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Biomedical subjects

A Bleich

Publications and source records attributed to A Bleich.

At least 19 recordsLinked to original sources
PubMed2005

Environment as a critical factor for the pathogenesis and outcome of gastrointestinal disease: experimental and human inflammatory bowel disease and helicobacter-induced gastritis.

Environmental factors play an important role in the manifestation, course, and prognosis of diseases of the gastrointestinal tract such as inflammatory bowel disease (IBD) and Helicobacter pylori-induced gastritis. These two disease complexes were chosen for a discussion of the contribution of environmental factors to the disease outcome in humans and animal models. Dissecting complex diseases like IBD and Helicobacter-induced gastritis has shown that the outcome of disease depends on the allelic constellation of a host and the microbial and physical environments. Host alleles predisposing to a disease in one genomic and/or environmental milieu may not be deleterious in other constellations; on the other hand, microbes can have different effects in different hosts and under different environmental conditions. The impact of the complex interaction between host genetics and environmental factors, particularly microflora, also underlines the importance of a defined genetic background and defined environments in animal studies and is indicative of the difficulties in analyzing complex diseases in humans.

Animals↗
PubMed2005

Multiple in vivo passages enhance the ability of a clinical Helicobacter pylori isolate to colonize the stomach of Mongolian gerbils and to induce gastritis.

The Mongolian gerbil is an excellent animal model for Helicobacter pylori-induced gastritis in humans. In this study, initially low colonization rates of the H. pylori strains ATCC 43504, SS1, or HP87 inoculated into gerbils caused difficulties in establishing this model. In order to increase the colonization ability and pathogenicity, the clinical HP87 isolate was selected for adaptation to the gerbil stomach by multiple in vivo passages through gerbils. Development of gastritis was examined histologically at 4-52 weeks after infection. The proportion of gerbils which tested positive for H. pylori by culture at four weeks after inoculation gradually increased from 11.1% of gerbils inoculated with HP87 without prior in vivo passage (P0) to 100% of gerbils inoculated with HP87 with seven in vivo passages (P7). In addition, adaptation of HP87 resulted in more severe histopathological changes. Gerbils infected with adapted HP87 (P7) exhibited severe infiltration by monomorphonuclear and polymorphonuclear leukocytes in the mucosa, submucosa, and subserosa of the gastric antrum, as well as epithelial changes consisting of hyperplasia, erosion, and ulceration. Histopathological changes increased in severity from four to 52 weeks after infection. Adaptation of HP87 during its passages through gerbils could be due to genetic changes in bacterial colonization factors. Identification of these changes might be useful to understand the underlying mechanism of gastric adaptation and pathogenesis of H. pylori.

Animals↗
PubMed2004

[What is the role of compulsory ECT therapy today?].

Electro-convulsive therapy (ECT) has been effective for years, but it arouses opposition among patients and especially in the general public. ECT treatment is limited and compared to other medical treatment it is considered exceptional by the law, regulations and treatment personnel. A question arises as to the position of therapists regarding compulsory ECT treatment. A questionnaire was sent on this subject to all the units utilizing ECT in Israel. Opinions ranged from complete negation of compulsory ECT, to regarding such treatment as possible in cases when the patient is compulsorily hospitalized and/or when the patient's guardian supports this treatment. The authors' opinion is that the Law of Patients' Rights regarding special treatment when the patient is in extreme danger must be followed. The law requires that three physicians agree to the treatment, and compulsory treatment is no longer applicable when the danger passes. ECT treatment is important and imperative in certain conditions, especially conditions endangering patients' lives. In these conditions the law provides the authority to physicians to make decisions regarding treatment.

Attitude to Health↗
PubMed2002

[A treatment unit within a medical center for adult survivors of childhood sexual abuse: an interdisciplinary approach].

Childhood sexual abuse is A highly prevalent phenomenon that has disastrous lifelong effects on emotional and physical development, interfering with almost every aspect of a persons existence. Research and clinical observations of psychological trauma have led to a clinical recognition of the complexity of survivors clinical presentation and needs, helping therapists to develop special treatment models for them. In this article we present a treatment model for survivors of childhood sexual abuse that was designed and implemented over the past three years in a specialized unit of psychiatric services at the Tel-Aviv Medical Center. Three case studies are used to illustrate the treatment process and the guiding theoretical model. The existence of such a treatment unit within a general medical center makes it possible to provide a diverse population of survivors with integrated psychological and physical care geared to their various needs. The former focuses on mental stabilization, strengthening of the ego, and improved adjustment to the trauma and its effects. Interdisciplinary guidance by the therapist ensures appropriate medical attention to the wide range of problems typical of survivors, such as gynecological and gastroenterological problems, eating disorders, and sexual differences.

Adolescent↗
PubMed2001

A naturalistic study on ending blind dosing in a methadone maintenance clinic in Israel.

Since many methadone maintenance treatment (MMT) clinics in the United States do not share with patients, information concerning their methadone dosage, we aimed to investigate the impact of patients being informed of their methadone dosage and the influence of ending blind dosing on treatment outcome. Seventy-four patients who were unaware of their methadone dosage took part in this study. We compared changes in opiate abuse, levels of methadone dosage and patients' perceptions of dosage adequacy before and after they were informed of their dosage. Data on opiate abuse were based upon bi-weekly randomly taken and observed urine tests provided the data on opiate abuse. Records on methadone dosage were kept and a short questionnaire on dosage-related attitudes, devised for this study, was administered. Most patients expressed the desire to know their dosage, but there were no significant changes in opiate abuse, methadone dosage or the patients' perceptions of dosage adequacy after they knew what it was. We conclude that informing patients of their methadone dosage and thereby ending blind dosing does not seem to have any negative effect on treatment outcomes. We believe that this policy is in accord with the patients' rights and expressed will to know their dosage and this justifies putting an end to blind dosing policies.

Chi-Square Distribution↗
PubMed2000

[Military psychiatry in Israel: a 50-year perspective].

The history of military psychiatry in Israel may be divided into 2 main periods. The first extended from the War of Independence in 1948, through the Sinai, Six Day and Yom Kippur Wars. Its outstanding feature was avoidance of the issue of combat stress reaction (CSR). The Yom Kippur War made the recognition of CSR inescapable, assisted in breaking up denial, and served as a stimulus for development of the next phase of the system. This second phase was characterized by impressive progress in all areas of military psychiatry. The rich experience accumulated during the wars, together with the assimilation of a research culture which began blooming, especially in the wake of the Lebanon War, aided the development and crystallization of concepts related to combat and non-combat military psychiatry alike. The build-up of the mental health organization overlapped field deployment of the Medical Corps.

History, 20th Century↗
PubMed2000

Clock drawing test: correlation with linear measurements of CT studies in demented patients.

OBJECTIVES: To investigate a presumed correlation between clock drawing ratings and linear measurements of computerized tomography (CT) studies in demented patients. DESIGN: Blinded evaluations of clock drawing tests and CT studies of elderly dementia patients were conducted by a geriatric psychiatrist and a neuroradiologist. SUBJECTS: Fifty-one community-dwelling elderly subjects meeting the criteria for DSM-IV diagnosis of dementia (Alzheimer's type dementia: N=31; vascular dementia: N=15; "mixed" type dementia: N=5). MATERIALS: Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clinical Dementia Rating (CDR). CAMCOG derived scored clock drawings were evaluated using adaptations of Shulman et al.'s and Freedman et al.'s methods. CT studies were evaluated using six different linear measurements of brain atrophy described in the literature. RESULTS: Of the CT linear measurements, only the Cerebro-Ventricular Index-2 (CVI-2; bicaudate index) significantly correlated with clock drawing ratings (CAMCOG's clock r=-0.407, p=0.003; Shulman's method r=0.357, p=0.01, Freedman's method r=-0.413, p=0.003) in the dementia group. There was no significant correlation between CVI-2 with demographic (age), cognitive (MMSE, CAMCOG) and clinical (duration of illness, CDR) ratings. Alzheimer's patients generally maintained a significant correlation between CVI-2 and clock drawings, but vascular dementia patients did not; CVI-2 also correlated significantly with the Praxis subtest of the CAMCOG in dementia and Alzheimer's patients but not in the vascular dementia group. Similarly, multiple stepwise regression analysis showed that only CVI-2 but not the other radiological measures studied, was selected as the significant variable to correlated with clock drawing test ratings in the dementia group and Alzheimer's patients. Partial correlation analysis controlling for demographic and clinical variables shows that controlled variables had no significant effect on the relationship between clock drawing ratings and CVI-2. CONCLUSION: A single and easy to perform measure of caudate atrophy correlates specifically and consistently with impairments revealed in the clock drawing test and with a Praxis subtest, suggesting possible caudate involvement with clock drawings in dementia in general and of the Alzheimer's type in particular.

Aged↗
PubMed2000

A comparison between demographic and clinical characteristics of younger and older elderly new referrals to an out-patient psychogeriatric service.

We compared the demographic and clinical characteristics of 37 subjects under and 41 subjects over 75 years of age who were consecutive new referrals to an out-patient psychogeriatric service in order to examine if an age-related dichotomy emerges in this population. Even though the groups were similar in most demographic (gender, education, years in Israel, family status) and some clinical aspects (number of physical diagnoses, medications taken) they differed significantly in some other clinical variables. "Functional" disorders, independence in performing household activities and Activities of Daily Living (ADL) and more recommendations for ambulatory follow-up were more prominent in the younger group. This profile has much in common with elderly patients newly referred to the general mental health services. The older group had more "organic" disorders, significant need for assistance in household activities and ADL, and more recommendations for follow-up in day-care centers, a profile more characteristic of patients who are treated in memory/dementia clinics. Thus, from a services organizational point of view, it is possible to subdivide out-patient elderly individuals with cognitive and emotional disturbances into separate groups, each with its own characteristics and needs.

Age Factors↗
PubMed2000

Post traumatic stress disorder with psychotic features.

AIM: To study the combined course and interaction of post-traumatic stress disorder (PTSD) and psychosis through detailed case studies. METHODS: We described 6 case studies of Israeli veterans with PTSD and psychosis, who were referred to our Center for the evaluation of their psychiatric status. RESULTS: All the patients developed PTSD shortly after the exposure to a combat/military trauma. Psychosis appeared after months or even years, sometimes after a trauma-related trigger. Psychotic symptoms, such as delusions or auditory hallucinations, were usually paranoid or depressive and related in content to the traumatic experience. CONCLUSION: The combined course of PTSD and psychotic disorder may reflect two distinct disorders, but in some cases it seems justified to make a diagnosis of PTSD with psychotic features. In addition, it seems that in certain conditions, traumatic exposure and/or PTSD may serve as a trigger for psychosis.

Adult↗
PubMed1999

Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic.

We aimed to study the prevalence patterns and course of benzodiazepine (BZD) abuse in an Israeli methadone maintenance (MMT) clinic using repeated random observed urine analysis as well as self-report data. Lifetime and current prevalence of BZD abuse were found in 66.3 and 50.8% patients, respectively. It was found that 44.6% of patients who abused BZDs during their first month of treatment ceased to do so after 1 year, while 27.4% who had not abused BZDs at the beginning of MMT did so after 1 year in treatment. Flunitrazepam was the most commonly abused BZD (92.9%), followed by diazepam (54.3%) and oxazepam (38.6%). Most of the patients swallowed BZDs (92.8%), 42.9% also smoked or snorted them while 8.6% injected BZDs intravenously. BZDs were used as self-medication for alleviating emotional problems rather than for recreational or other reasons. We conclude that BZD abuse is a significant clinical problem in heroin addicts both before entering and during MMT. MMT may have a positive as well as a negative influence on BZD abuse with the former being more prevalent.

Adult↗
PubMed1999

'Yes' ifs, ands or buts: examining performance and correlates of the repetition task in the mini-mental state examination.

The aim of this study was to examine whether the type of sentence used in the repetition task included in the Mini-Mental State Examination (MMSE) affected performance in a group of 79 demented and 19 non-demented Hebrew-speaking elderly persons. The cognitive functioning of the participants was assessed using the MMSE and CAMCOG examinations. The performance of the repetition task was evaluated by using three sentences: the literal translation of the English language expression used in the original MMSE; a well-known Hebrew proverb consisting of monosyllabic words and rhythmic effects; and another well-known Hebrew proverb without such attributes. Only a third of the participants successfully repeated the literally translated expression. It showed low predictive value and was highly affected by education. The well-known Hebrew monosyllabic proverb showed moderate predictive value but no discriminatory ability. The other well-known Hebrew proverb performed the best. The translation of the repetition task in the MMSE to other languages is problematic. Strict adherence to the original language proved to be the least desirable choice.

Aged↗
PubMed1999

Examining the reliability and validity of the Hebrew version of the Mini Mental State Examination.

The Mini Mental State Examination is used worldwide for the screening and diagnosis of dementia. The aim of the present study was to examine the reliability and validity of the Hebrew version of the Mini Mental State Examination. The Hebrew version of the Mini Mental State Examination was administered to 36 demented and 19 non-demented elderly persons. Test-retest reliability scores were calculated as exact agreement rates, and ranged from good to excellent for all the items. Strong convergent validity, as measured by the correlation between the MMSE and the CAM-COG (r = 0.94), was found. Good predictive value was observed as over three-quarters of the participants were correctly classified as demented or non-demented. The Hebrew version of the MMSE was found to be a useful and valid instrument for the determination of dementia in the elderly population.

Aged↗
PubMed1999

Correlates of benzodiazepine abuse in methadone maintenance treatment. A 1 year prospective study in an Israeli clinic.

AIMS: This study addressed the following questions for patients after 1 year of methadone maintenance treatment (MMT); (1) What are the demographic features and past history of drug use of benzodiazepine (BZD) abusers? (2) Do BZD abusers abuse more heroin, cocaine and/or cannabis and do they receive a higher methadone dosage level? (3) Do BZD abusers suffer more from hepatitis C (HCV) and do they have more HIV/HCV risk-taking behaviors than non-abusers? (4) Do BZD abusers have more psychopathology and more emotional distress than non-abusers? DESIGN: All 148 patients who completed 1 year of MMT underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; POMS; HIV/HCV risk-taking behaviors), interviews (ASI) and underwent testing for hepatitis C. Abuse in this study is defined as any use during the 12th month of treatment. FINDINGS: After 1 year of MMT, more BZD abusers (n = 63) were single, had spent time in prison, were unemployed and had at least one parent with an addiction problem or mental illness in comparison to non-abusers (n = 85). They had started using heroin and cocaine earlier and currently abused more cocaine, heroin and cannabis. They had significantly more psychopathology and negative mood. They had significantly more HCV and reported more HIV/HCV risk-taking behavior. IMPLICATIONS: We suggest that this group of patients is in need of more intensive pharmacological and psychological treatment.

Adult↗
PubMed1999

Agreement between spouses and children in descriptions of personality change in Alzheimer's disease.

The purpose of the present study was to evaluate the agreement among spouses and children in their describing the current and past personality of patients with Alzheimer's disease (AD) and to determine the relations between their descriptions and selected demographic and clinical variables. The subjects were 22 dementia out-patients who fulfilled the DSM-III-R criteria for uncomplicated dementia of the Alzheimer's type and the NINCDS-ADRDA criteria for AD. Spouses and children of these patients were separately administered Brooks and McKinlay's personality inventory consisting of 18 pairs of adjectives that characterize the extremes of a behavioral dimension, and were asked to judge where the subject's demeanor fell on a five-point scale, varying from +2 to -2, in which zero was regarded as neutral. Spouses and children reported marked changes in most measured behavioral dimensions following the onset of AD. Spouses identified significant changes on 14/18 items and children on 13/18 items. Spouses and children agreed on practically all items concerning personality attributes before the onset of illness, and on 16/18 items after it. Changes in personality were not correlated with the studied demographic characteristics of patients, spouses and children, nor with the cognitive deficits and illness duration of the patients.

Aged↗