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Biomedical subjects

T H Tulchinsky

Publications and source records attributed to T H Tulchinsky.

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

Mandating vitamin K prophylaxis for newborns in New York State.

New York State's infant deaths and hospitalizations attributed to hemorrhagic disease of the newborn and other neonatal hemorrhagic conditions were reviewed. In 65% of 34 deaths reviewed, vitamin K was not documented as given or was given only after the onset of hemorrhage. Vitamin K was not included in standing orders in any of 22 hospitals contacted. As a result of this review, vitamin K prophylaxis was made a mandatory newborn care procedure in the State Public Health Code.

Cerebral Hemorrhage↗
PubMed1993

Water quality, waterborne disease and enteric disease in Israel, 1976-92.

Israel experienced a large number of waterborne disease outbreaks between 1975 and 1985, followed by a steep decline in the period 1986-92. Large-scale community waterborne disease outbreaks occurred primarily in the late 1970s, and in 1985 (the Krayot, four small towns neighboring Haifa), but substantial outbreaks occurred as late as 1989, with 4 during 1986-90, and 1 during 1991-92. New water standards, including mandatory chlorination of all community water supplies, came into effect in late 1988. Water quality, as monitored by the Ministry of Health, showed a marked improvement even when measured by the more stringent standards of the 1988 regulations. Long-term trends in the total of reported enteric infectious diseases from all sources, including typhoid, hepatitis, Shigella and Salmonella in Israel are examined. Typhoid, which has been declining since the 1960s, peaked in 1985 with the large waterborne disease episode of the Krayot. Shigella and total hepatitis incidence increased slowly up to the mid-1970s, followed by large increases during the 1975-85 period, then by a rapid decline up to 1991. Shigella, from childhood contacts in kindergartens, increased in 1992. Salmonella incidence continues to increase steadily. Mandatory chlorination and more stringent water standards have had an important impact on water quality and on waterborne disease outbreaks in Israel. Empiric evidence suggests that improving water quality may also be a factor in the changing patterns of some enteric diseases and the total burden of enteric disease in Israel.

Chlorine↗
PubMed1993

Measles control in developing and developed countries: the case for a two-dose policy.

Despite major reductions in the incidence of measles and its complications, measles control with a single dose of the currently used. Schwarz strain vaccine has failed to eradicate the disease in the developed countries. In developing countries an enormous toll of measles deaths and disability continues, despite considerable efforts and increasing immunization coverage. Empirical evidence from a number of countries suggests that a two-dose measles vaccination programme, by improving individual protection and heard immunity can make a major contribution to measles control and elimination of local circulation of the disease. Cost-benefit analysis also supports the two-dose schedule in terms of savings in health costs, and total costs to society. A two-dose measles vaccination programme is therefore an essential component of preventive health care in developing, as well as developed countries for the 1990s.

Cost-Benefit Analysis↗
PubMed1991

Prevention of measles in Israel: short- and long-term intervention strategies.

Measles morbidity and mortality have declined in Israel since the introduction of routine vaccination in 1967. The reported incidence of civilian cases of measles declined from 50/100,000 in 1968-72, to 27/100,000 in 1983-87. There was also a decrease from 108 to 49 measles deaths, and from 84 to 29 cases of subacute sclerosing panencephalitis in these respective periods. The measles epidemic in 1982 included 7,864 reported civilian cases with an additional 3,000 cases in the Israel Defense Forces. The 1985-86 epidemic included 4,956 reported civilian cases. Current immunity levels leave large numbers (15-20%) of children and young persons susceptible to the disease and its transmission. Despite the long-standing childhood immunization program, the goal of complete control over and elimination of the disease will not be achieved in the near future by current immunization policies. The 3-4 year cycle of measles epidemics may be expected to cause large-scale morbidity and some mortality in the 1990-92 period. Short- and long-term measles control policies for this preventable disease are discussed.

Adolescent↗
PubMed1990

Costs and benefits of a second measles inoculation of children in Israel, the West Bank, and Gaza.

STUDY OBJECTIVE: Measles has been targeted by the WHO as a disease which should be eradicated. Use of existing vaccines during infancy has resulted in a substantial decline in cases in Israel, the West Bank, and Gaza. However the disease continues to occur in epidemic waves with large scale morbidity and mortality in all of these populations. This paper estimates the costs and benefits of three alternative strategies of adding immunisation at school age, and during young adult life to the present vaccination at 15 months. MEASUREMENTS AND MAIN RESULTS: A policy of immunising all Israeli children aged 6 (option A) would cost around $1 million and have estimated benefits of $4.5 million, yielding a benefit cost ratio of 4.53/1. Despite relatively lower medical care costs and work absence costs (as a result of the lower per capita GNP and lower female participation rate in the workforce), the West Bank and Gaza situations yield benefit to cost ratios of 5.74/1 and 9.59/1 respectively because of their relatively higher incidence rates. If implemented in Israel, a vaccination programme (such as option A) would prevent, over the next 10 years, approximately 28,700 simple cases, 3400 hospital admissions, eight non-fatal cases of encephalitis, and 2.2 cases of SSPE. It would save 28 lives. The adoption of option A, is expected to reduce incidence and mortality by around 13,600 and 32 cases in the West Bank, and by 18,000 and 64 cases in Gaza. CONCLUSION: The adoption of a two dose policy appears to be economically justifiable.

Child↗
PubMed1990

Tetanus in Israel, Judea/Samaria and Gaza, 1968-89: progress and challenge.

During the 1950s tetanus was a major public health concern in Israel, with incidence rates of up to 2/100,000 occurring predominantly among farmers and infants (tetanus neonatorum). These rates have declined considerably since then, with an average of 2 cases per year in recent years, and 5 cases in 1988. There has been a major decline in tetanus incidence in Judea/Samaria and Gaza, due to a successful vaccination program reaching over 90% of infants and schoolchildren and to educational programs. In Judea/Samaria and Gaza, prevention of tetanus neonatorum has improved as a result of the increasing number of hospital deliveries (now 62% in the West Bank and 80% in Gaza), and the widespread immunization of pregnant women and adolescent girls of childbearing age. Special efforts were given to the education of traditional birth attendants (dayas). Prevention of adult tetanus was achieved through immunization of high school students and laborers. Recent cases in all three areas are equally distributed between newborns and elderly persons. Because of the persistence of the incidence of tetanus, a review of Israel's immunization policy is indicated, focusing on high risk groups such as Bedouin women of childbearing age and the elderly.

Adult↗
PubMed1988

Waterborne enteric disease outbreaks in Israel, 1976-1985.

Waterborne enteric disease remains a major public health problem in developing countries, as well as in developed countries, such that the World Health Organization declared 1981-90 the International Water Decade. Israeli experience with waterborne disease outbreaks in the decade 1976-85 is reviewed. Community water systems accounted for 52 outbreaks, with 25 occurring between 1976 and 1980 and 27 between 1981 and 1985. Total cases reported in these outbreaks were 7,681 and 10,880 respectively. In the latter period, reported cases resulting from these outbreaks constituted a very high percentage of the total reported cases of diarrheal disease in the country. The waterborne disease outbreaks were mostly due to secondary contamination of water systems due to human error and poor maintenance. In comparison with the United States, Israel experienced 18.7 times as many community waterborne disease outbreaks per capita. The need for routine preventive chlorination, and filtration on a selective basis, of community drinking water systems is strongly indicated, as recommended in current United States and World Health Organization guidelines in order to improve this grossly substandard aspect of Israeli public health.

Bacterial Infections↗
PubMed1988

Microbiologic drinking water quality in Israel: standards, monitoring, and treatment.

Drinking water quality depends on standards, monitoring and treatment. Israel's microbiologic water standards are less stringent than those currently recommended internationally, and have focused primarily on bacteriologic levels. Compliance with routine monitoring requirements averaged 86% in 1985-86. However, compliance with retesting of contaminated samples averaged 49% in 1985-86. Compliance with treatment recommendations of district sanitary engineers has also been poor. Poor water quality continues to be a public health problem in Israel, and has contributed to a relatively high incidence of waterborne disease. Current international guidelines recommend filtration and chlorination, particularly for surface water and other contaminated sources. Israel should make this a major public health priority.

Bacteria↗
PubMed1986

Medical screening of former asbestos cement workers in Israel: a pilot program.

A pilot screening program for the evaluation of former asbestos-cement workers was carried out in the Chest Disease Clinic of the Acco Public Health Office (Ministry of Health), Israel. A total of 184 subjects were evaluated using medical and occupational questionnaires, clinical examinations, and pulmonary function tests (forced expiratory volume, forced vital capacity). Thirty percent of individuals with more than 1 year of work experience had symptoms of breathlessness or cough. Individuals with 10 years or more of work experience showed a high prevalence of râles and reduced pulmonary function, as compared to those with shorter work histories. These findings indicate the urgent need for active follow-up of Israeli ex-asbestos workers. A proposed screening and surveillance program for this high-risk group is discussed with emphasis on follow-up, health education, and smoking cessation.

Adult↗
PubMed1985

Use of growth charts as a simple epidemiological monitoring system of nutritional status of children.

Community monitoring of the nutritional status of children has hitherto involved field surveys and lengthy computer analysis. These procedures are complex and cannot always be carried out on a routine basis. In addition, they do not provide immediate feedback or longitudinal information on the population under surveillance. This study describes a simple, universally applicable community survey system for monitoring the growth of infants and children that affords both cross-sectional and longitudinal data.

Aging↗