Israel Medical Association Journal

Background: Religiosity has been examined as a mechanism of stress management. Since many studies have shown a high rate of psychological morbidity among medical students during different stages of training, it is important to investigate whether religiosity may serve as a protective factor.

Objectives: To assess the association between religiosity and depression or anxiety in a sample of medical students and to compare the results with a matched sample of students from other fields of study.

Methods: This cross-sectional study examined a sample of Tel Aviv University medical students and compared them with students in other faculties at the same university for any association between religiosity and depression or anxiety. The subjects completed the Beck Depression Inventory, the Beck Anxiety Inventory, a modified religiosity inventory, and a demographic and psychosocial variables inventory.

Results: Findings did not show a significant association between religiosity and depression or anxiety in the general sample (n=119). A positive significant correlation between religiosity and anxiety was found among medical students, with 29.4% of them reporting anxiety and 25.2% depression. While high rates of depression and anxiety were reported by students in the first to third years (pre-clinical years), there was a decrease in depression and anxiety in the fourth to sixth years (clinical years). However, higher anxiety and depression scores were noted among controls as compared to medical students.

Conclusions: In contrast to another recent investigation, a negative correlation between religion and depression/anxiety does not necessarily exist. An association between religiosity and mental health could have many theoretical and practical implications and requires further investigation. Similar to previous studies, the rates of depression and anxiety among Israeli medical students were comparable with those of other countries. These rates are considered higher than those in the general population and emphasize the importance of alertness to mental health issues among students, especially during the early study years.
 

Background: Pathologic breast conditions are rare in childhood and adolescence. The spectrum of breast disease in the pediatric age group is different from that in adults, and most lesions are benign

Objectives: To describe the causes and characteristics of breast asymmetry in adolescents with normal endocrine profiles and sexual development.

Methods: The files of patients with a diagnosis of breast asymmetry referred to a tertiary pediatric center from 1990 to 2007 were reviewed for history and findings on physical examination with or without imaging, treatment and outcome.

Results: Eleven patients aged 12.5 to 18 years were identified. The cause of the breast asymmetry was traced to unpreventable medical factors in eight patients (physiologic, Poland anomaly, scleroderma), preventable/iatrogenic factors in two patients (chest tissue biopsy, thoracic drain), and possible combined medical-iatrogenic factors in one patient (scoliosis treated by a body brace). All patients were referred for breast reconstruction after full breast development.

Conclusions: Severe breast asymmetry in adolescence may be due to congenital factors, diseases involving the breast tissue, or to the effects of medical treatment, and may have severe adverse psychological and social implications. To prevent iatrogenic breast asymmetry, physicians should be made aware of the sensitivity of the breast tissue and should avoid unnecessary tests/procedures that involve the chest wall. In most cases a precise medical history and physical examination can differentiate between physiologic and non-physiologic causes.

Background: Although the comprehensive evaluation of the fetal heart includes echocardiography by an experienced pediatric cardiologist, economic constraints sometimes dictate the need to select patients.

Objectives: To analyze the usefulness of fetal echocardiography in the detection of congenital heart disease according to the referral indication.

Methods: This retrospective survey relates to all 3965 FE studies performed in our center from January 2000 to December 2004. The diagnosed cardiac anomalies were classified as significant and non-significant malformations. All FE[1] studies were done by a single operator (A.L.) at Meir Medical Center, a referral center for a population of about 400,000. The 3965 FE studies were performed for the following indications: abnormal obstetric ultrasound scans, maternal and family history of cardiac malformations, medication use during the pregnancy, and maternal request. The relative risk of detecting CHD[2] was calculated according to the various referral indications.

Results: Overall, 228 (5.8%) cases of CHD were found. The most common indication for referral was suspicion of CHD during a four-chamber view scan in a basic system survey or during a level II ultrasound survey. No correlation was found between maternal age and gestational age at the time of scanning and the likelihood of finding CHD.

Conclusions: Our data suggest that a suspicious level-II ultrasound or the presence of polyhydramnios is an important indication for FE in the detection of significant CHD.

Background: Subcutaneous allergen immunotherapy is effective in treating allergic airway disease. Disadvantages include immediate local and systemic adverse reactions and poor compliance.

Objectives: To obtain real-life efficacy and safety data through a prospective observational study of SIT[1] in the allergist's office.

Methods: We prospectively collected data from all patients with a diagnosis of allergic rhinitis and/or asthma and a specific immunoglobulin E-mediated sensitization to one or more aeroallergens who began SIT during the 2 year period 1 January 2005 to 31 December 2006. As part of the routine immunotherapy care patients were asked to complete a disease activity questionnaire before and yearly during the treatment. The primary outcome measure was the combined rhinitis and asthma symptoms scores. Data from patients completing at least 1 year of immunotherapy were analyzed.

Results: Altogether, 133 enrolled patients with a mean age of 22.7 years completed at least 1 year of SIT. The allergic rhinitis and asthma disease activity score decreased from a mean of 8.1 to 3.3 (rhinitis) and from 4.8 to 2.4 (asthma) on a 10 cm visual analogue scale after 1 year of SIT (P < 0.001 for all comparisons). Rhinitis medication use in all patients and asthma medication use in asthmatics decreased significantly. Mild local adverse reactions were almost universal. There were 11 patients (8%) who developed 14 immediate systemic, mild to moderate reactions. All reactions were successfully treated in the clinic; none required additional observation or hospitalization.

Conclusions: In the hands of experienced allergists subcutaneous allergy immunotherapy is a safe and efficacious option for patients with allergic rhinitis and asthma. 

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.

Endometrial polyps are a frequent finding in infertile patients. Little is known about the true prevalence of polyps in infertile patients. It is unproved whether polyps are causative of infertility, or whether surgical polypectomy by hysteroscopy improves the likelihood of successful conception. This article reviews endometrial polyps in reproductive-age fertile and infertile women.

A 32 year old man presented with a huge tumor in the right chest wall that had increased dramatically in size over the previous 6 months.