Ethnic Variation in the Association of Hypertension With Type 2 Diabetes.

Lifestyle changes occurring with urbanization increase the prevalence of both type 2 diabetes mellitus (T2DM) and hypertension (HTN). Yemenites who have immigrated to Israel have demonstrated a dramatic increase in T2DM but the prevalence of HTN in diabetic Yemenites is unclear. In a cross-sectional study, the authors evaluated the prevalence of HTN and lifestyle patterns in Israelis with T2DM of Yemenite (Y-DM) and non-Yemenite (NY-DM) origin. Y-DM (n=63) and NY-DM (n=120) had similar age (63±7 vs 64±7 years, P=.5), diabetes duration, diet adherence, and exercise patterns. Y-DM had a lower prevalence of HTN (63%) than NY-DM (83%) (P<.01). Furthermore, Yemenite origin was independently associated with lower prevalence of HTN (odds ratio, 0.3; 95% confidence interval, 0.12-0.71). Blood pressure was well controlled with fewer antihypertensive medications in Y-DM than NY-DM (P<.01). Even though lifestyle patterns were similar in the two groups, Y-DM had a lower prevalence of HTN compared with NY-DM and required fewer antihypertensive medications.

Association of Atrial Fibrillation and Stroke: Analysis of Maccabi Health Services Cardiovascular Database.

BACKGROUND: Stroke is a leading cause of death and disability worldwide. The risk factors for stroke overlap those for cardiovascular disease. Atrial fibrillation (AF) is a particularly strong risk factor and is common, particularly in the elderly. Maccabi Healthcare Services (MHS) has maintained a vascular registry of clinical information for over 100,000 members, among them patients with heart disease and stroke. OBJECTIVES: To determine the prevalence of stroke in MHS, and whether the association of AF and stroke, along with other risk factors, in the Maccabi population is similar to that in published studies. METHODS: Data on stroke and AF patients aged 45 and older were collected from the database for the year 2010, including age, previous transient ischemic attack (TIA), body mass index (BMI), prior myocardial infarction (MI), diabetes, hypertension, anticoagulation and dyslipidemia. A cross-sectional analysis was used to estimate stroke prevalence by AF status. A case-control analysis was also performed comparing a sample of stroke and non-stroke patients. This permitted estimation of the strength of associations for atrial fibrillation and various other combinations of risk factors with stroke. RESULTS: Stroke prevalence ranged from 3.5 (females, age 45-54 years) to 74.1 (males, age 85+) per thousand in non-AF members, and from 29 (males, age 45-54) to 165 (males, age 85+) per thousand for patients with AF. AF patients had significantly more strokes than non-AF patients in all age groups. Stroke prevalence increased with age and was significantly higher in males. Multivariable analysis revealed that male gender, increasing age, AF, hypertension, diabetes, and history of TIA were highly significant risk factors for stroke. In addition, for males, dyslipidemia and prior Ml were moderately strong risk factors. CONCLUSIONS: Analysis of the MHS vascular database yielded useful information on stroke prevalence and association of known risk factors with stroke, which is consistent with the epidemiological literature elsewhere. Further analysis of health fund data could potentially provide useful information in the future.

A new risk score predicting 1- and 5-year mortality following acute myocardial infarction Soroka Acute Myocardial Infarction (SAMI) Project.

BACKGROUND: Risk stratification of patients following acute myocardial infarction (AMI), in order to identify patients whose clinical outcomes can be improved through specific medical interventions, is needed. OBJECTIVES: Development and validation of a prognostic tool comprising a variety of non-cardiovascular co-morbidities, to predict mortality of hospital survivors after AMI. METHODS: The study cohort included 2773 consecutive patients with AMI who were discharged live from the Soroka University Medical Center between 2002 and 2004. Two-thirds were used obtain the model (training set) and one-third to validate it (validation set). Data were collected from the hospital's routine computerized information systems. The primary outcome was post-discharge 1-year all-cause mortality. The weight of each variable in the final score was computed based on the odds ratio values of the multivariate model. Additionally, the ability of the index to predict 5-year mortality was assessed. RESULTS: These are comprised of the following parameters: 4 points - age >75 years, abnormal echocardiography findings; 3 points - at least one of following: gastro-intestinal hemorrhage, COPD, malignancy, alcohol or drug addiction, neurological disorders, psychiatric disorders; 2 points - no echocardiography results, renal diseases, anemia, hyponatremia; -3 points for PCI or thrombolytic therapy; -6 points - CABG; -2 points - obesity. The c-statistics for 1-year all-cause mortality were 0.86 and 0.83 in the training and validation sets, respectively. The c-statistics for 5-year mortality was 0.858 for both sets combined. CONCLUSIONS: The new score is a simple robust tool for predicting mortality in patients discharged alive following AMI.

Risk factors and outcome of acute myocardial infarction in Bedouins living in permanent compared to unrecognized villages in southern Israel.

BACKGROUND: The incidence and prevalence of coronary heart disease (CHD) among Bedouins living in the Negev region were very low until the 1960s. During the past 50 years this pattern has changed: in parallel to the changes in lifestyle and nutrition in the Bedouin population, a rapid increase in incidence and mortality from CHD occurred. The relationship between the rise in CHD incidence and the degree of urbanization in this population has not been investigated to date. The study hypothesis was that the prevalence of risk factors and the outcome of myocardial infarction in Bedouins differ between those settled in permanent villages and those remaining in unrecognized villages. OBJECTIVES: To compare the prevalence of cardiovascular risk factors, clinical characteristics, and in-hospital management of a first acute myocardial infarction (AMI) in two Bedouin groups: those residing in permanent villages versus those residing in unrecognized villages. METHODS: We conducted a retrospective analysis of in-hospital data of 352 patients admitted with a first AMI during the period 1997-2003 to Soroka Medical Center, the only medical facility in the region. RESULTS: There were no differences between the two groups regarding the major cardiovascular risk factors and outcome. A relatively greater number of patients from urban areas underwent catheterization of any sort during their hospitalization (primary, rescue, and risk stratification; P = 0.038). No significant difference was found between the two groups in the type of catheterization performed (P = 0.279). CONCLUSIONS: We found no differences in the clinical characteristics and in-hospital management of patients with AMI between Bedouins residing in permanent villages versus unrecognized villages.

Gender and ethnic disparities in outcome following acute myocardial infarction among Bedouins and Jews in southern Israel.

BACKGROUND: Previous studies have documented gender-ethnic disparities in outcomes following acute myocardial infarction (AMI). This study evaluates such disparities in the Negev, Israel, and reviews potentially responsible mechanisms. METHODS: Patients discharged with AMI were classified into young (<70 years), elders (≥70 years) and gender-ethnicity groups: Female Bedouins (FB), Female Jews (FJ), Male Bedouins (MB) and Male Jews (MJ). The primary outcome was 1-year all-cause mortality. Prognosis was assessed using Kaplan-Meier approach. Multivariable analyses assessing hazard ratios (HRs) for mortality were performed using the Cox proportional hazards regression models in two steps controlling for (i) the Ontario Acute Myocardial Infarction Mortality Prediction Rules (OAMIMPRs) and (ii) the OAMIMPR and additional potential confounders. RESULTS: Of 2669 subjects, 45.8% were elders, 66.2% male and 10.9% Bedouin. The mortality rate was 12.3% (young 4.6%, elders 22%). Survival was significantly lower in FB compared with MB in the elderly stratum (P = 0.025). Multivariate analyses demonstrated similar risks for dying among the young. In the elders, the first multivariate analysis showed greater risk for mortality in FB. Using FB as the reference group, the HRs were as follows: HR((MB)) = 0.36 [95% confidence interval (CI): 0.14-0.9]; HR((FJ)) = 0.5 (95% CI: 0.27-0.9) and HR((MJ)) = 0.5 (95% CI: 0.28-0.91). In the second analysis, the HRs were as follows: HR((MB)) = 0.37 (95% CI: 0.14-0.93); HR((FJ)) = 0.58 (95% CI: 0.32-1.07) and HR((MJ)) = 0.56 (95% CI: 0.31-1.03). CONCLUSIONS: Elderly FB have poor 1-year prognosis following AMI compared with MB, MJ and FJ when controlling for the OAMIMPR model, yet when controlling for other potential confounders the differences are of borderline significance in relation to Jewish subjects. A culturally and economically sensitive programme focusing on tertiary prevention in these patients is warranted.

Are measures of height and leg length related to incident diabetes mellitus? The ARIC (Atherosclerosis Risk in Communities) study.

This study was designed to estimate the risk of developing diabetes in relation to adult height components, namely leg length and leg length/height ratio. Data on 12,800 individuals without diabetes were obtained at the baseline examination from the ARIC cohort. Cox proportional hazard models were used to estimate hazard rate ratios of diabetes for each 5-cm difference in leg length and 1 SD difference in the leg length/height ratio. During a mean follow-up period of 7.6 years, the age-adjusted incidence per 1,000 person years of follow-up was 25.8, 24.2, 10.4, and 16.2 in African American (AA) women, AA men, white women, and white men, respectively. The hazard ratio for diabetes (95% CI) per 5-cm difference in leg length was 0.85 (0.75-0.95) in white men, 0.79 (0.69-0.90) in white women, 0.90 (0.75-1.07) in AA women, and 0.99 (0.77-1.27) in AA men, after adjusting for age, parental history of diabetes, parental socioeconomic status, and weight at age 25. The hazard ratio for diabetes per 1 SD difference in leg length/height ratio followed the same trend. Leg length is inversely and independently related to an increased risk of diabetes in middle-age white men and women but not in African-Americans. This sex-race heterogeneity suggests that nutritional and environmental factors in childhood may modify this risk through different pathways.

Improving combined diabetes outcomes by adding a simple patient intervention to physician feedback: a cluster randomized trial.

BACKGROUND: Research on synergistic effects of patient targeted interventions combined with physician-targeted interventions has been limited. OBJECTIVES: To compare a combined physician-patient intervention to physician feedback alone on a composite outcome of glycemic, lipid and blood pressure control. METHODS: In this cluster study 417 patients with adult-type 2 diabetes from four primary care clinics were randomized to receive either a physician-only intervention or a combined physician-plus-patient intervention. Physicians in all clinics received diabetes-related quality performance feedback during staff meetings. Patients at combined-intervention clinics also received a letter encouraging them to remind their doctors to address essential aspects of diabetes care at the next visit. At 1 year follow-up, outcome measurements included hemoglobin A1c, low density lipoprotein-cholesterol and systolic blood pressure: namely, the proportion of patients with HbA1c 9%, LDL <130 mg/dl and SBP <140 mmHg both as separate outcomes and combined. RESULTS: After adjusting for patient characteristics and baseline measures, follow-up levels of HbA1c (7.5% vs. 7.8%, P = 0.09), LDL (104.7 vs. 110.7 mg/dl, P < 0.05) and SBP (135.6 vs. 139.9, P = 0.10) were marginally better for combined-intervention patients compared to physician-only intervention patients. Significantly more patients in the combined-intervention (38.8%) than physician-only intervention (24.2%) met all three targets (HbA1c (9%, LDL (130 mg/dl and SBP <140 mmHg) as a single combined outcome (adjusted odds ratio 2.4, P < .01). CONCLUSIONS: Compared to physician-feedback alone, a dual intervention combining a patient letter with physician feedback produced modest improvements in glycemic, lipid and blood pressure control individually, but substantial improvement in a combined measure of these three outcomes together. Using composite outcomes may detect meaningful improvements in the management of complex chronic disease.

Lipid levels among African and Middle-Eastern Bedouin populations.

BACKGROUND: Previous studies observed higher high-density lipoprotein (HDL) levels and lower triglycerides levels among people of African ancestry. The goal of this study was to characterize lipid levels in Bedouins of African vs. Middle-Eastern ethnicity. MATERIAL/METHODS: A cross-sectional study was conducted in a Bedouin primary care clinic in southern Israel, with 4470 listed individuals over the age of 21, of whom 402 (9%) were of African origin. A stratified random sample was included in the analysis. Associations between ethnicity, age, gender and lipid levels were assessed. Multiple linear regression and logistic regression models were used for multivariate analysis. RESULTS: The study included 261 African Bedouins and 406 Middle-Eastern Bedouins. (median age: 37 years, 58.6% females). The average total cholesterol and low-density lipoprotein (LDL) levels were 10 mg/dl lower among African Bedouins as compared to Middle-Eastern Bedouins (total cholesterol: 168.6 vs. 179.6 mg/dl, p<0.001; LDL: 99.5 vs. 109.0 mg/dl, respectively, p<0.001). Average triglycerides levels were 36 mg/dl lower among African Bedouins as compared to Middle-Eastern Bedouins (102.8 vs. 138.9 mg/dl, respectively, p<0.001). Average HDL levels were 3 mg/dl higher among African Bedouins as compared to Middle-Eastern Bedouins (48.3 vs. 44.6 mg/dl, respectively, p<0.001). CONCLUSIONS: A lower prevalence of dyslipidemia was found in African Bedouins, as compared with Middle-Eastern Bedouins.

[Characteristics of morbidity and mortality from stroke in the Negev population in the years 1995 and 1999].

GOALS: (1) To describe the prevalence of known risk factors for stroke morbidity and mortality in the Negev population that was hospitalized in the Soroka Hospital in the years 1995 and 1999, and to compare results. (2) To depict case fatality for those patients. METHODS: A cross-sectional study of two periods: 1995 and 1999. Data was collected from medical charts of patients admitted during the relevant time frame to Soroka Hospital in Beer Sheba, Israel with a primary diagnosis of stroke according to the ICD-9. Case fatality was defined as patient death within 30 days of admission. RESULTS: A total of 608 hospitalizations were included in the study of which 385 were admitted in 1995 and 222 in 1999. Most of the hospitalizations were due to ischemic stroke (86.7%), and the rest due to hemorrhagic stroke (13.3%). The average age was 71.1-10.9 years. Case fatality was 10.1% from ischemic stroke, 30.3% from hemorrhagic stroke and 12.5% from both. The case fatality was substantially higher in 1999. This trend was also observed in both ischemic and hemorrhagic stroke separately. There were no differences in demographic details between the years. Differences were found in various stroke risk factors. The first leukocyte count recorded was found to be significantly higher for patients who died of ischemic stroke in comparison to survivors. No differences were found between fatalities and survivors in the first reports of blood pressure. DISCUSSION: Patients in 1999 were found to have less risk factors and previously diagnosed diseases, and were admitted with more severe life threatening strokes. A logistic regression model, assessing the relationship between risk factors and case fatality, found that atrial fibrillation, type of stroke, admission leukocyte count, age and year contributed to the prediction of case fatality. Based on the results, it is recommended to use an admission leukocyte count above 11,000 to help identify patients at risk of death from stroke.

Transient neurological symptoms after isobaric subarachnoid anesthesia with 2% lidocaine: the impact of needle type.

BACKGROUND: The reported incidence of transient neurological symptoms (TNS) after subarachnoid lidocaine administration is as high as 40%. We designed this clinical trial to determine the incidence of TNS with two different pencil-point spinal needles: one-orifice (Atraucan) and two-orifice (Eldor) spinal needles. METHODS: Ninety-nine ASA physical status I or II patients undergoing surgical procedures of the urinary bladder or prostate were prospectively allocated to receive spinal anesthesia with 40 mg, 2% isobaric lidocaine plus fentanyl injected through either a 26-gauge Atraucan (n = 52) or a 26-gauge Eldor (n = 47) spinal needle. During the first three postoperative days, patients were observed for postoperative complications, including TNS. The primary end-point for this trial was the percentage of TNS in both double- and single-orifice spinal needle procedures. RESULTS: The incidence of TNS was higher when spinal anesthesia was done through the Atraucan needle (28.8% vs 8.5%, P = 0.006). Fifty percent of the patients in the double-orifice group versus 100% of the single-orifice group developed TNS after surgery in the lithotomy position (P = 0.014). The relative risk for developing TNS with the Eldor needle was 0.29 (95% CI: 0.07-0.75) compared with the Atraucan needle. CONCLUSIONS: The use of a double-orifice spinal needle was associated with a lower incidence of TNS, which may have been due to the needle design.

[Temporal trends in characteristics of diabetic subjects in Beer Sheba in two cohorts: 1988-90 and 1996-97 is immigration part of these trends?].

BACKGROUND: Israel is a country with high immigration rates. In previous studies, immigrants were found to have a relatively higher risk for cardiovascular diseases, higher rates of hypertension, as well as overall mortality rates. In this study we examined whether patient characteristics in the diabetic population of selected clinics in Beer Sheba differed between the years 1988 and 1997, and if immigration could explain these differences. METHODS: All known diabetic patients diagnosed at age 30 and older were enrolled in the study from 3 clinics in Beer Sheba in the years 1988-90 (Cohort 1), and from one of those clinics in 1996-97 (Cohort 2). Demographic, behavioral, clinical and biochemical characteristics of the two cohorts were compared, paying special attention to recent immigrants (< 10 years in Israel). RESULTS: About 17% of Cohort 1 and 47% of Cohort 2 were recent immigrants. Patients from Cohort 1 were significantly younger and had lower BMI compared to Cohort 2. They had higher systolic (148+/-22 vs. 141+/-21, p<0.001) and diastolic (83+/-12 vs. 80+/-10, p<0.001) blood pressure. More patients from Cohort 2 were on oral hypoglycemic medications (56% vs. 75%, p<0.001). Glucose control by HbAlc was better in patients from Cohort 2. The differences between cohorts were maintained after stratification by immigration status. CONCLUSIONS: Diabetes-related characteristics of patients differed during the seven-year period and were not explained by immigration status. Improvement in care and more intensive management of patients with diabetes may explain, at least partially, the described differences.

The prevalence of low hemoglobin values among new infantry recruits and nonlinear relationship between hemoglobin concentration and physical fitness.

There is limited information regarding the optimal hemoglobin level for physical activity and most studies followed relatively few participants. The object of this study was to assess iron storage levels in a population of healthy young males and their impact on physical fitness. Blood samples were drawn from 358 consenting infantry recruits for hemoglobin, iron, ferritin, transferrin, folic acid, and B(12) levels. A detailed medical and nutritional history was noted. Recruits performed a field fitness test including a 2,000-m run. Mean hemoglobin was 13.8 +/- 1.0 g/dl. Level of hemoglobin lower than 14 and 12 g/dl were found in 53.6% and 4.5% of the recruits, respectively. Mean ferritin was 57 +/- 34 ng/ml, with 15% of the recruits under 25 ng/ml. On multivariate analysis, after adjusting for pre-induction sports activity (P < 0.001), intermediate pre-induction hemoglobin level (12-14 g/dl) was associated with significantly faster 2,000-m running time (530 +/- 69 s, n = 176) than both the lower hemoglobin group (570 +/- 77 s, n = 16) and the higher hemoglobin group (552 +/- 86 s, n = 166, P < 0.05). The subjects in this study were non-athletic healthy young men. The high rate of abnormally low hemoglobin and ferritin values probably indicates a nutritional deficit in this population. The slower running results in the group with hemoglobin below 12 g/dl are in line with previous work, indicating the need for iron supplementation. The decrease in running ability with increased hemoglobin above 14 g/dl is surprising and will need further evaluation.

Trends in the sensitivity, positive predictive value, false-positive rate, and comparability ratio of hospital discharge diagnosis codes for acute myocardial infarction in four US communities, 1987-2000.

Variations in the validity of hospital discharge diagnoses can complicate the assessment of trends in incidence of acute myocardial infarction (AMI). To clarify trends in the validity of discharge codes, the authors compared event classification based on published Atherosclerosis Risk in Communities (ARIC) Study criteria with the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge code for AMI (code 410). Between 1987 and 2000, 154,836 coronary heart disease events involving hospitalization in the four ARIC communities had ICD-9-CM codes screened for AMI. The sensitivity of ICD-9-CM code 410 for classifying AMI in men (sensitivity = 0.65, 95% confidence interval (CI): 0.63, 0.66) was statistically significantly greater than that found for women (sensitivity = 0.60, 95% CI: 0.58, 0.62) and was greater in Whites (sensitivity = 0.67, 95% CI: 0.65, 0.68) than in Blacks (sensitivity = 0.50, 95% CI: 0.47, 0.53). The ethnic difference was related to a greater frequency of hypertensive heart disease and congestive heart failure codes encompassing AMI among Blacks as compared with Whites. The authors found that although the validity of ICD-9-CM code 410 to identify AMI was generally stable from 1987 through 2000, differences between Blacks and Whites and across geographic locations support investment in validation efforts in ongoing surveillance studies.

Determinants of long-term satisfaction after vertical banded gastroplasty.

BACKGROUND: The long-term usefulness of vertical banded gastroplasty (VBG) in achieving weight loss is controversial, and adverse effects related to the procedure may attenuate patient satisfaction. Our objective was to evaluate patient satisfaction, and to identify parameters that are related to such satisfaction, 3 to10 years after VBG. METHODS: All consecutive patients who underwent VBG in one surgical ward were invited for a follow-up study 3 to 10 years after surgery. Questions relating to symptoms and quality of life were evaluated in a personal interview using a structured questionnaire. RESULTS: Of the 122 patients who underwent VBG from 1986 to 1992, 75 patients were located and agreed to participate in the follow-up study. The average time since surgery was 5.4 +/- 1.8 years. The average weight loss was 24.9 +/- 12.4%, representing an excess body-weight loss of 58.6 +/- 30.4%. Overall, 65% of the patients were satisfied with the results of surgery while 19% expressed dissatisfaction. Significant improvement was seen in respiratory difficulties, ability to perform physical exercise, and mental status. Successful weight loss and the frequency of respiratory difficulties were the only independent parameters associated with patient satisfaction. Although vomiting, gastroesophageal reflux and difficulty in swallowing occurred in over two-thirds of the patients, their presence was not correlated with patient dissatisfaction. CONCLUSION: Despite the presence of a multitude of adverse effects, the majority of our patients were satisfied with the long-term results of VBG. Successful weight loss and improvement in respiratory difficulties were the major determinants of patient satisfaction.

Videokeratography findings in children with vernal keratoconjunctivitis versus those of healthy children.

PURPOSE: To determine videokeratographic topography of eyes with vernal keratoconjunctivitis (VKC) and to assess whether the severity of the VKC is related to the presence of changes compatible with keratoconus. PARTICIPANTS: Seventy-six persons aged 6 to 21 years: 40 patients with VKC and 36 healthy controls. DESIGN: A comparative, observational case series. METHODS: We examined 76 persons, of whom 40 were patients with VKC and 36 were control subjects, and compared the outcomes of videokeratography (VKG) patterns (EyeSys Laboratories, Houston, TX), numerical corneal indices, and spherical equivalent refraction. MAIN OUTCOME MEASURES: Corneal topographic patterns, corneal numeric indices, and corneal mirror imagery. RESULTS: We found many more abnormal patterns on VKG among the VKC patients than expected when compared with 'normal' eyes (P = 0.02 for the right eye and P = 0.001 for the left eye). Videokeratography allowed us to define a subgroup of patients with infraclinical keratoconus. A trend of superior corneal steepening ('superior keratoconus') was also found. CONCLUSIONS: Vernal keratoconjunctivitis patients have more abnormal corneal topographic patterns than non VKC controls. Videokeratography may help decide how to follow-up and treat a presumed self-limiting disease.

Diabetes among Bedouins in the Negev: the transition from a rare to a highly prevalent condition.

BACKGROUND: Previous studies have shown a low prevalence of diabetes and other cardiovascular risk factors among Bedouins living in the Negev desert. New evidence suggests that diabetes is becoming highly prevalent. OBJECTIVES: To estimate the prevalence of diabetes in the town of Rahat, describe the cardiovascular risk factor profile and therapeutic modalities for diabetes and related conditions in this population, and compare these findings with those in the Jewish population. METHODS: A complete record review of all known diabetic individuals aged 35 and older registered at the Rahat Clinic (Clalit Health Services) was carried out by a trained nurse and a research assistant. Information on demographic, anthropometric and clinical characteristics was abstracted. Data on prescribed hypoglycemic agents and other medications were also obtained. RESULTS: Of the 316 known diabetic patients in the clinic, complete data were available for 271 (85.8%). The prevalence of known diabetes was 7.3% in males and 9.9% in females. Females had a significantly higher body mass index than males (30.9 vs. 29, P < 0.002), but lower levels of HBA1c and microalbuminuria. Oral hypoglycemic medications were taken by 69% of women and 76% of men, and insulin by 19% of women and 15% of men. CONCLUSIONS: Compared with data on Jewish diabetic patients in the Negev and Israel, the overall prevalence of diabetes in the population of Rahat is higher, but their cardiovascular risk profile is better, except for obesity. These findings support the hypothesis that diabetes and obesity have become major public health problems among Bedouins.

Long-term dietary changes after vertical banded gastroplasty: is the trade-off favorable?

BACKGROUND: Insufficient data exist about the long-term health consequences of gastric restriction procedures used for treatment of obesity. The long-term nutritional changes that occur after vertical banded gastroplasty (VBG) were evaluated. METHODS: All consecutive patients who underwent VBG surgery in one surgical ward were invited for a follow-up study 3-10 years after the surgery. Demographic and clinical characteristics were evaluated from the patients' medical charts. Dietary assessment was performed using a food frequency questionnaire, which included 52 frequently consumed food items. RESULTS: Of the 122 patients who underwent VBG between 1986-1992, 75 (62%) participated in the follow-up study. The average time since surgery was 5.4 +/- 1.8 years, and the average weight loss was 24.9 +/- 12.4%. Most of the patients eat only one major meal daily, and only one-third regularly ingest solid foods. Dietary analysis revealed a decreased intake of most nutrients compared with pre-surgery, with the exception of dairy products, sweet foods and fluids. The greatest decrease was found in the consumption of fiber-rich fruits and vegetables, followed by meat, fish and complex carbohydrates. CONCLUSION: While the weight loss itself and the reduction in fat consumption that are seen after VBG are probably beneficial, the long-term effects of the decreased consumption of fruit, vegetables, other complex carbohydrates and fish may counterbalance these benefits. The net effect of this trade-off on future health is difficult to predict and requires long-term evaluation of clinical outcome.

A framework for a diabetes mellitus disease management system in southern Israel.

Chronic diseases are a significant burden on western healthcare systems and national economies. It has been suggested that automated disease management for chronic disease, like diabetes mellitus (DM), improves the quality of care and reduces inappropriate utilization of diagnostic and therapeutic measures. We have designed a comprehensive DM Disease Management system for the Negev region in southern Israel. This system takes advantage of currently used clinical and administrative information systems. Algorithms for DM disease management have been created based on existing and accepted Israeli guidelines. All data fields and tables in the source information systems have been analyzed, and interfaces for periodic data loads from these systems have been specified. Based on this data, four subsets of decision support algorithms have been developed. The system generates alerts in these domains to multiple end users. We plan to use the products of this information system analysis and disease management specification in the actual development process of such a system shortly.