The association between post-polio symptoms as measured by the Index of Post-Polio Sequelae and self-reported functional status.

OBJECTIVE: To evaluate the association between self-reported severity of polio sequelae and current functional status among polio survivors. METHODS: This was a cross sectional study of 195 polio survivors attending a polio outpatient clinic at a university hospital. The main outcome measures of demographic, medical, social, and functional data were gleaned from a questionnaire adapted for the polio population. The severity of polio sequelae was evaluated with the self-reported Index of Post-Polio Sequelae (IPPS). RESULTS: The mean age of our sample was 57.6 ± 10.5 years, 53% were men, 38% had acquired higher education and 37% were employed. We found significant correlations between the total IPPS score and independence in activity of daily living (P<0.05), the use of walking aids (P<0.005) and mobility in and out-of-doors (P<0.0001). A positive correlation was also found between the total IPPS score and subjective assessment of physical and mental health (P<0.0001). CONCLUSIONS: Higher disability in ADL and mobility and lower perception of physical and mental health in polio survivors were associated with a higher score on the IPPS, reflecting greater severity of polio sequelae. These findings demonstrate the IPPS as a useful tool in the clinical evaluation of the polio population, however further data is needed in order to determine if this index can assess clinically significant changes over time.

Screening physical examinations in 25,000 Israeli schoolchildren.

UNLABELLED: Physical examinations in childhood and adolescence have been recommended by various professional organizations. In order to assess the value of periodic physical examinations in identifying previously undetected conditions, we analyzed the results of school screening examinations of approximately 25,000 Israeli students. METHODS: Entire student populations in the 1st, 5th, 7th, and 10th grades in the Tel Aviv-Yafo public school system were offered physical examinations during the 1996-1997 and 1997-1998 school years. Nine physicians performed these examinations. Referrals to the primary care physician were made for abnormal findings. The frequencies of the leading referrals were determined, and comparisons were made according to gender and grade. RESULTS: A total of 24,846 students were examined. The overall referral rate was 7.8 per 100 examinations. Leading referrals included "overweight", "heart murmur", and "spinal structural abnormalities" at all grade levels, and "nevi" in grades 5, 7, and 10. Referral rates increased between various grade levels for "spinal structural abnormalities", "nevi", and "varicocele", and decreased for "short stature" and "overweight". Of the 196 diagnoses documented after referral, 182 (93%) fell into three categories, namely, spinal, hernia and scrotal, and short stature. CONCLUSIONS: A wide range of physical findings were detected or referred at each of the grade levels in this large population of schoolchildren. Many of these were triggers for preventive health counseling, while approximately 1% of the examinations yielded important findings requiring intervention. These results provide a measure of justification for the American Academy of Pediatrics' recommendations for periodic physical examinations in childhood and adolescence.

Blood donors with positive direct antiglobulin tests are at increased risk for cancer.

BACKGROUND: Positive direct antiglobulin tests (DATs) have been associated with both autoimmunity and lymphoproliferative disorders. However, it is unknown whether DAT+ in healthy blood donors is associated with an increased risk of malignancies. STUDY DESIGN AND METHODS: In the current study, all blood donors with DAT+ samples were identified during the years 1999 through 2003 through the Magen David Adom National Blood Services in Israel. This study compared the risk of cancer among 586 DAT+ and 2344 DAT- donors who were matched according to sex, age, and year of donation. The risk of cancer in DAT+ donors was also compared to expected rates in the general Israeli population. Cancer was ascertained through the Israel Cancer Registry. RESULTS: Malignancies occurred among 17 (2.9%) of the DAT+ and 27 (1.2%) of the DAT- blood donors; of these, 3 donors in the DAT+ group were diagnosed with hematopoietic malignancies within 12 months of their donation. Even after excluding these early cases, the relative risk of developing cancer was 2.14 (95% confidence interval [CI], 1.13-4.10) comparing DAT+ with DAT- donors, while the relative risk for hematopoietic cancer was 8.3 (95% CI, 1.5-43.2). Comparing DAT+ blood donors with the general population, the standardized incidence ratios (observed/expected cases) were elevated at 2.11 (95% CI, 1.15-3.54; p = 0.16) for all malignancies and 8.03 (95% CI, 2.2-20.6; p = 0.003) for hematologic malignancies. CONCLUSION: There is evidence of a significantly increased risk of cancer, especially hematologic malignancies, among blood donors with a positive DAT even within a short follow-up period.

Hormonal contraception, sexual behaviour and HIV prevalence among women in Cameroon.

BACKGROUND: Data on the effect of contraceptive methods, other than the condom, on HIV acquisition is not clear. The aim of this study was to describe hormonal contraceptive use, sexual behaviour and HIV prevalence among women in Cameroon in order to provide baseline information for future analytical studies. METHODS: This is a cross-sectional descriptive study based a nationally representative sample of 4486 sexually active women aged 15-49 years who participated in the 2004 Cameroon Demographic and Health Survey. RESULTS: The overall HIV prevalence was 7.4% (332/4486). The HIV prevalence was higher in the 25-35 year age group (10.03%), urban residents (9.39%), and formerly married (18.48%), compared to their compatriots. The prevalence was lower in women with five or more living child (3.67%), women in the low wealth index category (3.79%) and women who had no formal education (3.37%). The HIV prevalence was higher among women who had two or more partners in the last 12 months (10.26%) and women who reported to have had four or more partners in their lifetime (12.40%). The prevalence of HIV was higher among current hormonal contraceptive users (6.63%) compared to the current non-users (3.06%), among ever users of hormonal contraception (13.27%) compared to the never users (7.11%). CONCLUSION: We conclude that the prevalence of HIV among sexually active women in Cameroon varies according to sociodemographic characteristics, sexual behaviour and hormonal contraceptive use. Our findings underscore the need to counsel women using hormonal contraception to be aware that hormonal methods do not protect against HIV infection. Given the biologic plausibility of the link between hormonal contraception and HIV infection, future research should focus on carefully designed prospective studies to establish the temporal relationship and estimate the incidence of HIV infection among women using and not using hormonal contraceptive methods.

A population-based study of hairy cell leukemia in Israel.

OBJECTIVES: Few population-based data exist on the incidence and prognosis of hairy cell leukemia (HCL). Our objectives were to study the effect of socio-demographic factors on this rare disease and the risk of second malignancies occurring in HCL patients. METHODS: We measured crude and age-adjusted incidence rates of HCL based on reporting to the Israel Cancer Registry (ICR) 1991-2001. Using Kaplan-Meier and multivariate analysis, we assessed survival by gender, ethnicity and geographic region. We ascertained additional primary tumors reported in this population and calculated standardized incidence ratios (SIRs) for tumors reported after the diagnosis of HCL. RESULTS: The ICR registered 147 cases of HCL among males and 34 in females between 1991 and 2001. Age-adjusted incidence rates were 1.62/10(6)/yr for women and 7.97/10(6)/yr for men, with rates 1.5 times higher in Jewish than in non-Jewish (mainly Arab) men. Mean overall survival also differed by ethnicity. In a multivariate model, increasing age at diagnosis (P < 0.001), as well as Arab origin (P = 0.008) were associated with poorer survival but gender did not significantly affect the survival after controlling for age and ethnicity. Other primary malignancies were reported in 20 (11%) individuals, with a predominance of genito-urinary tumors (65%) among males. Secondary genito-urinary tumors were significantly increased above the expected population rates (SIR 3.23, 95% confidence interval: 1.39-6.36, P = 0.008). CONCLUSIONS: In the Israeli population, age and ethnicity were associated with prognosis of HCL. Variations in disease characteristics, stage of disease at diagnosis or differential access to treatment may contribute to these findings. Patients with HCL appear to be at increased risk for genito-urinary malignancies.

Butyrylcholinesterase activity, cardiovascular risk factors, and mortality in middle-aged and elderly men and women in Jerusalem.

BACKGROUND: The association of butyrylcholinesterase (BuChE) with Alzheimer disease and the association of this disease with cardiovascular risk factors raise interest in the association of BuChE activity with cardiovascular risk factors and mortality. METHODS: A baseline cross-sectional study was conducted between 1985 and 1987, encompassing residents > or =50 years of age living in a Jewish neighborhood in western Jerusalem. Interviews were followed by examinations and nonfasting blood sampling (available for 1807 participants). Follow-up data to April 1996 on mortality and causes of death were obtained through record linkage with the Israeli Population Registry. RESULTS: BuChE activity was inversely related to age and was positively associated with serum concentrations of albumin (r = 0.35; P <0.001), cholesterol (r = 0.31; P <0.001), and triglycerides (r = 0.30; P <0.001). Enzyme activity was associated with measures of overweight, obesity, and body fat distribution (e.g., body mass index, r = 0.20; P <0.001). In multivariate analysis, the associations of enzyme activity with serum cholesterol, triglycerides, and albumin persisted strongly. After adjustment by Cox proportional hazards regression for other predictors of mortality in this population, individuals in the lowest quintile of BuChE activity had significantly higher mortality than those in the highest quintile [hazard ratios (95% confidence intervals): all-cause mortality, 1.62 (1.15-2.30); cardiovascular deaths, 1.79 (1.05-3.05)]. The association was attenuated by introduction of serum albumin into the models. CONCLUSIONS: This is the first study to report on the association between BuChE and mortality. The relatively strong association of BuChE with serum lipid and albumin concentrations requires elucidation. Our results suggest that low BuChE activity may be a nonspecific risk factor for mortality in the elderly.

The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem.

BACKGROUND: Lifestyle factors relevant to coronary risk factors differ between Palestinians and Israelis. Both have been exposed, albeit differently, to the stressors of the long-term conflict. We determined the incidence of coronary heart disease, previously unreported in Palestinians, in these Mediterranean populations and made international comparisons with the MONICA Programme. METHODS: We applied the rigorous World Health Organization MONICA protocol, which enables standardized international population-based comparisons, to determine all acute myocardial infarction events and coronary deaths among Palestinians and Israelis aged 25-74, residents of the Jerusalem district in 1997. RESULTS: We confirmed a total of 265 coronary events among 76,200 Arabs and 698 among 226,500 Jews. Rates among Arabs were substantially higher than in Jews, particularly so in women. Age-adjusted rate ratios (RRs) for coronary events were 1.58 [95% confidence interval (95% CI) 1.34-1.87] among men and 2.37 (95% CI 1.81-3.10) among women. When restricted to coronary deaths, Arab: Jewish RRs were 2.79 (95% CI 2.09-3.73) in men and 2.66 (95% CI 1.77-4.00) in women. Compared with MONICA populations in 20 countries, Arabs ranked first in total coronary event rates and first in non-fatal myocardial infarction rates, exceeded populations in Finland, Scotland, and Northern Ireland, and showed striking differences from the participating Mediterranean centres. CONCLUSIONS: Coronary risk appears to be particularly high in Palestinian Arabs. Determinants of these unexpected findings should be sought and prevention programmes initiated.

Is it possible to increase weight and maintain the protein status of debilitated elderly residents of nursing homes?

BACKGROUND: The care of elderly persons in chronic care nursing wards is generally complicated by nutritional problems such as weight loss and worsening protein status. An inability or refusal of the patient to consume enough food often necessitates the use of expensive commercial formulas for nutritional support. The purpose of this study was to determine whether the use of an in-house (high-protein, milk-based) low-cost formula with added minerals and vitamins for total nutritional support would be effective in maintaining weight and protein status of patients in the long term. METHODS: Participants were recruited from five nursing care units of a single geriatric facility. All residents who required formula feeding were followed prospectively. The formula was provided either as a pudding or a milkshake for oral feeding or as a liquid for tube feeding and served as the sole source of nutrition. Data were collected regarding the participants' weight (monthly), serum albumin level (periodically), and the manner of formula administration (oral, nasogastric, or gastrostomy tube). RESULTS: One hundred forty-three participants who received this formula were followed for a maximum period of 6 years. Mean weight increased by 5 kg during the first year and remained stable thereafter. Those participants who died within 6 months had no increase in weight. The long-term mean serum albumin level of all participants was an acceptable 4 g/dL. CONCLUSION: The long-term use of an inexpensive in-house formula for total nutritional support increased weight and maintained serum albumin levels in most of the chronically ill elderly nursing care patients who participated in the study.

An administrative intervention to improve the utilization of laboratory tests within a university hospital.

BACKGROUND: Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement. OBJECTIVE: To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization. DESIGN: An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention. SETTING: Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999-2003. INTERVENTION: The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention's results was sent to the wards and reviewed with senior medical staff. MAIN OUTCOME MEASURES: Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests. RESULTS: An overall reduction of 19% in laboratory tests (95% CI: 18.8-19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital's medical divisions, within a range of 14.9-43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% (P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of 'high-volume' tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively). CONCLUSIONS: The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.

Actinic damage among patients with psoriasis treated by climatotherapy at the Dead Sea.

BACKGROUND: Dead Sea climatotherapy is highly effective in the treatment of psoriasis. However, its potential side effects, especially the risk of skin cancer, are unclear. OBJECTIVE: We sought to determine the prevalence of solar damage and skin cancer among patients with psoriasis who underwent Dead Sea climatotherapy compared with control patients. METHODS: This multicenter controlled cross-sectional study was carried out at the Dead Sea Solarium Clinic and outpatient clinics of the participating centers. A total of 1198 participants (460 patients with psoriasis and 738 control patients) aged 20 to 70 years were included. A standard questionnaire including demographic parameters and sun exposure habits was administered to all participants. Patients were questioned about previous psoriatic treatments and climatotherapy at the Dead Sea. All participants underwent a structured physical examination of the skin. We compared the prevalence of solar damage for patients with psoriasis and control patients and assessed the extent of photodamage among patients with psoriasis according to exposure time at the Dead Sea in univariate and multivariate analyses. RESULTS: Elastosis ( P < .001), solar lentigines (P = .03), poikiloderma (P < .001), and facial wrinkles (P < .001) were significantly more common among patients with psoriasis compared with control patients and showed a dose response with increased Dead Sea exposure time. Self-reported previous skin cancers were more common in control patients compared with patients with psoriasis (8.2% vs 3.5%, P = .002), however, the prevalence of nonmelanoma skin cancer on examination did not differ between the two groups. No cases of malignant melanoma were detected in either group. CONCLUSIONS: Dead Sea climatotherapy is not associated with an increased risk of malignant melanoma or nonmelanoma skin cancer for patients with psoriasis in Israel. However, UV exposure at the Dead Sea may play a role in the development of solar damage.

Myocardial infarction occurrence in Jerusalem: a Mediterranean anomaly.

BACKGROUND: The Jewish population of Israel consumes a diet rich in polyunsaturated fatty acids with a relatively low proportion of saturated fat, has a small alcohol intake and a lipid profile characterized by low HDL-cholesterol and high lipoprotein(a) (Lp(a)). It is therefore of interest to compare occurrence rates of coronary heart disease (CHD) with those elsewhere. METHODS: The community-based event rate of CHD [comprising acute myocardial infarction (AMI) and CHD death] and case-fatality was determined in 1995-1997 by active surveillance among Jewish residents of the Jerusalem District aged 25-64 according to standardized WHO-MONICA criteria. We compared our findings with rates among MONICA populations in 21 countries. Twelve hundred and six events occurred in Jerusalem during approximately 399,000 [correction] person-years (930 non-fatal AMI and 276 CHD deaths). RESULTS: The age-adjusted incidence of CHD ranked high compared with the 21 countries (men third highest, women eighth highest), far exceeding the Mediterranean countries. In contrast, the pre-hospital mortality rate was low, similar to countries in the Mediterranean basin, and the 28-day case fatality was remarkably low, far lower than for any MONICA population in men, and second lowest in women. Correspondingly, the incidence of non-fatal AMI ranked extraordinarily high (men first, women third). The low case-fatality ranking persisted upon adjustment for treatment differences between populations. CONCLUSIONS: We report an unusual combination of a high incidence of CHD among Jewish residents of Jerusalem accompanied by extraordinarily low case fatality, the latter suggesting reduced susceptibility to lethal arrhythmias. Determinants of this anomaly require clarification.

Screening tests in prenatal care: a national study in Israel.

BACKGROUND: Prenatal care in Israel is established as a universal service, but the degree of compliance with care recommendations may vary with the healthcare provider or the characteristics of the population. OBJECTIVES: To study referral to and compliance with the performance of ultrasound, alpha-fetoprotein and amniocentesis and the factors associated with them in a national sample. METHODS: The sampling frame consisted of women who gave birth during March 2000. The sample included 1,100 Israeli Jewish and Arab women who resided in localities with over 50,000 and 20,000 inhabitants respectively. They were interviewed by phone 3 months after delivery. RESULTS: In both population groups 30% reported having seven or more ultrasounds during pregnancy. The performance of fetal body scans was relatively low. Factors associated with non-performance among Jewish women were: lower education, religiousness, and attending Mother and Child Health services as compared to all other services. Seventy-seven percent of Jewish women and 84% of Arab women reported that they had been referred for alpha-protein tests. For women aged 35 and over, 55% of Jewish women were referred for amniocentesis and 63% complied, whereas 39% of Arab women were referred but none complied. CONCLUSIONS: Ultrasound is almost universally performed among Jewish and Arab women, however fetal body scans, alpha-fetoprotein and amniocentesis (for women over the age of 35) are not. The reasons for the lower coverage may be due to under-referral and/or lack of compliance of the women, perhaps due to sociocultural barriers. In both population groups considerable out-of-pocket money is paid for the tests.

Are patients with psoriasis susceptible to the classic risk factors for actinic keratoses?

BACKGROUND: An increased prevalence of benign solar damage (eg, facial wrinkles) but not neoplastic lesions was observed among patients with psoriasis who were exposed to Dead Sea climatotherapy compared with controls. OBJECTIVES: To compare the prevalence of actinic keratosis in psoriatic patients and controls and to assess whether known risk factors behave similarly in both groups. DESIGN: Multicenter cross-sectional study. SETTING: Dermatology clinics in 4 participating Israeli hospitals and at a Dead Sea clinic. PARTICIPANTS: Adult subjects (n = 460) with plaque-type psoriasis were recruited from the Israel Psoriasis Association (volunteer sample) and from dermatology clinics (convenience sample). The control group (n = 738) consisted of nonimmunosuppressed patients attending these clinics for benign conditions unrelated to sun exposure, such as atopic or contact dermatitis. MAIN OUTCOME MEASURES: Prevalence and distribution of actinic keratoses and odds ratios associated with skin, hair, and eye color and propensity or history of sunburn adjusted for age, ethnicity, and sun exposure. RESULTS: Actinic keratoses were observed in 200 controls (27%) and 51 subjects (11%) (P<.001). This increased prevalence occurred in both sexes, participants aged 35 years or older, all ethnic groups, smokers, and nonsmokers. The anatomical distribution of lesions did not substantially differ between subjects and controls. In multivariate analysis, psoriasis conferred a protective effect (odds ratio, <1), as did dark skin, dark eyes, and a history of severe sunburn in childhood. However, significant interactions were observed between psoriasis and hair color as well as psoriasis and propensity to sunburn, whereby a linear association was observed for controls but not for patients with psoriasis. CONCLUSIONS: Psoriasis confers protection against actinic keratosis. Hair color and propensity to sunburn exert differential effects among psoriatic patients and controls.

Utilization of prenatal care services in larger townships in Israel: should the service be reorganized?

BACKGROUND: In Israel, preventive services for mothers and children are provided mainly by the Ministry of Health through a network of Maternal and Child Health clinics, and partly by municipalities and health maintenance organizations. Utilization of the MCH clinics for prenatal care has declined during the last decades. OBJECTIVE: To study the utilization and satisfaction with prenatal care services following the introduction of the National Health Insurance Law. METHODS: The study population comprised a national sample of Jewish and Arab women who were interviewed by telephone regarding the following: main service utilized for prenatal care, physician and nursing visits, satisfaction with care, and demographic and other characteristics. The response rate was 92% among Jewish women and 88% among Arab women. RESULTS: Twenty percent of the Jewish and 52% of the Arab women selected MCH clinics as the main service for prenatal care. The great majority of the study population attended the HMO services (clinics, independent physicians, women's health centers), while 7% of the Jewish and 4% of the Arab women visited a private clinic. The predisposing factors affecting the women's choice were educational level, ethnic group, religiosity, district of residence, and type of HMO. The mean number of physician visits was more than the eight visits recommended. Forty percent of the sample visited with three or more physicians at different services. More than 40% of the women had no appointment with a nurse, mainly those who chose the services of an HMO clinic, independent physician, or private physician. Satisfaction with the physician, nurse, and physical structure of the main service chosen for prenatal care was high. CONCLUSIONS: Since the majority of women preferred the HMO services, the merging of prenatal care with curative care provided by the HMOs has to be considered. Public health nurses should be integrated in the service, and their specific role needs to be defined.

[Evaluation of utilization of preventive services for infants in Israel--personal and organizational determinants].

UNLABELLED: Preventive services for prenatal and child health care were established 85 years ago by Henrietta Szold, president of the Women's Zionist Organization of America. A network of 1200 Mother and Child-Care clinics (known as "Tipat Halav") has developed as a result of this initiative. Preventive services are provided by the Ministry of Health, municipalities and recently, by all four Health Maintenance Organizations (HMO's) in Israel. OBJECTIVES: To assess the utilization and satisfaction of preventive health services during infancy. METHODS: The sample consisted of Jewish and Arab women who gave birth during March 2000. A total of 667 Jewish and 211 Arab mothers were interviewed after their infants reached the age of 15-19 months. The response rate was 92% and 88% respectively. RESULTS: It was found that 96% of the Jewish women and 100% of the Arab women utilized "Tipat Halav" services. Preventive services were provided mainly by the Ministry of Health and municipalities, while HMO's provided service to 15% of the Jewish infants and 19% of the Arab infants. Nine percent of the infants were not, examined by a physician within the framework of the preventive service, but all infants had health supervision by a nurse. Overall, 25% of the Jewish infants and 32% of the Arab infants had 11 or more visits with the nurse. It was observed that mothers with a higher educational level and those with many children began the process of health supervision at a later stage and visited the clinic less frequently. The number of visits to all health services combined, from birth to 15-19 months, was 26 for Jewish and 28 for Arab infants, indicating over-utilization and dependence. However, the performance of hearing and vision tests was inadequate. Referral to orthopedics was 41% for Jewish and 11% for Arab infants. The level of satisfaction with the service was high, with scores mostly above 3.0 out of a maximum of a total of 4.0 points. CONCLUSIONS: The preventive services provided by the different agencies do not differ significantly except in the case of private physicians and voluntary organizations in East Jerusalem, which do not comply with the recommended routines. RECOMMENDATIONS: Our recommendations include raising the compliance and performance of screening tests and defining the policy of referral to orthopedic services. Furthermore, the clinics should provide more outreach to high-risk families in order to optimize their utilization of services and compliance.

[Performance of screening tests in the preventive services for infants].

UNLABELLED: Early detection is one of the aims of the surveillance by the preventive services in infancy. OBJECTIVES: This article presents the performance of screening for anemia in infancy, compliance with iron supplementation and treatment, screening for hearing, and abnormalities of the hip joint, and referral to ear, nose and throat (E.N.T.) and orthopedic specialists according to the screening results. METHODS: The sample consisted of Jewish and Arab women who gave birth during March 2000. Mothers were interviewed after the infants reached the age of 15-19 months (667 Jewish and 211 Arab). All the women utilized the preventive services of the Ministry of Health, municipalities or H.M.O's. Arab women from East Jerusalem utilized the services of non-governmental organizations (NGO's). RESULTS: A total of 61% of the Jewish and 86% of the Arab infants had a hemoglobin examination. Eighty-five percent of the Jewish and 75% of the Arab infants received iron as a supplement or treatment for anemia. The performance of hearing tests was 88% and 77%, respectively. Among the infants referred to E.N.T. no hearing loss was detected. Fourteen percent were not screened nor referred by the family physician/pediatrician. Among the self referrals, one child was detected with a hearing loss. Percent referrals to the orthopedic surgeon was higher among Jewish than Arab infants. Among those not examined through the preventive services, the rate of pathology detected by the orthopedic surgeon was higher than those referred. RECOMMENDATIONS: Findings highlight the need to improve the quality of screening and increase the percent of infants screened in the Arab and Jewish population, particularly those of the N.G.O.'s, with emphasis on high risk groups. Furthermore, efforts should be directed to define and recommend routines for detection of abnormalities of the hip joint, and integrate the procedures within the health services.

A model-based evaluation of a cultural mediator outreach program for HIV+ Ethiopian immigrants in Israel.

This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study's approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.

Birth weight and weight, stature, and body mass index at ages 6 and 14 years.

To analyze the effect of birth weight on weight, stature, and the Body Mass Index (BMI) at the ages of 6 and 14 years, 1,115 Jerusalem schoolchildren were studied. Correlations were low, but higher between birth and 6 years (range 0.10-0.31) than between birth and 14 years (range 0.04-0.20). The positive predictive values for the highest quartile of BMI at 6 and 14 years were 29.6 and 29.4% among boys, 31.4 and 33.0% among girls. They were highest for menstruating girls, 35.6 and 40.0%, respectively. These girls were already heavier at age 6 than other girls and bodys. Aanalysis of covariance showed that birth weight was consistently associated with weight, stature, and the BMI, while mother's origin, education and age, and the number of children in the family were not. Overall, the explained variance was low and decreased with age in both sexes. It was higher for stature than for weight, and was specially low for the BMI. © 1993 Wiley-Liss, Inc.