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Baum N.,Bar - Ilan University | Kum Y.,Meuhedet Health Services | Shalit H.,Clalit Health Services | Tal M.,Ministry of Health
Qualitative Health Research | Year: 2017

This study explores social workers' perceptions of inequalities in Israel's 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. © 2017 SAGE Publications.


Taitelbaum-Swead R.,Ariel University | Taitelbaum-Swead R.,Meuhedet Health Services | Icht M.,Ariel University | Mama Y.,Ariel University
Journal of the American Academy of Audiology | Year: 2017

Background: In recent years, the effect of cognitive abilities on the achievements of cochlear implant (CI) users has been evaluated. Some studies have suggested that gaps between CI users and normalhearing (NH) peers in cognitive tasks are modality specific, and occur only in auditory tasks. Purpose: The present study focused on the effect of learning modality (auditory, visual) and auditory feedback on word memory in young adults who were prelingually deafened and received CIs before the age of 5 yr, and their NH peers. Research Design: A production effect (PE) paradigm was used, in which participants learned familiar study words by vocal production (saying aloud) or by no-production (silent reading or listening). Words were presented (1) in the visual modality (written) and (2) in the auditory modality (heard). CI users performed the visual condition twice-once with the implant ON and once with it OFF. All conditions were followed by free recall tests. Study Sample: Twelve young adults, long-term CI users, implanted between ages 1.7 and 4.5 yr, and who showed ≥50% in monosyllabic consonant-vowel-consonant open-set test with their implants were enrolled. A group of 14 age-matched NH young adults served as the comparison group. Data Collection and Analysis: For each condition, we calculated the proportion of study words recalled. Mixed-measures analysis of variances were carried out with group (NH, CI) as a between-subjects variable, and learning condition (aloud or silent reading) as a within-subject variable. Following this, paired sample t tests were used to evaluate the PE size (differences between aloud and silent words) and overall recall ratios (aloud and silent words combined) in each of the learning conditions. Results: With visual word presentation, young adults with CIs (regardless of implant status CI-ON or CIOFF), showed comparable memory performance (and a similar PE) to NH peers. However, with auditory presentation, young adults with CIs showed poorer memory for nonproduced words (hence a larger PE) relative to their NH peers. Conclusions: The results support the construct that young adults with CIs will benefit more from learning via the visual modality (reading), rather than the auditory modality (listening). Importantly, vocal production can largely improve auditory word memory, especially for the CI group.


Taitelbaum-Swead R.,Ariel University | Taitelbaum-Swead R.,Meuhedet Health Services | Fostick L.,Ariel University
Clinical Linguistics and Phonetics | Year: 2016

This study investigates the development of audiovisual speech perception from age 4 to 80, analysing the contribution of modality, context and special features of specific language being tested. Data of 77 participants in five age groups is presented in the study. Speech stimuli were introduced via auditory, visual and audiovisual modalities. Monosyllabic meaningful and nonsense words were included in a signal-to-noise ratio of 0 dB. Speech perception accuracy in audiovisual and auditory modalities by age resulted in an inverse U-shape, with lowest performance at ages 4–5 and 65–80. In the visual modality, a clear difference was shown between performance of children (ages 4–5 and 8–9) and adults (age 20 and above). The findings of the current study have important implications for strategic planning in rehabilitation programmes for child and adult speakers of different languages with hearing difficulties. © 2016 Taylor & Francis.


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.


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.

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