A. Kesler, P. Pianka, E. Rubinow, Y. Segev and N. Bornstein.
E. Kitai, S. Vinker, L. Halperin, A. Meidan and E. Grossman
Background: Recently the Joint National Committee (7th report) introduced the term “pre-hypertension.” Little is known on its prevalence in the general population.
Objectives: To assess the prevalence of pre-hypertension in a large national cohort.
Methods: We analyzed the database of all ≥ 18 year old members of Leumit Health Services, one of the four health management organizations in Israel, from which we retrieved the recorded blood pressure levels. Pre-hypertension was defined according to the JNC-7[1] criteria.
Results: Of the 426,033 subjects 18.6% had a diagnosis of hypertension or used antihypertensive medications. Only 40.8% of the other 346,799 subjects had had their BP[2] measured in the preceding 2 years. BP recording rates were higher in females than in males (45.1% vs. 36.3%) and higher in elderly subjects than in young subjects (56% aged 66–75 years vs. 32% aged 18–25). Pre-hypertension was observed in 80,625 (23.2%) of the 346,799 while only 56,113 (16.2%) had normal BP records. The prevalence of pre-hypertension increased with age (13.3% aged 18–25 vs. 44.8% aged 66–75), and was more prevalent in men than in women (24.0% vs. 22.5%).
Conclusions: BP levels among young people are low, even though the prevalence of pre-hypertension in this population may be high. Thus, more emphasis should be given to routine BP measurements and confirmation of the findings in all age groups.
B. Chazan, R. Ben Zur Turjeman, Y. Frost, B. Besharat, H. Tabenkin, A. Stainberg, W. Sakran, R. Raz
Background: The association between antibiotic use in the community and antimicrobial resistance is known. Attention has recently focused on the type of agents being prescribed.
Objectives: To implement, evaluate and compare the efficacy of two community interventions programs – continuous versus seasonal medical education – oriented to primary care physicians with emphasis on appropriate use of antimicrobial drugs.
Methods: From October 2000 to April 2003 we conducted two interventions: a) a monthly educational campaign in selected clinics promoting appropriate diagnosis of common infectious diseases and prudent antibiotic use (continuous intervention group); and b) a massive educational campaign, conducted before two consecutive winters, promoting the judicious use of antibiotics for treating respiratory infections (continuous intervention group and seasonal intervention group). Sixteen similar clinics were randomized (8 to each group). The total antibiotic use was measured as defined daily dose/1000 patients/day, and compared between the groups.
Results: The total use of antibiotics decreased between 1999-2000 and 2002-2003 in both groups, but slightly more significantly in the continuous intervention group. The DDD/1000 patients/day for the seasonal group in 1999-2000 was 27.8 vs. 23.2 in 2002-2003; and for the continuous group 28.7 in 1999-2000 vs. 22.9 in 2002-2003, a reduction of 16.5% and 20.0% respectively (p<0.0001). The main change in antibiotic use was noted for broad-spectrum antibiotics.
Conclusions: We present a successful community intervention program aimed to reduce unnecessary antibiotic use. Amplification of this type of intervention is imperative to stop the increase in antimicrobial resistance.
U. Givon, N. Sherr-Lurie, A. Schindler, A. Blankstein and A. Ganel
Background: Fractures of the femur in neonates are relatively uncommon. The infants feel pain and discomfort, causing parental distress, and the hospital stay is longer. Treatment of this specific fracture is problematic because of the small size of the baby.
Objectives: To review the results of the treatment of neonatal femoral fractures.
Methods: We retrospectively reviewed all neonatal fractures of the femur during a 12 year period. Thirteen fractures of the femur in 11 babies were treated with improvised Bryant skin traction of both legs. All the patients were re-examined after a mean follow-up period of 5.2 years.
Results: All fractures healed satisfactorily clinically and radiographically, with no residual deformity, no leg length discrepancy and no functional impairment.
Conclusions: Bryant’s traction for 2–3 weeks in hospital is a safe method for the treatment of femoral fractures in neonates, and the outcome is good.