Daniel Chemtob, MD, MPH, DEA, Leon Epstein, MD, MPH, Paul E. Slater, MD, MPH and Daniel Weiler-Ravell, MD
Background: Sensing an inadequacy of tuberculosis control due to an influx of TB associated with immigration, we analyzed TB treatment outcome in Israel by population groups.
Objectives: To provide an epidemiological basis necessary for any new national TB control policy, and to bring it to the attention of the medical profession in Israel and abroad since its results led to a change in Israel’s TB control policy.
Methods: We reviewed all TB cases notified during the period 1990 to September 1992. New cases” (820 cases, 93.5%) and “re-treatment cases” (57 cases, 6.5%) were analyzed according to three mutually exclusive groups: “successful outcome,” “death” and “potentially unsatisfactory outcome” (according to WHO/IUATLD definitions).
Results: Of 820 “new cases,” 26.6% had a satisfactory outcome,” 68.5% had a “potentially unsatisfactory outcome” and 4.9% died compared to 47.4%, 45.6% and 7% among 57 “re-treatment cases,” respectively. Using logistic regression analysis, outcome was associated with the district health office (P<0.0001), the TB experience” of the notifying clinic (P<0.0001), and the form of TB (P=0.02). No significant relationships were obtained for population groups, gender and age, interval between arrival in Israel and TB notification, and bacteriological results.
Pesach Shvartzman, MD, Howard Tandeter, MD, Aya Peleg, MD, Hava Tabenkin, MD, Nakar Sasson, MD and Jeffrey Borkan, MD, PhD
Background: Lower urinary tract symptoms are highly prevalent in older men, have been shown to affect men’s quality of life, and may be associated with more serious outcomes.
Objectives: To determine the prevalence of LUTS among men aged 50 years or older registered at family practice centers in Israel and to assess the effect of these complaints on different aspects of their life.
Methods: In a random sample cohort of men aged 50 years and older, fluent in Hebrew, drawn from those registered in four family clinics in Israel, patients identified with LUTS were interviewed by phone using a structured questionnaire.
Results: The prevalence of LUTS in our study was 21%. Less than a third of these patients had low severity LUTS (28%), 59% were rated moderate, and 13% had severe symptoms. Age had a positive correlation with the severity of LUTS, and increasing severity of symptoms had a negative effect on the daily function and quality of life of patients.
Conclusions: Our community-based study shows that LUTS is a common finding among men above the age of 50 (21%) and has a significant negative effect on their quality of life and daily function. Knowledge of these data should make primary care physicians more aware of this common problem and thus improve the treatment and quality of life of these patients by better identification and prompt treatment.
Manuel Katz, MD, Sheila S. Warshawsky, MSc, Avi Porat, MD and Joseph Press, MD
Background: Appropriateness of hospital admission has both clinical and economic relevance, especially in light of the growing pressure for increased efficiency of health services utilization. In Israel, the number of referrals and use of the emergency room continue to rise along with an increase in hospital admissions and the number of inappropriate admissions. Using evaluation protocols, such as the Pediatric Appropriateness Evaluation Protocol, international studies have shown that 10-30% of hospital admissions are medically unnecessary. Inappropriate hospitalizations have an economic impact as well as medical and psychological effects on the child and the family.
Objectives: To assess the extent and characteristics of inappropriate pediatric admissions to a tertiary care facility in Israel.
Methods: We conducted a prospective study using chart review of pediatric admissions to Soroka University Medical Center on 18 randomly selected days in 1993, and evaluated the appropriateness of admissions using the PAEP.
Results: Of the 221 pediatric admissions 18% were evaluated as inappropriate. The main reason for such an evaluation was that the problem could have been managed on an ambulatory basis. Inappropriate admissions were associated with hospital stays of 2 or less days, children older than 1 year of age, Jewish children, and self-referrals to the pediatric emergency room.
Conclusions: The assessment and identification of characteristics of inappropriate hospital admissions can serve as indicators of problems in healthcare management and as a basis for improving quality of care and developing appropriate medical decision-making processes.
Rachel Dankner, MD, MPH, Dipl Sports Medicine, Giora Kaplan, MA and Vita Barell, BA
Background: Israel lacks a systematic surveillance of sports injuries, and knowledge of risk factors and specific patterns of injury is inadequate. In order to promote prevention of sports-related injuries, the magnitude of the problem must first be identified and the incidence and severity of sports injuries described.
Objective: To conduct a survey on previous sports injuries among a sample of Israeli athletes.
Methods: A convenience sample of Israeli amateur athletes participating in the 1997 15th Maccabiah Games was randomly selected. The study group answered an anonymous self-administered questionnaire that included sociodemographic data, and information regarding their sports activity and sports-related injuries that had occurred during the previous 2 years.
Results: The study group, aged 12-3 years (median age 21), comprised 301 consenting athletes in 28 different sports. Of these athletes 56.1% reported having had at least one injury. Most injuries (75.6%) involved the upper and lower extremities, and 37.8% of the injured sportsmen had received medical attention from a physician. Half of the athletes participated in contact sports - both collision and limited impact. This group had a much greater proportion of reported injuries in all age groups.
Conclusion: Surveillance of sports injuries should be expanded in order to develop appropriate prevention programs in Israel.