[The Hebrew dizziness handicap inventory].

BACKGROUND: The dizziness handicap inventory (DHI) has become a well accepted method for specifically assessing the quality of life among dizzy patients and in evaluating the results of different types of therapy, especially of vestibular rehabilitation programs. OBJECTIVE: To assess the reliability of a translated Hebrew version of the DHI (HDHI) on a cohort of patients attending a tertiary dizziness clinic. METHODS: A double translation method was applied on the original DHI. Consecutive patients with symptoms of dizziness lasting at least six months were included. HDHI questionnaires were completed by patients on three occasions: while waiting to be examined, after the examination and one week later. Internal consistency reliability of each questionnaire and test- retest reliability between the questionnaires were analyzed on the total score and for each of the emotional, functional and physical subgroups of the questionnaires. RESULTS: Thirty-one patients completed all three questionnaires. Internal consistency reliability of the three subgroups of questions: physical, emotional and functional in each of the three questionnaires were all high (Cronbach's Alpha coefficient 0.83-0.96). The test- retest reliability, the correlation between the total DHI scores of the first and second questionnaire (same day) showed a correlation coefficient of 0.96, and between the first and third questionnaire (7 days apart) was 0.94, with P values of < 0.01. The correlation coefficient of the subgroups ranged from 0.93 to 0.97. CONCLUSION: The HDHI is a reliable test of dizzy patients' symptoms and may be applied in patient care and for reporting on their follow-up.

Characteristics of fibromyalgia in Muslim Bedouin women in a primary care clinic.

BACKGROUND: Fibromyalgia (FM) has been described and studied in various sociocultural settings in both developed and developing countries. OBJECTIVES: To study the clinical manifestations of FM and to describe its effect on quality of life in the unique setting of Muslim Bedouin women in the southern Israel Negev desert area. METHODS: One hundred two Bedouin women were recruited from a primary health care clinic in the Negev area. All patients fulfilled American College of Rheumatology criteria for the diagnosis of FM. Tenderness was assessed by manual dolorimetry and the fibromyalgia impact questionnaire was utilized to estimate the severity of FM symptoms. Anxiety and depression were assessed by the Arthritis Impact Measurement Scales subscales and quality of life was evaluated by the SF-36 questionnaire. RESULTS: The study population was characterized by a low educational level, a high rate of consanguinity, a high number of children per mother, and a high rate of polygamy. There was a high frequency of classic FM symptoms such as pain and fatigue, as well as anxiety and depression. The overall impact of FM on quality of life was exceedingly high (8.9 on a scale of 0 to 10). CONCLUSIONS: FM is relatively common in the unique setting of Muslim Bedouin women and has a very significant impact on their quality of life as well as on their dependents. Physicians involved in the primary care of this population should be attentive to the manifestations of FM and related disorders.

Hubble bubble equals trouble: the hazards of water pipe smoking.

A Narghile, one of the names for a water pipe, is an instrument for tobacco smoking that has became a trend among the youth in Israel. The mistaken opinion that smoking a Narghile is not as dangerous as smoking cigarettes makes the youngsters and their parents take it lightly and contributes to the expansion of its use. The objective of this paper was to review the literature on the health risks of Narghile smoking. A literature search of Medline (PubMed) and the Internet on the health hazards of Narghile smoking was conducted. The health hazards that the Narghile smoker is exposed to include interference with oxidation, damage to genetic compounds, increased risk of developing malignancies, infectious diseases, damage to the fetus and newborn, and exposure to commonly abused chemicals. It is concluded that increased awareness of the expanded use of the Narghile is imperative and education programs about the prevention of cigarette smoking and substance abuse should also include Narghile smoking.

"Bread madness" revisited: screening for specific celiac antibodies among schizophrenia patients.

PURPOSE: A possible association between gluten consumption and schizophrenia has been reported. The objective was to compare patients with chronic schizophrenia and matched controls for sociodemographic variables, prevalence of celiac-specific anti-endomysial antibodies and disease-related variables. SUBJECTS AND METHODS: The study group was comprised of 50 consecutive patients diagnosed with schizophrenia, 18 years of age and older attending the out-patient clinic of the Mental Health Center in Beer-Sheva, Israel. The control group was comprised of mentally normal volunteers who came to primary care clinics for blood tests unrelated to gastrointestinal tract complaints and who were not diagnosed with celiac disease. Known celiac patients and those who refused to participate, did non-speak Hebrew or were incoherent were excluded from the study. All participants in both groups underwent a blood test for anti-endomysial IgA antibody and completed a questionnaire. RESULTS: Each group was comprised of 50 participants. There were no significant differences between the groups in gender, BMI or country of birth. The mean age of the study group was significantly higher than the controls. All tests for anti-endomysial antibody in both groups were negative. DISCUSSION AND CONCLUSIONS: In contrast to previous reports, we found no evidence for celiac disease in patients with chronic schizophrenia as manifested by the presence of serum IgA anti-endomysial antibodies. It is unlikely that there is an association between gluten sensitivity and schizophrenia.

The clinical and economic burden of fibromyalgia compared with diabetes mellitus and hypertension among Bedouin women in the Negev.

BACKGROUND: Fibromyalgia (FM) is a common idiopathic chronic, widespread pain syndrome with tenderness in anatomically defined tender points. OBJECTIVES: The purpose of the present study was to describe and characterize the economic and daily work burden of FM compared with diabetes mellitus and hypertension. METHODS: A retrospective study was conducted in 2001 in a primary care clinic, the Kuseife clinic of the Clalit Health Services. Data for the three study groups were obtained from the computerized database of the Kuseife clinic and the Negev District, Israel. The study group included 102 FM patients. The control groups included 102 diabetes patients and 103 patients with hypertension. RESULTS: Hospitalization and hospital day care services were the main expenses incurred by patients in this study. There were no differences among the study groups in any cost parameter examined except for the cost of diagnostic tests (P < 0.01), which was less for FM patients. FM patients were referred to specialists and diagnostic procedures more frequently than the control groups. No statistical difference was found in the total number of clinic visits, but FM patients visited physicians more frequently and visited nurses less frequently than patients in the other two groups (P < 0.05). CONCLUSIONS: FM patients consume health care resources to a similar extent to patients with other chronic diseases such as diabetes mellitus and hypertension, but the latter usually receive much more attention from the health care system. Greater awareness of this disorder can improve management and facilitate planning of health care resources, thus improving quality of care.