Search PubMed⌕ Search

Biomedical subjects

N Zilber

Publications and source records attributed to N Zilber.

At least 37 records · Page 2Linked to original sources
PubMed1993

Laterality of onset in idiopathic torsion dystonia.

Idiopathic torsion dystonia (ITD) is a dominantly inherited disorder with incomplete penetrance. It is important to identify factors that may cause dystonia or prevent its occurrence in a genetically predisposed individual. Because dystonia may be precipitated by peripheral triggers, we have investigated whether the preferential use of a limb affects the development of dystonia. Analysis of the correlation between the side of motor dominance and the limbs in which dystonic symptoms first appeared was performed in 49 patients with ITD ascertained in a country-wide survey in Israel. The dominant motor side was determined in 45 cases (92%). Among 29 patients with lateralized limb onset, 24 showed right-side motor dominance, of whom 21 had dystonia onset in a right limb. The first sign was in a left limb for all five cases with left-side motor dominance (90% coincidence). The pattern of limb involvement was studied. Detection bias could be ruled out. The highly significant relationship between the motor dominance and the laterality of limb onset in ITD patients suggests that the preferred use of a limb may trigger the onset of dystonia.

Dystonia Musculorum Deformans↗
PubMed1993

Utilization patterns of community mental health services by newly referred patients.

The present study compared the pattern of service utilization over a 1-year period, of 349 newly referred adult patients to the four community mental health clinics in Jerusalem. Treatment in these clinics is provided free of charge and there are no limits on length of treatment. Irrespective of patient diagnosis and clinic setting, the percentage of patients remaining in contact with the clinics declined sharply during the first 3 months, and after 6 months stabilized to around 25-40%. However, among patients with nonmajor psychiatric disorders, inter-clinic variation in compliance with treatment was observed. In clinics with a long-term psychotherapeutic orientation, a larger proportion of patients was referred to other services following intake, and a larger proportion of patients dropped out of treatment. In these clinics, more patients were placed on waiting lists before beginning treatment, and the drop-out rate among these patients was significantly higher than that of patients in treatment. The implications of these results for treatment policy in public services are discussed.

Adolescent↗
PubMed1992

An association between multiple sclerosis and type I diabetes mellitus.

We report five patients who had multiple sclerosis (MS) associated with type I diabetes mellitus (TODM). Examination of the Israeli National Neurological Disease Register revealed the prevalence of TODM among 334 MS patients under the age of 30 years to be 8.98 per 1,000. This is significantly higher than the prevalence of TODM in the general population of Israel for the same age group, which is 0.095 per 1,000. MS and TODM share clinical, epidemiological and immunological features, and both diseases have a target site that is neuroectodermal in origin. The association between these two putative autoimmune diseases may suggest a similar pathogenetic mechanism.

Adolescent↗
PubMed1991

Long-term utilization of community mental health outpatient services in Jerusalem.

A survey of the long-term users of community mental health clinics in Jerusalem was conducted in 1986. The study population included all patients in regular contact for at least one year (789 patients). Data on clinical diagnosis, type of treatment and selected sociodemographic variables were extracted from the patient's file at the clinic. Long-term utilization rates were calculated for the different catchment areas and for different sociodemographic and diagnostic groups. It was found that for patients suffering from major psychiatric disorders (2/3 of the long-term users), the long-term utilization rates were similar across catchment areas, and higher in those socioeconomic groups that are also reported to have high true prevalence rates. On the other hand, for patients suffering from non major psychiatric disorders, the long-term utilization rates varied between clinics, reflecting local treatment policies, specifically the extent to which the clinics use psychotherapy as a treatment modality.

Ambulatory Care Facilities↗
PubMed1991

The Libyan Creutzfeldt-Jakob disease focus in Israel: an epidemiologic evaluation.

In a country-wide study of Creutzfeldt-Jakob disease (CJD) in Israel, we diagnosed 114 cases, among them 49 Libyan-born, with onset of their disease during the years 1963-1987. After age adjustment, the mean annual incidence rate per million population was 43 among Libyan-born and 0.9 in the rest of the population. Among Jews born in Egypt and Tunisia, neighboring countries of Libya, the adjusted rates were higher than in the other Israelis (3.5 and 2.3 per million, respectively). Among Libyan Jews, there was no association between incidence rate of CJD and age at immigration, ie, duration of exposure to hypothetical infectious factor in Libya. The percent of familial cases among Libyan Jews (41 to 47%) is one of the highest ever published. Genetic factors seem to be important for the high incidence of CJD among Libyan Jews.

Adult↗
PubMed1991

Do Creutzfeldt-Jakob disease patients of Jewish Libyan origin have unique clinical features?

A focus of Creutzfeldt-Jakob disease is present in Israel among Jews born in Libya. The present study examines the clinical features in this particular group of patients. In a country-wide study of Creutzfeldt-Jakob disease, we identified 114 patients; 49 were Libyan immigrants, and 65 (three of whom had Libyan ancestors) were born in other countries. The clinical presentation and evolution of the disease is very similar in patients born in Libya and others without Libyan ancestors, but it tends to be more classical in the Libyan patients, with higher frequency of myoclonic jerks and periodic EEG and a progressive course of shorter duration. The Libyan patients tend to complain more often of headache, which is most probably an ethnic expression for depression and loss of concentration. There was no difference between the familial and nonfamilial cases.

Adult↗
PubMed1990

Patterns and correlates of psychiatric hospitalization in a nationwide sample. II. Correlates of length of hospitalization and length of stay out of hospital.

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984. A multivariate analysis was performed, where the dependent variables were: the cumulative length of all hospitalizations, the mean duration of hospitalization and the mean length of stay out of hospital. The independent variables were: age, sex, marital status, ethnic origin, diagnosis, and various indices of previous hospitalizations. For patients whose hospitalization in 1980 (index hospitalization) was the first in their life, older age and male gender predicted a low probability of readmission, and the diagnosis of schizophrenia a long cumulative stay. For patients whose index hospitalization was not the first in their life, the main variables predictive of long cumulative stay were: old age, being single, long duration and high frequency of previous hospitalizations. Patients tended to maintain the same relative length of inpatient stay and the same frequency of readmission from the beginning of their hospitalization history.

Adolescent↗
PubMed1989

Patterns and correlates of psychiatric hospitalization in a nationwide sample. I. Patterns of hospitalization with special reference to the "new chronic" patients.

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984 regarding their hospitalization patterns. Information about hospitalizations as well as demographic and diagnostic data were obtained from the Israel Central Psychiatric Case Register. Two main contrasting patterns of hospitalization emerged. One pattern consisted of a single short hospitalization during the entire follow-up period. This pattern was found among more than 50% of those patients for whom this hospitalization was the first in their life. The second pattern characterized the patients who accumulated long periods of inpatient stay, that is, at least one year during the follow-up period. These are the "new chronic" patients (about 30% of the total sample). About one third of these "new chronic" patients (8.2% of the total sample) accumulated their long stay through one continuous hospitalization, thus resembling the "old chronic" patients; two-thirds accumulated their long stay over several hospitalizations. Each patient has a fairly constant pattern of hospitalization, regarding the length of stay in hospital and out of hospital.

Chronic Disease↗
PubMed1989

Effects of a psychiatrists' strike on emergency psychiatric referral and admissions.

This is a report on the effects of a psychiatrists' strike in Israel on emergency psychiatric referrals and admissions from two catchment areas. One had comprehensive psychiatric services, the other did not. Three periods were compared - before, during and after the strike. During the strike period, overall referrals to the emergency room decreased by 3.9%. A significant 15.8% decrease in referrals was registered in the comprehensive psychiatric service area, and an 11.4% increase in referrals in the other catchment area. Although no increase was seen in total emergency admissions during the strike, involuntary admissions increased by 21.6%, within the catchment area which did not have a comprehensive service, whereas within the area with the comprehensive service there was a significant decrease of 33% in involuntary admissions. The impact of these services on emergency referrals and admissions, especially during the strike, is discussed.

Emergency Services, Psychiatric↗
PubMed1989

Mortality among psychiatric patients--the groups at risk.

This study examined standardized mortality ratios (SMR) among the patients who had undergone psychiatric hospitalization in Israel in 1978. The size of the sample (83,175 person-years) allowed us to calculate simultaneously SMR by age, sex, diagnosis and cause of death. The global SMR was 2.3 and decreased with age. Excess mortality was found in patients from all diagnostic groups for death from both natural and unnatural causes. Excess mortality from cancer was found only among patients aged under 40. The SMR for death by suicide was lower than that reported in the literature. The highest excess mortality was due to respiratory and infectious diseases in all groups and especially among young alcoholics and drug addicts (SMR = 273). This points to the importance of an ongoing follow-up of the physical health of psychiatric patients.

Adolescent↗
PubMed1988

Multiple sclerosis and birth order.

The relation between birth order and risk of multiple sclerosis (MS) was studied among MS patients in Israel. The evaluation was both by case-control study and comparison of expected and observed birth order in Israel-born patients. Results showed an excess of first-born and a low birth order among MS patients. Conversely, in MS patients born abroad but who developed the disease in Israel, MS was connected with an excess of last-born and high birth order. These contradictory results could not be explained by bias of case selection, difference in age, or changes in family size with time, and could indicate that different etiological factors are responsible for MS in distinct populations.

Birth Order↗
PubMed1987

The etiology of schizophrenia: a replication test of the social selection vs. the social causation hypotheses.

A quasi-experimental design was used to test the social causation-social selection hypotheses for the etiology of schizophrenic disorders. It was based on first admissions to psychiatric in-patient facilities for Jerusalem Jewish residents aged 15 years and over. Data were extracted from hospital charts; diagnoses were made based on the NHSI, DSM III and RDC classificatory systems. The results showed that among the lower class the ethnically advantaged had higher rates of schizophrenic disorders than the ethnically disadvantaged. The results were statistically significant when the ethnic contrast was maximized. Though the results support the social selection hypothesis, social stress factors are not entirely ruled out.

Educational Status↗
PubMed1986

Presenile dementia in Israel.

A nationwide epidemiologic study of presenile dementia of the Alzheimer type (PDAT) with onset through age 60 years was carried out in Israel. The Israeli National Neurologic Disease Register and clinical records of all patients discharged from hospitals between 1974 and 1983 with a neurologic or psychiatric diagnosis suggestive of dementia were reviewed. A total of 71 Jewish patients with onset of PDAT between 1974 and 1978 was ascertained. The age at onset in these patients ranged from 43 to 60 years. The median survival was 8.1 years, with slightly longer survival if onset occurred before age 55 years, even after correction for expected mortality according to age and sex. The average annual incidence rate per 100,000 population at risk was 2.4 in the population aged 40 through 60 years. Although the incidence rates were slightly greater for women, the difference between the rates by sex was not statistically significant. The age- and sex-adjusted incidence of PDAT per 100,000 population was significantly higher in those born in Europe or America (2.9) than in those born in Africa or Asia (1.4). No significant difference in survival was found between these two groups. The curve of the incidence rates by age for PDAT in Israel is continuous with that for senile dementia of the Alzheimer type collected by similar methods elsewhere, which suggests that one disease process may account for both conditions.

Adult↗
PubMed1985

Amyotrophic lateral sclerosis. A study of its presentation and prognosis.

All identified Israeli patients with amyotrophic lateral sclerosis (ALS) with onset of the disease from 1959 through 1975 (n = 318) were evaluated clinically. Most of our patients (63%) presented with weakness; only 10% presented with atrophy and 3% with fasciculations. In 31% of the cases, the onset of the disease was focal and 22% of the patients presented with bulbar signs, but only 6 patients presented with emotional lability (pseudo-bulbar). Twelve per cent of the patients presented with muscle cramps, pain or paraesthesia. Atypical signs such as motor cranial nerve lesion, dementia, sphincter disturbance and deep sensation loss are discussed. A relatively high proportion of our patients suffered from malignant tumour, but with no association with any specific tumour. The median survival time was 3 years. Patients with onset of their disease with bulbar signs had a shorter life expectancy (2.2 years): Twenty nine per cent of our patients survived for more than 5 years and 16% for more than 10 years.

Adult↗
PubMed1984

Changes in the incidence of amyotrophic lateral sclerosis in Israel.

The incidence of amyotrophic lateral sclerosis (ALS) in Israel was determined for the period 1959 through 1974. A total of 246 patients with ALS was ascertained. The male-female ratio was 1.62:1. The average annual age-adjusted incidence per 100,000 persons increased during this period by 41%. The increase was almost entirely due to a higher rate in persons more than 60 years of age and was greater in women than in men. This led to a decrease in the male-female ratio. The mean age of onset increased from 52.8 to 58.6 years during the same period. The increment in incidence could not be explained by better case ascertainment or increased life expectancy, but greater precision in diagnosis of ALS in the aged may have partially contributed to the increase.

Adult↗