Menashe N. Mukamel, MD, Yosef Weisman, MD, Raz Somech, MD, Zipora Eisenberg, MSc, Jacob Lanman, MD, Itzhak Shapira, MD, Zvi Spirer, MD and Uri Jurgenson, MD
Background: The modest clothing that Orthodox Jewish women wear exposes very little of their skin to sunlight. Under these conditions they may develop vitamin D deficiency, even in sunny Israel.
Objectives: To determine and compare the vitamin D nutritional status in Jewish orthodox mothers to that of non-orthodox mothers who live in the same metropolitan area in Israel.
Methods: 25-Hydroxyvitamin D was measured by competitive protein-binding radioassay in the sera of 341 Jewish Israeli mothers (156 orthodox and 185 non-orthodox). The sera were obtained 48-72 hours after childbirth during the late summer of 1998 and the spring of 1999.
Results: The mean (SD) serum concentration of 25-OHD was significantly (P<0.002) lower (13.5 ± 7.5 ng/ml) in the orthodox than in the non-orthodox mothers (18.6 + 9.6 ng/ml). Vitamin D deficiency (<5 ng/ml) and insufficiency (<10 ng/ml) were more common in the orthodox mothers (5.1% and 32.7% respectively) than in the non-orthodox mothers (2.7% and 13%, respectively). In subgroups of mothers supplemented with 400 units of vitamin D daily during pregnancy, vitamin D deficiency and insufficiency were less common (2.2% and 13%, respectively) in orthodox and non-orthodox mothers (0% and 8.1%, respectively). Vitamin D insufficiency was more common in the winter than in the summer only among nonorthodox mothers.
Conclusions: The high prevalence of vitamin D deficiency and insufficiency in Israeli mothers raises the question whether vitamin D supplements should be given to pregnant women in Israel, at least to orthodox mothers.
Haim Reuveni, MD, Shifra Shvarts, PhD, Joachim Meyer, PhD, Asher Elhayany, MD, MPA and Dan Greenberg, MSc
Background: On 1 January 1995 a new mandatory National Health Insurance Law was enacted in Israel, The new law fostered competition among the four major Israeli healthcare providers (HMO5 or sick funds) already operating in the market due to the possibility that an unlimited number of patients and the relative budget share would shift among the HMOs. This led them to launch advertising campaigns to attract new members.
Objectives: To examine newspaper advertising activities during the early stages of healthcare market reform in Israel.
Methods: Advertising efforts were reviewed during a study period of 24 months (July 1994 to June 1996). Advertisements were analyzed in terms of marketing strategy, costs and quality of information.
Results: During the study period 412 newspaper advertisements were collected. The total advertising costs by all HMOs was approximately US$4 million in 1996 prices. Differences were found in marketing strategy, relative advertising costs, contents and priorities among the HMOs.
Conclusions: The content of HMO5 newspaper advertising was consistent with their marketing strategy. The messages met the criteria of persuasive advertising in that they cultivated interest in the HMOs but did not provide meaningful information about them. Future developments in this area should include consensus guidelines for advertising activities of HMOs in Israel, instruction concerning the content of messages, and standardization of criteria to report on HMO performance.
Alessandra Della Rossa, MD, Antonio Tavoni, MD, Chiara Baldini, MD and Stefano Bombardieri, MD
Mixed cryoglobulinemia is a systemic vasculitis described as a triad characterized by purpura, weakness and arthralgias. Since the first description of the disease in 1964 by Meltzer and Franklin our understanding of its pathogenesis has increased considerably. The striking association of the disease with hepatitis C virus infection was initially noted in 1990. Since then, the disease has gained growing attention among investigators involved in the study of autoimmune systemic disorders because it represents one of the most intriguing models of autoimmunity triggered by a virus. Nonetheless, a number of answered questions still remain to be resolved and are reviewed in this article.
Nirit Lev, MD and Eldad Melamed, MD
Philipp von Landenberg, MD and Yehuda Shoenfeld, MD
In diagnosing sepsis the rapid identification of bacteremia at an early stage of the disease is critical for a favorable outcome. Furthermore, it is important that exact information on the stage of the disease be obtained rapidly in order to choose and initiate the appropriate therapy. In recent years many new techniques have been added to the diagnostic tools. In this review we will focus on three new methods for the early diagnosis of sepsis. These are: polymerase chain reaction, which offers the possibility to attain detailed information about the involved bacterial (or viral) species, and the laboratory markers procalcitonin and hypophosphatemia, which are indicators of the presence of infection with gram-negative bacteria. The approaches reviewed here were developed to expedite the diagnosis of especially early sepsis and might be a further step towards the improvement of therapy for sepsis.
Hanna J. Garzozi, MD, Nur Shoham, MD, Hak Sung Chung, MD, PhD, Larry Kagemann, MS and Alon Harris, PhD
Carmi Bartal, MD, Maximo Maislos, MD, Doron Zilberman, MD and Emanuel Sikuler, MD
Jacob Gilad, MD, Abraham Borer, MD, Dafna Hallel-Halevy, MD, Klaris Riesenberg, MD, Michael Alkan, MD and Francisc Schlaeffer, MD
Anna Basok, MD, Alla Shnaider, MD, David Tovbin, MD and Boris Rogachev
Shmuel Shilo, MD, Yodphat Krausz, MD, Constantin Reinus, MD and Uzi Beller, MD
Doron M. Behar, MD, Shimon A. Reisner, MD and Haim Ben-Ami
Shahr Lavi, MD and Giris Jacob, MD, DSc
Stacey Spivack, MD, Elliot Kalker, MD, David Samuels, MD and Dan E. Orron, MD