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Biomedical subjects

R Gross

Publications and source records attributed to R Gross.

At least 109 records · Page 6Linked to original sources
PubMed1998

[Characteristics of adults with emotional distress in Israel-- patterns of mental health services used].

We sought firsthand data on the extent of perceived mental health needs and on patterns of use of mental health services among Israelis aged 22 and over. The data are from a national survey conducted in 1995. A random sample of phone numbers from the telephone company's computerized listings yielded 1,395 completed questionnaires (response rate, 81%). At some point in their lives, 27% had experienced emotional distress or mental health problems with which they had difficulty coping alone; 13.4% reported that they had such an experience during 1995. According to multivariate analysis, those more likely to report mental health problems were women, those with a chronic disease, Russian immigrants, divorced or widowed adults, those with a low level of education, and members of the Clalit sick fund. 38% of those who had ever had emotional or mental health problems had asked for help. The proportion of those seeking help was high among respondents aged 35-55, Hebrew speakers (compared to speakers of Russian or Arabic), and city dwellers, and the rate was low among members of the Clalit sick fund. Of those who did seek help, 39% went to a psychologist or a psychiatrist, 25% to their family doctor, 19% to a family member or friend, 7% to a social worker or social service agency, 6% to other medical personnel, and 4% to a psychiatric hospital. 30% turned for assistance to the private sector and 70% to the public sector. These findings have special significance in view of the impending reform of the mental health services. As mandated by the new National Health Insurance Law, mental health services are to be included in the basket of health services provided by the sick funds. The data can be of use in the management of sick funds and for physicians working in the community, as they prepare for this change. In addition, the data will be of aid to national policy makers in planning services suited to the needs of different population groups and to allocate resources more rationally.

Adult↗
PubMed1998

Deletion and site-directed mutagenesis of the Wolinella succinogenes fumarate reductase operon.

Wolinella succinogenes is known to grow at the expense of fumarate respiration with formate or sulfide as electron donor. A W. succinogenes mutant (delta frdCAB) lacking the fumarate reductase operon did not grow with fumarate as terminal electron acceptor and either formate or sulfide as electron donor. The delta frdCAB mutant grown with formate and nitrate did not contain fumarate reductase activity and did not catalyze electron transport from sulfide to fumarate, in contrast to the nitrate-grown wild-type strain. A mutant constructed by integration of frdCAB into the delta frdCAB mutant genome showed wild-type properties with respect to growth and enzyme activities. The frdC2 gene located downstream of the fumarate reductase operon frdCAB possibly encodes a diheme cytochrome b that is similar to FrdC (41% identical residues). The corresponding transcript differs from that of frdCAB. A delta frdC2 mutant showed wild-type properties with respect to growth and enzyme activities. Using site-directed mutagenesis, each of the four histidine residues that are predicted to serve as the axial heme ligands in FrdC (His44, His93, His143, and His182) was replaced by alanine or other residues. The resulting mutants did not grow with formate and fumarate and did not contain fumarate reductase activity, FrdA or FrdC when grown with formate and nitrate. In contrast, substitution of two histidine residues that are not considered heme ligands, yielded mutants (H114A and H120A) that grew with fumarate. It is concluded that FrdCAB is an obligatory component of fumarate respiration with formate and with sulfide in W. succinogenes. FrdC2 is not involved in fumarate respiration. Replacement of the putative heme ligands of FrdC prevents formation of a functional fumarate reductase.

Alanine↗
PubMed1998

[Patients' opinions of the role of primary care physicians and the organization of health care services].

Patients' opinions of the role of the primary care physician were studied. The study population consisted of Hebrew-speaking members of the Clalit Sick Fund, aged 18+, who visited primary care and specialty clinics. Interviews took place during January-March 1995 in the Emek and Jerusalem, and during August-October 1995 in Beer Sheba. A total of 2,734 interviews were conducted, and the response rate was 88%. 64% of the respondents preferred the primary care physician as the first address for most problems occurring during the day. Multivariate analysis revealed that the variables predicting this reference were: being over age 45, having completed less than 12 years of schooling, being satisfied with the physician, and when a child's illness was involved. Whether the physician was a specialist had only a marginal effect. The findings also show that among those who did go directly to a specialist for the current visit, 49% would still prefer the primary care physician to be the first address for most problems. However, half of the respondents initiated the current visit to the specialty clinic themselves. The findings also showed that a preference for the primary care physician to be the first address had an independent and statistically significant effect on the following aspects of service consumption: taking the initiative to go to a specialist, the intention to return to the primary care physician or to the specialist for continuing care, and the patient's belief that referral to a specialist was needed. The findings of the study may be of assistance to policy-makers on the national level and to sick funds in planning the role of the primary care physician, so that it corresponds, on the one hand, to the needs of the sick funds and the economic constraints in the health system, and on the other, to the preferences of the patient.

Adult↗
PubMed1998

A periplasmic flavoprotein in Wolinella succinogenes that resembles the fumarate reductase of Shewanella putrefaciens.

During growth with fumarate as the terminal electron transport acceptor and either formate or sulfide as the electron donor, Wolinella succinogenes induced a peri-plasmic protein (54 kDa) that reacted with an antiserum raised against the periplasmic fumarate reductase (Fcc) of Shewanella putrefaciens. However, the periplasmic cell fraction of W. succinogenes did not catalyze fumarate reduction with viologen radicals. W. succinogenes grown with polysulfide instead of fumarate contained much less (< 10%) of the 54-kDa antigen, and the antigen was not detectable in nitrate-grown bacteria. The antigen was most likely encoded by the fccA gene of W. succinogenes. The antigen was absent from a DeltafccABC mutant, and its size is close to that of the protein predicted by fccA. The fccA gene probably encodes a pre-protein carrying an N-terminal signal peptide. The sequence of the mature FccA (481 residues, 52.4 kDa) is similar (31% identity) to that of the C-terminal part (450 residues) of S. putrefaciens fumarate reductase. As indicated by Northern blot analysis, fccA is cotranscribed with fccB and fccC. The proteins predicted from the fccB and fccC gene sequences represent tetraheme cytochromes c. FccB is similar to the N-terminal part (150 residues) of S. putrefaciens fumarate reductase, while FccC resembles the tetraheme cytochromes c of the NirT/NapC family. The DeltafccABC mutant of W. succinogenes grew with fumarate and formate or sulfide, suggesting that the deleted proteins were not required for fumarate respiration with either electron donor.

Amino Acid Sequence↗
PubMed1998

Two membrane anchors of Wolinella succinogenes hydrogenase and their function in fumarate and polysulfide respiration.

Wolinella succinogenes can grow by anaerobic respiration with fumarate or polysulfide as the terminal electron acceptor, and H2 or formate as the electron donor. A DeltahydABC mutant lacking the hydrogenase structural genes did not grow with H2 and either fumarate or polysulfide. In contrast to the wild-type strain, the mutant grown with fumarate and with formate instead of H2 did not catalyze the reduction of fumarate, polysulfide, dimethylnaphthoquinone, or benzyl viologen by H2. Growth and enzymic activities were restored upon integration of a plasmid carrying hydABC into the genome of the DeltahydABC mutant. The DeltahydABC mutant was complemented with hydABC operons modified by artificial stop codons in hydA (StopA) or at the 5'-end of hydC (StopC). The StopC mutant lacked HydC, and the hydrophobic C-terminus of HydA was missing in the hydrogenase of the StopA mutant. The two mutants catalyzed benzyl viologen reduction by H2. The enzyme activity was located in the membrane of the mutants. A mutant with both modifications (StopAC) contained the activity in the periplasm. The three mutants did not grow with H2 and either fumarate or polysulfide, and did not catalyze dimethylnaphthoquinone reduction by H2. We conclude that the same hydrogenase serves in the anaerobic respiration with fumarate and with polysulfide. HydC and the C-terminus of HydA appear to be required for both routes of electron transport and for dimethylnaphthoquinone reduction by H2. The hydrogenase is anchored in the membrane by HydC and by the C-terminus of HydA. The catalytic subunit HydB is oriented towards the periplasmic side of the membrane.

Amino Acid Sequence↗
PubMed1998

Healing environment in psychiatric hospital design.

Mental health professionals have long speculated that the physical environment in which treatment occurs has an impact on both the treatment process and its outcome. The few empirical studies that evaluated the effects of psychoenvironmental design have shown encouraging results and demonstrated clinically desirable behavioral changes and even reduced psychopathology. In view of the concept that architecture is a tool in the therapeutic process, the design and execution of the psychiatric hospital in the Chaim Sheba Medical Center at Tel-Hashomer, Israel, were conducted by a multidisciplinary team of architects, mental health professionals, and administrators. The hospital contains three acute inpatient wards and a day care and large outpatient clinic. Its operation began in 1991. This paper deals with the merging of "user-friendly" architectural and environmental design components that create an integral healing environment. The paper discusses the positive effects of specific components on patients and staff, and suggests that our model of psychoenvironmental approach to psychiatric hospital design can provide an important and effective tool in the pursuit of a humane, efficient containment and reduction of severe psychopathology.

Architecture↗
PubMed1998

Evaluating the Israeli health care reform: strategy, challenges and lessons.

Evaluating the implementation of health care reform provides important information on its effect, as well as a factual basis for deciding upon mid-course modifications. Although researchers in various countries are addressing the impact of reform, only few governments have initiated a structured, planned evaluation to accompany reform efforts. In Israel, the 1995 National Health Insurance Law earmarked 0.1% of the health care budget for research on the law, coordinated by the National Institute for Health Policy and Health Services Research. This paper describes the evaluation strategy of the JDC-Brookdale Institute which is taking part in the research efforts. Implementation of the evaluation strategy and the challenges of evaluating a major reform of the health system are discussed. The evaluation strategy combines elements of formative and summative evaluation using a 'case study' approach which seeks to integrate in-depth understanding of the changing health system and of health care provider's organizational behavior, with a variety of outcome measures. The Israeli case provides support for the proposition that an integrated approach to evaluating health reform provides a better understanding of the subject under review and thus a better basis for making useful recommendations to policy makers. In addition, such an approach enhances the validity and credibility of the data and thus the probability of making an impact, which is a main objective of formative evaluation. Examination of the Israeli case, provides important insights about evaluation of health system reform, and may benefit researchers in other countries attempting to evaluate health care reform.

Evaluation Studies as Topic↗
PubMed1998

The association between BMI and haemoglobin and work productivity among Indonesian female factory workers.

OBJECTIVE: To investigate the relationship between body mass index (BMI), haemoglobin (Hb) concentration and work productivity in Indonesian female industrial workers engaged in cigarette rolling. DESIGN: Randomized-stratified, cross-sectional study. SETTING: A clove cigarette factory in Central Java Province, Indonesia. SUBJECTS: Two-hundred and thirty female cigarette-rollers. METHODS: Anthropometric variables (height, weight, mid-upper arm circumference, BMI), body composition (lean body mass and fat mass from skinfolds thicknesses), Hb, work productivity (cigarettes/hour) were determined. RESULTS: Of the 230 selected subjects 40.4% were anaemic and 41.3% had BMI < 18.5. Average production was 620 +/- 86 cigarettes/h. Productivity was positively correlated with work experience (r = 0.214, P < 0.01), lean body mass (r = 0.183, P < 0.01), height (r = 0.150, P < 0.05), Hb (r = 0.141, P < 0.05), and arm muscle area (r = 0.120, P < 0.05). Anaemic subjects produced 4.9% less (P < 0.01) than the non-anaemic ones. No linear relationship existed between BMI and productivity, but subjects with a BMI < 18.5, or < 17.0, produced respectively 5.1% (P < 0.05) and 6.8% (P <0.05) less than subjects with BMI between 18.5-22.5. CONCLUSIONS: Work productivity of persons with low BMI and Hb may be reduced. However, BMI was not a good screening tool to detect low producers. When using BMI < 18.5 and a production < 550 cigarettes/h as cut-offs sensitivity (64.7%) and specificity (55.5%) were low.

Adult↗
PubMed1998

Moderate zinc and vitamin A deficiency in breast milk of mothers from East-Jakarta.

OBJECTIVE: To gain information about the micronutrient status of urban, middle-income, breast-feeding mothers in relation to zinc and selected fat-soluble vitamins in plasma and breast milk and to assess possible interaction between the measured micronutrients. DESIGN: Cross-sectional study. SUBJECTS: 91 mothers and their infants living in middle-income areas of Jakarta, Indonesia. RESULTS: None of the measured anthropometric data of the mothers (e.g. BMI: 22.0+/-3.1 kg/m2) and their infants (birth weight: 3.2+/-0.5 kg) gave any indication of undernutrition. The mean concentrations in blood were 124+/-18 g/l for hemoglobin, 385+/-111 microg/l for retinol, 34+/-23 microg/l for alpha-carotene, 104+/-72 microg/l for beta-carotene, 7.7+/-3.3 mg/l for alpha-tocopherol, 0.57+/-0.23 mg/l for gamma-tocopherol, 855+/-242 microg/l for zinc, and the median concentration of lycopene was 29 microg/l. The median breast milk concentrations were 420 microg/l for retinol, 7.8 microg/l for beta-carotene, and 2.7 mg/l for zinc. With increased duration of lactation, vitamin A and zinc concentrations significantly decreased in breast milk whereas plasma zinc concentration increased. Plasma alpha- and beta-carotene were positively correlated (P < 0.0001) with each other and with plasma lycopene. Breast milk beta-carotene was positively correlated with breast milk retinol and with plasma beta-carotene (P < 0.0001). There was no correlation between zinc and vitamin A in either breast milk or plasma. Forty per cent of the mothers were anemic, 29.1% had a low plasma zinc concentration, and 23.7% had a moderately low plasma vitamin A concentration. Breast milk from 70% of the women had a low concentration of vitamin A and that from 66% had a low concentration of zinc. CONCLUSIONS: Multi-micronutrient intervention should be considered to provide a sufficient supply of zinc and vitamin A for growth of exclusively breast-fed infants.

Adult↗
PubMed1998

Specificity of the BvgAS and EvgAS phosphorelay is mediated by the C-terminal HPt domains of the sensor proteins.

Despite the presence of highly conserved signalling modules, significant cross-communication between different two-component systems has only rarely been observed. Domain swapping and the characterization of liberated signalling modules enabled us to characterize in vitro the protein domains that mediate specificity and are responsible for the high fidelity in the phosphorelay of the unorthodox Bvg and Evg two-component systems. Under equimolar conditions, significant in vitro phosphorylation of purified BvgA and EvgA proteins was only obtained by their histidine kinases, BvgS and EvgS respectively. One hybrid histidine kinase consisting of the BvgS transmitter and HPt domains and of the EvgS receiver domain (BvgS-TO-EvgS-R) was able to phosphorylate BvgA but not EvgA. In contrast, the hybrid protein consisting of the BvgS transmitter and the EvgS receiver and HPt domains (BvgS-T-EvgS-RO) was unable to phosphorylate BvgA but efficiently phosphorylated EvgA. These results demonstrate that the C-terminal HPt domains of the sensor proteins endow the unorthodox two-component systems with a high specificity for the corresponding regulator protein. In the case of the response regulators, the receiver but not the output domains contribute to the specific interaction with the histidine kinases, because a hybrid protein consisting of the EvgA receiver and the BvgA output domain could only be phosphorylated by the EvgS protein.

Bacterial Proteins↗
PubMed1998

Identification of histidine residues in Wolinella succinogenes hydrogenase that are essential for menaquinone reduction by H2.

The cytochrome b subunit (HydC) of Wolinella succinogenes hydrogenase binds two haem B groups. This is concluded from the haem B content of the isolated hydrogenase and is confirmed by the response of its cytochrome b to redox titration. In addition, three of the four haem B ligands were identified by characterizing mutants with the corresponding histidine residues replaced by alanine or methionine. Substitution in HydC of His-25, His-67 or His-186, which are, in addition to His-200, predicted to be haem B ligands, caused the loss of quinone reactivity of the hydrogenase, while the activity of benzylviologen reduction was retained. The corresponding mutants did not grow with H2 as electron donor and either fumarate or polysulphide as terminal electron acceptor. The mutants grown with formate and fumarate did not catalyse electron transport from H2 to fumarate or to polysulphide, or quinone reduction by H2, in contrast to the wild-type strain. Cytochrome b was not reduced by H2 in the Triton X-100 extract of the mutant membranes, which contained wild-type amounts of the mutated HydC protein. Substitution in HydC of His-122, His-158 or His-187, which are predicted not to be haem B ligands, yielded mutants with wild-type properties. Substitution in HydA of His-188 or of His-305 resulted in mutants with the same properties as those lacking one of the haem B ligands of HydC. His-305 is located in the membrane-integrated C-terminal helix of HydA. His-188 of HydA is predicted to be a ligand of the distal iron-sulphur centre that may serve as the direct electron donor to the haem B groups of HydC. The results suggest that each of the three predicted haem B ligands of HydC tested (out of four) is required for electron transport from H2 to either fumarate or polysulphide, and for quinone reactivity. This also holds true for the two conserved histidine residues of HydA.

Bacterial Proteins↗
PubMed1998

Vanadyl treatment normalizes submandibular salivary gland insulin-like immunoreactivity in streptozotocin-diabetic rats.

Rat submandibular salivary glands (SSG) contain a compound displaying insulin-like immunoreactivity (ILI) and various biological activities of insulin. As SSG ILI levels were reported to be increased in streptozotocin (STZ)-induced diabetes but not normalized by a two-week insulin treatment, we decided to check whether another antidiabetic treatment, vanadyl sulphate (VOSO4), was able to regulate SSG ILI concentration. A short term (8 days) i.p. VOSO4 treatment (total dose = 1.3 mmol/kg) of rats made diabetic 8 days earlier by a single i.v. injection of STZ (60 mg/kg BW) was able to induce a long-term (4 weeks) correction of hyperglycemia while weight gain was re-established. In untreated diabetic animals (approximately -25%) and increased (approximately +175%) as compared to normal rats. Both parameters were normalized in VOSO4-treated diabetic rats.

Animals↗
PubMed1998

[Clinico-anatomic study of the spina nasalis ossis frontalis and its role within the scope of frontal sinus surgical approach].

BACKGROUND: During endonasal frontal sinusotomy using the sharp spoon (endonasal frontal sinus surgery type II according to Draf or May and Schaitkin) a solid piece of bone is frequently encountered anterior to the neo-ostium. This bone may be referred to as a "nasal spine". A prominent spine may render a sinusotomy difficult or even impossible. METHODS: A maximum endonasal frontal sinusotomy was performed on 36 anatomical specimens by means of a sharp spoon producing neo-ostia of 7 x 5 mm on average. The dimensions of the remaining nasal spine were measured subsequently together with the diameter of the inferior frontal sinus, the thickness of the anterior frontal sinus wall, and the distance from the neoostium to the anterior ethmoidal artery. RESULTS: Almost every specimen (97%) showed a relevant nasal spine. The average height of the spine was 10 mm. The anterior-posterior dimension was 6 mm on average. A correlation was found between the nasofrontal angle and the a.-p. dimension of the spine: the more acute the angle, the thicker the spine was. In three out of four specimens the neo-ostium was separated by just one anterior ethmoidal cell from the anterior ethmoidal artery. CONCLUSIONS: In the majority of the specimens a sufficient endonasal approach to the frontal sinus could be obtained by enlarging the natural ostium as described by Draf or May and Schaitkin. The anterior ethmoidal artery is a valuable landmark for locating the ostium. The maximum diameter of the frontal sinus approach in frontal direction can be estimated by measuring of the nasofrontal angle.

Endoscopes↗
PubMed1998

Ecological and geographic characteristics predict nutritional status of communities: rapid assessment for poor villages.

The quality of poverty alleviation programmes relies heavily on appropriate targeting and priority setting. Major problems in assessing poverty include identification of the indicators of poverty and the methods used for its assessment. Nutritional status, expressed by anthropometric indices, has been proposed as a poverty indicator because of its validity, objectivity, reliability and feasibility. This study was conducted to explore the application of remote sensing to poverty mapping based on nutritional status at the community level. Relationships between the nutritional status within a community and the ecological characteristics of the community were investigated. Multiple linear regression tests were executed, and the resultant equations were tested for their validity in predicting communities with poor nutritional status. Among geographical and ecological indicators used, distance to the nearest market, main soil type, rice field area, and perennial cultivation area were found to be most useful predictors for the ranking of the communities by nutritional status. Among non-ecological determinants, food consumption, health service status and living conditions were also found as predictors. The highest correlation was found if total population was also taken into account in the regression model (R2 = 0.69; p < 0.0001). In the assessment of the sensitivity and specificity of the eight models studied, 'undernutrition' was defined as a condition where a community belongs in the first quartile for nutritional status (highest prevalence of undernutrition), and the baseline nutritional survey was considered as a standard method for final diagnosis. Most models which included only ecological factors in the equations had lower sensitivity and specificity than models which included all determinant factors in the equations. All models which took into account the total population had higher sensitivity and specificity than those that did not take total population into account. The best model of those that took into account only the geographical and ecological characteristics of the community's living environment had similar sensitivity and specificity (80% and 94.1%, respectively) as the models that considered non-geographical and non-ecological variables in addition to geographical and ecological variables. In the case of West Sumatra, only four ecological and geographic characteristics were sufficient to predict poverty in village. Since these characteristics could be surveyed by remote sensing, it may well be possible to use remote sensing for a rapid method for poverty mapping.

Data Collection↗
PubMed1998

Urinary iodine excretion is the most appropriate outcome indicator for iodine deficiency at field conditions at district level.

To empower local authorities to plan and evaluate adequate interventions, appropriate iodine deficiency disorders (IDD) indicators need to be identified. The aim of this study was to describe the magnitude and severity of IDD with different outcome indicators and associate them with functional indicators. Schoolchildren (n = 544) aged 8-10 y were assessed in 11 villages within five subdistricts of Malang District, East Java, Indonesia. Outcome indicators of IDD were goiter size as measured by palpation and ultrasonography (USG), urinary iodine excretion (UIE) and serum thyroid stimulating hormone (TSH) concentration in blood as well as functional indicators such as intellectual performance (IQ: Catell's Culture Fair Intelligence Test) and anthropometric indices. The total goiter rate (TGR) measured by palpation and USG were 35.7 and 54.4%, respectively. Based on UIE and TSH, the prevalence of iodine deficiency was 63.7 and 3.4%, respectively. In individuals, goiter, thyroid volume and UIE were associated significantly (r = -0.35; P < 0.001 and r = -0.30; P = 0.02 respectively). Among villages, TGR measured by palpation was significantly correlated with thyroid volume (r = 0.61; P = 0.045) and UIE (r = 0.68; P = 0.021), whereas TSH was not significantly associated with any of the observed indicators in individuals or groups. Multiple regression analysis showed that USG (beta = -0.67; P < 0.001) and UIE (beta = 4.39; P = 0.008) related significantly with cognitive performance (IQ). The associations between IDD indicators and cognitive performance and height-for-age Z scores suggest that socioeconomically advantaged children had better iodine status. We suggest that UIE is the best indicator for local authorities to assess iodine deficiency.

Child↗
PubMed1998

Quality of care and patient satisfaction in budget-holding clinics.

A budget-holding program was implemented in nine primary care clinics in the Negev district of Kupat Holim Clinic, Israel's largest sick fund. This study, carried out from 1991 to 1994, evaluates the impact of this program on patient satisfaction and other selected indicators of quality of care, using a controlled case study methodology. Structured questionnaires were used in face-to-face interviews with a representative stratified sample of 523 patients registered in the clinics. Patient reports were used to measure patient satisfaction, accessibility of services, comprehensiveness of care, responsiveness to patients' needs and performance of preventive medicine activities. Other research tools included staff surveys, in-depth interviews and administrative data on transfer among sick funds. The findings counter fears that budgetary control and cost-containment negatively affect quality of care and patient satisfaction. However, the program did not fulfill expectations regarding improvement in clinic services and patient satisfaction.

Budgets↗