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PubMed2006

Monitoring long-term court order psychiatric hospitalization: a pilot project in Israel.

BACKGROUND: In Israel, the rules of compulsory psychiatric hospitalization, including hospitalization under a court order, are set out in the Israel Mental Health Act, 1991 (MHA). The MHA does not specifically define the time limits of hospitalization by Court Order, though every patient, by law has to be brought before the Regional Psychiatric Board (RPB) once every six months for reevaluation. The Supreme Court recently addressed this issue and suggested that by having no specific time span, the way lies open for infringement of individual rights (Criminal Appeals 3854\02). Consequently the Supreme Court suggested that some court committed patients should be moved from the criminal to the civil track which inflicts less severe infringement of the mentally ill patient's rights. This ruling generated rethinking at the ministerial level aimed at improving the monitoring of the care of long-term psychiatric hospitalization in criminal cases. The Ministry of Health initiated a project designed to study this issue. OBJECTIVES: The main objective of this project, which is described below, is to monitor the type and incidence of forensic mental patients hospitalized in Israel for more than 10 years, and to propose alternatives to replace this untenable situation. METHODS: All the 12 psychiatric hospitals in Israel which hospitalize forensic patients were sent written requests for data on criminal patients hospitalized under court orders, including demographic data, diagnosis and type of offense. We identified in all 65 such patients. The data received were compared with the National Psychiatric Register databank of the Ministry of Health and divided in subgroups according to diagnosis, type of offence, demographic variables and length of hospitalization. RESULTS: Most of the subjects of the sample (89%) suffered from psychotic disorder mainly schizophrenia of the paranoid type. 95.5% were male. The most prominent type of offense was assault against family members (37%), which is in keeping with statistics reported in the relevant literature. The profile of the typical patient of this sample is: male, aged 45-65, unmarried, with 8 years of education and suffering from paranoid schizophrenia. DISCUSSION: No correlation between type and severity of offense and length of involuntary forensic hospitalization was found. We suggest some possible alternatives to improve the current handling of the group of long term hospitalized forensic patients. We also feel that a further study should be carried out on forensic patients hospitalized for a period of five to ten years.

Hospitalization↗
PubMed2006

Rabies vaccination programme for red foxes (Vulpes vulpes) and golden jackals (Canis aureus) in Israel (1999-2004).

Since 1956, red foxes (Vulpes vulpes) and, to a lesser extent, golden jackals (Canis aureus), have been the primary vectors maintaining endemic wildlife rabies in Israel. Starting in the autumn of 1998, oral rabies vaccination campaigns have been conducted in Israel targeting these two wildlife species, with increasing yearly geographical extension. Significant data have been accumulated from an area of approximately 5,200 km2 in Northern Israel. In the spring of 2003 the project was extended to 14,000 km2 and in the autumn to 21,000 km2, covering almost all inhabited areas in Israel and the West Bank. A total of two million RABORAL V-RG (Merial) vaccine-filled baits were distributed bi-annually by plane or helicopter at 14-19 baits km2. Since the onset of oral vaccination activities in 1998, annual bait acceptance in the vaccination zones has been demonstrated by biomarker detection (with tetracycline) in 55 % (429/783) of bone samples of target animals submitted for diagnosis. In 1999 to 2004, vaccine contact and induction of immunity in animals collected from the vaccination zones were reflected by seroconversion in 66 of 284 animals (23 %). By the year 2004, rabies cases declined sharply in all progressively vaccinated areas.

Administration, Oral↗
PubMedDate not supplied

Mumps incidence in Israel--impact of MMR vaccine.

BACKGROUND: Measles-mumps-rubella (MMR) vaccine replaced measles vaccine in the routine childhood vaccination schedule in Israel in December 1988, primarily to eliminate congenital rubella syndrome. In this observational study, we report on changes in mumps incidence in Israel from the time of the introduction of MMR vaccine until the end of 1991. METHODS: The report is based upon passive surveillance of mumps incidence, which has been notifiable in Israel since 1977. RESULTS: In the three years since the introduction of MMR vaccine, reported mumps incidence has fallen to less than 10% of the pre-vaccine period. CONCLUSIONS: Although this report is based on a relatively short period of observation, it can be tentatively concluded that MMR has led to a reduction in mumps incidence in Israel. It would be imprudent, however, to predict that mumps outbreaks will not occur in the future, and further observation of morbidity data will be needed to determine the magnitude and durability of the observed trend.

Cost-Benefit Analysis↗
PubMedDate not supplied

The decline of acute rheumatic fever in Israel.

INTRODUCTION AND METHODS. In Israel, as in most economically developed countries, rheumatic fever has become uncommon, although cases continue to be reported each year, particularly in the Arab population. In this observational survey, based on cases notified to, and investigated by, the Ministry of Health, we review the epidemiology of acute rheumatic fever in Israel in the decade 1981-90. RESULTS AND RECOMMENDATIONS. Where it persists in Israel, acute rheumatic fever remains commoner in non-Jews than in Jews and in males rather than in females, in children aged 5-14, and in children from relatively overcrowded and deprived homes. Despite the steady decline in rheumatic fever incidence in the past decade, its continued occurrence in Israel, and reports of outbreaks of acute rheumatic fever and virulent streptococcal infection in North America and Europe, demand that clinicians continue to treat streptococcal sore throats with full curative antibiotic doses, that confirmed cases receive extended chemoprophylaxis, and that surveillance and notification of acute rheumatic fever be continued.

Acute Disease↗
PubMed1990

Levels and correlates of blood pressure in recent and earlier Ethiopian immigrants to Israel.

Blood pressure (BP) and anthropometric data were collected on 483 recent immigrants from Ethiopia to Israel, and on 171 adults and 100 adolescent boarding school students who had immigrated two to three years earlier. Comparison of samples within the Ethiopian groups, and between new and early Ethiopian immigrants with Israel and resident Israelis revealed the following: Systolic and diastolic BP were considerably lower in recent immigrants of both sexes than among counterparts residing in Israel for two to three years. The latter group significantly approached, but did not reach, the BP levels of veteran Israelis. A similar comparison of 100 immigrant Ethiopian boarding school children with an Israeli high school population revealed apparently larger differences among the boys than the girls, whose BP was 'adapted' to a greater degree. Differences in relative weight paralleled those identified for BP, with the Quetelet index (QI) progressively higher when comparing new immigrants with earlier ones, and with persons who have lived in Israel for a longer period. Whether the weight differences provide a complete explanation for BP changes cannot be definitely stated, pending prospective data on weight and BP changes. Correlations of BP with anthropometric parameters and pulse rate indicated that weight rather than QI was the stronger correlate of BP in adults, whereas weight and height, but not QI, correlated with BP in adolescent boys. QI correlated with BP in adolescent, apparently sexually mature girls, but not in boys.

Adolescent↗
PubMedDate not supplied

Trends in human immunodeficiency disease in Israel.

BACKGROUND AND METHODS: A total of 144 cases of AIDS and 28 cases of AIDS-related complex (ARC) were reported to the Israel Ministry of Health for the period 1980-1990. In this longitudinal observational study, we examine the progress of the disease in Israel, a country having experienced relatively few cases and with a cumulative incidence rate which is low compared to other developed nations. RESULTS: The cumulative AIDS incidence was 34 cases/million. There were also 545 human immunodeficiency virus (HIV) seropositives reported. Of the 172 AIDS/ARC cases, 161 (93.6%) were males. Almost half (45.9%) were homosexuals, 14.5% were intravenous drug abusers, and 13.4% were persons with hemophilia. Between 1980 and 1988, 51.5% of all cases were homosexuals and 11.3% intravenous drug abusers (IVDAs); while in 1989-1990, the relative contribution of homosexuals fell to 38.7% and that of IVDAs rose to 18.7%. The rate of increase in the annual incidence rate of AIDS has been lower in Israel than elsewhere, but trends in the distribution of risk groups among cases are similar to what has been seen in other Western countries. CONCLUSIONS: Periodic seroprevalence surveys and studies of specific high-risk behaviors in defined populations at risk are needed to help predict the course the AIDS epidemic will take in Israel in the 1990s, and the effect of two mass immigrations, from Ethiopia and the USSR, will have to be assessed. Increased efforts will be needed in the development and delivery of specific targeted educational programs in the 1990s.

AIDS-Related Complex↗
PubMedDate not supplied

Israel's prevention programs and screening policies for cardiovascular disease.

For all four broad ethnic groups in Israel, mortality rates declined over the last decade for both ischemic heart disease (IHD) and cerebrovascular disease (CVD), the first and third most important causes of death in the country. The four broad ethnic groups consist of persons born in Israel, Asia, North Africa, and Europe. Mortality data also indicate a low male to female ratio in mortality from IHD, a definite female predominance in mortality from CVD, and high mortality rates for IHD and CVD in males and females born in North Africa. Morbidity data, especially incidence, are scarce for CVD in both sexes and IHD in females. The feasibility of preventive intervention needs to be tested under the specific conditions of Israel. Although a multiple risk factor trial in Jerusalem showed that such a program can be conducted in a primary care framework, it clearly still needs to be tested in clinics rather than in a model teaching institution. The best place for intervention would seem to be the primary health care system, which has almost complete access to the country's population. Kupat Holim (the Health Insurance Institute of the General Federation of Labour) is attempting systematically to identify and manage hypertension patients. To date, management of acute coronary disease has been emphasized in Israel. Although additional resources are needed for primary prevention services, other options are suggested for obtaining those services.

Coronary Disease↗
PubMedDate not supplied

The role of epidemiology in prevention of hypertension in Israel.

High blood pressure may be the most important modifiable determinant of severe morbidity and mortality in the adult population in Israel. Because hypertension control can effect a reduction in this morbidity and mortality, programs of secondary--and subsequently primary--prevention can have a far-reaching impact on the state of health in the nation. The primary care delivery system in Israel is structurally well suited to centrally directed initiatives. Major hypertension control programs are being introduced in Israel. The General Federation of Labour Sick Fund (Kupat Holim)--the nation's chief provider of primary care--has recently undertaken a wide-scale initiative for detection and treatment of high blood pressure in its neighborhood primary care clinics. A policy decision has thus been made on a national level; resources for intervention have been made available and activities initiated. The issue in need of resolution, the authors believe, is that of the integration of rigorous epidemiologic methodology into the planning and execution of the programs, particularly in program evaluation and resultant program modification. The authors outline selected epidemiologic characteristics of hypertension in Israel, emphasizing the major role that elevated blood pressure plays as a determinant of mortality; the present status of hypertension control; current programs for control; and the role of epidemiology in preventive programs.

Adult↗
PubMedDate not supplied

Male breast cancer in Israel: selected epidemiological aspects.

The 17-yr incidence of male breast cancer was analyzed from data of the Israel Cancer Registry for Jews and non-Jews, and for the Jewish subgroups of European/American-born and Asian/African-born. The 187 observed cases among Jewish males in Israel were compared with the 194 cases reported in the U.S. Third National Cancer Survey and with female breast cancer rates for the same period. Results show that the dependence of male breast cancer (MBC) on the female rate seems to exist in both countries. The disputed observation of a higher rate of MBC among Jews is supported by the higher rates of MBC in Israel than in the USA. Data on the laterality and histological features of MBC are presented. The series included eight cases among non-Jews (Arabs). The on going survey of the Israel Cancer Registry revealed four families in which both husband and wife had breast cancer and one family with breast cancer in both father and son.

Adult↗
PubMed1995

Use of asbestos in expected and unexpected places in Israel.

The main human exposures to asbestos in Israel were in manufacturing and processing of asbestos-cement products, removing and fixing brakes and clutches for vehicles, removing old insulation containing asbestos in various plants, and in preparing and using textile products containing asbestos. Asbestos is still used in Israel, even though its health hazards are well described in the medical literature. In this paper current asbestos use in Israel is described. We emphasize the "less expected" places where asbestos was found in Israel. The detection of asbestos in unexpected places requires that we stay alert and constantly search for asbestos in every workplace and residence and in the environment.

Asbestos↗
PubMed1994

Epidemiology of Crohn's disease in southern Israel.

OBJECTIVES: Crohn's disease in Israel was described in the past as being of low incidence, more common in Europe-America-born Jews than other Jews, and of uncharacteristically low morbidity. However, recent experience has suggested that these premises are no longer correct. METHODS: The records of all hospital and outpatient cases of Crohn's disease in southern Israel for the period 1968-1992 were reviewed. Private family practitioners and specialists were contacted to assure complete case ascertainment. RESULTS: The prevalence rate of Crohn's disease among Jews on December 31, 1992, was 50.6/10(5) (Asia-Africa-born Jews 55.0/10(5), Europe-America-born Jews 58.7/10(5), and the rate was 8.2/10(5) among Bedouin Arabs. The annual incidence rate (1987-1992) was calculated as 4.2/10(5)/yr in Jews (Asia-Africa-born 4.6/10(5)/yr, Europe-America-born 3.9/10(5)/yr). The age of presentation declined progressively over the study period, was lower in Israel-born patients than immigrants, and was lower in ileocolonic versus other sites of disease. CONCLUSIONS: The data show that Crohn's disease has become more common in Jews in Israel, losing ethnic differences of frequency, and that it occurs at a younger age than before. In Arabs, the disease is more rare.

Crohn Disease↗
PubMed1994

Pediatric telephone advice: a new medical service in Israel.

Although controversy still exists about dispensing medical advice over the telephone, such services are widely offered by pediatricians in the USA. In Israel, however, such services have not yet been developed. In a joint project of the Moked Keshev (a private medical help line) at Magen David Adom (national ambulance service) and the Children's Medical Center of Israel, the first pediatric telephone advice service in Israel was established. In this study we analyzed 512 consecutive incoming calls received during the first 11 months of service operation. Of these, 42% of calls concerned children in the 1 month to 1 year age group. Unexpectedly, calls were almost evenly distributed throughout the week with a slight decrease on Fridays and Saturdays (sabbath), and 45.7% of the calls were received during the morning shift. The three most common reasons for contact were: of a general nature such as fever (23%), gastrointestinal problems (19%), and medical questions (18%). In only 20.7% of the cases were the patients advised to go to the nearest hospital emergency department, emphasizing the non-emergent nature of the calls. At the time of follow-up (within 24 h), patient status was assessed as: improved (73.7%), same (22.6%), and worse (3.8%). Of those who became worse, none required an emergency department evaluation. The present study demonstrates that a Pediatric Telephone Advice Service in Israel is technically functional, medically safe, and contributes to the health management of children.

Adolescent↗
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↗
PubMed1995

How many HIV infections are there in Israel? Reconstructing HIV incidence from AIDS case reporting.

BACKGROUND: The reporting of AIDS cases to Israel's Ministry of Health is believed to be accurate, but the completeness of HIV surveillance is unknown. We implement a model that reconstructs HIV incidence in Israel from AIDS case reports excluding Ethiopian immigrants. METHODS: We apply the well-known method of backcalculation to AIDS cases reported to the Ministry of Health. The data are adjusted statistically to account for reporting delays and the elimination of AIDS Related Complex reporting. The analysis also accounts for the impact of differential administration of antiretroviral therapy to HIV-infected persons over time. RESULTS: Excluding Ethiopian immigrants, we find that the cumulative number of HIV infections reported to the Ministry of Health through December 1993 (1,011) is not statistically different from the model's estimate of 922 (z = 1.04; p = 0.30), though the reported number of new infections in recent years exceeds the modeleted rate. CONCLUSIONS: The low HIV incidence estimated among non-Ethiopian Israelis is consistent with other studies of sexually transmitted diseases and HIV-related risky behavior in Israel. This result counters the hypothesis that an explosive HIV epidemic will occur. That the number of recently reported new infections exceeds the estimate from the model could indicate that the reporting system is catching up with the extant spread of disease, or that the model is missing some aspect of the dynamics of HIV in Israel. We suggest that comparing future annual HIV incidence rates to the model's upper bound of 80 infections per year will enable resolution of this issue over time.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The impact of Jewish identity on the psychological adjustment of Soviet Jewish immigrants to Israel.

The following study investigated the role which Jewish identity plays in the psychological adjustment of recent Soviet Jewish immigrants to Israel. Five hundred Soviet Jews ages 18-53 who immigrated to Israel within anywhere from two months to approximately two years were selected from various "ulpan" settings (Hebrew language courses), absorption centers and community centers in several cities, and administered a detailed questionnaire. Subjects with weakest levels of Jewish identity were significantly most distressed and least satisfied with Israel. These findings confirm the importance of the role which Jewish identity plays in the adjustment of Soviet Jewish immigrants to Israel. Clinical and empirical implications are discussed in light of the findings.

Acculturation↗
PubMed1996

Requalifying examination and employment in immigrant physicians as predictors of successful immigration to Israel.

Thirty physicians who immigrated together from South America to Israel were followed during their first two years in Israel. Success in the medical requalifying examination and finding work as physicians correlated directly with permanency in Israel, and, inversely, returning to country of origin was associated with being unqualified and unemployed. Age, sex, marital status, religion and previous professional status were not associated with permanency in Israel.

Adult↗
PubMed2006

Childhood burns in Israel: a 7-year epidemiological review.

INTRODUCTION: Understanding the etiology of severe burns injuries and identifying high risk groups are essential for allotting resources for prevention and treatment. The objective of this study was to develop a profile of severe childhood burns in Israel. METHODS: A retrospective study of children (ages 0-14) hospitalized with a burn, between 1998 and 2004. Data from all five burn units in Israel was retrieved from the National Trauma Registry. RESULTS: Two thousand seven hundred and five children were hospitalized with burns (51% of all burn admissions). Infants (ages 0-1) had the highest prevalence (45%). Scalds caused 68% of burns. Burn extent in 83% of the patients was less than 20% TBSA, 3% suffered 40%TBSA burns. Surgical intervention increased from 6% in 1998 to 21% in 2002. Non-Jewish children sustained proportionally more burn injuries (48%). Among Jewish children an increase in burn injuries was noted on Thursdays and Fridays. CONCLUSION: Infants, boys and non-Jewish children were found to be at greatest risk for a burn injury, while older children were at higher risk for severe burns. Prevention programs should target these high risk groups, with an emphasis on the unique characteristics of each group. Policy makers should reassess the benefits of a pediatric burn unit in Israel. The increase in rates of surgical intervention should be further investigated.

Burns↗
PubMed2006

Enteral feeding in end-stage dementia: a comparison of religious, ethnic, and national differences in Canada and Israel.

BACKGROUND: Although enteral feeding in end-stage dementia is thought by many clinicians to be "futile," it is still widely used. We examined rates of tube feeding (gastrostomy or nasogastric) in end-stage dementia in hospitals in both Canada and Israel, and hypothesized that Canadian non-Jewish affiliated hospitals would have the lowest (and Israeli institutions the highest), with Canadian Jewish hospitals exhibiting intermediate rates. METHODS: We conducted a cross-sectional survey of six geriatric long-term hospitals: two in Israel and four in Canada (two Jewish affiliated, two not; two in Ontario, two in Quebec province). Patients with end-stage dementia were assessed and further analyzed for type of feeding. RESULTS: In the six hospitals, 2287 long-term beds were surveyed, of which 1358 (59.4%) were used by demented patients of whom 376 (27.7%) were severely demented (Global Deterioration Scale-level 7). Of these, 24.5% (92) were fed by nasogastric tube or gastrostomy tube. Significant differences in tube-feeding prevalence were found between Canada (11%) and Israel (52.9%), with only 4.7% seen in non-Jewish Canadian institutions. Jewish affiliated hospitals in Canada exhibited an intermediate rate of 19.6%. However, for within-country dyads, wide differences were also found. When we examined patient religion, we found that Canadian non-Jewish patients had the lowest rates (3.2%), Israeli Jewish patients the highest (51.7%), and Canadian Jewish patients exhibited an intermediate rate (19.0%) of tube use. CONCLUSIONS: Despite reservations concerning its utility, feeding tube use is reasonably widespread in patients who have reached the stage of severe dementia. Canadian institutions exhibited a lower prevalence of feeding tube use than did Israeli hospitals. Between-country and between-province differences in practice may be explained by some combination of administrative and/or financial incentives, religion, and culture; within-country and within-ethnic group differences may be caused, at least in part, by differing institutional cultures.

Aged, 80 and over↗