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Biomedical subjects

E Kahan

Publications and source records attributed to E Kahan.

At least 37 records · Page 2Linked to original sources
PubMed2000

Behavior of patients with flu-like symptoms: consultation with physician versus self-treatment.

BACKGROUND: The reasons that patients consult the clinic physician for common minor symptoms are not clearly defined. For seasonal epidemic events such as flu-like symptoms this characterization is relevant. OBJECTIVES: To identify the factors that prompt patients to seek medical attention, and correlate patient behavior with different demographic and disease variables. METHODS: A random sample of 2,000 enrolled people aged 18-65 years and registered with eight primary care clinics located throughout Israel were asked to report whether they had had flu-like symptoms within the previous 3 months. Those who responded affirmatively (n = 346) were requested to complete an ad hoc questionnaire evaluating their treatment-seeking behavior. RESULTS: A total of 318 patients completed the questionnaire (92% response rate), of whom 271 (85%) consulted a physician and 47 (15%) did not. Those who sought medical assistance had more serious symptoms as perceived by them (cough, headache and arthralgia) (P < 0.05), and their main reason for visiting the doctor was "to rule out serious disease." Self-employed patients were more likely than salaried workers to visit the clinic to rule out serious disease (rather than to obtain a prescription or sick note or to reassure family). They also delayed longer before seeking treatment (P = 0.01). CONCLUSION: In our study the majority of individuals with flu symptoms tended to consult a physician, though there were significant variations in the reasons for doing so, based on a combination of sociodemographic variables. We believe these findings will help primary care physicians to characterize their practices and to program the expected demand of flu-like symptoms.

Adolescent↗
PubMed2000

Primary care physicians' attitudes to battered women and feelings of self-competence regarding their care.

BACKGROUND: Previous descriptive studies have demonstrated the problematic nature of physicians' attitudes toward battered women. However, little empirical research has been done in the field, especially among the various medical specialties. OBJECTIVES: To compare the approach and feelings of competence regarding the care of battered women between primary care and non-primary care physicians. The non-primary care physicians who are likely to encounter battered women in the ambulatory setting are gynecologists and orthopedists. METHODS: A self-report questionnaire formulated for this study was mailed to a random sample of 400 physicians working in ambulatory clinics of the two main health maintenance organizations in Israel (300 primary care physicians, 50 gynecologists and 50 orthopedists). RESULTS: In both physician groups, treating battered women tended to evoke more negative emotional states than treating patients with infectious disease. The most prevalent mood state related to the management of battered women was anger at her situation. Primary care physicians experienced more states of tension and confusion than non-primary care physicians and had lower perceived self-efficacy and self-competence in dealing with battered women. CONCLUSIONS: Though both physician groups exhibited negative feelings when confronting battered women, the stronger emotion of the primary care physicians may indicate greater sensitivity and personal awareness. We believe that more in-service training should be introduced to help physicians at the undergraduate and postgraduate levels to cope both emotionally and professionally with these patients.

Adult↗
PubMed1999

[Pediatric research in an office-setting network--a new dimension in pediatric research in Israel].

Pediatric care in the community is gradually replacing traditional care in hospitals. Despite that, research activity in the community setting is minimal due to objective difficulties. These are mainly constraints of time, office work and lack of research-supporting logistics. In the past decade, throughout the world, primary physicians interested in research have grouped together and formed research networks. The aim of such networks is to support and promote research in the community. An Israel Pediatric Research in Office-Setting network (IPROS) was established 2 years ago by the Israel Ambulatory Pediatric Association (IAPA). Today, there are over 140 pediatricians listed in IPROS, representing the heterogeneous composition of pediatricians in Israel. The network's policy is defined by a joint steering committee. The committee is composed of IAPA representatives, senior network members and Schneider Hospital senior investigators. The research subjects are diverse, and represent common practical issues. Effective intra-net communication is vital to the existence of the network, and is accomplished by 3 modalities: 1) semiannual updates by mail, 2) e-mail, using an electronic mailing list to facilitate connection between members, 3) semi-annual meetings. Research budgets are derived from public sources like the Ministry of Health and IAPA, and private sources such as pharmaceutical companies. The administration of the network is supported by Schneider Children's Medical Center, and financed by IAPA.

Ambulatory Care↗
PubMed1999

Workers' right-to-know legislation: does it work?

Workers' right-to-know (WRTK) laws and regulations were established to empower workers to protect their health by providing them with information about the hazards to which they are exposed while at work. The present study was conducted to examine the implementation of WRTK regulations in Israel. We interviewed 552 workers and 33 safety officers from a random sample employed at 50 industrial plants. The workers' questionnaire included items on awareness and self-management of workplace hazards, and the safety officers answered questions about job experience and hazards communications to workers. In 36% of cases workers and their safety officers disagreed about the existence of hazards in the workplace (p < 0.001). Most (78%) of the workers' knowledge about work hazards was based on informal sources, i.e., not those stipulated by the regulations. There were also discrepancies between worker and safety officer reports regarding the provision of safety training upon employment (p < 0.001), recent instructions about special risks and distribution of relevant printed material. We found that more than 5% of workers were unable to read the language in which the hazards material was written and 22% had levels of education below that required to comprehend the technical terms used. There are serious problems in the implementation of WRTK regulations in Israel. We recommend that employers be made aware of the importance of these laws and of their proactive duty to comply with them and that the material distributed to workers be written in simpler terms and/or explained orally in a language they understand. These findings have important implications for all countries with similar legislation and should form the basis for further and more comprehensive studies world-wide.

Adolescent↗
PubMed1999

Medical investigations requested by patients: how do primary care physicians react?

BACKGROUND AND OBJECTIVES: We investigated the characteristics of patients who request medical investigations and the type of tests requested to study the manner in which primary care physicians react to these requests. METHODS: The study was conducted within the framework of a national health insurance system. Twelve primary care practices from three randomly chosen clinics with different population characteristics participated in the study. The attending physicians were instructed to ask all patients who presented to the clinics within a 7-month period and requested a medical test to complete a questionnaire, indicating the type of test(s) requested and the reason. The physicians were asked to rate the manner in which the patient made the request, their own reaction to the request, and whether they ordered the tests that were requested. RESULTS: During the survey period, 12,322 patients visited the clinics, of whom 295 (2.4%) were reported by a physician to have requested a medical investigation. More-educated patients were more likely to request tests for disease prevention. The types of tests requested were imaging scans, laboratory (blood) tests, and others. The main reason for the request was symptoms (60%), followed by disease prevention (25%). More than 30% of the requests generated self-reported negative feelings in the physician. Physician compliance with patient requests was not significantly correlated with the reason for the request. Laboratory tests were ordered significantly more often than other types. There was a strong correlation between physicians' compliance with the request and physicians' feelings about the request. CONCLUSION: Our findings raise questions about the frequency with which physicians order tests solely in response to patients' requests and provide information about circumstances in which patients make requests for medical investigations.

Adult↗
PubMed1998

[Diagnosing community health by factorial analysis].

OBJECTIVE: To identify the needs of medical care and to determine priorities in the delivery of health services by the factorial analysis of the health indicators obtained from study of the demographic, economic and family features of those registered at a Primary Care Centre. DESIGN: Descriptive and crossover. SETTING: Tlalpan area, Federal District, Mexico, divided into geo-statistical zones. Patients and other participants. A randomised sample of 590 dwellings, with proportional coverage, based on 173,000 inhabitants and 17,895 ordinary dwellings. INTERVENTION: Survey conducted in the home (April-July, 1993). MEASUREMENTS AND MAIN RESULTS: 16 health markers were classified into four categories, demographic, social, health-damaging and family. Nine markers with a reading on the Pearson's correlation index over 0.40 were chosen. Factorial analysis determined two main factors. CONCLUSIONS: The identification of the main risk factors by means of factorial analysis helped in diagnosing community health. A project needs to be worked out to define a methodology for studying medically dysfunctional families and to introduce a prevention and early diagnosis programme for Diabetes Mellitus.

Cross-Over Studies↗
PubMed1998

A controlled trial of desmopressin and behavioral therapy for nocturnal enuresis.

The combination of desmopressin (DDAVP) and behavioral therapy for treatment of nocturnal enuresis was compared with use of each of these modes alone. We randomly assigned 226 enuretic children being treated in primary care clinics of a major medical center in the largest health maintenance organization in Israel into 3 groups: Group A) DDAVP plus behavioral therapy (double-blind); Group B) behavioral therapy plus placebo (double-blind); and Group C) DDAVP alone (open group). DDAVP (20 micrograms/naris) and placebo were administered by intranasal spray. Both pharmacologic and behavioral therapy were initiated after a 2-week observation period and continued for 8 weeks. All patients were followed for 2 months after completion of treatment. A significant reduction in the number of wet nights/week was registered for all 3 groups: 49% in Group A, 45% in Group B, and 19% in Group C. After controlling for confounding factors, no significant difference in effect was noted among the 3 types of treatment during the trial period. However, on follow-up the results for the DDAVP patients were significantly less stable compared with the other 2 groups (p = 0.015). Minor side effects were registered, but none of the participants withdrew from the trial. To our knowledge, this is the largest randomized trial of nocturnal enuresis conducted to date. Our findings suggest that simply discussing the problem with the patient and family leads to improvement, and that behavioral therapy is also beneficial. DDAVP can help, but the relapse rate on discontinuation is high.

Adolescent↗
PubMed1997

The variability of exposure over time: a prospective longitudinal study.

Four hundred and forty personal air measurements were carried out on 54 workers, employed in the main processes in six different factories (6-13 in each). Potential exposure was to lead, benzene and dust. Ten randomly repeated hygiene surveys were carried out over 1 year. In order to estimate the magnitude of the variability in workers' exposure over time, its sources, the variance between workers and the variance within a worker, a nested unbalanced analysis-of-variance model was fitted to the log-transformed data. Of the total exposure variance, the within variance of a worker's exposure over time was 51% (geometrical standard deviation, GSD = 3.1) and the between workers, factories and air contaminants variance was 49%. The exposure variance between all the workers was due mainly to variance between workers within the same factory (67%). Outdoor locations, mobility of the worker and mobility of the sources of exposure result in a positive influence on both the variance between (26%, ANOVA) and the variance of a worker over time (39%, regression). These variables are therefore important in the sampling strategy of workers' exposure. For valid compliance testing and assessment of workers' exposure the mean and the within- and between-variance of the workers' exposure over time should be considered. The exposure should be measured several times a year randomly in order to prevent workers misclassification. To assess yearly exposure, a GSD = 3.1 can be used to calculate confidence limits for the arithmetic mean of worker's exposure measurements, in circumstances similar to those in this study.

Air Pollution↗
PubMed1997

Association between pancreatic cystadenocarcinoma, malignant liver cysts, and polycystic disease of the kidney.

Polycystic kidney disease is an autosomal dominant disease that may be associated with cystic disease of the liver. In women, the cysts may develop early and be more troublesome than in men. Cystadenocarcinoma of the pancreas is uncommon, comprising 1% of primary pancreatic malignancies. This case report is the first to describe a familial association between polycystic kidney disease and cystadenocarcinoma of the pancreas and liver in the English medical literature. A patient with autosomal dominant polycystic kidney disease (ADPKD) and multiple hepatic cysts developed cystadenocarcinoma of the pancreas with multiple malignant liver cysts. The patient's mother, sister, and niece had ADPKD, and the patient's sister also died of pancreatic cystadenocarcinoma. We believe that the development of these two disease entities in which the primary pathology is cyst formation has a genetic association.

Aged↗
PubMed1997

The impact of Hymenoptera venom allergy on occupational activities.

The objective of this study was to investigate the impact of allergy to hymenoptera venom on the occupational activities of patients undergoing immunologic treatment for insect sting anaphylaxis. The design was a cross-sectional study conducted in a sample of 500 out of 1,500 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. A self-administered questionnaire was used to collect data about demographic characteristics of patients, severity of the allergic reaction and adverse effects on occupational activities. Of the 204 respondents who were part of the labour force, 48.5% reported adverse effects on routine occupational activities. The factors with a significant influence on the probability of adverse occupational effects were: (1) patient's type of work (blue collar vs. white collar: OR = 3.22, p < 0.001: army vs. white collar: OR = 5.28, p = 0.001); (2) severity of the allergic reaction (severe reaction vs. mild/moderate reaction: OR = 2.34, p = 0.007). Our findings suggest that severe insect sting allergy has an adverse impact on patients' occupational activities. This factor requires special attention by the medical community. Social workers and occupational physicians should collaborate in the assessment and management of these patients.

Adolescent↗
PubMed1997

Factors associated with family physicians' involvement in research in Israel.

OBJECTIVES: To identify the factors that encourage or deter family medicine physicians and residents in Israel from participating in research. METHOD: In October 1995, a questionnaire containing items on demographic variables, research attitudes, and academic and research activities in primary care settings was mailed to a random sample of 200 family medicine physicians and residents (out of approximately 600) employed by the General Sick Fund, the largest health maintenance organization in Israel. The questionnaire also contained items regarding difficulties in participating in research and asked for opinions about several general statements about research in family practice. RESULTS: In all, 190 physicians responded, for a response rate of 95%. Based on their responses, the respondents were divided into four groups by amount of research involvement. Univariate analysis using the chi-square test was used for the comparison of variables among the four groups. The respondents reporting greater knowledge of and involvement in research were, by and large, men (p = .01) who were qualified specialists with academic status (p < .00001). They also taught students (p = .0005) and residents (p < .0005), participated in more conferences (p < .0005), and while in residency training had had a mentor who encouraged involvement in research (p = .0001). CONCLUSION: Research is essential to family medicine with regard to both primary care practice and academic activities, its development, however, has been inhibited. Given the results of this preliminary study, family medicine residency programs would be well advised to assign a research mentor to every resident; also, time and resources should be devoted to research in postgraduate training programs. Perhaps more important, women physicians in Israel should be encouraged to participate more actively in research, and support for them in their special needs should be made available.

Adult↗
PubMed1997

Cancer patterns in the Middle East--special report from the Middle East Cancer Society.

To update its cancer statistics, the newly established Middle East Cancer Society examined the cancer frequency patterns in Egypt and the Gaza Strip. The results revealed differing overall patterns. For men the highest frequencies were found for lymphoma, bladder cancer and cancers of the oral cavity and pharynx in Egypt, and for lung cancer, leukaemia and lymphoma in Gaza. For women, breast cancer had the highest frequency in both areas, followed by cancers of the oral cavity and pharynx in Egypt, and leukaemia and lymphoma in Gaza. The distribution of cancer occurrence by organ system also varied. In the light of the different ethnicities, lifestyles, socioeconomic levels and carcinogenic exposure among the countries of the Middle East, this kind of comparison can provide the background for more sophisticated approaches for discerning risk factors in cancer. We believe that further cooperation among participating countries will overcome the present limitations in data collection, registration and access.

Adult↗
PubMed1996

Monitoring blood lead levels in workers overexposed to occupational lead: an analysis of Israeli data.

In a retrospective cohort study, we followed the blood lead [Pb(B)] and zinc protoporphyrin (ZPP) determinations of 292 workers found to have Pb(B) levels above the biological exposure index (BEI) during 1987-1993. The results indicated that (a) 22.6% of these workers were never retested for Pb(B) during the follow-up period; (b) 38.5% of the workers tested in the first year of the follow-up continued to exhibit Pb(B) levels above the BEI (84.7% of them also had ZPP > or = 100 micrograms/dl); (c) about 25% of the remaining cohort had at least one more result above the BEI during the fourth, fifth, and sixth years of follow-up; and (d) the incidence density rate of recurrence of Pb(B) concentrations above the BEI was 0.236. We recommend the establishment of a target value lower than the BEI that should be reached before the reinstatement of the overexposed worker. In our view this target value, combined with an efficient control of industrial hygiene conditions, will decrease the rate of recurrence of overexposure.

Cohort Studies↗
PubMed1996

Constipation: a different entity for patients and doctors.

BACKGROUND: Medical definitions of constipation vary. Some are specific, based on the interval between defecations, with three days or twice weekly as the upper limit of normality. Others are vague. OBJECTIVE: This study investigates patients definitions, attitudes and management of 'constipation' and compares their definitions with physicians' criteria. METHODS: Survey of 1) 531 randomized patients of family clinics of the sick Fund of the General Federation of Labor of Israel, and 2) 100 randomized specialists and residents in family medicine. RESULTS: The present survey showed that constipation is more common in women and in the older (> 40 years) age group. The most important finding of this investigation was the wide discrepancy in the criteria used by doctors and patients to diagnose constipation. Fifty per cent of the patients defined constipation differently from accepted medical definitions--27% of the patients defined it as defecation every 2 days or less and 25% as hard stool alone. All 57 doctors who were asked the same question defined constipation as defecation every 3 or 4 days or less, sometimes in combination with hard stool. CONCLUSIONS: This study suggests that patients and doctors refer to different entities when they talk of 'constipation'. It is the doctor's responsibility to ensure that this misunderstanding is avoided so that unnecessary tests and treatment are not undertaken and, patient-doctor acrimony is avoided.

Adult↗
PubMed1996

Attitudes of primary care physicians to the management of asthma and their perception of its relationship to patients' work.

The results of a questionnaire on the attitude of family physicians and general practitioners to the management of asthma, and their perception of the relationship between working conditions and asthma are reported. Family physicians were three times more likely than general practitioners to treat asthmatic patients themselves, without referral to a specialist. However, there were no other major differences between these two groups regarding the weight they attributed to the occupational factor in asthma. Overall, both groups routinely asked patients about their job (78%) and exposure at work (75%), but at least in half the cases this issue was not followed-up to determine if occupation-related counselling or problem management were necessary. Differences in the primary care of asthmatics were also noted between physicians in Israel and America. In Israel, physicians tended to explain everything to the patients at the initial visit, and then leave them to cope on their own unless the episodes remained uncontrolled, whereas their American counterparts continued their educational activities in subsequent visits as well. We conclude that family medicine residency training in Israel, despite the inclusion of courses and lectures on occupational health in general and on respiratory diseases in particular, does not sufficiently emphasize this subject. Clinicians should be trained to take a more in-depth and active approach to this problem in order to avoid misdiagnosis and improve prevention.

Adult↗
PubMed1996

Risk factors associated with the severity of systemic insect sting reactions.

To evaluate risk factors associated with the severity of systemic insect sting reaction and to determine the type of insect responsible for systemic anaphylaxis, we conducted a cross-sectional study of 498 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. Data were collected by questionnaire and review of patient records. Eighty percent of the patients were treated with honeybee venom, which was used as a single therapy in 60% of the group. In a multivariate logistic model the major factors identified as significantly influencing the probability of a more severe systemic reaction were short time of onset of reaction after stinging (<30 min), high number of prior stings (> or = 4), and age (> or = 18 years). A total of 79.3% of the patients had been stung outdoors, and 50% had lived all their lives in rural areas as compared to 10% in the general Israeli population. This study reports clinically valuable risk factors for the severity of systemic sting reaction. A practical finding was that the honeybee is the insect mostly responsible for sting reactions in Israel, but the type of insect is not a significant predictor of the severity of the reaction.

Adolescent↗