potential to substantially decrease invasive pneumococcal disease in southern Israel.

Negev nutritional studies: nutritional deficiencies in young and elderly populations.

The importance of nutrition to public health and preventive medicine is evident. Undernutrition is a main nutritional risk factor in the elderly and has been established as a cause of excess morbidity and mortality in different segments of the older population. In the infant population, inadequate nutrition is one of the causes of iron-deficiency anemia, which is associated with impaired physical and cognitive development and lowered immunity. The aim of this paper was to estimate the nutritional pattern and micronutrient deficiencies in elderly and young populations in the Negev. In southern Israel, 351 subjects over 64 years old reported mean dietary intake that was lower than that in younger persons and was independent of the presence of chronic diseases. Current data from southern Israel on healthy Jewish children revealed anemia prevalence of 15% in the second year of life. Data from recent prospective study on Bedouin children showed that anemia affected one quarter of children at age one year. Thus, infants in this area are at high risk for iron deficiency. The findings require the attention of public health authorities and food manufacturers, and should result in a range of activities including publicity and educational programs, fortification of foods, and supplementation programs in high risk-groups.

Giardia lamblia carriage in Israeli Bedouin infants: risk factors and consequences.

Giardiasis is a common protozoan infection, with varying clinical manifestations. We investigated the associations between Giardia lamblia carriage and environmental, family, illness, and growth characteristics. Bedouin infants (n=234) were followed from birth to age 18-23 months. At monthly home visits, stool samples were obtained, history of illness was determined, and an environmental assessment was done. The comparisons presented are between 4 groups defined by length of carriage of G. lamblia. Study children had a mean+/-SD of 4.1+/-2.9 diarrhea episodes. No illness, environmental, or family characteristics were associated with length of carriage. Significant differences were found in weight-for-age and weight-for-height z scores between the never-positive-for-G. lamblia group and all other carriage groups combined. Faltering growth was shown to be subsequent to G. lamblia infection rather than preceding it. Our findings confirm that G. lamblia carriage is not associated with diarrhea. However, the effect on growth deserves further investigation.