The Association between Health and Culture: The Perspective of Older Adult Hospital In-Patients in Israel.

People from different cultures are often hospitalized while the staff treating them do not have sufficient knowledge about the attitudes and feelings of the patients regarding culture and health. To fill this gap, the aim of this study was to examine the perspective of Israeli older adult hospital in-patients regarding the association between health and culture and to understand the meaning of the participants' experiences with regards to the medical staff's attitude towards them. This study was carried out using qualitative methodology that followed the interpretive interactionism approach. The research participants were 493 (mean age 70.81, S.D.: 15.88) in-patients at internal care departments at a hospital in Israel who answered an open-ended question included in the questionnaire as part of a wide study held during 2017 to 2018. Two main themes were found: (1) a humane attitude of respect and the right to privacy and (2) beliefs, values, and traditional medicine that are passed down through generations. The findings highlighted the issue of the patients' cultural heritage and ageist attitudes they ascribed to the professional staff. This study provided recommendations for training the in-patient hospital workforce on the topic of cultural competence, beginning from the stage of diagnosis through treatment and to discharge from the hospital, in order to improve the service.

[Morbidity of Israeli travelers after traveling to developing countries].

BACKGROUND: International tourism, including traveling to developing countries, has become increasingly popular. The number of Israeli travelers to developing countries is estimated at approximately 170,000 annually. AIM: This study aims to analyze the morbidity among returning Israeli travelers. METHODS: A retrospective evaluation was conducted of patient files for those attending the Tropical Disease clinic at the Sheba Medical Center between 1994-2004. RESULTS: A total of 842 patients attended the clinic during this period, with 1126 different diagnoses, including 20.9% of patients who were hospitalized in Israel and 6.2% abroad. Slightly more than half (56.7%) were male, 70% were in the 20-29 year age group. Most of the patients attended the clinic shortly after returning from traveling, but some attended the clinic more than 1 year later. The main destinations were Asia (49.2%), Latin America (23.4%) and Africa (23.2%). The most common diagnoses were gastrointestinal disease (41%), fatigue (25.8%), dermatological conditions (23.4%) and febrile diseases (22.7%). The typical diagnoses in travelers returning from Asia were chronic diarrhea and dengue fever. Dermatological conditions including leishmaniasis were prominent in travelers returning from Latin America, and in travelers returning from Africa--malaria, and schistosomiasis. In addition, there were gender differences; males acquired malaria, leishmaniasis and schistosomiasis more often, while females had more gastrointestinal complaints and fatigue. CONCLUSIONS: Travelers acquired different health problems in different continents. This must be taken into consideration when patients seek medical advice either before or after their journey. Furthermore, physicians must be aware of the importance of having a thorough travel history of their patients, since medical problems acquired during travel may manifest long after returning home.

Lipoid pneumonia: a preventable complication.

BACKGROUND: Lipoid pneumonia is a pneumonitis resulting from the aspiration of lipids, and is commonly associated with the use of mineral oil as a laxative. LP is relatively unfamiliar to clinicians and is probably underdiagnosed. OBJECTIVES: To increase physicians' awareness of LP, its diagnosis and prevention. METHODS: We present two illustrative cases of LP and review the literature. RESULTS: Two cases of LP were diagnosed within half a year in an internal medicine ward. Both cases were elderly patients, and LP was associated with the use of mineral oil as a laxative agent. Computerized tomography revealed bilateral low attenuation infiltrates, associated with a "crazy paving" pattern in one case. Sudan Black staining was diagnostic in both cases--in one on a transbronchial biopsy specimen, and in the other on sputum cytologic examination. Both patients suffered from neurologic diseases and were at risk of aspiration. In both cases clinical symptoms and signs continued for several months prior to diagnosis but resolved after the mineral oil was discontinued. CONCLUSIONS: LP often occurs in elderly patients who are at risk of aspiration. The condition may be underdiagnosed. Since in most cases mineral oil cathartics are the causative agent, an effort at primary prevention is indicated. It is suggested that the licensing of mineral oil for internal use be changed.

The clinical manifestations of lithium intoxication.

BACKGROUND: Lithium has been a part of the psychiatric pharmacopoeia for more than half a century. Its efficacy is marred by a narrow therapeutic index and significant toxicity. OBJECTIVES: To increase physicians' awareness of the various manifestations of lithium intoxication. METHODS: We reviewed the clinical data of cases of lithium poisoning occurring in a municipal hospital during a 10 year period. RESULTS: Eight patient records were located. The mortality rate was 12.5%. All patients were women and the mean age was 66.4 years. The most common symptoms were neurologic. One illustrative case is described in detail with lithium serum levels showing the usual two-phase decline. CONCLUSIONS: Lithium poisoning can present in many forms. Increased physician awareness and the early use of effective treatment, mainly hemodialysis, will prevent mortality and protracted morbidity associated with this condition.

[Bezoars: from ancient talismans to modern disease].

Bezoars are concretions of foreign materials that are created in the intestinal tract of various animals and humans. They have been known to western medicine since ancient times, when they were used for countering and preventing poisoning. In modern times bezoars were described as an unusual cause for various gastrointestinal symptoms. Trichobezoars are an infrequent form of bezoar, formed from ingested hair. We present a case of a trichobezoar, which appeared as a large abdominal mass, with gastric bleeding, ulceration and perforation. As in most previously reported cases, the diagnosis was not made on clinical grounds prior to imaging studies.

The association between serum uric acid and diabetes mellitus is stronger in women.

OBJECTIVE: Previous studies have demonstrated an association between increased serum uric acid (SUA) levels and incident diabetes. Most clinical and epidemiological investigations, however, focused solely on male populations or did not analyze men and women separately. We assessed the association between SUA levels and diabetes incidence in a large cohort of apparently healthy men and women. METHODS: Data were retrospectively gathered from 9140 adults who participated in annual medical screening visits during 2000-2009. Mean follow-up time was 4.8 years, and the median age was 50 years. Laboratory test results, data from physical examinations, medical history, and lifestyle information were extracted. The main outcome measure was incident diabetes, defined as two consecutive fasting glucose tests higher than 125 mg/dL. Cox proportional-hazards multivariate models were applied for measuring hazard ratios (HRs) for diabetes according to continuous and categorical levels of uric acid. RESULTS: We identified 499 new cases of diabetes (total, 5.5%: men, 6.2%; women, 3.6%) during the follow-up period. The gender-specific HRs for diabetes, adjusted for age and a set of prespecified multiple risk and protective factors, were 1.57 for each 1 mg/dL increase in SUA (95% confidence interval [CI], 1.32-1.86) in women and 1.08 (95% CI, 0.99-1.17) in men; p for interaction of SUA by gender <0.001. CONCLUSION: SUA is independently associated with diabetes outcome, considerably more in women than in men.

Human African trypanosomiasis in a traveler: diagnostic pitfalls.

Abstract. An Israeli traveler returning from Tanzania presented with a relapsing febrile illness. A diagnosis of Trypanosoma brucei rhodesiense infection was established by blood smear after nearly a month. Blood polymerase chain reaction failed to provide an early diagnosis of human African trypanososmiasis. Recognition of suggestive signs should prompt physicians to perform repeated tests before ruling out human African trypanososmiasis.

Pregnancy course and outcome in women traveling to developing countries.

BACKGROUND: The issue of travel to developing countries during pregnancy has not been sufficiently studied. The aim of this study is to investigate the rate, course, and outcome of pregnancies in women who traveled to developing countries while pregnant, or became pregnant during such travel. METHODS: Women visiting two major travel clinics in Israel for consultation within the years 2004 to 2009, who were pregnant or declared an intention of becoming pregnant during travel were contacted. This was followed by a telephone interview by an obstetrician with those women who were actually pregnant. Background characteristics, morbidity during travel, and pregnancy course and outcome were collected. RESULTS: Overall 52,430 travelers' records had been screened. Of these, we identified 49 women who were pregnant during their trip, but 3 declined participation. Of the remaining 46 women, 33 were pregnant at departure, and 13 conceived during travel. The incidence of pregnancy during travel was thus 0.93/1000 travelers. Thirty-three women traveled to East Asia, 8 to South and Central America, 5 to Africa. More than two thirds of women received pretravel vaccinations. Adherence to the World Health Organization recommendations regarding food and drink was high (87%) and travelers' diarrhea occurred in only 11% of women. Five of 22 women traveling to malarious areas had taken antimalarial prophylaxis. Six women required medical therapy during travel. Pregnancy outcome was not different from the normal population except for an unusually low rate of preterm delivery. CONCLUSIONS: In this cohort, travel to developing countries was not associated with adverse pregnancy outcome. Larger studies are needed to support these findings.