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PubMedDate not supplied

Reduction in hepatitis A antibody prevalence among young adults in Israel.

BACKGROUND: Hepatitis A (HAV) is endemic in Israel. A number of developed countries have reported marked reductions in prevalence of antibodies. The objective of this study was to determine whether change in prior infection took place over a 7-year period and to investigate the sociodemographic characteristics of infection in Israel. METHODS: Recruitment into military service in Israel at the age of 18 is compulsory. Representative samples of male recruits were selected in 1977 and 1984. Antibodies to HAV were tested by solid phase radioimmunoassay in the 1977 sample and by an enzyme immunoassay in the 1984 sample. RESULTS: HAV antibody prevalence in 1977 was 69% (95% confidence interval (CI) 65% to 72%) versus 54% (95% CI 49% to 59%) in 1984 (p < 0.0001). The reduction was evident in all ethnic-origin groups comprising the Jewish population. In 1984 the prevalence was 28% for Jewish men of European origin, 60% for Asian origin, and 80% for the North African origin group. A statistically significant independent effect of education was evident. CONCLUSIONS: These findings point to a reduction in feco-oral transmission and hepatitis A virus infection in childhood in Israel, yet reveal considerable continuing ethnic and educational inequalities in prior exposure to infection. A potential for large outbreaks exists during transition from high to low endemicity, particularly in high-risk military populations. These populations are candidates for application of active hepatitis A vaccines now undergoing testing.

Adolescent↗
PubMed2003

Risk factors for carriage of group B streptococcus in southern Israel.

BACKGROUND: In southern Israel, a discrepancy between a relatively high prevalence of Group B streptococcus maternal carriage (12.3%) and a very low incidence of neonatal disease (0.1/1,000 live births) has been found despite the fact that no preventive strategy has been implemented. OBJECTIVES: To determine the risk factors for maternal carriage in order to clarify this discrepancy and further examine the different aspects of GBS in southern Israel. METHODS: Cultures for GBS were obtained from 681 healthy pregnant women, and relevant demographic and obstetric data were collected. The medical records of 86 neonates born to carrier women were retrospectively examined. Statistical analysis was performed using the Pearson chi-square test. RESULTS: Women who were not born in Israel, particularly immigrants from the former USSR, were significantly prone to carry the pathogen compared to native Israeli women (Bedouins and Jews) (P = 0.03). CONCLUSIONS: A high GBS transmission rate is expected among immigrants who came from areas with a high prevalence of maternal carriage to one with a low incidence of neonatal disease environment and were not subject to any preventive strategy. Clinical attention should be directed to this issue throughout Israel.

Adult↗
PubMed2003

[Water-pipe tobacco smoking among school children in Israel: frequencies, habits, and attitudes].

BACKGROUND: Tobacco smoking via a water-pipe (Nargile) is a new phenomena among school children in Israel in recent years. Water-pipe tobacco has the potential for nicotine addiction, for other smoking-related damages and for drug abuse. GOALS: Our primary goal was to characterize the frequencies of water-pipe smoking among school children in Israel, its distribution according to age, gender, habits and attitudes. The secondary goal was to compare its use to cigarette smoking among these school children. METHODS: A self-reported questionnaire was distributed among 388 school children (ages 12-18 years old) in grades A, and C, of middle schools and grade B of high schools in a central region of Israel. The questionnaires were answered unanimously and the process was conducted in classes by the school teacher and by nursing school students. RESULTS: Among all school children in this study, 41% smoke a water-pipe at various frequencies. Of all the children, 22% smoke at least every weekend. Water-pipe smoking was 3 times more frequent than cigarette smoking and was almost equally distributed among both genders, but girls were heavier smokers than boys, of either water pipe or cigarette smoking. Six percent of water-pipe smokers add psychoactive drugs or alcohol to the tobacco. The main reasons for water-pipe smoking were the pleasure achieved and the intimacy that it adds to the youngsters' meetings. Ninety percent of all the school children believe that water-pipe smoking is not healthy, but at least 50% believes it is less harmful than cigarettes. According to school children that smoke water-pipes at least every weekend, 40% of their parents are current or ex-smokers of water-pipes, in contrast with 10% of parents to non-smoking children and about a quarter of the children who smoke also do so together with their parents. CONCLUSIONS: Tobacco smoking via water-pipes is a very common phenomena among middle and high school children in Israel. Girls are heavier smokers and adding drugs or alcohol to water-pipe tobacco is a fact. School children and their parents perceive that tobacco smoking via water-pipe is much safer than cigarette smoking. These alarming findings call upon the need for aggressive intervention by the Ministries of Education and Health, as well as the Anti-Drug Authority. More rigorous efforts should be implemented in terms of education and dissemination of the data regarding known hazards among schoolteachers, parents and school children. Further research is also necessary in order to prevent other ominous and camouflaged modalities of nicotine addiction at an early age.

Adolescent↗
PubMed2003

Medical services for persons with intellectual disability in Israel.

BACKGROUND: The first school for children with intellectual disability (ID) was opened in Tel Aviv in 1929; the first boarding school for children with ID was established in Jerusalem in 1931; and the first center for assessment of children with ID established in Tel Aviv in 1936. With the establishment of the State of Israel in 1948, there was a total of four residential care centers providing services for 150 children with ID. OBJECTIVE: This paper will describe the history and development of the public health work with persons with intellectual disability from the birth of the State of Israel in 1948 until today, with a focus on medical and nursing care and ideas for future work with this population. DATA SOURCES: Studies and documents from the Office of the Medical Director, Division for Mental Retardation of the Ministry of Social Affairs in Israel. DATA EXTRACTION: The Division for Mental Retardation is in contact with approximately 23,000 persons of all ages. Residential care is provided to about 6,000 persons in 54 institutions countrywide. In addition, 2,000 persons receive residential care in hostels or protected apartments within the community. More than 50 other settings provide vocational and educational services to 15,000 persons--day-care kindergartens, day-treatment centers, sheltered workshops, or integrated care within the community. DATA SYNTHESIS: Data on the health profile, morbidity, and mortality of the residents in residential care centers are used to illustrate the medical and nursing work with this population. CONCLUSIONS: We recommend that the direction in Israel should be a combination of both community and institutional care for the population of persons with ID. We recommend the establishment of a subspecialty for physicians and nurses in intellectual disability and the establishment of a Health Division within the Ministry of Social Affairs to facilitate better service, education, and research.

Adolescent↗
PubMed2003

Compliance with influenza and pneumococcal vaccinations in Israel, 1999-2002.

BACKGROUND: In a previous study, we found a relatively low compliance with influenza vaccination among the elderly (65 years and over) in both 1998/1999 and 1999/2000 winters. Prior to the 2000/2001 winter season, a campaign was conducted by the Israeli Ministry of Health and the local health maintanance organizations for improving compliance with influenza and pneumococcal vaccinations. The main purpose of the present study was to monitor the impact of that campaign on compliance with influenza and pneumococcal vaccinations. OBJECTIVES: (a) To compare the compliance rate of target groups with influenza vaccination in Israel during 2000/2001 and 2001/2002 winter seasons with previous years, (b) to estimate the compliance rate of the elderly with pneumococcal vaccination in Israel in the last 5 years, (c) to determine reasons for non-compliance. METHODS: Questions about compliance with influenza and pneumococcal vaccinations were included in quarterly national telephone surveys monitoring acute morbidity in Israel. Each survey was based on a sample of about 900 households and was carried out during three successive evenings. Questions were directed at interviewees of 18 years and over who were asked to report the vaccnation status of all the household members. RESULTS: A gradual increase in compliance with influenza vaccination was demonstrated for the elderly (aged 65 years and over) in the 2000/2001 (54.4%) and 2001/2002 (60.8%) winter seasons compared to the previous two seasons (51.6% in 1998/1999 and 49.1% in 1999/2000). A slight nonsignificant increase was also observed in the 50-64 age group (18.3% in 2002 survey). The proportion of the elderly who were reported to be vaccinated against pneumonia in the five years preceding the interview was higher in the 2002 survey (27.9%) compared to that of 2001 (20.1%). Lack of physician recommendation and low degreee of risk perception seem to be the major reasons hindering the achievement of higher rates of vaccination coverage. CONCLUSION: The vaccination campaign carried out in Israel prior to the 2000/2001 winter season was moderately successful in increasing the coverage of influenza and pneumococcal vaccinations in target groups. Performing this type of campaign every year before the influenza season should contribute to improving the compliance with vaccination of target groups.

Aged↗
PubMed2004

[Western bio-ethics--Israel between North America and Europe].

In an attempt to re-structure and formulate western bio-ethics in the '80's, the four principles of beneficence, non-maleficence, autonomy and justice were promulgated in North America and the United Kingdom. Extensive criticism was leveled against this endeavor, as being erroneous in principle or substantially inadequate. Furthermore, European opponents of this effort claimed that the Continent's 'true' set of values greatly differs from those of North America, hence negating attempts for global bio-ethics based on these principles. In this review the principles of modern American bio-ethics are presented and criticisms presently deliberated in Europe are introduced, while offering alternative principles. Israel's unique position is demonstrated by its legislation on issues such as the national health system, organ transplantation, the right to refuse medical treatment and stem cell research, all confirming that Israel begs to differ. We conclude that European values have much in common with Israel's tradition and culture, commending due modification of our ethical conceptions and training programs. The coming years should be characterized by constant dialogue between the proponents of European and American values, while Israel's individual standpoint is maintained.

Bioethics↗
PubMed2004

[Large loop excision of the transformation zone in Israel--2001].

BACKGROUND: Large loop excision of the transformation zone (LLETZ) is regarded as the treatment of choice in cases of Cervical Intraepithelial Neoplasia (CIN). Since the method is easy to learn and the equipment is inexpensive, many gynecologists now perform it in the clinic. Concern has been raised regarding the use of this procedure with insufficient indication by physicians who have not been adequately trained in performing LLETZ. AIM: This article aims to verify whether the indications for LLETZ in Israel are similar to those accepted in the updated literature and to discuss the need for licensure to perform LLETZ. Licensure would limit the use of LLETZ only to professionals specifically trained to conduct this procedure. METHOD: A questionnaire was sent to gynecologists, heads of obstetrics and gynecology departments as well as managers of public and private hospitals, regarding LLETZ performed in 2001. Topics covered in the questionnaire included: the number of LLETZ procedures performed, the patient's age, pre- and post-operative histopathological diagnosis, complications, follow-up and recurrence rate. The physicians were asked to complete separate questionnaires for each of the clinics in which he or she worked. RESULTS: The completed questionnaires comprised of 625 LLETZ procedures in eight public and three private colposcopy clinics. The ages of the women ranged from 18 to 70 years old, with 49% in the 18 to 34 age range. Most women (416) who underwent the LLETZ procedure had CIN grades 2 or 3. However, 128 women with CIN 1 were also treated. Among this group, 50% were confirmed CIN 1 according to the surgical specimen but 43 women had normal epithelium, 20 (15.6%) had high grade CIN (2-3) and one had invasive cancer. The most common post-operative short and long-term complication was heavy bleeding. Involvement of the surgical specimen borders was found in one fifth of the cases. CONCLUSIONS: The finding that about half of the women who underwent LLETZ were below the age of 35 years is of particular significance since the health insurance agencies in Israel only cover a pap smear screening test for women between the ages 35-54, once every three years. Therefore, there is an indication to start screening from the age 18. Similar to other countries in the world, the main indication to perform LLETZ in Israel is CIN 2-3. However, performing LLETZ for CIN 1 in many cases, and administering general anesthesia in certain centers, calls for the introduction of licensure for performing LLETZ. Involvement of the margins of the specimen in the neoplastic process in one fifth of the patients was similar to that reported in the literature. The various centers in Israel have different approaches as to the required surveillance period for women following LLETZ. It is suggested that women with involvement of the surgical specimen margins by CIN should be under medical surveillance at colposcopy clinics for a period of at least eight years.

Female↗
PubMed1992

[A family outbreak of trichinosis acquired in Israel].

Trichinosis is a parasitic disease transmitted to man by ingestion of contaminated raw meat, usually pork, containing cysts of Trichinella spiralis. Formerly appearing as serious epidemics, it has now become uncommon due to public health control measures. Since the Jewish and Moslem religions forbid consumption of pork, the disease is even rarer in Israel. The literature indicates that all the cases of trichinosis hospitalized in Israel were contaminated abroad. We describe an Israeli family in which trichinosis following the eating of boar meat, hunted along Israel's northern sea coast (Hof HaCarmel). We believe that this is the first report of trichinosis acquired in Israel. Only family members who ate the meat raw became ill, while those who ate it well-cooked were spared. However, not all of our cases were symptomatic, some showing only laboratory evidence (eosinophilia and a rise in CPK). In accord with postmortem data in the USA, this indicates that trichinosis is probably more common than estimated due to the many asymptomatic cases (about 4% of all Americans).

Adult↗
PubMed2004

Electronic medical record systems in Israel's public hospitals.

BACKGROUND: Various medical centers in Israel have recently incorporated electronic medical record systems. Knowing the EMR systems' features and pattern of use is an essential step for developing locally and nationally integrated systems. OBJECTIVES: To evaluate the status of EMR systems in all major general hospitals in Israel in terms of the applications used and the patterns of use. METHODS: Structured questionnaires were sent to hospital directors and directors of medical informatics units of 26 general and pediatric hospitals serving the vast majority of the population in Israel. The questionnaire included questions pertaining to the EMR systems, their usage, and the attitude of the participants to data security issues. RESULTS: Of the 26 general hospitals 23 (88.4%) returned the questionnaires. Of these, 21 (91.3%) use EMR systems. Twenty-seven different types of systems are in use in Israeli hospitals, and generally more than one type is used in a hospital. Physicians work with EMR systems in over 98% of the departments. Also, the EMR systems are used for clinical admission and discharge in over 90% of the departments and for medical daily follow-up in about 45%. CONCLUSIONS: Most of the hospitals in Israel use EMR systems but there is no standard data model. Physicians are the main users but the amount of data entered is still limited. Adoption of standards is essential for the integration of electronic patient records across Israeli healthcare organizations.

Adolescent↗
PubMed2004

[The expected shortage of registered nurses in Israel].

In the last several years, many countries have experienced a shortage of registered nurses. This phenomenon is expected to escalate in the future. Recent studies have established significant relationships between the proportion of registered nurses and the quality of care, preventing health complications and achieving desired clinical outcomes. Thus, the shortage of nurses has a direct effect on the overall population's health. Israel, like other countries, will experience a nursing shortage in the near future. Many reasons are associated with this problem, some of which are attributed to the policy of the Ministry of Health, which did not invest sufficient resources in maintaining workers in the nursing profession. Furthermore, existing educational programs were closed and insufficient efforts were invested in the development of alternative educational programs. Until recently, new immigrants were a significant source of candidates to become nurses in Israel. Due to the decrease in the number of new immigrants to Israel, the nursing profession may be affected and the positive trend of nursing employment might be hampered. Other reasons for the nursing shortage can be related to the improvement in the economical situation in Israel, the increasing demand for registered nurses due to medical complexity and new sophisticated technologies in hospitals and in the community. This intimidating problem must be resolved immediately including broad creative strategies focusing on both short and long-term solutions.

Government Agencies↗
PubMed2004

Psychiatric services in nursing homes in Israel: should the American legislation be adopted?

BACKGROUND: Nursing homes provide care for the elderly who require medical, nursing or rehabilitation services. Legislation for the public health model of mental health care for nursing home residents in the USA was enacted in 1987. OBJECTIVE: To determine whether the USA act regulating psychiatric care for nursing homes may be applied in Israel. METHODS: Publications analyzing the outcome of the USA regulations demonstrate improved care as reflected by decrease in restraints and better use of psychotropic compounds. The shortcomings as well as benefits of the USA legislation are tested as to their relevance to the specific economic, environmental and medical issues in Israel. CONCLUSIONS: The adoption of USA legal acts regulating nursing home residents' psychiatric care may not be feasible in Israel. However, quality of care in nursing homes can be significantly improved if such regulations were "tailored" to Israel's unique structure of nursing homes.

Aged↗
PubMed2005

Intrapartum prophylaxis of group B streptococcal disease in Israel: guidelines and practice.

BACKGROUND: The incidence of perinatal, early-onset Group B streptococcal sepsis is very low in Israel and there are no local guidelines for prevention of the disease. OBJECTIVES: To determine to what extent the current Centers for Disease Control guidelines are practiced in Israel, the reasons for their adoption or rejection, and the need for local official guidelines. METHODS: A telephone questionnaire was conducted of all 27 delivery units in Israel. Answers were obtained from 26, either from the clinical director or the senior obstetrician in charge at the time of the interview. RESULTS: Only in 2 of the 26 delivery units (8%) are the CDC guidelines adhered to exactly; in 6 units they are deliberately rejected, and in 8 units they are not practiced although they are allegedly implemented. Thus, the CDC guidelines are not practiced in 14 delivery units (54%). Medico-legal consideration is the sole or major reason for adopting these guidelines in 80% (16/20) of the delivery units where they are seemingly implemented. In the majority of these units (18/20) there is readiness to abandon current practice, should local guidelines differ from those of the CDC, provided that local guidelines are issued by an authoritative source. CONCLUSION: CDC guidelines are either deliberately rejected or incorrectly practiced in most Israeli delivery units. The medico-legal argument is one of the main reasons for practicing these guidelines. Since the CDC guidelines probably do not apply in Israel, official local guidelines are urgently needed.

Delivery, Obstetric↗
PubMed2005

Congenital cytomegalovirus infection in Israel: screening in different subpopulations.

BACKGROUND: The incidence of congenital cytomegalovirus in Israel has never been determined, either in general or in relation to various population subgroups. We recently proved the utility of newborn urine polymerase chain reaction as a screening tool for congenital CMV. OBJECTIVES: To define the incidence of congenital CMV infection in two different subpopulations, as a model for the entire population of Israel. METHODS: Urine specimens were randomly collected from 2,000 newborns in Shaare Zedek Medical Center, Jerusalem, and HaEmek Medical Center, Afula (1,000 specimens each). These hospitals have many characteristic differences, presumably representing the diverse population of Israel. Urine specimens were subjected to a CMV PCR reaction and positive specimens were validated by urine viral culture. Maternal seroprevalence was determined in a representative sample of the mothers in each hospital. Epidemiologic characteristics of the mothers were extracted from hospital records and compared. RESULTS: The population in Shaare Zedek Medical Center was mostly Jewish (97.7%) and urban (87.0%), as compared to that of HaEmek Medical Center (49.2% and 61.0%, respectively, P < 0.01). Nevertheless, CMV seroprevalence was similar: 81.5% and 85%, respectively. Ten (1.0%) and 4 (0.4%) newborns, respectively, were found to have congenital CMV infection (not significant). CONCLUSIONS: The combined incidence of congenital CMV infection in the study population was 0.7% (95% confidence interval 0.3-1.0%). If this rate is extrapolated to the entire population of Israel, then a total of 945 cases of congenital CMV can be expected among the 135,000 annual deliveries. A nationwide screening program for congenital CMV should be considered.

Cytomegalovirus Infections↗
PubMed2005

Perinatal outcome among non-residents in Israel.

BACKGROUND: Foreign workers in Israel are not covered by the comprehensive medical insurance that all Israelis receive. They have national insurance and injury-related coverage, which does not include routine pregnancy follow-up OBJECTIVES: To compare perinatal outcome between partially insured non-resident migrants in Israel and comprehensively insured Israeli women. METHODS: Parameters of perinatal outcome were compared between 16,012 Israeli and 721 foreign women living in Israel. Outcome measures included birth weight, distribution of gestational age at delivery, neonatal complications, cesarean section, neonatal intensive care unit admission, intrauterine fetal death rates, and duration of post-partum hospitalization. RESULTS: Deliveries prior to 28 weeks gestation occurred more frequently among non-residents (1.3% vs. 0.6%, P < 0.001). Gestational diabetes and preeclamptic toxemia were significantly more prevalent among non-residents (3.2% vs. 1.9%, P < 0.05 and 4.9% vs. 3.1%, P < 0.05, respectively). The cesarean rates were 18% and 35% for residents and non-residents, respectively (P < 0.001), and the post-cesarean recovery period was longer among non-residents (4.8 vs. 3.6 days, P < 0.05). The mean birth weight was similar in the two groups (3,214 vs. 3,231 g), although macrosomia (>4,000 g) was more prevalent among non-residents, who also had higher rates of NICU admission ((9.6% vs. 8%, P < 0.05) and intrauterine fetal death (6.6/1,000 vs. 3.7/1,000, P < 0.05). CONCLUSIONS: Non-resident parturients in Israel are more susceptible to an adverse perinatal outcome than their Israeli counterparts. We suggest that government subsidization of non-residents' health expenditures would reduce the differences in perinatal outcome between these two groups.

Birth Weight↗
PubMed2005

Pediatric advanced life support (PALS) courses in Israel: ten years of experience.

BACKGROUND: The Pediatric Advanced Life Support course of the American Heart Association/American Academy of Pediatrics was established in Israel in 1994 and has since been presented to over 3,108 medical and paramedical personnel. OBJECTIVES: To assess the achievements of participants in the PALS course, as a cohort and by professional group, and their evaluations of different aspects of the course; and to describe the educational modifications introduced to the course since its introduction in Israel based on our teaching experience. METHODS: The study sample consisted of physicians, nurses and paramedics from all areas of Israel who registered for PALS between January 2001 and December 2003. Participants took a standardized test before and after the course; a score of 80 or higher was considered a pass. On completion of the course, participants were requested to complete a 24-item questionnaire evaluating the quality of the course as a whole, as well as the lectures, skill stations, and instructors' performance. Items were rated on a 5-point scale. Results were analyzed using the BMPD statistical package. RESULTS: Altogether, 739 subjects participated in 28 courses: 13 attending (in-hospital) physicians (1.8%), 89 community pediatricians (12%), 124 residents (16.8%), 304 nurses (41.1%), and 209 paramedics (28.3%). About half (48.9%) were hospital-based, and about half (47.9%) had no experience in emergency medicine. A passing grade was achieved by 89.4% of the participants; the mean grade for the whole sample was 87.2%. The mean test score of the residents was significantly better than that of the nurses (P < 0.05) and pediatricians (P < 0.01). The median evaluation score for four of the five stations was 5, and the mean overall score for all items was 4.56 (range by item 3.93-4.78). CONCLUSIONS: PALS was successfully delivered to a large number of healthcare providers in various professional groups with very good overall achievements and high participant satisfaction. It significantly increased participants' knowledge of pediatric resuscitation. We therefore recommend the PALS course as an educational tool in Israel.

Emergency Medicine↗
PubMed2005

Self-medication with antibiotics by a population in northern Israel.

BACKGROUND: The current study is part of a larger study--Self-Medication with Antibiotics and Resistance Levels in Europe (SAR project)--coordinated by the University of Groningen in the Netherlands and run in 19 European countries and Israel. OBJECTIVES: To estimate self-medication with antibiotics by a population in northern Israel. METHODS: We sent by post a questionnaire on antibiotic usage to 2,615 adults, both Jewish and Arab, living in northern Israel. RESULTS: The overall response rate was low (17.9%), particularly among the Arab population (9.4% of respondents). Among the 467 respondents, 169 (36.2%) reported 215 antibiotic courses within the last year. Amoxicillin was the antibiotic most commonly used (32.7% of courses); 89.4% of antibiotics were obtained via a physician's prescription; 114 respondents (24.4%) stored leftover antibiotics at home, and 81 (18.7%) would consider self-medication with antibiotics without a medical consultation. CONCLUSIONS: Over-the-counter acquisition of antibiotics is rare in Israel. However, the storage of leftover antibiotics in the home constitutes an alternative potential source of self-medication that can have untoward consequences, not only for the individual patient but also for the general population since inappropriate antibiotic usage contributes to the increasing rates of antimicrobial resistance.

Adolescent↗
PubMed2006

A national survey of acute cerebrovascular disease in Israel: burden, management, outcome and adherence to guidelines.

BACKGROUND: There are no national data on the burden and management of acute cerebrovascular disease in Israel. OBJECTIVES: To delineate the burden, characteristics, management and outcomes of hospitalized patients with acute cerebrovascular disease in Israel, and to examine adherence to current guidelines. METHODS: We prospectively performed a national survey in all 28 hospitals in Israel admitting patients with acute cerebrovascular events (stroke or transient ischemic attacks) during February and March 2004. RESULTS: During the survey period 2174 patients were admitted with acute cerebrovascular disease (mean age 71 +/- 13 years, 47% women; 89% ischemic stroke or TIA, 7% intracerebral hemorrhage and 4% undetermined stroke). Sixty-two percent of patients were admitted to departments of medicine and a third to neurology, of which only 7% were admitted to departments with a designated stroke unit. Head computed tomography was performed during hospitalization in 93% of patients. The overall rate of urgent thrombolytic therapy for acute ischemic stroke was 0.5%. Among patients with ischemic stroke or TIA, 94% were prescribed an antithrombotic medication at hospital discharge, and among those with atrial fibrillation about half were prescribed warfarin. Carotid duplex was performed in 30% and any vascular imaging study in 36% of patients with ischemic events. The mean (+/-SD) length of hospital stay was 12 +/- 27 days for ICH and 8 +/- 11 days for ischemic stroke. Among patients with ICH, 28% died during hospitalization and 66% died or remained with severe disability while for ischemic stroke the corresponding rates were 7% and 41% respectively. Mortality rates within 3 months were 34% for ICH and 14% for ischemic stroke. CONCLUSIONS: This national survey demonstrates the high burden of acute stroke in Israel and reveals discordance between existing guidelines and current practice. The findings highlight important areas for which reorganization is imperative for patients afflicted with acute stroke.

Acute Disease↗
PubMed2006

Polygenic detection of Rickettsia felis in cat fleas (Ctenocephalides felis) from Israel.

The presence of Rickettsia felis, an emerging bacterial pathogen, was investigated in 79 cat flea (Cteno-cephalides felis) pools from Israel (5 to 20 fleas each) by polymerase chain reaction (PCR) and sequencing of 5 different genes. Amplified targets included both metabolic (gltA and fusA) and surface antigen (ompA, ompB, and the 17-kDa antigen) genes. R. felis DNA was detected in 7.6% of the flea pools. Two genotypes similar in their housekeeping gene sequences but markedly different in their surface antigenic genetic milieus were characterized. This is the first detection of this flea-transmitted rickettsia within its vector in Israel and the Middle East. Although no clinical case has been reported in human beings in Israel to date, these findings suggest that this infection is prevalent in Israel.

Amino Acid Sequence↗