Development and Efficacy of an Electronic, Culturally Adapted Lifestyle Counseling Tool for Improving Diabetes-Related Dietary Knowledge: Randomized Controlled Trial Among Ethnic Minority Adults With Type 2 Diabetes Mellitus.

BACKGROUND: Ethnic minority populations exhibit disproportionately high rates of type 2 diabetes mellitus (T2DM). Electronic health tools have the potential to facilitate the cultural adaptation and tailoring of T2DM education to improve the knowledge and management of diabetes mellitus (DM). OBJECTIVE: This study aimed (1) to develop an adaptable Interactive Lifestyle Assessment, Counseling, and Education (I-ACE) software to support dietitian-delivered lifestyle counseling among low-socioeconomic status (SES) ethnic minority patients with T2DM and (2) to evaluate its effect on DM-related dietary knowledge and management compared with standard lifestyle advice (SLA) in a randomized controlled trial (RCT). METHODS: The I-ACE software, developed in consultation with clinical dieticians, incorporates evidence-based dietary and physical activity (PA) recommendations and educational materials. The features and behavioral change techniques include quantitative lifestyle (dietary intake and PA) assessment and simulation, individually tailored education and recommendations, motivational interviewing, and goal setting. For the unblinded pilot RCT, 50 overweight or obese Arab adults (aged 40-62 years) with poorly controlled T2DM were recruited from primary care clinics and randomly assigned to receive 4 in-person, dietician-delivered counseling sessions over 6 months using either (1) the I-ACE tool (experimental arm) or (2) the SLA methods (comparison arm). All outcome assessments were face-to-face. DM-related dietary knowledge (primary outcome) was measured at baseline, 3, 6, and 12 months. Lifestyle and other parameters were measured before, during, and after the intervention. Multiple linear regression and repeated measures linear mixed models were used to compare the changes in study outcomes and explore time trends in between-group and within-group changes. RESULTS: A total of 25 participants were enrolled in each arm, of whom 24 and 21 completed the final assessment of the primary outcome in the I-ACE and SLA arms, respectively. DM-related lifestyle knowledge increased more rapidly in the I-ACE arm than in the SLA arm (P value for study arm×time interaction=.02). Within the I-ACE arm, the mean (SE) differences in added sugar and dietary fiber intakes from baseline to 12 months were -2.6% (SE 1.0%) of total energy (P=.03) and 2.7 (SE 0.0) g/1000 kcal (P=.003), respectively. The odds of engaging in any leisure PA at 12 months tended to be higher in the I-ACE arm versus SLA arm, but did not reach statistical significance (odds ratio 2.8; 95% CI 0.7-11.6; P=.16). Both arms exhibited significant reductions in HbA1c (P value for change over time <.001). CONCLUSIONS: The use of the I-ACE software in a 6-month, 4-session dietician-delivered lifestyle counseling intervention improved the efficiency of lifestyle education, compared with SLA, among low-SES, ethnic minority patients with T2DM. This pilot trial provides justification for conducting a large-scale trial to evaluate its effectiveness and applicability in routine clinical care among ethnically diverse populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT01858506; https://clinicaltrials.gov/ct2/show/NCT01858506.

[EPIDEMIOLOGY OF RITALIN PRESCRIPTION IN 6-18 YEARS OLD ISRAELI CHILDREN - TIME TO CHANGE POLICY].

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a worldwide problem and treatment is controversial among physicians and parents. OBJECTIVES: To clarify the prescribing of methylphenidate to children in the center of Israel, the use and possible effect that gender, socioeconomic status (SES), ethnic and cultural characteristics play in the treatment of ADHD. METHODS: We assessed the prescription rate of methylphenidate in the years 2005, 2007 and 2011 in children and adolescents age 6-18 years provided from Sharon Shomron and Dan Petach Tikva Clalit Health Services pharmacies. RESULTS: Methylphenidate (MPH) prescriptions showed an increase in prevalence from 4.2% to 7.5% in the years 2007 to 2011, respectively. Jewish children were four times more likely to be prescribed MPH than Arab children, with significant discrepancies along SES and gender lines (p < .001). Higher socioeconomic status (SES) and male gender were associated with greater use of MPH. General pediatric prescription rates of MPH in all communities increased by 85%, compared with year 2007 statistics (p < .001). CONCLUSIONS: It is time to change policy. Efforts should be directed at over-treated and under-treated populations. DISCUSSION: Prescription patterns for MPH in children reflect diagnostic patterns of ADHD that appear to be heavily influenced by additive factors of SES, cultural attitudes and gender.

Changing Epidemiology of Methylphenidate Prescriptions in the Community: A Multifactorial Model.

OBJECTIVE: To examine dispensing patterns of methylphenidate (MPH) to determine how socioeconomic status (SES), ethnocultural affiliation, and gender affect the medical treatment of ADHD. METHOD: We reviewed MPH prescription records for year 2011 of children aged 6 to 18, from regional pharmacies serving homogeneous neighborhoods. RESULTS: MPH prescriptions showed an increase in prevalence from 4.2% to 7.5% in the years 2007 to 2011, respectively. Jewish children were four times more likely to be prescribed MPH than Arab children, with significant discrepancies along SES and gender lines ( p < .001). Higher SES and male gender were associated with greater use of MPH. General pediatric prescription rates of MPH in all communities increased by 85%, compared with year 2007 statistics ( p < .001). CONCLUSION: Prescription patterns for MPH in children reflect diagnostic patterns of ADHD that appear to be heavily influenced by additive factors of SES, cultural attitudes, and gender. Dispensing data provide valuable information for targeting underserved groups and defining potential areas of abuse.

[Adolescents ask physicians on the Internet: a one-year survey of adolescents' questions on health issues in an Internet forum].

INTRODUCTION: During the past decade, the internet has become a major information resource in various domains of life and a communication venue among young people and adolescents who seek health information via the internet. Until now, the contents of Israeli adolescents' questions regarding health issues on internet sites have not been published. PURPOSES: (1) A survey of the characteristics of adolescents who seek health information and their questions presented to the Ynet forum "The body during adolescence". In this forum physicians experienced in adolescent medicine respond to these questions and to comments of other forum participants. (2) Presentation of problematic issues in professionals' responses to health questions in the internet. METHODS: Survey of a representative sample of contacts to the Ynet forum "The body during adolescence" during 2009 gathering information on gender and age of contacting person, parents' contacts, contacts' contents and physicians responses. RESULTS: A total of 412 contacts were surveyed, 210 (51%) females, aged 14-17 years--60%, 10-13 years--17% and 18-21 years 15%. Parents' questions appeared in 39 (9%) of contacts. Of all contacts, 44% related to sexuality issues and 17% related to self image and body composition. The physicians provided complete responses to 60% of the contacts, while in 40% the physician's responses included referral to clinical medical consultation. CONCLUSIONS: An internet health forum enables adolescents and parents to ask questions and raise doubts and anxieties regarding various health issues without the fear of being exposed and enables them to express their concerns face-to-face with a healthcare provider Sensitive issues regarding sexuality and self-image, which are not raised frequently during clinical encounters, are expressed and receive professional responses in the forum. Notwithstanding the significance of a rapid professional contribution, physicians responding to contacts in internet forums need to recognize the barrier related to professional communication with persons whom they have not met and for whom follow-up is impossible.

Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy.

We prospectively compared the efficacy and safety of iron deficiency anemia prophylaxis with iron gluconate (IG) or iron polymaltose complex (IPC) in healthy infants attending a community pediatric center. Participants were randomly assigned to receive one of the test drugs from age 4 to 6 months to age 12 months. Parents/guardians were given extensive information on iron-rich diets and anemia prevention. Main outcome measures were blood levels of hemoglobin, hematocrit, mean corpuscular volume, red blood cell distribution width, and serum iron, ferritin, and transferrin, in addition to adverse effects. One hundred five children completed the study: 53 in the IG group and 52 in the IPC group Mean hemoglobin levels at study end were significantly higher in the IG group (12.04±0.09 g/dL vs. 11.68±0.11, P<0.014). A hemoglobin level <11 g/dL was detected in 3 infants of the IG group, and in 10 infants of the IPC group (P<0.04). Adverse effects (spitting, vomiting, diarrhea, constipation, discolored teeth) were significantly more common in the IG group (47% vs. 25%, P>0.025). In conclusion, both oral IG and IPC prevent iron deficiency anemia in infants. Iron gluconate seems to be more effective but less tolerable.

Fetal alcohol spectrum disorder in Israel.

BACKGROUND: Fetal alcohol spectrum disorder is a range of disabilities caused by gestational exposure to alcohol. FASD is the leading cause of preventable mental retardation and developmental disability in the United States, with an incidence of 1-10 per 1000 live births. FASD in Israel has yet to be examined systematically. OBJECTIVES: To evaluate professionals' experience, awareness and knowledge of FASD in Israel and their awareness of maternal consumption of alcohol, and to collect epidemiological data on the syndrome in Israel. METHODS: A short questionnaire was sent to all 43 program directors of genetic institutes (n = 14) and child developmental centers in Israel (n = 29). Four questions related to their experience and knowledge of FASD. The epidemiological survey included data from all 17 hospitals in Israel and from the two main health management organizations within the public health care system. RESULTS: The response rate was 98% (n = 42). A total of 38.1% of respondents reported having diagnosed at least one case of FASD and fewer than 10% of respondents stated that the knowledge regarding FASD among physicians in Israel was adequate. Developmental pediatricians were more likely to have diagnosed at least one case as compared to geneticists. During the period 1998-2007 the diagnosis of FASD appeared in the records of only 4 patients from the total number of 17 hospitals in Israel. During the same period only six patients were diagnosed at the HMO within the public health care system. CONCLUSIONS: Despite the accumulated knowledge on FASD in many countries and the increase in alcohol consumption in Israel, professionals' awareness of its potential damage is limited. Educational programs to increase physician awareness should accompany publicity campaigns warning the public of the dangers associated with alcohol consumption during pregnancy.

[Reported practices of antimicrobial use for upper respiratory tract infections].

AIM: To determine the reported antibiotic prescribing practices for upper respiratory tract infections in children among pediatricians and family physicians. METHODS: Regional survey of practicing pediatricians and family physicians and comparison of the survey responses of 81 physicians with the recently published recommendations of the Centers for Disease Control and Prevention. RESULTS: Whereas almost all the physicians agreed that a diagnosis of acute otitis media required documentation of middle ear effusion and acute illness, 28% of family physicians and 12% of pediatricians reported that they routinely prescribed antibiotics for children with bronchitis, even though this is not recommended. In this survey 39% of pediatricians and 47% of family physicians reported that they omitted laboratory testing for the diagnosis of group A streptococcal pharyngitis, and of those who submitted samples for testing, most reported that they prescribed antibiotics immediately without waiting for the results. Even though these recommendations state that sinus tenderness is rare in young children with sinusitis, more than 48% of the physicians believed that both this and the presence of purulent rhinitis were essential to confirm this diagnosis. While none of the pediatricians reported prescribing antibiotics for the common cold, 17% of the family physicians did so (p = 0.006). CONCLUSIONS: The reported prescribing practices of the physicians in this survey are not in line with the recommendations. Effective intervention is needed to encourage the judicious use of antibiotics in Israel.