Israel Medical Association Journal

Contamination of food with streptococci could present with unusual outbreaks that may be difficult to recognize in the early stages. This is demonstrated in a large food-borne outbreak of streptococcal pharyngitis that occurred in 2003 in a factory in Israel. The outbreak was reported to the public health services on July 2 and an epidemiologic investigation was initiated. Cases and controls were interviewed and throat swabs taken. An estimated 212 cases occurred within the first 4 days, the peak occurring on the second day. There was a wave of secondary cases during an additional 11 days. The early signs were of a respiratory illness including sore throat, weakness and fever, with high absenteeism rates suggesting a respiratory illness. As part of a case-control study, cases and controls were interviewed and throat swabs taken. Illness was significantly associated with consumption of egg-mayonnaise salad (odds ratio 4.2, 95% confidence interval 1.4–12.6), suggesting an incubation period of 12–96 hours. The initial respiratory signs of food-borne streptococcal pharyngitis outbreaks could delay the identification of the vehicle of transmission. This could be particularly problematic in the event of deliberate contamination.

Background: The Muslim Circassians in Israel represent a unique ethnic community, distinct from Jews and Arabs. This endogamous group has a limited genetic variability that allows studying risk factors associated with type 2 diabetes.

Objectives: To estimate the prevalence of type 2 diabetes among Israeli Circassians and its correlation to obesity and genetic susceptibility.

Methods: Israeli Circassian women (n=450) and men (n=289) older than 35 were included in the study. They were classified as having or not having diabetes, and their risk factors, including hypertension, body mass index, family history of diabetes, and laboratory tests, were examined retrospectively.

Results: The age-adjusted prevalence of diabetes among the 739 participants was 12% (men 14.6%, women 10.7%). It was higher among those with BMI[1] > 30 than in those with lower BMI and a family history of diabetes without high BMI. But the risk of diabetes with BMI > 30 plus a family history was three times higher than when these factors were missing (odds ratio 2.96, 95% confidence interval 1.30–6.6). Multivariate analysis, however, found familial history of diabetes to be the strongest risk factor, independent of obesity (OR[2] 2.47, 95% CI[3] 1.45–4.20).

Conclusions: The results yielded by this homogeneous Circassian population, sharing the same environmental influences and having an endogamous pattern of marriage, suggest a role of genetic risk factors for diabetes. Israeli Circassians are suitable for additional genetic studies that may lead to the identification of susceptibility genes for type 2 diabetes.

Background: Israeli youth lead 27 western countries in dieting. The prevalence of eating disorders has been rising in the last 30 years, causing social problems and medical complications.

Objectives: To examine the prevalence of eating disorders among high school students in a region in northern Israel (Misgav) and to examine the relationship between the parents' employment status and the subject’s eating disorder.

Methods: A structured questionnaire was administered to collect demographic data. The short version of the Eating Attitudes Test (EAT-26) was used to evaluate the subject’s attitudes toward and preoccupation with food, dieting, eating, physical appearance, and personal control over eating.

Results: Of 360 students approached, 283 (78%) completed the self-report EAT-26. One of every 5 females and one in every 20 males had an abnormal eating attitude. The rate of pathologic EAT-26[1] results, 20.8%, falls within the high range of similar community-based samples of female adolescents. There were no differences in EAT-26 score between students with an employed or unemployed mother; however, there was a trend for higher EAT-26 scores among those whose father was unemployed (21.4% vs. 12.7%, c²  = 0.14).

Conclusions: The findings support our hypothesis of a relatively high rate of abnormal eating attitudes (as reflected by high EAT-26 score) in this population. Another possible risk factor is having an unemployed father, which warrants further research and attention. Our next step is to introduce an intervention program in the school and to study its effect.

Background: Anti-influenza vaccination has proven cost-effective for society. In Israel, however, vaccination rates remain relatively low in comparison to other countries.

Objectives: To analyze the socioeconomic and health status factors affecting the decision to be vaccinated against flu and to compare these factors to results from other countries in order to determine which segments of the adult population should be targeted for increased coverage in influenza vaccination programs.

Methods: Our source was the 1999/2000 Health Survey of the Central Bureau of Statistics for the group aged 25 and above, comprising 16,033 individuals. We used statistical methods such as the Probit regression model to estimate the effects of socioeconomic and health status variables on the decision to get a flu shot. The variables included gender, age, marital status, education, ethnic origin, religious affiliation and housing density, as well as chronic illnesses, smoking, hospitalizations, membership in health management organizations and kibbutz membership.

Results: Our findings indicate that being a post-1990 immigrant from the former Soviet Union, living in a densely populated house, being unmarried and smoking heavily are important factors in predicting the decision not to be vaccinated. In contrast, chronic illness, previous hospitalizations, older age, and kibbutz membership have a positive effect on the decision to take the vaccine.

Conclusions: It is necessary to identify the socioeconomic and health variables marking population sectors that are less likely to be vaccinated in order to design a suitable policy to encourage vaccination.

Background: The rate of trauma in the elderly is growing.

Objectives: To evaluate the characteristics of non-hip fracture-associated trauma in elderly patients at a level I trauma center.

Methods: The study database of this retrospective cohort study was the trauma registry of a level I trauma center. Trauma patients admitted from January 2001 to December 2003 were stratified into different age groups. Patients with the diagnosis of hip fracture were excluded.

Results: The study group comprised 7629 patients. The non-hip fracture elderly group consisted of 1067 patients, 63.3% women and 36.7% men. The predominant mechanism of injury was falls (70.5%) and most of the injuries were blunt (94.1%). Injury Severity Score was found to increase significantly with age. The average mortality rate among the elderly was 6.1%. Age, ISS[1], Glasgow Coma Score on admission, and systolic blood pressure on admission were found to be independent predictors of mortality.

Conclusions: Falls remain the predominant cause of injury in the elderly. Since risk factors for mortality can be identified, an effective community prevention program can help combat the future expected increase in morbidity and mortality associated with trauma in the elderly.

Premature very low birth weight (< 1500 g) infants are one of the largest groups receiving parenteral nutrition. PN[1] should be optimized to answer their large nutritional requirements and suit their metabolic status, but should also be validated pharmaceutically. PN can be provided as a standard, usually commercial, formulation, representing the average needs of a large group of patients. Alternatively, an individualized PN compound adapted to the patient's needs can be prescribed and prepared, usually on a daily basis. The main advantage of individually prescribed PN is that it is tailored to suit a specific patient, thereby assuring the best possible nutrition and biochemical control. Batch-produced standardized PN bags can be readily available as ward stocks in neonatal intensive care units, enabling initiation of early PN immediately after the delivery of a premature infant. Moreover, standard PN solutions incorporate expert nutritional knowledge and support. A combination of standardized PN bags, prepared under strict standardization criteria, for most neonates, with a small number of specifically tailored individualized PN formulations for those in need for them, could reduce pharmacy workload and costs, and increase safety, while maintaining the desired clinical flexibility. For those in need of the individualized PN formulations, a computerized ordering system can save time, decrease prescription and compounding errors, and improve quality of nutritional care.