Israel Medical Association Journal

Background: General hospital staff are often required to care for physically ill patients who arouse concern regarding risk of harm to themselves or others. Some of these patients will receive one-to-one "constant observation." This is the first Israeli study of general hospital patients with high risk behavior.

Objectives: To examine a population of general hospital patients whose behavioral management required the use of constant observation. Demographic and clinical parameters including physical diagnoses were examined, and risk factors for constant observation were identified. The findings of this study were compared to findings in previous studies.

Methods: This prospective observational study examined 714 inpatients referred for psychiatric consultation; 150 were found to require constant observation, and 156 who did not served as a control group.

Results: In this study younger age, suicidal concerns and alcohol/substance abuse were identified as risk factors for ordering constant observation. Ischemic heart disease and chronic obstructive pulmonary disease were the only physical diagnoses found to be significantly correlated with a longer duration of observation, regardless of admission duration. Constant observation was less frequently used in the management of organic brain syndrome patients in this study compared to other studies.  

Conclusions: Some of our results (predictive factors for constant observation) confirmed the findings of overseas studies. Our finding that a diagnosis of organic brain syndrome was not a predictive factor for constant observation was unexpected and requires further investigation. The correlation between a diagnosis of ischemic heart disease or COPD[1] and duration of observation has not been reported previously and warrants further studies.  

Research findings have shown the protective effect of religiosity – among both Christians and Israeli Jews – in terms of morbidity and mortality. To explore the relationship between religiosity and health behavior as a possible explanation for these findings we conducted 3056 telephone interviews, representing the Israeli adult urban Jewish population. Health status, health behavior, frequency of medical checkups, and eating habits were measured. Logistic regressions were used to estimate the religiosity gradient on health behavior, controlling for other personal characteristics. We found a lower prevalence of stress and smoking among religious persons; we also found that religious women exercise less than secular women and that religious people – both men and women – are more obese than their secular counterparts. While no religiosity gradient was found with relation to the frequency of blood pressure, cholesterol and dental checkups, religious women are less likely to undergo breast examinations and mammography. Finally, religious people generally follow a healthier dietary regime, consuming less meat, dairy products and coffee, and much more fish. The lower smoking rates, lower levels of stress, and the healthier dietary regime are consistent with the previously shown longer life expectancy of religious people; however, obesity might become a risk factor in this community.

Background: The patient package insert, an information leaflet included by law in the packaging of prescription drugs, contains information for the user on the specific medication.

Objectives: To explore how patient information leaflets influence patient anxiety and adherence.

Methods: A prospective cohort study was conducted in the practices of 15 family physicians. All patients receiving a new prescription for antibiotics, analgesics or antihypertensives were included. Physicians completed a questionnaire containing demographic data, assessment of the patient’s anxiety, a prediction about adherence to the treatment, and response to the information leaflet. Patients were contacted by telephone for a follow-up structured interview. Patients' reactions to the information leaflet, adherence to treatment, and use of other sources of information on medication were assessed.

Results: The study group comprised 200 patients. The patient information leaflet was read by 103 of them (51.5%). A higher educational level and a chronic medication were associated with reading the leaflet (P = 0.02 and 0.01 respectively). In 36 (34.9%), an increase in anxiety was reported after reading the leaflet. Among those who read the leaflet, 9.7% had decreased adherence. Patients who stated that reading the leaflet caused anxiety were more likely to reduce their use of the medication – 7/36 (19.5%) vs. 3/67 (4.5%), P = 0.01.

Conclusions: The proportion of patients reading the drug information leaflet is about 50%, lower than that found in previous studies. Reading the leaflet did not greatly affect adherence but aroused anxiety and decreased adherence in some patients.
 

Background: Healthcare behavior occurs within the context of the family unit. Little research has investigated the influences among adult family members regarding their use of medical care services.

Objectives: To investigate the effects of maternal attendance patterns and maternal self-assessed health status on those of adult children.

Methods: This study was a retrospective cohort, analyzing both patient records for physician visits and mailed self-administered questionnaires regarding subjective health assessment. We evaluated a unique study group of multi-generational families with free and equal access to medical services at a primary care kibbutz clinic in Israel. This enabled an exclusive focus on the association between the use of healthcare by mothers and their grown children.

Results: Controlling for the subjects' age, gender and number of chronic diagnoses, a significant association exists between the family physician visit rates of a mother and those of her grown offspring (P = 0.03). Low self-health assessment is associated with higher levels of physician utilization (P = 0.003). Maternal self-health evaluation is associated with her adult children's own self-health evaluation (odds ratio 5.9, P = 0.04) and their rates of physician utilization (one additional offspring visit per year for low maternal self-health, P = 0.02).

Conclusions: A mother’s behavior patterns measured via self-rated health status and physician visit rates serve as a proxy for maternal attitudes regarding healthcare, and these attitudes are possibly imparted to her children for life. This study provides unique evidence for a maternal health behavior effect on grown children, and enables a more complete understanding of families attending the primary care clinic.
 

Background: Israel, as a country of immigration, has a heterogeneous distribution of risk for human immunodeficiency virus. Therefore, general population-based surveys of sexual behaviors among young adults may be useful for guiding prevention policy. To the best of our knowledge, the present survey is the first one among Israeli adults ever published.

Objectives: To survey knowledge, attitudes and practices regarding sexually transmitted infections in Israeli adults in order to target the future AIDS public campaigns for the general population.

Methods: A national sample of 800 individuals, aged 18–45, was interviewed telephonically in September 2000.

Results: The average number of sexual partners reported in the previous 3 months was 1.3. Accurate knowledge on HIV[1] transmission modes was expressed by 99% of respondents for unprotected sexual intercourse, 97% for re-use of needles and syringes, and 85% for mother-to-child infection. However, incorrect notions on transmission were also prevalent (34% for insect bites, 29% for kissing and 21% for public toilets). Prevention of STIs[2] and prevention of pregnancy were the most common reasons for using condoms (72–73%); HIV prevention was the motivation for 39%. Fifty percent of single individuals without steady partners always/usually used condoms. It was decided that women need empowerment to negotiate condom use.

Conclusions: Gaps were found between knowledge (at high level), attitudes (perceiving greater risk for others than themselves) and behavioral practices (combining low level of partner exchange with widespread disregard for safe sex). Promptly implemented, these findings will serve as a baseline for further surveys.

Behavioral genetics is the identification of behavioral traits that are genetically determined, the identification of the genes that are involved, and the discovery of modes of intervention to alter the expected course of the disease. Unlike the classical Mendelian traits, many specific aspects of behavior are, in part, determined by several genes. The corresponding abnormalities of behavior or deficiencies are therefore polygenic. New genetic techniques are leading to the discovery of these genes, and the techniques and knowledge developed in the Human Genome Project make it possible to screen the genome of any individual for the presence of known polymorphisms. This raises great hopes for diagnosis and the individualization of therapy. However, the genetic prediction of unacceptable behavior can further lead to social and occupational discrimination and enforced therapy. This raises serious concerns about how this information will be collected and who will have access to it.

Background: The threat to the individual’s physical integrity and well-being as well as to those of significant others, the disruption of normal patterns of life, and property losses make wartime a highly stressful condition.

Objectives: To assess the level of psychological distress in primary care attenders in a district of Jerusalem (Gilo) that experienced long-term exposure to gunfire.

Methods: A self-administered questionnaire exploring emotional distress (anxiety and depression symptoms), fire exposure, patterns of help-seeking behavior, and prescription of sedative or hypnotic drugs was administered to a sample of 125 consecutive attenders to a general practitioner during a 10 week period in the autumn of 2001. Eighty-four attenders residing in Gilo were compared with 41 attenders residing in neighborhoods that had not been under fire. T-tests and Mann-Whitney two-sample tests were used to determine statistical significance of differences.

Results: The mean distress score was significantly higher among the Gilo residents than among their counterparts in other neighborhoods (1.1 ± 0.8 vs. 0.8 ± 0.5, t = 1.73, P <0.01); 15.5% of the former reported probable clinically significant distress. Emotional distress was associated with periods of intensive gunfire exposure, psychological care-seeking behavior, and the prescription of sedative or hypnotic drugs. No significant differences in distress levels were found between those living in zones of Gilo that were at differential gunfire risk, nor between those whose houses and cars were or were not damaged.

Conclusions: War-related life events would seem to be associated with elevated emotional distress. A motivated primary care physician could easily and reliably ascertain the attenders’ psychological status and identify those requiring psychological support. These identification and intervention stages are facilitated if the specialized services are community-based.

Background: Alternative medicine use is increasing worldwide and the associated expenditures are significant. In Israel 19% of patients who consulted their family physician had also sought treatment by an alternative medicine practitioner.

Objectives: To explore the correlation between different modalities of healthcare utilization, health behavior, and health belief among adult members of a kibbutz. This unique study population enabled the use of a simplified quantitative model due to the minimal individual differences in cost and access.

Methods: Healthcare utilization data were obtained for 220 kibbutz members aged 15–70 years from patient medical files and self-administered questionnaires over a 45 month period. Patient visits to the family practitioner and other specialist physicians were tallied, and individuals reported alternative medicine consultations during the previous year. Multiple regression analysis was used to control for age, chronic disease, and other background characteristics.

Results: The mean number of patient FP visits was 3.6 per patient per year. Women and chronic disease sufferers visited the doctor more frequently. A patient’s number of FP visits and other specialist physician visits were closely correlated, with each specialist physician consult resulting in an additional 0.64 FP visit for a given individual (P=0.007). Our analysis indicated that self-reported alternative therapy utilization was positively associated with the number of FP visits; patients reporting alternative therapy use visited their primary care physician once additionally per year (P=0.03). Low self-rated health status was correlated with increased likelihood of alternative therapy use (borderline significance).

Conclusion: These results suggest that a patient who seeks treatment from one type of healthcare practitioner will seek out other practitioners as well. This study supports the notion that unconventional therapies are used in conjunction with, rather than instead of, mainstream medical care.