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PubMed2000

A pilot study to examine the relationships of dyspnoea, physical activity and fatigue in patients with chronic obstructive pulmonary disease.

A descriptive-correlational design was used to examine the relationships between dyspnoea, physical activity, and fatigue in patients with chronic obstructive pulmonary disease (COPD). Lazarus and Folkman's theory of stress, appraisal, and coping provided a framework to guide the study. Dyspnoea was measured by a vertical visual analogue scale, fatigue by the Fatigue subscale of the Profile of Mood States, and physical activity by the six-minute walk (6 MW) test and an open-ended question. A convenience sample of seven male and 15 female patients with COPD provided data for analysis. The sample was characterized by relatively high forced expiratory volume in one second (FEV1) indicating mild lung impairment and high mean levels of fatigue and dyspnoea. No significant gender difference was found in the ratings of dyspnoea and fatigue and the 6 MW distance. Dyspnoea, physical activities, and fatigue were all significantly inter-related (P < 0.001). Results indicated that the higher the dyspnoea scores, the shorter the 6 MW distance walked, and the higher the fatigue scores. Limitations and suggestions for nursing practice and future research are presented.

Adult↗

PubMed2000

Improvement of clonality detection rate in multiple myeloma using fluorescent IgH PCR with different sets of primers.

The IgH rearrangement provides a useful marker of clonality in B-cell malignancies and amplification of this rearrangement is the method of choice to monitor the residual tumor cells in multiple myeloma (MM). The critical point of this analysis was the false-negative rate observed at diagnosis in patients presenting tumor cells well above the limit of detection. The aim of this study was therefore to increase the clonality detection rate by IgH polymerase chain reaction (PCR). Bone marrow DNA from 37 MM patients were analyzed at diagnosis. IgH PCR with agarose gel detection was performed between framework regions FR3 and FR1, both in combination with 5 different primers in FR4. Fluorescent IgH PCR with highly resolutive capillary electrophoresis was used to improve the detection and to size clonal PCR products. Sixty-two percent of the clonal rearrangements were initially detected with JHD primer specific to the JH segments 1,2,4,5. The use of JH3 and JH6 homologous primers increased the detection rate to 78%, whereas a consensus JH primer only reached 67% of positivity. The lowest detection rates were obtained with JHExt and JH3 with a detection of respectively 43 and 14%. However, three rearrangements were exclusively amplified by JHExt and two additional cases were detected by JH3. The combined use of primers yielded the best score with 89% of positivity. With Genescan analysis, two additional cases showed a monoclonal rearrangement improving the detection rate to 95%. The use of multiple sets of primers along with a highly sensitive genescan analysis makes possible the follow-up of minimal residual disease for most MM patients.

B-Lymphocytes↗

PubMed1999

[Treatment of isolated systolic arterial hypertension and prevention of dementia in aged patients. The Syst-Eur multicenter study].

UNLABELLED: The aim of the vascular dementia project, set up in the framework of the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial, was to investigate the influence of antihypertensive drug treatment on the incidence of vascular dementia. The study was run on non-demented patients, at least 60 years old, with isolated systolic hypertension (sitting blood pressure of 160-219 mmHg for systolic and below 95 mmHg for diastolic). Treatment was initiated with nitrendipine (10-40 mg/day) possibly associated with enalapril (5-20 mg/day) and/or hydrochlorothiazide (12.5-25 mg/day). Cognitive function was assessed at baseline and annually by the Mini Mental State Examination (MMSE). The diagnosis of dementia was based on the DSM-III-R criteria. The etiology of dementia was established using the Modified Ischemic Score or the Hachinski score when brain imaging was not available. Median follow-up by intention-to-treat was 2.0 years. The incidence of dementia was reduced by 50% from 7.7 per 1000 patient-years in the placebo group (number of patients 1,180) to 3.7 cases per 1000 p-a in the active treatment group (n = 1,238) (21 vs 11 patients, p = 0.05). At the last available evaluation, systolic and diastolic blood pressure were 8.3 mmHg and 3.8 mm Hg lower (p < or = 0.001) in the active-treatment group, but on average the MMSE scores remained stable in both groups. CONCLUSION: In older people with isolated systolic hypertension, antihypertensive treatment started with nitrendipine may reduce the incidence of dementia. At the rate observed in the placebo group, treating 1,000 patients for 5 years would prevent 19 cases of dementia.

Aged↗

PubMed2006

An enhanced microsatellite map of diploid Fragaria.

A total of 45 microsatellites (SSRs) were developed for mapping in Fragaria. They included 31 newly isolated codominant genomic SSRs from F. nubicola and a further 14 SSRs, derived from an expressed sequence tagged library (EST-SSRs) of the cultivated strawberry, F. x ananassa. These, and an additional 64 previously characterised but unmapped SSRs and EST-SSRs, were scored in the diploid Fragaria interspecific F2 mapping population (FVxFN) derived from a cross between F. vesca 815 and F. nubicola 601. The cosegregation data of these 109 SSRs, and of 73 previously mapped molecular markers, were used to elaborate an enhanced linkage map. The map is composed of 182 molecular markers (175 microsatellites, six gene specific markers and one sequence-characterised amplified region) and spans 424 cM over seven linkage groups. The average marker spacing is 2.3 cM/marker and the map now contains just eight gaps longer than 10 cM. The transferability of the new SSR markers to the cultivated strawberry was demonstrated using eight cultivars. Because of the transferable nature of these markers, the map produced will provide a useful reference framework for the development of linkage maps of the cultivated strawberry and for the development of other key resources for Fragaria such as a physical map. In addition, the map now provides a framework upon which to place transferable markers, such as genes of known function, for comparative mapping purposes within Rosaceae.

Chromosome Mapping↗

PubMedDate not supplied

Postoperative nausea management and patient-controlled analgesia.

Following the establishment of an acute pain service in one UK acute NHS trust, including the introduction of patient-controlled analgesia (PCA), pain scoring, and a rationalization of the use of simple analgesics, attention was drawn to an apparent increase in postoperative nausea and vomiting (PONV) among women given PCA following abdominal hysterectomy. Audits were conducted into clinical practice and patient satisfaction and it was agreed that an evaluation of the evidence should be conducted to ensure that the correct direction for development in the management of PONV could be established. This article discusses the evidence surrounding the issues regarding the management of PONV in patients who have been given PCA. The possibility of adding antiemetics to the analgesic solution, and the choice of antiemetic drugs, are investigated. Other factors that can affect the incidence of PONV in patients with PCA are also discussed, and an auditable framework for the evaluation of clinically effective practice is suggested.

Analgesia, Patient-Controlled↗

PubMed2000

Quantitative trait locus mapping using human pedigrees.

In the past decade phenomenal progress has been made in molecular and statistical genetic methods for localizing quantitative trait loci. Because of these advances, we can anticipate a long period of active genetic research in which the genes influencing human quantitative variability will be mapped and their effects accurately evaluated. Here, we review the current state of the science in statistical genetic methods for quantitative trait linkage analysis. In particular, we detail a variance component-based framework for localizing quantitative trait loci and for accurately estimating their relative effect sizes. Attention is paid to the optimal design of human family studies for localizing genes of small to moderate effect. In addition, methods and strategies are described for dealing with the most important complications of quantitative variation, including the assessment of genotype x environment interaction and epistasis.

Bias↗

PubMed2026

Pangenomes aid accurate detection of large insertions and deletions from targeted sequencing: the case of cardiomyopathies.

BACKGROUND: Gene panels represent a widely used strategy for genetic testing in a vast range of Mendelian disorders. While this approach aids reliable bioinformatic detection of short coding variants, it often fails to detect many larger variants. Recent studies have recommended the adoption of pangenome references (as opposed to linear reference genomes like GRCh38) to augment detection of large variants from targeted sequencing, potentially providing diagnostic laboratories with the possibility to streamline diagnostic work-ups and reduce costs. METHODS: Here, we analyze 1969 cardiomyopathy cases and 1805 controls sequenced with the Illumina Trusight Cardio panel using a pangenome-based workflow (GRAF) and five conventional orthogonal methodologies (GATK HaplotypeCaller, GATK-gCNV, ExomeDepth, Manta and Lumpy-SV) to detect variants ≥ 20 bp in size. RESULTS: Following lab-based variant validation by means of PCR and Sanger sequencing, we show that GRAF conjugates higher precision and recall (F1 score 0.86) compared with other methods (F1 0-0.57) in detecting potentially pathogenic variants ≥ 20 bp from short-read panel data. Results were complemented by a comparison of the tools' performance in detecting ground truth variants on reference sample HG002 from Genome In A Bottle, which confirmed GRAF to outperform other tools also on exome sequencing (F1 0.97 vs. 0-0.94). Notably, in the HG002 benchmark dataset, GRAF also showed slightly improved performance compared to GATK HaplotypeCaller in the identification of small variants (1-19 bp; F1 0.975 vs. 0.968). CONCLUSIONS: Our results indicate that pangenome-based workflows aid improved detection of large variants from targeted sequencing data in the clinical context and suggest that they may contribute to more unified variant detection frameworks for all-size genetic variants in the future.

Humans↗

PubMed2006

Evidence for the effectiveness of the Early Literacy Support programme.

BACKGROUND: It is widely recognized that effective interventions for poor reading involve training in phoneme awareness and letter-sound knowledge, linked in the context of reading books. From the applied perspective, it is important to gather data on the effectiveness of different forms of implementation of literacy support within this framework. AIM: We evaluate the effectiveness of the UK Early Literacy Support (ELS) programme (Department for Education and Skills [DfES], 2001) relative to a programme of Reading Intervention based on 'sound linkage' (Hatcher, Hulme, & Ellis, 1994). SAMPLE: The sample comprised 128 6-year-old children, from 16 primary schools in a Local Education Authority (LEA) in the north of England. METHOD: The children were nominated as in need of special help by their class teachers and allocated to one of the two programmes. RESULTS: After controlling for a difference in spelling ability at the start of the intervention, it was found that both groups of children made equivalent and significant gains in reading and spelling that were maintained at follow-up. The standardized scores were in the average range. Regression analyses confirmed the importance of initial reading ability as well as letter identification, phoneme manipulation, and sound linkage in predicting progress in learning to read and to spell. CONCLUSION: The ELS programme provides a cost effective method of boosting 6-year-old children's reading to an average level.

Child↗

PubMedDate not supplied

Social class gradients and health in childhood.

OBJECTIVE: To determine if there are social class gradients in health in children aged 6 to 11 years. METHODS: Self and parent reports of health of children in 5 sites across the United States were assessed using the Child Health and Illness Profile-Child Edition. Distribution of scores in 4 domains: satisfaction (with health); comfort; resilience; and risk avoidance were used to create profiles of health. Social class was defined as a composite of parental education and work participation. RESULTS: Social class gradients were found for all but the satisfaction domain and for most subdomains in the parent version; the most notable gradient was in the risk avoidance domain, with better health the higher the social class. Apparent gradients did not reach statistical significance in the child reports. Children from a higher social class were more likely to be in excellent/average health and less likely to be in poor health profiles than were lower class children. CONCLUSIONS: The findings generally mirror those from a prior study of adolescents, using the same conceptual framework for health and the same measure of social class, and are consistent with a cumulative effect for most aspects of health, and with a critical-period effect for risky behaviors.

Child↗

PubMed1986

Baccalaureate education and NCLEX: the causes of success.

A systems framework was used to study the unusual failure rate on the National Council Licensing Examination (NCLEX) experienced by one-third of the 1983 graduates of a Northwestern Bachelor of Science Nursing (BSN) program. The study group included 176 graduates; 28 were nonsuccessful and 148 were successful candidates. All candidates experienced an integrated curriculum in the two-year nursing major. This comprehensive study addressed the conceptual and experiential areas of the curriculum as well as student academic potential and performance. It is one of the first research reports to include the new NCLEX as the dependent variable. Data were analyzed for correlational and causal relationships using regression analysis and tests of statistical inference. Results indicated that graduates who entered the program with low SAT scores, low cumulative and Science GPAs, who scored below the class mean on School of Nursing examinations and whose cumulative grade point averages drifted downward while in the School of Nursing were at a significantly high risk of failing the NCLEX. It was demonstrated that the bulk of the learners attracted to the University program fell in the B to C range of academic performance, some graduates were dissatisfied with faculty teaching skill and methods, as well as with the amount of hands-on experience available either in skills labs or clinical settings. The integrated curriculum used by the School of Nursing, threading concepts across practice areas, also presented a difficulty for students. Overall, the study indicated a concern about whether the avant-garde integrated curriculum and teaching methods used by the School of Nursing met the needs of average learners attracted to the program.

Achievement↗

PubMed2003

Parallel comparison of chronological risk changes among cancers of the breast, the uterine cervix and the stomach, as tested in 9 female populations of the world from early 1960s to mid 1980s: a stochastic study.

The purpose of this study was to investigate comparatively the chronological changes of age-adjusted incidence rate (AAIR) as well as age-specific incidence rate (ASIR) of cancers of the breast (Br), the uterine cervix (Cer) and the stomach (St) from early 1960s to mid 1980s (5 data collections) using the data sets of 9 female populations world wide, the total data set number amounting to 45 per tumor. More specifically, we wanted to see whether or not there was any regular relationship between the differential time trends of the above 3 human neoplasias and their oncogene-tumor suppressor gene balances. Our investigation proceeded in 3 steps as follows: step 1, straight line regression analysis of log AAIR was applied to each of tumor pairs Br(x)-Cer(y), Br(x)-St(y) and Cer(x)-St(y). Step 2, direct successive elimination test (Gauss) of log AAIR was applied to each of 6 tumor pairs (Br-St, Br-Cer, Cer-St, Cer-Br, St-Br and St-Cer) to assess the fitness of a test tumor (x-partaner of fitness test) to either the oncogene type equilibrium model (r=-1.000) or the tumor suppressor gene type equilibrium model (r=+1.000). For each of 6 tumor pairs, the fitness test was repeated 3 times using i) the original data set in the ordinary (x,y) framework, ii) the rect-type data sets in the rect-(x,y) framework, and iii) the para-type data set in the para-(x,y) framework. The fitness of a test tumor (x partner in the calculation) to an equilibrium system was assessed in terms of the correlation coefficient value r within the range of -1.000 to +1.000 (step 3). Staging of the whole carcinogenesis process was attempted for each of 3 human neoplasias using either the ASIR profiles of a high- and low-risk populations, and/or those of early 1960s and mid 1980s. Results of key importance are given as follows: i) Br with rapidly growing cancer risk, Cer with rapidly declining cancer risk and St with slowly declining cancer risk were clearly distinguished from one another by the single regression analysis. ii) The fitness test demonstrated that Br, Cer and St each were found to have one score in the positivity test of oncogene activation (r=-1.000), whereas Br with 4 scores, Cer with 2 scores and St with 3 scores of tumor suppressor gene inactivation (r=+1.000) were found to have differential openness to the fitness test of Gauss for the detection of tumor suppressor gene inactivation. It is indicated that the differential opennesses of a window to tumor suppressor gene inactivation observed in 3 human neoplasias represent a measure of the time-linked aggressiveness of cancer risk. iii) The comparison of 4 ASIR profiles of Br suggested the presence of 3 stages of carcinogenesis progression, of which the 1st stage was tentatively classified as of heredity-dependent origin, and the 2nd and the 3rd stages were classified as of environment-dependent origin. The St ASIR profile represents a fusion product of very minor heredity-dependent stage I and a major environment-dependent stage II. In contrast, the Cer ASIR profile completely lacked a heredity-dependent stage. The integrity of the above findings is discussed in the light of a number of pioneering achievements along the line of the steroid criminal theory of carcinogenesis in humans and in non-human mammals.

Age Factors↗

PubMed1993

Functional status and hope in elderly people with and without cancer.

The relationships and differences in hope and functional status in elderly people with and without cancer were studied to enhance knowledge concerning these patients' quality of life. A conceptual framework was established using Roy's Adaptation Model of nursing and hope was measured as an indicator of adaptation using Miller's Hope Scale (MHS). In addition, functional status was assessed by six domains using the Philadelphia Geriatric Center's Multilevel Assessment Instrument (MAI). The with-cancer group was a convenience sample of 86 patients 65 years of age and older with cancer who were attending an oncology clinic. The without-cancer group consisted of 88 elderly people in the community who perceived their health as good or excellent and who had never been diagnosed with cancer. Using a regression model, physical health was the only MAI domain, along with the demographic variables of income and education, that was related significantly to MHS scores. The results of this study indicate that declining physical health is a threat to hope and that lower socioeconomic status may be a threat to hope; however, age, gender, or a diagnosis of cancer are not.

Activities of Daily Living↗

PubMed1990

A refined linkage map for DNA markers around the pericentromeric region of chromosome 10.

A refined genetic linkage map for the pericentromeric region of human chromosome 10 has been constructed from data on 12 distinct polymorphic DNA loci as well as the locus for multiple endocrine neoplasia type 2A (MEN 2A), a dominantly inherited cancer syndrome. The map extends from D10S24 (at 10p13-p12.2) to D10S3 (at 10q21-q23) and is about 70 cM long. Overall, higher female than male recombination frequencies were observed for this region, with the most remarkable female excess in the immediate vicinity of the centromere, as previously reported. Most of the DNA markers in this map are highly informative for linkage and the majority of the interlocus intervals are no more than 6 cM apart. Thus this map should provide a fine framework for future efforts in more detailed mapping studies around the centromeric area. A set of ordered cross-overs identified in this work is a valuable resource for rapidly and accurately localizing new DNA clones isolated from the pericentromeric region.

Chromosome Mapping↗

PubMed2006

An exploratory mixed methods study of the acceptability and effectiveness of Mindfulness-Based Cognitive Therapy for patients with active depression and anxiety in primary care.

BACKGROUND: Mindfulness Based Cognitive Therapy (MBCT) is an 8-week course developed for patients with relapsing depression that integrates mindfulness meditation practices and cognitive theory. Previous studies have demonstrated that non-depressed participants with a history of relapsing depression are protected from relapse by participating in the course. This exploratory study examined the acceptability and effectiveness of MBCT for patients in primary care with active symptoms of depression and anxiety METHODS: 13 patients with recurrent depression or recurrent depression and anxiety were recruited to take part in the study. Semi-structured qualitative interviews were conducted three months after completing the MBCT programme. A framework approach was used to analyse the data. Beck depression inventories (BDI-II) and Beck anxiety inventories (BAI) provided quantitative data and were administered before and three months after the intervention. RESULTS: The qualitative data indicated that mindfulness training was both acceptable and beneficial to the majority of patients. For many of the participants, being in a group was an important normalising and validating experience. However most of the group believed the course was too short and thought that some form of follow up was essential. More than half the patients continued to apply mindfulness techniques three months after the course had ended. A minority of patients continued to experience significant levels of psychological distress, particularly anxiety. Statistically significant reductions in mean depression and anxiety scores were observed; the mean pre-course depression score was 35.7 and post-course score was 17.8 (p = 0.001). A similar reduction was noted for anxiety with a mean pre-course anxiety score of 32.0 and mean post course score of 20.5 (p = 0.039). Overall 8/11 (72%) patients showed improvements in BDI and 7/11 (63%) patients showed improvements in BAI. In general the results of the qualitative analysis agreed well with the quantitative changes in depression and anxiety reported. CONCLUSION: The results of this exploratory mixed methods study suggest that mindfulness based cognitive therapy may have a role to play in treating active depression and anxiety in primary care.

Adult↗

PubMed2026

From genes to trajectories: mapping genetic influences on Huntington's disease progression.

MOTIVATION: There are many diseases with established genetic factors, such as Huntington's disease (HD), that are characterized by variable rates of progression. However, beyond the contribution of the known genetic factors - in this case the Huntingtin (HTT) gene - the impact of the full human genome on the natural progression of such diseases throughout a patient's life remains largely unknown. The increased availability of genome wide association (GWA) data in HD gene expansion carriers (HDGECs), combined with the clinical assessment scores on the same set of patients, has provided a perfect opportunity to assess the potentially broader genetic impact on the natural progression of HD. RESULTS: We present a genetics-driven, probabilistic disease progression model designed to identify and investigate the ways in which a range of genetic factors affect the natural progression of HD. When applied to a clinico-genomic HD dataset, our model identified several single nucleotide polymorphisms (SNPs) with previously unreported effects on disease progression that act at distinct stages and with varying magnitudes. This discovery may shed light on the potential mechanistic impact of previously unidentified genes on HD that may have implications for clinical management. As increasing amounts of GWA data become available more generally, we anticipate that this modeling framework will be broadly applicable to other diseases with strong genetic components. AVAILABILITY AND IMPLEMENTATION: The source code for IHDPM is available at https://github.com/BiomedSciAI/IHDPM.

Huntington Disease↗

PubMed1996

"Sepsis/SIRS," physiologic classification, severity stratification, relation to cytokine elaboration and outcome prediction in posttrauma critical illness.

OBJECTIVE: To develop a quantitative severity stratification within the framework of a Physiologic State Classification (PSSC) system that can be applied to critically ill post-trauma patients with "sepsis/SIRS" and to relate PSSC to the nature of the plasma cytokine response. MATERIALS AND METHODS: At each study time period, a patient was classified into one of seven physiologic States previously derived from clustering 17 cardiopulmonary and metabolic variables from 338 critically ill patients: R = reference, A = normal stress response, B = metabolic insufficiency, C1 (early) and C2 (late) = respiratory insufficiency, D = cardiogenic insufficiency, H = nonshock hypovolemia. MAIN RESULTS: The PSSC used State data from a developmental set of 159 trauma patients in a logistic model (L2PDEATH) to provide a quantitative index of severity. This severity index was tested on 80 new trauma patients (mean injury Severity Score (ISS) = 27.6, 64% survivors). Using PSSC State distributions for evaluation of enzyme-linked immunosorbent assay (ELISA) measured cytokines interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor (TNF) showed the multicytokine score to be greatest in those C2- and B-State regions associated with a higher severity as measured by L2PDEATH. Compared with ARDEATH of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, L2PDEATH provided a better indicator of severity of sepsis/systemic inflammatory response syndrome (SIRS) for posttrauma patients. CONCLUSIONS: PSSC allows classification of the physiologic and cytokine mediator response to trauma and permits stratification of severity in posttrauma critical illness.

APACHE↗

PubMed2003

Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature.

OBJECTIVE: To identify evidence-based prognostic factors in the subacute phase after a stroke for future residence at six months to one year post stroke. DESIGN: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, PsycLIT and Sociological Abstracts. (2) Reference lists, personal archives and consultation of experts in the field. (3) Guidelines. METHODS: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for future residence; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. RESULTS: From 1027 potentially relevant studies 10 studies involving a total of 3564 patients met the inclusion criteria. No prognostic factor was identified in at least two level A (i.e., a good level of scientific evidence according to the methodological score) studies, our standard for scientific proof. The following factors were found in at least one level A study: low initial ADL functioning, high age, cognitive disturbance, paresis of arm and leg, not alert as initial level of consciousness, old hemiplegia, homonymous hemianopia, visual extinction, constructional apraxia, no transfer to the stroke unit, nonlacunar stroke type, visuospatial construction problems, urinary incontinence and female gender. CONCLUSIONS: At present there is insufficient evidence concerning possible predictors in the subacute stage of stroke to make an evidence-based prediction of the future residence. In the scientific research until now social factors and their contribution to the possibility of living independently have not been investigated, or at least less well. None of the studies in this review described a conceptual framework as basis for the choice of the examined prognostic factors.

Activities of Daily Living↗

PubMed2004

[Evaluation of utilization of preventive services for infants in Israel--personal and organizational determinants].

UNLABELLED: Preventive services for prenatal and child health care were established 85 years ago by Henrietta Szold, president of the Women's Zionist Organization of America. A network of 1200 Mother and Child-Care clinics (known as "Tipat Halav") has developed as a result of this initiative. Preventive services are provided by the Ministry of Health, municipalities and recently, by all four Health Maintenance Organizations (HMO's) in Israel. OBJECTIVES: To assess the utilization and satisfaction of preventive health services during infancy. METHODS: The sample consisted of Jewish and Arab women who gave birth during March 2000. A total of 667 Jewish and 211 Arab mothers were interviewed after their infants reached the age of 15-19 months. The response rate was 92% and 88% respectively. RESULTS: It was found that 96% of the Jewish women and 100% of the Arab women utilized "Tipat Halav" services. Preventive services were provided mainly by the Ministry of Health and municipalities, while HMO's provided service to 15% of the Jewish infants and 19% of the Arab infants. Nine percent of the infants were not, examined by a physician within the framework of the preventive service, but all infants had health supervision by a nurse. Overall, 25% of the Jewish infants and 32% of the Arab infants had 11 or more visits with the nurse. It was observed that mothers with a higher educational level and those with many children began the process of health supervision at a later stage and visited the clinic less frequently. The number of visits to all health services combined, from birth to 15-19 months, was 26 for Jewish and 28 for Arab infants, indicating over-utilization and dependence. However, the performance of hearing and vision tests was inadequate. Referral to orthopedics was 41% for Jewish and 11% for Arab infants. The level of satisfaction with the service was high, with scores mostly above 3.0 out of a maximum of a total of 4.0 points. CONCLUSIONS: The preventive services provided by the different agencies do not differ significantly except in the case of private physicians and voluntary organizations in East Jerusalem, which do not comply with the recommended routines. RECOMMENDATIONS: Our recommendations include raising the compliance and performance of screening tests and defining the policy of referral to orthopedic services. Furthermore, the clinics should provide more outreach to high-risk families in order to optimize their utilization of services and compliance.

Arabs↗