The prevalence of gastrointestinal diseases in Israeli adolescents and its association with body mass index, gender, and Jewish ethnicity.

OBJECTIVE: The objectives of this study were to describe gastrointestinal (GI) disease prevalence in Israeli adolescents, and possible associations between prevalence and body mass index (BMI), sex and Jewish ethnicity. DESIGN: A retrospective analysis of screening for GI disease performed by the Israeli Defense Forces recruiting office between 1998 and 2003. SETTING: Screening was performed at the recruiting office, and included detailed history and physical examination performed by a general practitioner. Further testing was performed as needed and the final diagnosis was established by a gastroenterologist at the recruiting office. PATIENTS: Seventeen-year-old Israeli nationals. RESULTS: During the study period, 466,855 (58.5% male) adolescents were screened for GI disease. Peptic ulcer disease, irritable bowel syndrome, and nonulcer dyspepsia were the most prevalent disorders affecting 466/10, 460/10, and 296/10, respectively. There was an increase in the prevalence of lactose intolerance during the study period and also an increase in the prevalence of peptic ulcer disease in females. The prevalence of inflammatory bowel disease has also increased from 100/10 to 149/10, although this trend failed to reach statistical significance (P=0.097). Higher BMI was associated with statistically significant higher prevalence rates of gastroesophageal reflux disease (P<0.05). A stronger association in females was found in gallbladder disease (P<0.001). Lower BMI was associated with higher prevalence rates of irritable bowel syndrome (P<0.001), and higher rates of inflammatory bowel disease and lactose intolerance in males (P<0.01 and <0.001, respectively). CONCLUSIONS: GI diseases are not uncommon among adolescents, and for some disorders prevalence is rising. The association between BMI and prevalence has been further clarified.

Comparison of health care services for career soldiers throughout the world.

Health care systems operate differently in every country and are products of historical and political factors. We compared health care systems for career soldiers in various countries with those of the Israel Defense Forces. Questionnaires requesting data regarding military health care services provided in their countries were sent to military attaches serving in Israel. The countries for which data were gathered include Argentina, Brazil, Chile, China, England, France, Finland, Germany, Hungary, Israel, Poland, Romania, Spain, and the United States. In most countries, career soldiers receive better health care services than civilians, especially in countries with military rule or under military threat.

Evaluating delivery of primary health care to military personnel during low-intensity conflict using a patient satisfaction survey.

The delivery of medical health care to soldiers serving in active front units in the Israeli Defense Forces requires the ability to adjust to different military activity settings. This study was conducted to compare patient satisfaction, as a tool for assessing quality of care, in different activity settings: training and Low-intensity conflict setting. A patient satisfaction survey was conducted simultaneously in battalions during low-intensity conflict and training activities. Data analysis showed that patients' perception of the quality of care they received and of medical staff attitude was higher in the conflict setting. Correlation analysis revealed that patients during conflict perceived outcome of care and accessibility as most important in evaluating overall satisfaction. We suggest that perception of high-quality medical care can be obtained during conflict conditions. Interestingly, in the conflict setting, the physical environment of the clinics appears to be less crucial to patient satisfaction than physician availability and medical outcome. These results may serve as a basis for changing health delivery systems by health policy makers.

Recommendations for nursing requirements at a field hospital, based on the Israel Defense Forces field hospital at the earthquake disaster in Turkey--August 1999.

On the 17th of August 1999, an earthquake of 7.4 magnitude on the Richter Scale struck the Marmara region in Turkey causing a massive casualties event with an estimated 2,680 deaths and 5,300 injuries just at the city of Adapazari alone. A field hospital was set up by the Israel Defense Forces at Adapazari in order to provide temporary medical services until regular medical forces recovered. The aim of the paper is to overview the requirements of the nursing staff at a field hospital based on our experience and analysis of the nursing activity at the field hospital at Adapazari. The methods implemented include interviewing all nurses and many of the doctors who took part in the field hospital as well as a review of medical literature about disasters. We found an inverted nurse:phycisian ratio of 1:1.77, as opposed to a 2.5-3:1 ratio in regular civilian hospitals. The nurses in our field hospital had to work longer and more intensive shifts than in a regular hospital. They had to overcome language barriers and cultural differences, and faced difficult hygiene conditions. Our overview analysis of results brought up several recommendations. Firstly, although it is not possible to predictthe number and types of casualties, it is necessary to provide an adequate number of nurses (1-1.5:1 nurse:physician ratio). Furthermore, the nurses should be specialized and rotated as needed. Secondly, the language and cultural barriers should not be undermined despite the abundance of translators. Finally, the hygiene status in a field hospital requires management by nurses with active participation of all members.

Influence of personal armor on distribution of entry wounds: lessons learned from urban-setting warfare fatalities.

BACKGROUND: This study was undertaken to examine the distribution of entry wounds resulting from firearms and shrapnel in soldiers wearing military personal armor systems (MPAS) in low-intensity urban combat conditions. METHODS: Data were collected for a retrospective analysis on all combat fatalities sustained by the Israeli Defense Force (IDF) between March 30, 2002, and April 22, 2002, during Defensive Shield Operation in the West Bank. Twenty-six of the 30 fatalities were evaluated in the Israeli National Center of Forensic Medicine. RESULTS: A total of 149 entrance wounds were divided into shrapnel and bullet groups. The "face-neck" region had the highest density rate compared with other body regions in both shrapnel and bullet groups (2.97 and 2.41, respectively; p < 0.0001). In both groups, the overall prevalence of anterior injuries was significantly higher than posterior ones (78.9% vs. 21.1% in the shrapnel group and 68.5% vs. 31.5% in the bullet group, p < 0.001). However, anterior and posterior chest injuries had a reverse yet more even distribution (43.8% and 56.2% in the bullet group and 40% and 60% in the shrapnel group, respectively; p < 0.001). The difference in the average diameters of entry wounds in the covered versus uncovered regions (0.79 +/- 0.42 cm vs. 0.73 +/- 0.29 cm, respectively) was not statistically significant (p = 0.11). CONCLUSION: The use of MPAS turned the face-neck region into the most vulnerable body part, as shown by its prominent density rate, especially in the shrapnel group. MPAS designed for urban setting warfare should provide maximal shielding both to the anterior and posterior chest regions. The diameter of entrance wounds in the covered versus the uncovered areas was not statistically significant, suggesting that only a minor deformation of the bullet takes place while traversing the Kevlar vest.