Pilot validation of a verbal practical judgement assessment (VPJ) among community-dwelling older adults in Israel: the first step toward a national standard / Validação piloto de uma avaliação de julgamento prático verbal (VPJ) entre idosos residentes na comunidade em Israel: o primeiro passo em direção a um padrão nacional

ABSTRACT. Increased longevity and subsequent increase in older populations emphasize the importance of assisting older people to continue living in safe and residential situations for as long as possible. Judgement, an important aspect of cognition, and a predictor of function may become impaired and compromise safe living. Yet, judgement is difficult to assess, and few valid instruments are utilized in clinical settings that accurately evaluate judgement in older people. Objectives: This pilot study aimed to translate, culturally adapt, and initiate the validation of the Hebrew version of the verbal practical judgement (VPJ) assessment among community-dwelling older people. Methods: A total of 50 older adults, aged over 65 years, living in the community in Israel, half of whom were independent (n=27, 54%), and the rest dependent participants in a day centre with some level of cognitive/functional decline, completed the VPJ evaluation and comparison assessments. Results: Positive and significant (p<0.05) relationships between VPJ and standard assessments were found, demonstrating convergent validity. By comparing VPJ scores between independent and dependent older adults, results also supported discriminant validity. Finally, a multiple hierarchical regression demonstrated a positive relationship between instrumental activities of daily living and judgement. Conclusions: This pilot study found the VPJ feasible, likely valid, and culturally adaptable to assess judgement in Israeli older adults. Assessing judgement will provide older adults and their families with essential information regarding function, cognition, and safety and will enable them to live/return home in accordance with their autonomy, safety, and well-being.

RESUMO. O aumento da longevidade e o subsequente aumento das populações mais velhas enfatizam a importância de ajudar os idosos a continuar vivendo em situações residenciais seguras pelo maior tempo possível. O julgamento, um aspecto importante da cognição e um preditor da função, pode ser prejudicado e comprometer uma vida segura. No entanto, o julgamento é difícil de avaliar e poucos instrumentos válidos são utilizados em ambientes clínicos que avaliam com precisão o julgamento em pessoas idosas. Objetivos: Este estudo piloto teve como objetivo traduzir, adaptar culturalmente e iniciar a validação da versão hebraica da avaliação Verbal Practical Judgment (VPJ) entre idosos residentes na comunidade. Métodos: Cinquenta idosos, com mais de 65 anos, residentes na comunidade em Israel, metade dos quais eram independentes (n=27, 54%) e o restante participantes dependentes de um centro diurno com algum nível de declínio cognitivo/funcional, completaram o VPJ avaliações de avaliação e comparação. Resultados: Foram encontradas relações positivas e significativas (p<0,05) entre VPJ e avaliações padrão, demonstrando validade convergente. Ao comparar os escores VPJ entre idosos independentes e dependentes, os resultados também apoiaram a validade discriminante. Finalmente, uma regressão hierárquica múltipla demonstrou uma relação positiva entre AIVD e julgamento. Conclusão: Este estudo piloto considerou o VPJ viável, provavelmente válido e culturalmente adaptável para avaliar o julgamento em idosos israelenses. A avaliação do julgamento fornecerá aos idosos e suas famílias informações essenciais sobre função, cognição e segurança e os capacitará a viver/voltar para casa de acordo com sua autonomia, segurança e bem-estar.

The association between parenting styles, maternal self-efficacy, and social and emotional adjustment among Arab preschool children

Abstract Parenting styles and parental self-efficacy are major factors that affect the overall adjustment of children. The current study examined parenting styles and maternal self-efficacy and their association with social-emotional adjustment among Arab preschool children living in Israel. Parenting Styles Questionnaire , Maternal Self-Efficacy Questionnaire , and Adjustment Questionnaire were administered to 420 Arabic-speaking mothers of 3- to 4-year-old children. After employing multiple regression analyses, the results indicated that parenting styles and the overall adjustment of children were significantly correlated. More precisely, a significant association between authoritative parenting style and higher levels of social-emotional adjustment among preschool children was found. Furthermore, maternal self-efficacy was significantly correlated to the overall adjustment of children. In this regard, higher maternal self-efficacy is associated with increased social-emotional adjustment among preschool children. The findings of our study show the applicability of these constructs found relevant across numerous cultures in a unique sample of Arab children living in Israel. Lastly, this study supports intervention programs that promote authoritative parenting style and parental self-efficacy in Arab communities.

Israel y covid-19: ¿cómo se escribirá en el futuro la historia de la epidemia en este país? / Israel and covid-19: how will the history of the epidemic in this country be written in the future?

Resumen El presente artículo representa un intento de reflexionar hipotéticamente sobre la manera en que los historiadores de la ciencia escribirán en el futuro sus investigaciones sobre el desarrollo de la pandemia de la covid-19 en Israel, dentro de un contexto que incluye: la crisis política que vivió el país en esos momentos; la historia de las instituciones de salud pública establecidas desde la época de los primeros colonos judíos en Palestina, a principios del siglo XX, y modificadas ligeramente por una ley de 1994; los esquemas conceptuales desarrollados durante las últimas décadas por historiadores de la salud pública y las pandemias en general.

Abstract This article attempts to hypothetically reflect on how historians of science will write their research on the development of the covid-19 pandemic in Israel in the future, within a context that includes: the political crisis experienced by the country at that time; the history of the public health institutions established from the time of the first Jewish settlers in Palestine, at the beginning of the twentieth century, and slightly modified by a law of 1994; the conceptual schemes developed during the last decades by historians of public health and pandemics in general.

Maternal metal concentration during gestation and pediatric morbidity in children: an exploratory analysis

BACKGROUND@#The majority of studies linking exposure to metals with certain health outcomes focus on known toxic metals. Alternatively, this study assesses the extent to which exposure to a wider range of metals during gestation is associated with childhood morbidity.@*METHODS@#We analyzed the concentrations of 25 metals found in urine samples of 111 pregnant women of Arab-Bedouin origin collected prior to birth. In addition, we collected medical records on their offspring for six years following birth, including every interaction with HMOs, local hospitals, and pharmacies.@*RESULTS@#The main types of morbidities diagnosed and treated during this period were preterm births, malformations, asthma-like morbidity, cardiovascular and behavioral problems, and obesity. Multivariable analysis showed that offspring born before term were more likely to have been exposed to elevated maternal concentrations of zinc, thallium, aluminum, manganese, and uranium, all with adjusted relative risk above 1.40 for an increase by each quintile. Likewise, children with asthma had been exposed to higher levels of magnesium, strontium, and barium at gestation, while behavioral outcomes were associated with elevated biometals, i.e., sodium, magnesium, calcium, selenium, and zinc, as well as higher levels of lithium, cobalt, nickel, strontium, cadmium, vanadium, arsenic, and molybdenum. A heatmap of adjusted relative risk estimates indicates the considerable implications that exposure to metals may have for preterm birth and developmental outcomes.@*CONCLUSIONS@#The current study shows that perinatal exposure to metals is adversely associated with pediatric morbidity. Further such analyses on additional samples are warranted.

The emergency department length of stay: Is the time running out? / 中华创伤杂志(英文版)

PURPOSE@#To examine the relationships between emergency department length of stay (EDLOS) with hospital length of stay (HLOS) and clinical outcome in hemodynamically stable trauma patients.@*METHODS@#Prospective data collected for 2 years from consecutive trauma patients admitted to the trauma resuscitation bay. Only stable blunt trauma patients with appropriate trauma triage criteria requiring trauma team activation were included in the study. EDLOS was determined short if patient spent less than 2 h in the emergency department (ER) and long for more than 2 h.@*RESULTS@#A total of 248 patients were enrolled in the study. The mean total EDLOS was 125 min (range 78-180). Injury severity score (ISS) were significantly higher in the long EDLOS group (17 ± 13 versus 11 ± 9, p < 0.001). However, when leveled according to ISS, there were no differences in mean in diagnostic workup, admission rate to intensive care unit (ICU) or HLOS between the short and long EDLOS groups.@*CONCLUSION@#EDLOS is not a significant parameter for HLOS in stable trauma patients.

The top 10 most-cited articles on the management of fractured instruments: a bibliometric analysis

OBJECTIVES: The purpose of this research was to identify the top 10 most-cited articles on the management of fractured or broken instruments and to perform a bibliometric analysis thereof. MATERIALS AND METHODS: Published articles related to fractured instruments were screened from online databases, such as Web of Science, Scopus, PubMed, and ScienceDirect, and highly cited papers, with at least 50 citations since publication, were identified. The most-cited articles were selected and analysed with regard to publication title, authorship, the journal of publication, year, institution, country of origin, article type, and number of citations. RESULTS: The top 10 most-cited articles were from various journals. Most were published in the Journal of Endodontics, followed by the International Endodontic Journal, and Dental Traumatology. The leading countries were Australia, Israel, Switzerland, the USA, and Germany, and the leading institution was the University of Melbourne. The majority of articles among the top 10 articles were clinical research studies (n = 8), followed by a basic research article and a non-systematic review article. CONCLUSIONS: This bibliometric analysis revealed interesting information about scientific progress in endodontics regarding fractured instruments. Overall, clinical research studies and basic research articles published in high-impact endodontic journals had the highest citation rates.

Design and 3D-printing of titanium bone implants: brief review of approach and clinical cases

Additive manufacturing (AM) is an alternative metal fabrication technology. The outstanding advantage of AM (3D-printing, direct manufacturing), is the ability to form shapes that cannot be formed with any other traditional technology. 3D-printing began as a new method of prototyping in plastics. Nowadays, AM in metals allows to realize not only net-shape geometry, but also high fatigue strength and corrosion resistant parts. This success of AM in metals enables new applications of the technology in important fields, such as production of medical implants. The 3D-printing of medical implants is an extremely rapidly developing application. The success of this development lies in the fact that patient-specific implants can promote patient recovery, as often it is the only alternative to amputation. The production of AM implants provides a relatively fast and effective solution for complex surgical cases. However, there are still numerous challenging open issues in medical 3D-printing. The goal of the current research review is to explain the whole technological and design chain of bio-medical bone implant production from the computed tomography that is performed by the surgeon, to conversion to a computer aided drawing file, to production of implants, including the necessary post-processing procedures and certification. The current work presents examples that were produced by joint work of Polygon Medical Engineering, Russia and by TechMed, the AM Center of Israel Institute of Metals. Polygon provided 3D-planning and 3D-modelling specifically for the implants production. TechMed were in charge of the optimization of models and they manufactured the implants by Electron-Beam Melting (EBM®), using an Arcam EBM® A2X machine.

A coordination project for improvement of osteoporosis medication use among patients who sustained an osteoporotic fracture: The Israeli experience

OBJECTIVES: The aim of this study was to examine whether coordination between healthcare providers at an inpatient rehabilitation facility and healthcare providers in a community setting improves osteoporosis medication use in the community. METHODS: In 2012, a coordination project between an inpatient geriatric rehabilitation facility located in north-central Israel and general practitioners in the community setting was initiated. In this retrospective pseudo-experimental study, we compared osteoporosis medication use among patients who were hospitalized at the facility following an osteoporotic fracture during 2011–2012, and who constituted the control group (n=20), and patients who were hospitalized at the facility during 2013–2015, and who constituted the trial group (n=129). Data were collected from the patients' records and from records of the health maintenance organization concerning medications issued to the patients by pharmacies. RESULTS: Differences were observed between the trial and the control group in osteoporosis medication management by healthcare providers, both at the inpatient rehabilitation facility and in the community, suggesting favorable trends. However, osteoporosis medication use in the community was slightly lower in the trial group, then in the control group (32.8% vs. 34.2%, respectively). A regression analysis indicated that the only variable predicting use of osteoporosis medications in the community was a previous diagnosis of osteoporosis in the community. CONCLUSIONS: The study results indicate that mere coordination between the healthcare settings is insufficient in order to ensure continued care in the community, emphasizing the need for an osteoporosis coordinator.

Do trauma individual ao trauma coletivo. Os Xiitas do sul do Líbano e os bombardeios israelenses 2006 / From individual trauma to collective trauma. The Shi'ites of southern Lebanon and the Israeli bombing 2006 / Del trauma individual al trauma colectivo. Los chiitas del sur del Líbano y el bombardeo israelí 2006

O artigo é uma síntese das pesquisas de campo realizadas com a comunidade xiita do sul do Líbano em 2008. Procurou-se averiguar a conexão e superposição do trauma individual ao trauma coletivo na luta de resistência à invasão das forças israelenses a suas terras. O grupo étno-confessional participa depois de décadas de uma conjuntura nacional de enfrentamentos mortíferos entre suas comunidades. De outro lado da fronteira, há Israel, o inimigo que depois de submeter sua região por vinte anos, volta a atacá-los em 2006. Foram registradas vinte entrevistas com indivíduos de ambos os sexos, cujas questões abertas objetivaram suas histórias de vida. A análise de conteúdo do material permitiu sua separação em três grupos. Os depoimentos de seus representantes coloca em relevo o grau de afetação provocado pelos eventos. Averiguamos as disposições psíquicas desses sujeitos que vivem constantemente situações de stress e de eventos traumáticos. Observamos o papel da identificação grupal à mensagem de seus mitos fundadores e como fator de reforço egoico no enfrentamento a esse real catastrófico.

This article is a synthesis of field studies carried out in the Shiite community in South Lebanon in 2008. The aim of this study was to investigate the connection and superposition of the individual trauma over the collective trauma in the struggle and resistance against the invasion of Israeli forces in their lands. This ethnic confessional group has for decades been involved in a series of nationwide deadly struggles within their communities. On the other side of the border lies Israel, the enemy that after subjugating their region for twenty years, attacked them again in 2006. We then studied the psychological conditions of these subjects that constantly undergo traumatic and stressful situations. We observed how this group identifies with the message of their forefathers and myths and how it strengthens their egos on facing this catastrophic reality.

El presente artículo es una síntesis de las investigaciones de campo realizadas con la comunidad chiita del sur del Líbano en 2008. El objetivo fue investigar la conexión y la superposición del trauma individual al trauma colectivo durante la lucha de resistencia a la invasión de las fuerzas israelíes a sus tierras. Este grupo étnico-confesional participa, después de décadas, de una coyuntura nacional de enfrentamientos mortales entre sus comunidades. Del otro lado de la frontera está Israel, el enemigo que después de haber ocupado la región por veinte años, vuelve a atacarlos en 2006. Se realizaron veinte entrevistas a través de preguntas abiertas a individuos de ambos sexos, con la finalidad de estudiar sus historias de vida. El análisis de contenido del material permitió separarlo en tres grupos. Los testimonios de sus representantes colocan en evidencia el grado en que estos acontecimientos los afectaron. Se investigó las estructuraciones psíquicas de estos individuos que viven constantemente situaciones de estrés y hechos traumáticos. Fue observado, igualmente, el papel de la identificación del grupo en relación al mensaje de sus mitos fundadores y de qué forma estos actúan como factor de refuerzo del ego en el enfrentamiento a esa realidad catastrófica.

IgE-mediated food allergies in children: prevalence, triggers, and management / 소아과

Food allergy (FA) is a serious health problem, and severe FA such as food-induced anaphylaxis can often be life threatening. The incidence of FA has been increasing especially in children. They usually develop early in life and affect up to 10% of children. The 2 most common food allergens worldwide are milk and eggs, while the third one varies depending on the countries: peanuts in the United States and Switzerland, wheat in Germany and Japan, tree nuts in Spain, sesame in Israel, and walnuts in Korea. These common food allergens are different and difficult to identify because of differing study methodologies, population, geography, age, and dietary exposure patterns. The current management of FA relies on the strict avoidance of culprit allergens, the prompt treatment of allergic reactions, including epinephrine use for food-induced anaphylaxis, monitoring, and education to prevent further reactions. Newer approaches for tolerance induction to FA and FA immunotherapy have been under investigation but are not yet ready for real-world application. Thus, consistent and systematic education of patients, caregivers, and food-handling people is of primary importance for the management and prevention of FA reactions. This review assesses and compares IgE-mediated FA in children in Korea and other countries, with a focus on summarizing the prevalence, common triggers, and management of FA.

Follow-up after infants younger than 2 months of age with urinary tract infection in Southern Israel: epidemiologic, microbiologic and disease recurrence characteristics

Abstract Background The timing of most recurrences after neonatal urinary tract infection is during the first year of life, with peak incidence 2–6 months after the initial infection. Information on the microbiologic characteristics of recurrent urinary tract infection episodes in relation to the microbiology of the initial episodes is limited. Objectives To analyze the epidemiologic/microbiological characteristics of 1st and recurrent urinary tract infection in infants <2 months of age. Methods A retrospective study including all infants <2 months of age with urinary tract infection admitted during 2005–2009 and followed till the age of 1 year. Results 151 neonates were enrolled (2.7% of all 5617 febrile infants <2 months of age admitted). The overall incidence of urinary tract infection occurring during the first 2 months of life was 151/73,480 (0.2%) live births during 2005–2009 in southern Israel (2.1 cases/1000 live births). One pathogen was isolated in 133 (88.1%); Escherichia coli, Klebsiella spp., Enterococcus spp., Morganella morganii, Proteus spp., and Enterobacter spp. represented the most common pathogens (57.9%, 12.2%, 7.9%, 6.7%, 6.1%, and 5%, respectively). Trimethoprim/sulfamethoxazole, ampicillin, and cefuroxime-axetil were the most commonly recommended prophylactic antibiotics (45%, 13.2%, and 8%, respectively). Twenty-three recurrent urinary tract infection episodes were recorded in 20 (13.2%) patients; 6/23 (26%) were diagnosed within one month following 1st episode. E. coli was the most frequent recurrent urinary tract infection pathogen (12/23, 52.2%). No differences were recorded in E. coli distribution between first urinary tract infection vs. recurrent urinary tract infection. Seventeen (74%) recurrent urinary tract infection episodes were caused by pathogens different (phenotypically) from those isolated in 1st episode. Recurrent urinary tract infection occurred in 25.0%, 8.3%, and 0 patients recommended trimethoprim/sulfamethoxazole, cefuroxime-axetil, or amoxicillin prophylaxis, respectively. Conclusions (1) The study determined the incidence of urinary tract infection in febrile infants <2 months of age in Southern Israel; (2) E. coli was responsible for the majority of first and recurrent urinary tract infection; (3) recurrent urinary tract infection was caused mostly by pathogens different than the pathogens isolated at initial episode.

Contribution of Arab countries to pharmaceutical wastewater literature: a bibliometric and comparative analysis of research output

BACKGROUND: Recently, the pharmaceutical manufacturing industry has been growing rapidly in many countries in the world, including in Arab countries. Pharmaceuticals reach aquatic environments and are prevalent at small concentrations in wastewater from the drug manufacturing industry and hospitals. Such presence also occurs in domestic wastewater and results from the disposal of unused and expired medicines. Therefore, the objective of this study was to analyze and compare the quantity and quality of publications made by researchers in Arab countries on pharmaceutical wastewater. METHODS: To retrieve documents related to pharmaceutical wastewater, we used the Scopus database on November 21, 2015. All documents with terms related to pharmaceutical wastewater in the title or abstract were analysed. Results obtained from Arab countries were compared with those obtained from Turkey, Iran and Israel. RESULTS: Globally, a total of 6360 publications were retrieved while those from Arab countries, Iran, Turkey and Israel, were 179, 113, 96 and 54 publications respectively. The highest share of publications belonged to Kingdom of Saudi Arabia (KSA) with a total of 47 (26.2 %) publications, followed by Egypt (38; 21.2 %), Tunisia (17; 9.5 %) and Morocco (16; 8.9 %). The total number of citations was 1635, with a mean of 9.13 and a median (inter quartile range) of 3 (1.0–10.0). The study identified 87 (48.6 %) documents with 32 countries of international collaboration with Arab countries. It was noted that Arab researchers collaborated mainly with authors in Western Europe (54; 30.2 %), followed by authors from the Asiatic region (29; 16.2 %) and Northern America (15; 8.4 %). The most productive institution was King Saud University, KSA (13; 7.3 %), followed by the National Research Centre, Egypt (10; 7.3 %). CONCLUSIONS: This study showed that KSA has the largest share of productivity on pharmaceutical wastewater research. Bibliometric analysis demonstrated that research productivity, mainly from Arab countries in pharmaceutical wastewater research, was relatively lagging behind. More research effort is required for Arab countries to catch up with those of non-Arab Middle Easter countries on pharmaceutical wastewater research.

Israeli Arabs develop diverticulitis at a younger age and are more likely to require surgery than Jews / Árabes israelitas desenvolvem diverticulite em idade mais jovem e estão mais sujeitos ao tratamento cirúrgico do que os judeus

BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis. .

RACIONAL: Somente poucos estudos examinaram o impacto das diferenças raciais na idade de início, curso e os resultados da diverticulite. OBJETIVO: Fornecer dados sobre a epidemiologia da diverticulite no norte de Israel, e determinar se a etnia é preditor de idade de início, complicações e necessidade de tratamento cirúrgico. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários de todos os pacientes diagnosticados com um primeiro episódio de diverticulite em nosso hospital entre 2005 e 2012. RESULTADOS: Foram encontrados 638 pacientes com um primeiro episódio de diverticulite aguda no intervalo de oito anos. Os árabes israelenses desenvolveram o primeiro episódio de diverticulite em idade mais jovem em comparação com os judeus (51,2 vs 63,8 anos, p<0,01). Árabes que vivem em áreas rurais a diverticulite foi desenvolvida em idade mais jovem do que os árabes que vivem em centros urbanos (49,4 vs 54,5 anos, p=0,03). Homens judeus e árabes desenvolveram diverticulite em idade mais jovem em comparação com os seus homólogos do sexo feminino (59,9 vs 66,09, p<0,01, e 47,31 vs 56,93, p<0,01, respectivamente). Os árabes eram mais prováveis ​​do que os judeus de necessitar de tratamento cirúrgico (urgência ou eletiva) para a diverticulite [odds ratio (OR)=1,81, intervalo de confiança de 95% (CI) 1,12-2,90, p=0,017]. CONCLUSÕES: Os árabes israelenses tendem a desenvolver diverticulite em idade mais jovem e são mais propensos a necessitar de tratamento cirúrgico para a diverticulite em comparação com os judeus. Árabes que vivem em áreas rurais desenvolvem diverticulite em idade mais jovem do que os árabes que vivem em centros urbanos. Estes resultados destacam a necessidade de abordar a causa raiz para diferenças étnicas em início, o curso e o resultado da diverticulite aguda. .

Dilataciones endoscópicas del tracto gastrointestinal / Endoscopic dilation of the gastrointestinal tract

Las dilataciones en el tracto gastrointestinal se llevan a cabo para aliviar la obstrucción sintomática, ya sea funcional u orgánica, secundarias a una variedad de patologías tanto benignas como malignas. Con el advenimiento de las nuevas tecnologías, virtualmente toda estenosis digestiva puede ser manejada en forma mínimamente invasiva. Pese a su amplia difusión en la práctica actual, existen pocos estudios controlados que comparen las diferentes modalidades de dilatación. En el presente artículo realizamos una revisión de esta técnica, así como de la evidencia disponible para su aplicación en los diferentes segmentos del tracto gastrointestinal. El futuro de la dilatación incluye el desarrollo de dilatadores que permitan evaluar la dilatación durante su realización. Estos advenimientos, así como la ejecución de estudios controlados prospectivos van a mejorar las indicaciones, beneficios y riesgos para cada uno de los sistemas de dilatación existentes.

The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation of prospective controlled studies will improve the indications, benefits and risks for each of the existing systems of dilations.

Adherence to acute otitis media treatment guidelines among primary health care providers in Israel

AIMS: To determine the appropriateness of the acute otitis media antibiotic treatment prescribed in the community in relation to the therapeutic guidelines. METHODS: Children aged 3 months-3 years diagnosed with simple uncomplicated acute otitis media in 6 community primary care clinics were enrolled. Data on the antibiotic treatment were collected using computerized medical files. RESULTS: 689 simple uncomplicated acute otitis media patients were enrolled; 597 (86.9%) were treated with antibiotics by 38 family medicine practitioners, 12 pediatricians and 7 general practitioners. 461 (77.2%) patients were <2 years of age. Amoxicillin was administered to 540 (90.5%) patients, with no differences between the various medical specialties. 127/540 (23.5%) patients did not receive the appropriate dosage; 140/413 (33.9%) patients treated with appropriate dosage did not receive the treatment for the appropriate duration of time. 258/357 (72.3%) evaluable patients <2 years of age received an antibiotic considered inappropriate to guidelines (38 not treated with amoxicillin, 94 received inappropriate dosage and 126 not treated for 10 days); 53/100 (53%) evaluable children >2 years of age received an inappropriate antibiotic treatment. CONCLUSIONS: The majority of primary care physicians treat simple uncomplicated acute otitis media with the recommended antibiotic drug. However, incorrect dosage and shorter than recommended duration of therapy may jeopardize the quality of care in children with simple uncomplicated acute otitis media. .

Clinical characteristics and outcomes of patients admitted with presumed microbial keratitis to a tertiary medical center in Israel / Características clínicas e desfechos dos pacientes internados com diagnóstico de ceratite microbiana em um centro terciário em Israel

PURPOSES: Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment. The objective of this study is to describe the clinical characteristics and outcomes of patients with presumed microbial keratitis admitted to The Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel. METHODS: A cross-sectional study was conducted, in which the medical records of patients with presumed microbial keratitis admitted during a period of 3 years were reviewed. RESULTS: Keratitis was diagnosed in 276 patients (51% males and 48.9% females). The mean age was 39.29 ± 22.30 years. The hospital length of stay ranged from 1 to 65 days (mean 5.69 ± 5.508). Fortified antibiotics were still used at discharge in 72% of the cases. Overall visual acuity improved significantly from the time of admission to the 1st-week follow up visit showing a p<0.001 on the Wilcoxon signed ranks test. Contact lens wearing was present in 36.1% of the patients, although there was no significant relation with severity of the presentation and visual outcome (p>0.05). The degree of hypopyon and cells in the anterior chamber was significantly related to the hospital length of stay (r Spearman=0.31; p<0.001 and r Spearman=0.21; p<.001, respectively) as well as to a worse visual outcome (r Spearman=0.32; p<0.01 and r Spearman=0.18; p=0.01, respectively). Of all patients, 2.3% required an urgent therapeutic penetrating keratoplasty, and 1% underwent evisceration. There was no enucleation. CONCLUSION: Treating keratitis aggressively and assuring patient compliance is imperative for a good final visual outcome. Inpatient treatment may have a positive impact on this outcome.

OBJETIVOS: Ceratite microbiana é comumente diagnosticada em todo mundo e ainda continua a causar uma significante morbidade ocular. É necessário tratá-la de forma imediata e apropriada. O objetivo deste estudo é descrever as características clínicas e os desfechos dos pacientes com ceratite microbiana presumida que foram internados no Goldschlager Eye Institute, Sheba Medical Center, Tel Aviv University, Israel. MÉTODOS: Um estudo transversal foi realizado onde arquivos hospitalares dos pacientes internados com ceratite microbiana presumida durante um periodo de três anos foram analisados e revisados. RESULTADOS: Ceratite foi diagnosticada em 276 pacientes (51% masculinos e 48,9% femininos). A média de idade foi 39,29 ± 22,30 anos. A duração da internação foi de 1 a 65 dias (média 5,69 ± 5,508). Antibióticos fortificados permaneceram usados na alta em 72% dos casos. A acuidade visual do seguimento da primeira semana após a alta em relação a internação melhorou na media de forma estatisticamente significativa (p<0,001 usando Wilcoxon signed ranks test). O uso de lentes de contato estava presente em 36,1% dos pacientes, porém não houve relação estatisticamente significativa entre a gravidade da apresentação clínica e a acuidade visual nestes pacientes (p>0,05). O grau de hipópio e células na câmara anterior foram estatisticamente significativos em relação ao tempo de internação (r Spearman=0,0.31; p<0,001 and r Spearman=0,21; p<0,001, respectivamente) e para a acuidade visual (r Spearman=0,32; p<0,01 e r Spearman=0,18; p=0,01, respectivamente). De todos os pacientes, apenas 2,3% necessitaram ceratoplastia penetrante urgente e 1% necessitaram evisceração. Não houve enucleações. CONCLUSÕES: Tratar a ceratite de forma agressiva e garantir a aderência do paciente ao tratamento é imperativo para o bom resultado visual final. O tratamento internado pode ter um impacto positivo neste desfecho.

Triagem pré-participação com ECG em recrutas militares / Pre-participation ECG screening in military recruits

FUNDAMENTO: Os achados e investigações adicionais necessários com base na triagem pré-participação com eletrocardiograma (ECG) entre os recrutas militares estão mal definidos na literatura. OBJETIVOS: Este estudo foi elaborado para avaliar a taxa de achados anormais na triagem pré-participação com ECG em adultos jovens e as avaliações adicionais necessárias com base nestes resultados. MÉTODOS: Um estudo de coorte retrospectivo foi realizado no centro aero-médico da Força Aérea de Israel (IAF), para candidatos das unidades das academias de voo e de tropa s de elite. Os candidatos das unidades das Academias de voo e de elite passam por uma triagem pré-participação com ECG antes do alistamento nas Forças de Defesa de Israel (IDF). Desde 2010, todos os ECGs são realizados no centro aero-médico da IAF. Todos os ECGs realizados desde janeiro de 2010 foram analisados por um de três cardiologistas e todos aqueles nos quais resultados significativos foram identificados foram encaminhados para uma avaliação mais detalhada, a pedido do cardiologista. As causas de encaminhamento para avaliação posterior, as avaliações realizadas e os resultados dessas avaliações são notificados para a população de estudo. RESULTADOS: 1.455 ECGs foram realizados nos anos 2010-2011. Desses, 1.388 (95,39%) foram interpretadas como normais. 67 indivíduos foram encaminhados para uma avaliação mais detalhada com base nos achados do ECG. Os achados mais comuns levando a uma avaliação mais detalhada foram alterações da onda T (16 casos, 23,88%), padrão de pré-excitação (14, 20,89%) e critérios de voltagem para hipertrofia ventricular esquerda (11; 16,41%). Apenas 7 indivíduos (10,44%) tinham resultados anormais que foram considerados clinicamente significativos no final da avaliação médica. CONCLUSÕES: A taxa de achados significantes levando à desqualificação para a atividade militar é extremamente baixa e o encaminhamento para investigações adicionais baseado nos achados do ECG de 12 derivações deve ser criterioso.

BACKGROUND:The findings and additional investigations required based on pre-participation electrocardiography (ECG) among military recruits are poorly defined in the literature. OBJECTIVES: This study was designed to evaluate the rate of abnormal findings on pre-participation ECG in young adults and the additional evaluations required based on these findings. METHODS: A retrospective cohort study was performed in the Israeli Air Force (IAF) aero medical screening center for flight academy and elite units' candidates. Flight academy and elite units' candidates undergo pre-participation ECG prior to enlistment to the Israeli Defense Forces (IDF). Since 2010, all ECGS have been performed at the IAF aero medical center. All ECGs performed since January 2010 were analyzed by one of three cardiologists and all those in which significant findings were identified were referred to further evaluation upon the cardiologist's request. Causes of referral for further evaluation, the evaluations performed and the results of these evaluations are reported for the study population. RESULTS: 1455 ECGS were performed in the years 2010-2011. Of these, 1388 (95.39%) were interpreted as normal. 67 subjects were referred to further evaluation based on ECG findings. The most common findings leading to further evaluation were T wave changes (16 cases, 23.88%), pre-excitation pattern (14, 20.89%) and voltage criteria for left ventricular hypertrophy (11, 16.41%). Only 7 subjects (10.44%) had abnormal findings which were considered clinically significant at the end of the medical evaluation. CONCLUSIONS: The rate of significant findings leading to disqualification from military activity is extremely low and referral to continued investigations based on 12-lead ECG findings should be judicious.

The integration process of North Korean defector physicians into the South Korean medical system

Physicians who have defected from North Korea and settled in South Korea (North Korean defector physicians, NKDPs) have experienced hardship in the occupational integration process due to their low socio-economic status, lack of information, and differences in medicosocial cultures, English-based medical terminology, and the clinical knowledge gap between North and South Korea. Here, we review the relevant literature on the credentialing process for former Soviet physicians in Israel. We present empirical findings regarding the ongoing educational experience of NKDPs preparing for the Korean national medical licensing examination. The approval process from the National Health Personnel Licensing Examination Board for NKDPs to sit for the national medical licensing examination under the current licensing system needs more objective credentialing criteria. Systematic and sustained supportive plans are needed for educating NKPDs to prepare for the licensing examination. Securing additional internships and residencies is needed for further sustained training of NKDPs after certification. A continuing medical education program can address the needs of those who have not completed a residency program for primary care and improve quality of care. We hope more extensive discussion will take place on the credentialing and integration of NKPDs following a policy of engagement from the perspective of human resource building and partnership for unification of the medical system between South and North Korea.