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.
Boaz Meijer, MD, David Branski, MD and Eitan Keren, MD
Background: Prevention of cigarette smoking is an important issue in public health policy. Since most adult smokers began smoking in childhood, understanding behavorial factors associated with smoking initiation would contribute to smoking initiation programs. Health-related behavior may vary between different ethnic groups.
Objectives: To determine the prevalence of smoking among Jewish and Arab adolescents in Jerusalem, and whether there are differences in smoking initiation between the two ethnic groups.
Methods: We carried out a cross-sectional survey of all students in the 6th to 11th grades (age range 11-17 years) of a Jewish school and an Arab school in the Jerusalem area, using an anonymous self-completion questionnaire. A total of 791 questionnaires was analyzed, 479 from the Jewish students and 312 from the Arab students.
Results: The lowest prevalence of smoking was found among Arab female students and the highest among Jewish female students (9% vs. 41%, P<O.OO1). The prevalence of smoking among Jewish and Arab males was similar. More Arab female students smoked than their mothers. Peer pressure seemed to be a more important factor among Jewish students.
Conclusions: This study demonstrated the presence of ethnic differences in smoking prevalence and the reasons for smoking among adolescents in Israel. These results suggest the need for specific smoking prevention policies for different ethnic groups.
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.
Michael D. Lockshin, MD
Autoimmune diseases are said to have high female/male (F/M) ratios, but these ratios are imprecise. Published definitions and classifications of autoimmune diseases differ substantially, as do the F/M ratios themselves. Imputed causality of auto-immune diseases requires better precision. Some thyroid, rheumatic and hepatic diseases consistently have high F/M ratios, but marked differences exist in the reported quantity of the ratios. Other autoimmune diseases have low F/M ratios. Because F/M ratios reflect incidence and not severity of disease, gonadal hormones, if they play a role, must do so through a threshold or permissive mechanism. Sex differences related to environmental exposure, X-inactivation, imprinting, X or Y chromosome genetic modulators, and intrauterine influences remain as alternate, theoretical, explanations for sex differences of incidence. The epidemiology of the sexdiscrepant autoimmune diseases - young, female - suggests that an explanation for sex discrepancy lies in differential exposure, vulnerable periods, or thresholds, rather than in quantitative aspects of immunomodulation.
Yosef S. Haviv, MD and Jerry Blackwell, PhD
Michael Mullerad, MD, Tzipora Falik, MD, Ralph Madeb, MD and Ofer Nativ, MD
Howard Carp, MB, BS, FRCDG
Alberto Kurzbaum, MD, Claudia Simsolo, MD, Ludmilla Kvasha, MD and Arnon Blum, MD
Guy Vogel, MD, Abraham Ganel, MD and Moshe Salai, MD
Leonid Feldman, MD, Anna Basok, MD, Leonid Kachko, MD and David Tovbin, MD
Mehrdad Herbert, MD, Michael Segal, MD, Gratiana Hermann, MD and Judith Sandbank, MD
by Rasmi Megadle, MD, Paltiel Weiner, MD, Alexander Sotzkover, MD, Miri Mizrahi-Reuveni, MD and Noa Berar Yanay, MD
Alexandra Osadchy, MD, Rivka Zissin, MD and Myra Shapiro-Feinberg, MD