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Israel

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PubMed | Bar - Ilan University, Meuhedet Health Services, Ministry of Health and Clalit Health Services
Type: | Journal: Qualitative health research | Year: 2016

This study explores social workers perceptions of inequalities in Israels national health care system. Unlike previous studies, which relied on patients and practitioners reports, it is based on interviews with 60 social workers in hospitals and ambulatory clinics. The findings show that although Israeli law provides for (almost) free, universal medical care, the treatment of persons lacking in money, education, and social affiliation may be compromised by difficulties in paying for medications, treatments, and travel to and from hospital; by difficulties in understanding doctors instructions; and by reluctance to ask questions. Most doctors tend to focus exclusively on patients medical needs, seem to lack sympathy with less educated patients, have little understanding of the life circumstances that impinge on their compliance, and make little effort to speak to them in the language they can understand. Practical suggestions are made with regard to the need to turn doctors attention to their patients non-medical needs.


Hoffman R.D.,Maccabi Health Services | Hoffman R.D.,Meuhedet Health Services | Hoffman R.D.,Tel Aviv University | Golan R.,Meuhedet Health Services | And 2 more authors.
Israel Journal of Health Policy Research | Year: 2016

Background: It has become clear in recent years that a healthy lifestyle, including physical exercise is crucial for health maintenance. Nevertheless, most people do not exercise regularly. Physician intervention is beneficial in increasing patient exercise. In Israel, the 1994 "Sports Law" regarding exercising in a gymnasium requires a physician's written authorization, but does not direct the physicians what they should ascertain before issuing the certificate. This pre-exercise certificate has been widely discussed in Israel over the last year as the law is to be revised to enable using a modification of the PAR-Q+ (Physical Activity Readiness questionnaire) patient questionnaire as a screening tool. This will leave the requirement for a pre-exercise certificate for a less healthy population, yet without clear instructions to the primary care physician on criteria for ascertaining fitness. Our aim was to evaluate how primary care physicians deal with the ambiguity of defining health criteria for issuing exercise authorization/certificate. Methods: We used an anonymous ten-item attitude/knowledge multiple choice questionnaire with an additional 13 personal/education and employment questions. We assessed each potential predictor of physician attitude and knowledge in univariate models. Results: 135 useable questionnaires were collected. Of these, 43.7% of the doctors will provide the pre-exercise certificate to all their patients; 63% were aware of their HMO/employers guidelines for issuing certificates; 62% stated they complied with these guidelines, and 16% stated they did not follow them. In addition, 70% of the physicians reported regular exercise themselves, an average of 4.12h/week. These physicians tended to provide the pre-exercise certificate to all patients unconditionally, as compared to physicians that did not exercise regularly. (46% vs. 14.5%, p<0.01) Conclusions: Most Israeli primary care physicians will provide the required certificate allowing their patients to exercise in the gym. There is a wide variation as to what physicians check before providing the certificate. The modification of the law has made the need for standardization of the nature of what is expected of primary care physicians more urgent. A large portion of physicians exercise on a regular basis - and exercising physicians are more positive regarding pre-exercise certificates. Our study clearly shows a gap in knowledge transfer; and we call for a standardized approach to pre-exercise certificates utilizing computerized patient medical files. © 2016 Hoffman et al.


Korchia G.,Meuhedet Health Services | Amitai Y.,Meuhedet Health Services | Amitai Y.,Bar - Ilan University | Moshe G.,Bar - Ilan University | And 5 more authors.
Israel Medical Association Journal | Year: 2013

Background: Hypovitaminosis D is common worldwide, even in sunny regions. Objectives: To assess the prevalence and determinants of vitamin D deficiency in toddlers. Methods: A cross-sectional prospective study was conducted in healthy Jewish children aged 1.5-6 years at five primary care pediatric clinics in the Jerusalem area during the period October 2009 to November 2010. Parents were interviewed regarding personal and demographic data and sun exposure. Blood samples were obtained for serum 25-hydroxyvitamin D [25-OHD] level. Vitamin D deficiency and insufficiency were defined as 25-OHD < 20 ng/ml and < 30 ng/ml, respectively. Results: Of 247 children studied, 188 (76%) were ultraOrthodox and 59 (24%) were Orthodox, traditional or secular. Mean (± SD) 25-OHD level was 25.7 ± 10 ng/ml. Only 73 children (29.6%) had sufficient 25-OHD levels, 104 (42.1%) had insufficiency, and 70 (28.3%) had 25-OHD deficiency. The difference between ultra-Orthodox and others was insignificant (25 ± 10 vs. 27.8 ± 10.5 ng/ml respectively, P = 0.062). Children aged 1.5-3 years had higher 25-OHD levels than those aged 3-6 years (28.6 ± 10.7 and 24 ± 9.2 ng/ml respectively, P < 0.001). Vitamin D deficiency was more common in winter (53%) and autumn (36%) than in summer (19%) and spring (16%). Toddlers attending long-day kindergartens had higher 25-OHD level than those staying at home or at short-day kindergartens (28.8 ± 11.5 and 24.7 ± 9.6 ng/ml respectively, P < 0.05). Conclusions: A high prevalence of vitamin D deficiency was found in toddlers in our study, mainly in older children and in the winter and autumn. We recommend routine supplementation of vitamin D for children beyond the age of one year.


Erez G.,Meuhedet Health Services | Tirosh A.,Harvard University | Tirosh A.,Chaim Sheba Medical Center | Rudich A.,Ben - Gurion University of the Negev | And 11 more authors.
International Journal of Obesity | Year: 2011

Aims:Over 75% of obese subjects fail to maintain their weight following weight loss interventions. We aimed to identify phenotypic and genetic markers associated with weight maintenance/regain following a dietary intervention.Subjects and methods:In the 2-year Dietary Intervention Randomized Controlled Trial, we assessed potential predictors for weight changes during the weight loss phase (0-6 months) and the weight maintenance/regain phase (7-24 months). Genetic variation between study participants was studied using single-nucleotide polymorphisms in the leptin gene (LEP).Results:Mean weight reduction was 5.5% after 6 months, with a mean weight regain of 1.2% of baseline weight during the subsequent 7-24 months. In a multivariate regression model, higher baseline high-molecular-weight adiponectin was the only biomarker predictor of greater success in 0- to 6-month weight loss (Β0.222, P-value0.044). In a multivariate regression model adjusted for 6-month changes in weight and various biomarkers, 6-month plasma leptin reduction exhibited the strongest positive association with 6-month weight loss (Β0.505, P-value0.001). Conversely, 6-month plasma leptin reduction independently predicted weight regain during the following 18 months (Β0.131, P-value0.013). Weight regain was higher among participants who had a greater (top tertiles) 6-month decrease in both weight and leptin (3.4% (95% confidence interval 2.1-4.8)) as compared with those in the lowest combined tertiles (0.2% (95% confidence interval 1.1 to 1.4)); P-value0.001. Weight regain was further significantly and independently associated with genetic variations in LEP (P0.006 for both rs4731426 and rs2071045). Adding genetic data to the phenotypic multivariate model increased its predictive value for weight regain by 34%.Conclusion:Although greater reduction in leptin concentrations during the initial phase of a dietary intervention is associated with greater weight loss in the short term, plasma leptin reduction, combined with the degree of initial weight loss and with genetic variations in the LEP gene, constitutes a significant predictor of subsequent long-term weight regain. © 2011 Macmillan Publishers Limited All rights reserved.


Benyamini Y.,Tel Aviv University | Geron R.,Tel Aviv University | Steinberg D.M.,Tel Aviv University | Medini N.,Tel Aviv University | And 2 more authors.
American Journal of Health Promotion | Year: 2013

Purpose. To assess whether forming general behavioral intentions and implementing intentions through action plans promotes weight loss and is moderated by weight loss goals and self-efficacy. Design. A quasi-experimental study comparing change in body mass index (BMI) for 15 months between a behavioral intentions condition (BIC), an implementation intentions condition (IIC), and a comparison condition (CC). Setting. Ten-week weight loss program delivered in weekly group meetings at community medical centers. Subjects. Six hundred thirty-two attendants at the weight loss program (80% of program attendants participated in the study). Intervention. Weight loss program focused on lifestyle changes, augmented by two experimental conditions (vs. a comparison condition): BIC, intended use of weight loss techniques; IIC, intended use and detailed plans for two techniques. Phone follow-up was conducted 3 and 12 months later. Measures. Main outcome: BMI during the program (computed on the basis of weight and height measured on a mechanicalmedical scale). Experimental manipulations included exposure to list of techniques (BIC/IIC) and structured planning form (IIC); independent variables were assessed with questionnaires (eating selfefficacy, weight loss goal, demographics). Analysis. Linear mixed models estimating changes in BMI and their interactions with the planning interventions, goals, and self-efficacy. Results. Participants in the BIC and IIC lost 40%more weight during the 10-week program than those in the CC(1.10 and 1.11 BMI points compared with .79; ts,<-2.76, ps<.01). Weight loss goals interacted with implementation intentions (t = 2.98, p < .01). Self-efficacy was unrelated to weight loss. No differences were found between conditions at 3 and 12 months after the program. Conclusion. Findings revealed that forming implementation intentions promotes weight loss within a weekly program at a field setting and that its effectiveness depends on initial high goals. Copyright © 2013 by American Journal of Health Promotion, Inc.


PubMed | Meuhedet Health Services and Tel Aviv University
Type: | Journal: Israel journal of health policy research | Year: 2016

It has become clear in recent years that a healthy lifestyle, including physical exercise is crucial for health maintenance. Nevertheless, most people do not exercise regularly. Physician intervention is beneficial in increasing patient exercise. In Israel, the 1994 Sports Law regarding exercising in a gymnasium requires a physicians written authorization, but does not direct the physicians what they should ascertain before issuing the certificate. This pre-exercise certificate has been widely discussed in Israel over the last year as the law is to be revised to enable using a modification of the PAR-Q+ (Physical Activity Readiness questionnaire) patient questionnaire as a screening tool. This will leave the requirement for a pre-exercise certificate for a less healthy population, yet without clear instructions to the primary care physician on criteria for ascertaining fitness. Our aim was to evaluate how primary care physicians deal with the ambiguity of defining health criteria for issuing exercise authorization/certificate.We used an anonymous ten-item attitude/knowledge multiple choice questionnaire with an additional 13 personal/education and employment questions. We assessed each potential predictor of physician attitude and knowledge in univariate models.135 useable questionnaires were collected. Of these, 43.7% of the doctors will provide the pre-exercise certificate to all their patients; 63% were aware of their HMO/employers guidelines for issuing certificates; 62% stated they complied with these guidelines, and 16% stated they did not follow them. In addition, 70% of the physicians reported regular exercise themselves, an average of 4.12h/week. These physicians tended to provide the pre-exercise certificate to all patients unconditionally, as compared to physicians that did not exercise regularly. (46% vs. 14.5%, p<0.01).Most Israeli primary care physicians will provide the required certificate allowing their patients to exercise in the gym. There is a wide variation as to what physicians check before providing the certificate. The modification of the law has made the need for standardization of the nature of what is expected of primary care physicians more urgent. A large portion of physicians exercise on a regular basis - and exercising physicians are more positive regarding pre-exercise certificates. Our study clearly shows a gap in knowledge transfer; and we call for a standardized approach to pre-exercise certificates utilizing computerized patient medical files.


PubMed | The Edmond and Lily Safra Childrens Hospital, Meuhedet Health Services and Tel Aviv University
Type: Journal Article | Journal: PloS one | Year: 2015

Survivors of childhood cancer are at high risk for developing non-melanoma skin cancer and therefore are firmly advised to avoid or minimize sun exposure and adopt skin protection measures. We aimed to compare sun exposure and protection habits in a cohort of pediatric patients with a history of malignancy to those of healthy controls.Case-control study of 143 pediatric patients with a history of malignancy (aged 11.24.6 y, Male = 68, mean interval from diagnosis 4.43.8 y) and 150 healthy controls (aged 10.44.8 y, Male = 67). Sun exposure and protection habits were assessed using validated questionnaires.Patients and controls reported similar sun exposure time during weekdays (9482 minutes/day vs. 8165 minutes/day; p = 0.83), while during weekends patients spent significantly less time outside compared to controls (10385 minutes/day vs. 12487 minutes/day; p = 0.02). Time elapsed from diagnosis positively correlated with time spent outside both during weekdays (r = 0.194, p = 0.02) and weekends (r = 0.217, p = 0.01), and there was a step-up in sun exposure starting three years after diagnosis. There was no significant difference regarding composite sun protection score between patients and controls. Age was positively correlated with number of sunburns per year and sun exposure for the purpose of tanning, and was negatively correlated with the use of sun protection measures.Although childhood cancer survivors are firmly instructed to adopt sun protection habits, the adherence to these instructions is incomplete, and more attention should be paid to improve these habits throughout their lives. Since sunlight avoidance may results in vitamin D deficiency, dietary supplementation will likely be needed.


Moshe G.,Bar - Ilan University | Amitai Y.,Bar - Ilan University | Korchia G.,Meuhedet Health Services | Korchia L.,Hadassah University Mt Scopus | And 3 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2013

OBJECTIVE:: The aim of this study was to study the relative contribution of dietary sources of iron in children with high prevalence of anemia and iron deficiency (ID). METHODS:: A cross-sectional study in 263 healthy, 1.5- to 6-year-old children in the Jewish sector of Jerusalem, Israel. Venous blood samples and a qualitative Food Frequency Questionnaire on iron-rich foods were obtained. Anemia was defined as hemoglobin <11 g/dL for children younger than 4 years and <11.5 g/dL for children older than 4 years; ID was defined as ferritin <12 μg/L. RESULTS:: Anemia was found in 11.2%, ID in 22%, and iron-deficiency anemia in 3.7%. The prevalence of anemia was higher in toddlers ages 1.5 to 3 years compared with children ages 3 to 6 years (17.7% vs 7.3%, P = 0.01). Children with extremely low red meat consumption (seldom) had 4-fold higher rates of ID than those who consumed ≥2 times per week (odds ratio 3.98; 95% confidence interval 1.21-13.03; P = 0.023), whereas poultry consumption was not associated with ID. Soy consumption was inversely associated with ferritin (marginally significant, r =  -0.134, P = 0.057). CONCLUSIONS:: The high prevalence of anemia and ID found in this study, mainly in children 1.5 to 3 years old, is related to low red meat consumption. The characteristically high poultry consumption in the Israeli population was not protective. The shift toward reduced red meat consumption and higher poultry consumption in developed countries may result in increasing the risk of ID. Copyright © 2013 by European Society for Pediatric Gastroenterology.


Ekstein S.,Meuhedet Health Services | Laniado D.,Meuhedet Health Services | Glick B.,Meuhedet Health Services
Clinical Pediatrics | Year: 2010

Objectives: Picky eating is a major source of parental concern, and children with picky eating habits are potentially at risk for nutritional deficits. This research aimed to determine whether picky eating is related to being underweight in young children. Methods: Participants included 34 children with picky eating behavior who were referred to the Pediatric Feeding and Nutrition Clinic for evaluation and 136 healthy controls.Weight and height measurements were obtained, and weight-to-length data were calculated for each child. Results: In all, 7 of 34 children (20.6%) in the picky eaters group and 9 of 136 children (6.6%) in the control group were underweight (P =.02). Underweight was found in 15 children (14.2%) at or under 36 months and in 1 child (1.6%) older than 36 months (P =.002). Conclusions: Children with picky eating habits, especially those younger than 3 years of age, are at increased risk of being underweight.


PubMed | Meuhedet Health Services
Type: Journal Article | Journal: International journal of obesity (2005) | Year: 2011

Over 75% of obese subjects fail to maintain their weight following weight loss interventions. We aimed to identify phenotypic and genetic markers associated with weight maintenance/regain following a dietary intervention.In the 2-year Dietary Intervention Randomized Controlled Trial, we assessed potential predictors for weight changes during the weight loss phase (0-6 months) and the weight maintenance/regain phase (7-24 months). Genetic variation between study participants was studied using single-nucleotide polymorphisms in the leptin gene (LEP).Mean weight reduction was -5.5% after 6 months, with a mean weight regain of 1.2% of baseline weight during the subsequent 7-24 months. In a multivariate regression model, higher baseline high-molecular-weight adiponectin was the only biomarker predictor of greater success in 0- to 6-month weight loss ( = -0.222, P-value = 0.044). In a multivariate regression model adjusted for 6-month changes in weight and various biomarkers, 6-month plasma leptin reduction exhibited the strongest positive association with 6-month weight loss ( = 0.505, P-value < 0.001). Conversely, 6-month plasma leptin reduction independently predicted weight regain during the following 18 months ( = -0.131, P-value < 0.013). Weight regain was higher among participants who had a greater (top tertiles) 6-month decrease in both weight and leptin (+3.4% (95% confidence interval 2.1-4.8)) as compared with those in the lowest combined tertiles (+0.2% (95% confidence interval -1.1 to 1.4)); P-value < 0.001. Weight regain was further significantly and independently associated with genetic variations in LEP (P = 0.006 for both rs4731426 and rs2071045). Adding genetic data to the phenotypic multivariate model increased its predictive value for weight regain by 34%.Although greater reduction in leptin concentrations during the initial phase of a dietary intervention is associated with greater weight loss in the short term, plasma leptin reduction, combined with the degree of initial weight loss and with genetic variations in the LEP gene, constitutes a significant predictor of subsequent long-term weight regain.

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