Hepatitis c virus infection in employees of a large university hospital in Israel.

OBJECTIVE: To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel. DESIGN: Seroprevalence survey. SETTING: A 1,006-bed, tertiary-care university hospital in Jerusalem. PARTICIPANTS: All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey. METHODS: Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables. RESULTS: Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood > or = 10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia. CONCLUSIONS: Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.

[Post-polio symptoms].

A crossectional study was conducted to assess the prevalence of late symptoms among post-polio survivors. The aim was to increase awareness of late symptoms among professionals involved in rehabilitation, and to evaluate the need for accessible diagnostic and treatment facilities. Of the 146 subjects surveyed, about half reported decline in general health since maximal recovery. Among the late symptoms were muscle and joint pain (46%), fatigue (31%), cold intolerance (67%) and muscle cramps (39%). About 25% reported decreased functional ability and 13% required braces or mobility devices. Most of the late symptoms appeared gradually (median time 45 years after onset of polio). The prevalence of these late symptoms is slightly lower than that described in previous studies, but that of decreased functional ability, much lower. These differences may be due to differences in the populations surveyed. Symptomatic post-polio subjects should be identified and encouraged to use appropriate medical facilities.

Factors affecting the utilization of prenatal health care services in Jerusalem.

Health service utilization patterns during pregnancy were studied among 780 women from selected neighborhoods of Jerusalem who delivered between December 1, 1985 and June 30, 1986. Factors affecting the choice of care-provider, the timing of the first contact with the prenatal care service and the frequency of visits to prenatal care centers were studied with respect to several demographic, socio-economic and needs variables. About one half of the women visited the Family Health Centers, the traditional site for delivery of prenatal care. Forty percent visited their regular doctor during pregnancy while about 30% sought private care. In all, fifty two percent of women consulted more than one source of medical care service during pregnancy. Logistic regression analysis showed that the choice of care was determined by the type of insurance, need factors and education. The timing of the first visit depended on origin, level of education and parity. The frequency of visits was related to the type of insurance and to perceived health.

Utilization of pediatric health services in Jerusalem.

The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mother's perception of her child's health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.

Occupational and non-occupational hepatitis B virus infection among hospital employees in Jerusalem: a basis for immunisation strategy.

The present study was designed to assess the risk of hepatitis B virus (HBV) infection among hospital employees, who often contract the infection before the beginning of their employment, and to suggest a prevention strategy. The study population consisted of 2518 subjects working or studying at the two Hadassah University hospitals, on Mount Scopus and at Ein Kerem in Jerusalem. The total prevalence for anti-HBc positivity as an indicator for past or present HBV infection was 17.6%. Several variables, including country of birth, age, and duration of employment significantly affected the rate of anti-HBc positivity. The highest rates for anti-HBc+ were found in personnel of selected departments such as haemodialysis (31.8%), haematology/oncology (28.3%), and the blood bank (24.0%), after adjustment for country of birth, age, and sex. Specific occupations in the hospital were associated with an increased rate of anti-HBc positivity. Thus the highest rate of HBV infection (after adjustment for country of birth, age, and sex) was shown for housekeepers (32.4%) and departmental secretaries (23.6%), who take care of waste products containing blood, or who transfer vials containing blood to the hospital laboratories. By comparison, anti-HBc was positive in 17.2% of nurses, 15.6% of physicians, and only 7.8% of administrative clerks. Israel is a country of immigration, and anti-HBc rates were four times higher in employees born in countries where HBV is more endemic--for example, in north Africa and Mediterranean countries--than in employees born in western Europe or the United States. However, rate of anti-HBc + increased significantly with age as well as duration of employment in the hospital, irrespective of country of birth. These data indicate that although HBV infection often occurs in Israel before commencement of employment in the hospital, hospital employees are at significant risk for contracting HBV infection during their professional lifetime regardless of where they were born. Moreover, paramedical personnel such as housekeepers and departmental secretaries are in the highest risk group for contracting HBV. Finally, as a result of the high background of anti-HBC positivity in selected ethnic groups, mandatory screening for anti-HBc before employment in medical institutions in Israel is recommended for them, then active vaccination against HBV for employees at risk. Employees who immigrated from western Europe and the United States should be immunised without pre-vaccination screening for HBV.

Periodontal treatment needs, by CPITN, among employees of a Jerusalem hospital.

A survey, employing the Community Periodontal Index of Treatment Needs (CPITN), was conducted among 344 employees of a Jerusalem hospital. Of the population surveyed, 2.2 per cent demonstrated totally healthy mouths, 1.5 per cent had, at the worst, bleeding symptoms, 13.3 per cent had calculus, 53.4 per cent had 4-5 mm ('shallow' according to WHO) pockets and 29.6 per cent had deep pockets (6 mm or more) as their worst CPITN scores. Results revealed an average of 0.55 edentulous sextants, 0.68 healthy sextants, 0.87 sextants with bleeding symptoms, 1.36 with calculus, 1.95 with 4-5 mm pockets and 0.61 sextants with deep pockets. In general, females were healthier than males, had a significantly greater number of healthy sextants, less sextants with calculus and less sextants with deep pockets. A deterioration in periodontal health with age was evident, according to mean number of sextants per person by CPITN scores. Associations were also analysed between CPITN and demographic variables. Few significant associations were revealed. Based on FDI and WHO estimates, the calculated periodontal treatment needs for the hospital employees was found to be about 2 hours per person. Compared with data for other countries, as reported by the WHO, this status demands serious efforts to be made towards periodontal health promotion.

Secondary prevention of low-back pain. A clinical trial.

A clinical trial, aimed at secondary prevention of low-back pain, was performed in 142 hospital employees reporting at least three annual episodes of this condition. Participants were randomly assigned to one of three groups: a calisthenics program (CAL) for 3 months with biweekly sessions of flexion exercises, a back school program (5 sessions), and a control group. The effectiveness of the two intervention programs was evaluated over a 1-year period. Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected. A monthly surveillance for the whole year showed a mean of 4.5 "painful months" in the CAL group versus 7.3 and 7.4 months in the back school and control groups, respectively (P less than 0.0001). The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength. The increased trunk flexion was associated with the rate of participation in the CAL sessions. Further research is needed to answer the question of "intensity versus type of exercise" by comparing different intervention programs, with similar intensity.

Association of smoking with periodontal treatment needs.

A total of 344 Jerusalem hospital personnel participated in the present survey which examined periodontal needs according to CPITN (a measure of treatment needs) and smoking habits. Females and younger subjects were found to be generally periodontally healthier than their male and older counterparts. The effect of both smoking and the number of cigarettes smoked were shown to have a clearly deleterious effect on periodontal status when assessed using the CPITN. Younger women were found to be most susceptible to this effect.

Detection of genotoxic substances in cancer patients receiving antineoplastic drugs.

A short-term bacterial mutation test, the SOS Chromotest, has been used to detect the excretion in urine of genotoxic metabolites of antineoplastic drugs administered to cancer patients. In this test, the damage to the DNA of the test bacteria is expressed by the production of beta-galactosidase, which can be quantitatively assessed and is proportional to the concentration of the drug. Kinetic curves of excretion for adriamycin, bleomycin, dacarbazine, cis-platinum and vincristine and their mixtures have been constructed from standard curves relating the intensity of the beta-galactosidase response to the concentration of drugs dissolved in normal urine. Comparative data on extraction and concentration of the drugs from urine or serum by means of selective resin or silica columns are presented.

Perioperative changes in blood pressure and heart rate.

In order to evaluate the possible physiologic significance of intra- and postoperative hypotension, we monitored arterial blood pressure and heart rate continuously for 36 hr starting the night before and ending the morning after operation in 34 gynecologic patients. The lowest pressures that occurred during physiologic sleep were compared with the lowest arterial pressures that occurred during anesthesia without deliberate hypotension. Two values were calculated: a preoperative baseline pressure, i.e., the average value recorded during the second hour of monitoring on the night before surgery, and a preanesthetic standard pressure, i.e., the average value of 15 consecutive measurements made at 1-min intervals in the operating room before the induction of anesthesia. The results indicate that a systolic pressure 10% below the PAS during anesthesia does not constitute physiologically significant hypotension because this range resembles the range that occurs spontaneously during unmedicated sleep or sleep aided with a mild hypnotic. These physiologic nadirs in blood pressure are assumed to be tolerated well by the patient. Intraoperative pressures in elderly patients frequently drifted below sleep-associated levels of blood pressure and may, therefore, constitute physiologically significant hypotension.

Prevalence of diabetes among ethnic groups in Jerusalem. The Kiryat Hayovel Community Health Study.

The prevalence of diabetes was determined in a community health survey in the Kiryat Hayovel neighborhood of west Jerusalem. The prevalence rates of diabetes among 4,938 people aged greater than or equal to 15 years were 5.8% in men and 4.6% in women, with a male/female age-adjusted ratio of 1.15. One-third of the diabetics were first diagnosed in this study. In both sexes, the rates increased steeply with age. A higher prevalence rate of diabetes was found in Jews of North African origin, especially in men, than in the other ethnic origin groups. These ethnic differences in men do not appear to be explained by differences in body mass.

Evaluation of a community program for the control of cardiovascular risk factors: the CHAD program in Jerusalem.

A community-focused program for the control of cardiovascular risk factors, the CHAD program, was instituted in a family practice in western Jerusalem in 1971. Its effectiveness was evaluated by comparing the changes detected by surveys conducted in 1970 and 1975 with those observed in an adjacent control neighborhood. Hypertension decreased in prevalence by 33%, hypercholesterolemia by 31%, cigarette smoking by 23% (among men), and overweight by 13%. Allowing for the reductions observed in the control population, the net percent reductions in prevalence were 20% for hypertension, 15% for hypercholesterolemia, 11% for cigarette smoking (men) and 13% for overweight. The net reductions in hypertension, smoking and overweight were statistically significant. The net reductions in mean systolic and diastolic pressures and weight were also significant. The results suggest that intervention centered in primary health care can have an appreciable effect on cardiovascular risk factors in the population.