Adult-onset diabetes among Arabs and Jews in Israel: a population-based study.

AIMS: To study the age at presentation and factors associated with adult-onset diabetes (≥ 20 years) among Arabs and Jews in Israel. METHODS: Participants (n = 1100) were randomly selected from the urban population of the Hadera District in Israel. The study sample was stratified into equal groups according to sex, ethnicity (Arabs and Jews) and age. Information on age at diabetes presentation, family history of diabetes, history of gestational diabetes, socio-demographic and lifestyle characteristics was obtained through personal interviews. Self reports of diabetes were compared with medical records and were found reliable (κ = 0.87). The risk for diabetes was calculated using Kaplan-Meier survival analysis. Factors associated with diabetes in both ethnic groups were studied using Cox proportional hazard model. RESULTS: The prevalence of adult-onset diabetes was 21% among Arabs and 12% among Jews. Arab participants were younger than Jews at diabetes presentation. By the age of 57 years, 25% of Arabs had diagnosed diabetes; the corresponding age among Jews was 68 years, a difference of 11 years (P < 0.001). The greater risk for diabetes among Arabs was independent of lifestyle factors, family history of diabetes and, among women, history of gestational diabetes; adjusted hazard ratio 1.70; 95% confidence interval 1.19-2.43. CONCLUSIONS: Arabs in Israel are at greater risk for adult-onset diabetes than Jews and are younger at diabetes presentation. Culturally sensitive interventions aimed at maintaining normal body weight and active lifestyle should be targeted at this population. Possible genetic factors and gene-environmental interactions underlying the high risk for diabetes among Arabs should be investigated.

Urinary tract infections and sexual activity in young women.

A group of 147 young women with symptomatic urinary tract infection (UTI) were compared with a control group of 105 symptom-free young women belonging to the same population. On logistic-regression analysis, sexual activity was the only significant and independent behavioral difference between the groups (87% of women with UTI were sexually active vs 32.7% of the control group). Of the 147 episodes of UTI, only 28.9% occurred within 24 hours of sexual intercourse; of 24 episodes that occurred during follow-up, the percentage that occurred within 24 hours of intercourse was 33.3%. This finding is in discordance with the close temporal association between UTI and sexual intercourse reported in previous studies.

A clinical model for diagnosis of urinary tract infection in young women.

To develop a clinical model for diagnosis of bacterial urinary tract infection, we conducted a prospective study on 266 dysuric young women, 147 of whom had urinary tract infections. Five variables were found to be significant and independent correlates to bacterial urinary tract infection on logistic regression analysis: sexual activity, absence of vaginal discharge, short duration of complaints, leukocyturia, and hematuria. An algorithm combining the logistic model and a Gram-stained urine specimen, which was used in only a third of our patients, afforded a sensitivity of 86% and a specificity of 84%. The algorithm was validated in a second set of 166 dysuric women, 77 of whom had urinary tract infections. The algorithm led to a diagnosis of bacterial urinary tract infection with a sensitivity of 91% and specificity of 79%; the only laboratory test needed except for urinalysis was a Gram's stain of urine, obtained for 30% of the patients.

Routine quantitative blood cultures in children with Haemophilus influenzae or Streptococcus pneumoniae bacteremia.

The potential clinical value of quantitative blood cultures determined by a commercially available lysis-direct plating method was studied in 50 children with either Haemophilus influenzae or Streptococcus pneumoniae bacteremia. The magnitude of bacteremia correlated with the severity of the infection; patients with greater than or equal to 100 colony-forming units per milliliter were significantly more likely to have meningitis (P less than .01, chi 2 = 7.5). On the other hand, all patients with S. pneumoniae bacteremia with colony counts lower than 15 colony-forming units per milliliter had "occult bacteremia" with no focus of infection. The data suggest that patients with higher levels of bacteremia have more severe disease. Quantitative blood culture results may be helpful in identifying which children are at risk for invasive disease.

Outbreak of cryptosporidiosis in a day-care center.

An outbreak of diarrhea due to infection with Cryptosporidium occurred in a day-care center. During a period of 2 months, 23 of 53 (43%) children attending the day-care center and 15 of 104 (14%) household contacts had diarrhea. Cryptosporidium oocysts were identified in 13 of 20 (65%) symptomatic children tested compared with three of 27 (11%) asymptomatic children (chi 2 = 12.56, P less than .001). Enteropathogenic bacteria, enteroviruses, rotavirus, and other protozoan parasites were ruled out as the cause of the diarrhea. A history of diarrhea in household contacts was associated with excretion of Cryptosporidium oocysts by the children. Human-to-human transmission of the infection was suggested by the epidemiology.

Case-control study of hyperpyrexia in children.

To test the association of hyperpyrexia (temperature greater than or equal to 41.1 degrees C) with increased rates of bacteremia and serious bacterial illness in young children, we performed a retrospective case-control study. Seventy-six hyperpyrexic children and an equal number of control cases with temperatures of 39.1-40 degrees C and 40.1-41.0 degrees C were identified. A significantly larger number of diagnostic procedures including blood cultures, urine cultures, chest x-rays and white blood cell counts were performed in the hyperpyrexic children (P less than 0.05). The frequency of serious bacterial infections and bacteremia did not differ among the groups (P greater than 0.05). Hyperpyrexic children need to be evaluated as thoroughly and carefully as any other febrile child but do not merit special consideration.

Risk of infection during adrenocorticotropic hormone treatment in infants with infantile spasms.

We reviewed the clinical features and laboratory findings of 27 infants with infantile spasms treated with adrenocorticotropic hormone or prednisone during febrile episodes in order to evaluate the incidence of bacteremia, the risk of serious infection, determination of whether serious infections can be identified at presentation and the outcome of febrile episodes. There were 75 febrile episodes including 4 episodes of identified bacteremia (5.3%). Three children who were treated with adrenocorticotropic hormone dosage larger than recommended died. Leukocytosis and a differential count with many immature granulocytes predicted bacteremia in this population. Chest radiography was useful in identifying the cause of fever. The pathogens isolated were similar to those found in this age range. We conclude that the frequency of bacteremia in our patient population is similar to that observed in infants of the same age; however, the outcome is frequently fatal. In addition this increased mortality may be associated with the use of a larger dosage of adrenocorticotropic hormone than recommended.

Malassezia furfur skin colonization in infancy.

Malassezia furfur, a lipophilic yeast, has become recognized as a cause of sepsis in infants receiving parenteral fat emulsions via indwelling deep venous catheters. Colonization of infants' skin may be a prerequisite to colonization of the intravascular catheter and subsequent infection with M furfur. Three hundred ninety-three surveillance cultures were performed on 146 infants during their first 12 weeks of hospitalization in the intensive care unit (ICU) or the neonatal transitional unit (NTU). In addition, 47 full-term newborn infants and 38 healthy infants in the well-baby clinic were cultured. Colonization rates were greatest (48%) during the second month of hospitalization for the infants in the ICU/NTU group. In contrast, 0 of 47 newborn infants and 2 of 38 healthy infants were colonized. Prematurity and a prolonged length of stay were identified as risk factors for colonization.

A practical guide to the diagnosis of congenital infections in the newborn infant.

Every attempt should be made to identify an etiologic agent in infants with suspected congenital infection. Some of the infections are treatable, such as herpes simplex, syphilis, and toxoplasmosis. For other infectious agents (i.e., CMV and rubella), close follow-up will enable early detection of hearing impairment and permit early educational intervention. In addition, appropriate isolation measures will reduce the risk of nosocomial infections due to herpes simplex, rubella, hepatitis B, and CMV. Rational use of the available diagnostic tools will enable detection of most symptomatic congenitally infected neonates at a reasonable cost.

Malassezia furfur fungemia in infancy.

Malassezia furfur was recovered from blood cultures obtained through an indwelling line in seven severely ill infants hospitalized in a neonatal intensive care unit. While two of the patients were asymptomatic, the other patients had signs and symptoms compatible with sepsis. One patient had evidence of endocarditis.

The chloride-stimulated K(+)-secretion by insect midgut and its modification in the presence of osmotic gradients: a short-circuit current and noise-analysis study.

K(+)-secretion in the midgut of the larval moth, Manduca sexta, was studied by measuring the kinetics of the lumen-directed short-circuit current (Isc) and the conduction noise from basolateral K+ channel block by Ba2+. Hemolymph chloride as well as hypotonicity both stimulate this K+ current (IK). The kinetic nature of the stimulation is, however, different in each case. Analysis of blocker noise supports, to a large degree, the interpretation obtained from kinetics, namely: chloride ions do not act via changes in cell volume but influence ion turnover and channel number.

Nursing, nursing education, and anxiety.

One hundred seventy-one graduating students in associate degree, diploma, and baccalaureate nursing programs completed a questionnaire concerning various state and trait measures of emotions (including general anxiety, apprehension about communication, and anxiety about one's future nursing career). Differences among the three groups of nursing students on the various dimensions of emotions, anxiety, and communication apprehension were assessed from the perspective of Mehrabian's theory of emotion. Predictors of anxiety about one's nursing career were investigated for the overall sample and for the three groups separately. Findings indicate that baccalaureate students are least apprehensive about communicating and feel most dominant in their setting. In addition, associate degree students were most anxious about nursing if they did not feel dominant, diploma students were most anxious if they did not feel dominant or were apprehensive about communication, and baccalaureate students were most anxious if they were generally unhappy. The results are discussed in terms of Mehrabian's emotion theory, the current crisis in and future direction of nursing education, and the use of theory in designing a strategy for nursing as a profession.

Keeping juvenile delinquents in school: a prediction model.

The purpose of this study was to test an empirically based prediction model of school dropout on a sample of 137 juvenile delinquents, some who have dropped out and some who have remained in school. The specific factors among the many found in previous research that are salient for predicting whether delinquent youths will drop out or remain in school were determined. An important finding of this study is that it required only four factors to yield a high level of prediction: misbehavior in school, disliking school, the negative influence of peers with respect to dropping out and getting into trouble, and a marginal or weak relationship with parents. The four factors identified create a model that is directly applicable to prevention strategies and is extremely parsimonious.

Working with high-risk youth in prevention and early intervention programs: toward a comprehensive wellness model.

Societal problems resulting from school dropouts, teenage pregnancy, drug abuse, suicide and other health-damaging behavior are increasing, along with the financial costs. This paper presents a theory of youth development and learning, and an integrated, interactive and reciprocal model for the prevention of health-damaging behavior.