Diurnal and seasonal variation of cough episodes in healthy young adults.

SETTING: We developed an algorithm to assess recorded cough episodes and differentiate them from similar, non-cough sounds. OBJECTIVE: To measure cough episodes in healthy young adults, cigarette smokers and non-smokers over a 24-hour recording period, during the course of normal activity. DESIGN: The study subjects were students, aged 20-40 years old. 24-hour sound recordings were conducted by a portable recorder. Analysis used an algorithm that was developed and tested in the study. RESULTS: Seventy students were recruited. Recordings included 2628 cough episodes in 1704 h of recording. The cough detection algorithm successfully detected 88.5% of recorded cough episodes and 95.6% of non-cough sounds. There was a clear tendency for more coughs among smokers. Autumn was the season with the highest mean cough episodes per day (58.65), while summer had the lowest (14.19). There was a strong correlation between self-reported cough episodes and recorded coughs. Cough episodes were significantly more frequent between noon and midnight (p < 0.0001). CONCLUSION: There is a very large range in daily coughs among healthy young adults. During sleeping hours there are less cough episodes. In autumn and spring there are more cough episodes compared to summer and winter, probably secondary to environmental factors. In smokers, the coughing rate is relatively high. If the cough detection device will be able to discriminate between cough variants (i.e., healthy versus patient), and stringent validation will confirm sensitivity and specificity, valuable data from this device may ease the decision regarding medications, or any other changes in order to improve outcome.

Normal hemoglobin at the age of 1 year does not protect infants from developing iron deficiency anemia in the second year of life.

BACKGROUND: Iron deficiency anemia (IDA) is the most common hematologic disorder worldwide. Measures to prevent IDA in infants have been successful with questionable sustainability. AIM: To evaluate the incidence of developing IDA in the second year of life, in infants who were nonanemic at the age of 1 year on routine blood test. METHODS: Blood samples were obtained from 193, 24-month-old toddlers, from 2 large clinics of both main sectors in Southern Israel, comparable for lower economic status. IDA was defined as hemoglobin < 11 gr% and microcytosis as mean corpuscular volume < 70 fL. RESULTS: IDA was detected in 8 of 118 Bedouins (5 males) and in 10 of 75 Jewish (6 males) infants (P < 0.01). The probability of a nonanemic child to develop IDA in the second year of life for the whole study population was 9.3% (18 of 193 infants) and significantly higher in the Jewish population (13.3.0% vs. 6.8%, P < 0.01). CONCLUSIONS: Given the difficulty of toddlers to maintain a non-IDA status, and the very low probability of iron overload, our results clearly support the need to continue iron supplementation into the second year.

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.

[Family health centers in Israel: to change or not to be].

As reported in this issue, the Ministry of Health Family Health Centers (FHC) in Israel is not fulfilling some of the requirements of the Ministry of Health. For example, hemoglobin levels are not checked in all of the babies and at least 31% of the babies do not receive supplemental iron. Universal neonatal screening for hearing loss by objective methods is not conducted nor recommended by the Ministry of Health, as advised by pediatric professional organizations, while screening for hearing loss is conducted in the second half of the first year by a method which is not currently recommended. FHC physicians conduct initial screening for suspected developmental dysplasia for only some of the children, while too many children go directly to the orthopedic specialist. Previous studies have shown that only 20% of Jewish women residing in larger townships in Israel use the FHC for prenatal care. Based on all the above the government policy makers are facing hard decisions regarding FHC services. One option is to transfer all services to the health maintenance organizations. A second option is to maintain the FHC with the following modifications: 1) revise and update the health management guidelines to meet universal recommendations; 2) improve compliance to guidelines; 3) improve outreach and acceptance by the public of the services of the FHC.