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Biomedical subjects

Alex Leventhal

Publications and source records attributed to Alex Leventhal.

At least 37 records · Page 2Linked to original sources
PubMed2003

Relative prevalence of malformations at birth among different religious communities in Israel.

The aim of this research was to determine the relative prevalence at birth of major malformations among the different religious communities in Israel as a way to better understand their causes. We collected data on malformations present among liveborn infants in a 10-year period from the national registry of birth defects according to the religious affiliation. In a total of 1,203,763 liveborn infants, the prevalence of major malformations was in a similar range among Jews and Christians and much higher among Muslim and Druze. These observations may be explained by differences between these communities, in particular, the rates of consanguinity and of therapeutic abortions. The Muslim and Druze communities in Israel are those with the highest consanguinity rates and the lowest rates of termination of pregnancies when a malformation is diagnosed. Analysis of the differences in the rate of malformations at birth in different communities is important for Public Health planning. It may also help to delineate causes and serve as the basis for research.

Christianity↗
PubMed2003

A tap water turbidity crisis in Tel Aviv, Israel, due to technical failure: toxicological and risk management issues.

Herein, we report on the actual events linked to an ammonia spillage into the main waterline of the Tel-Aviv metropolitan area and its surrounding municipalities. Based upon a large magnitude increase of unknown origin in the turbidity and ammonia levels of the main drinking water supply, area residents were warned of possible serious contamination and advised to refrain from drinking tap water until further notice. Turbidity was later linked only to CaCO3, which was precipitated from the water due to the rise in pH caused by the excessive ammonia levels. The source of the ammonia (a malfunction of the measurement buoy in the ammonia tank) was not identified until several days after the warning was issued. The toxicological implications of the turbidity and ammonia elevations are considered and reconciled with the management strategies that followed. Of consequence to the management of this crisis was the approach of Ministry of Health officials to regard the ammonia, from the onset, as an indicator of several possible sources of origin rather than as a contaminant. Decision-making policies were hampered by ineffective communication between the national water supplier and government health officials. An outcome of this crisis was a heightened awareness of the potential of a water crisis occurring during peace time and not only in association with terrorist activities, to which Israeli citizens are highly sensitized. Finally, the present paper may serve to guide municipal environmental and health officials more appropriately in the event of similar drinking water crises in Israel or elsewhere.

Ammonia↗
PubMed2003

SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program.

During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.

Contraindications↗
PubMed2003

The impact of congenital malformations and Mendelian diseases on infant mortality in Israel.

BACKGROUND: Infant mortality in Israel is twofold higher among non-Jews than Jews. OBJECTIVES: To determine the impact of congenital malformations and Mendelian diseases on infant mortality. METHODS: We compared the causes of infant mortality in a 4 year period among Jewish and non-Jewish Israeli citizens. Classification was done by analyzing all the death reports according to whether or not the child had any known major malformation, Mendelian disease and/or a syndrome, irrespective of the immediate cause of death. RESULTS: The infant mortality among non-Jews was double that among Jews (9 versus 4.4 per 1,000 live births). The rate of children with malformations/genetic syndromes was 3.1 times higher among non-Jews than among Jews (2.94 vs. 1.25 per 1,000 live births). The most significant difference was in the rate of Mendelian diseases, which were 8.3 times more frequent in non-Jewish children (0.16 vs. 1.33 per 1,000 live births respectively). A Mendelian disease was diagnosed in almost 15% of the non-Jewish infants and in less than 5% of the Jewish infants. CONCLUSIONS: The most striking difference between the Jewish and non-Jewish infants was the incidence of congenital malformations and Mendelian diseases parallel to the differences in the consanguinity rates between the two populations.

Abortion, Therapeutic↗
PubMed2003

[The IDF evacuation from southern Lebanon in 2000: impact on the delivery of health care to displaced Lebanese population].

BACKGROUND: The State of Israel controlled a protective security zone in southern Lebanon from 1982 until May 2000, when the Israel Defense Forces (I.D.F.) evacuated this area within two days. Officers and soldiers of the South Lebanese Army, a local militia, which had formerly cooperated with the I.D.F., chose to come to Israel with their families. The provision for the health needs of this displaced population of over 5,861 persons was coordinated by the Northern Region Health Office of the Ministry of Health. AIM: To describe the deployment and provision of health care for this displaced population and to present the lessons learned. METHODS: Data was collected from interviews with the personnel most actively involved in the decisions and execution of the enterprise, as well as from relevant documents. RESULTS: The main health needs of the displaced South Lebanese were related to anxiety, outbreak of chickenpox, dental problems and provision of medical equipment for the disabled. CONCLUSION: The experience accrued by the Northern Region Health Office over the years in provision of care to displaced populations at short notice was implemented. Cooperation within the health sector and between the health services and the military and defense forces was invaluable and essential to deal successfully with this unusual situation.

Arabs↗
PubMed2003

Addition of essential micronutrients to foods--implication for public health policy in Israel.

Micronutrient deficiencies have reoccupied the center stage of public health policy with the realization that folic acid deficiency results in neural tube defects and possibly other birth defects as well as ischemic heart disease. These, in turn, have raised an older debate on food fortification policy for the elimination of iodine, iron and vitamin D deficiencies. Data from the First Israeli National Health and Nutrition Survey (MABAT 2000) provided an impetus to develop an active national nutrition policy aimed to improve the nutritional status of iodine, iron, vitamins A and D and B-vitamins, including folate. In this paper we examine some of the micronutrient deficiency issues in Israel and their implications for public health, and suggest options for the formulation of policy.

Food, Fortified↗
PubMed2003

Bovine spongiform encephalopathy in Israel: implications for human health.

Only one case of a cow infected with bovine spongiform encephalopathy has been reported in Israel. Its publication, in 2002, caused both public and professional concern. The inevitable health policy question raised was whether or not to recommend against consuming beef and what public health measures should be taken. In this article we describe the prion diseases among animals and humans, their interaction and the precautionary procedures that were carried out by the state Veterinary Services and the Ministry of Health since 1988. The BSE case (a 10 year old dairy cow) is believed to be the result of local consumption of infected mammalian meat and bone meal more than a decade earlier. The risk assessment took into consideration that no cases of vCJD (a new variant of Creutzfeldt-Jacob disease) have ever been diagnosed in Israel, as well as the low risk of contamination of the meat due to the religious method of slaughtering performed in the country. The policy decision was to implement a contingency plan prepared in advance. Israel was reclassified from the level II category of geographic risk where BSE is unlikely but not excluded in the herds, to level III where BSE is likely but not confirmed, or confirmed at a lower level. No undue damage to the meat industry has occurred. By the end of 2002, despite the examination of more than 3,800 brains from slaughtered cows older than 3 years, no other cases of BSE have been detected.

Animals↗
PubMed2003

[Israeli guidelines for investigation and management of SARS cases and their contacts].

As the first emerging epidemic of the 21st century, SARS has raised much interest and fear among statesmen, economists, and the general public, as well as within the medical community. This new disease is characterized by several daunting challenges, including person-to-person transmission, an environmentally resistant agent, a non-specific clinical presentation, and a high fatality rate among high risk individuals. In Israel, as elsewhere, public health authorities were forced to quickly design appropriate measures to confront this new threat. The Israeli guidelines for surveillance, epidemiologic investigation and intervention in the event of a SARS outbreak were drafted in the absence of complete data on some of the most basic epidemiologic characteristics of the disease. Discrepancies between published guidelines from several countries made the decision-making process even more complicated. We describe the epidemiologic guidelines for SARS drafted by the Israeli working group, as well as the considerations on which they are based. The recent experience with this new outbreak has already provided several valuable lessons on policy making which may help future planning for emerging and re-emerging infectious diseases.

Disease Outbreaks↗
PubMed2003

[Migrant workers: evolution of the Israel health system approach to the new social issue].

The immigration of workers from poor countries to Israel began in earnest in 1993, and by 2003 their number had reached 250,000, the majority without work permits. In this article we describe the evolution of the Israeli approach to providing health services to migrant workers, noting particularly the swings between exclusion and inclusion, ranging from providing only the most minimal services to providing a complete health services package. The National Insurance Institute was the first to provide benefits to documented migrant workers, mandating compensation benefits for those injured at work or in terrorist incidents. The health care sector provided an ever-increasing package of health benefits for documented migrant workers, culminating in the Foreign Workers Law of 2000 obligating employers to insure workers with a health package similar to that of Israeli citizens. The provision of health services to undocumented migrant workers and their families arose more gradually, but ultimately included the full range of mother and child preventive health services, school health services, provision of ambulatory medical care by volunteer physicians members of human rights organization, the possibility of enrolling their children at a reduced premium in Meuchedet Health Fund, free diagnostic and treatment services for tuberculosis and sexually transmitted diseases, free antiretroviral treatment of HIV-positive pregnant women, and, finally, the ability to obtain gas masks for a token deposit prior to the Iraq War of 2003

Delivery of Health Care↗
PubMed2003

[A comprehensive program for prevention of genetic diseases among Arabs in Israel].

Genetic diseases are relatively prevalent among the Arab population, and are a significant cause of morbidity and mortality in this population. The relative high rate of genetic diseases among the Arabs in Israel is a direct result of very high rates of consanguinity. In order to reduce the frequency of congenital malformations/inherited diseases, it is important to choose combined strategies, including efforts focused on health education and health promotion, with an emphasis on the medical consequences of marriages within the family. Primary prevention is conducted by genetic counseling prior to marriage or prior to the first pregnancy and secondary prevention focuses on early genetic screening during the pregnancy. In order to provide the necessary tools for such a program, genetic research must first characterize the common genetic diseases in the small communities, and identify their responsible mutations.

Arabs↗
PubMed2002

A model-based evaluation of a cultural mediator outreach program for HIV+ Ethiopian immigrants in Israel.

This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study's approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.

Community-Institutional Relations↗
PubMed2002

When is an epidemic an epidemic?

BACKGROUND: The large number of cases of West Nile fever diagnosed in Israel in 2000 once again brought into focus the confusion that frequently accompanies the use of the term "epidemic." OBJECTIVES: To examine the different definitions of the term "epidemic" and to propose ways in which it can be used to both improve communication among professionals and provide the public with a better sense of the associated risks. METHODS: The literature was reviewed for the various definitions of the terms "epidemic" and "outbreak." Sources included popular and medical dictionaries, ancient documents, epidemiology texts, legal texts, and the medical literature. RESULTS: The term epidemic is variously defined. The broad definition given by epidemiologists--namely, more disease than is anticipated by previous experience--is less meaningful to the general public. In some ways it conflicts with the definitions found in the popular literature, which generally imply danger to the public and a very large number of victims. CONCLUSIONS: The interpretation of the term epidemic may vary according to the context in which it is used. For risk communication, we suggest that every effort be made to add descriptive terms that characterize the epidemic.

Communication↗
PubMed2002

[Soy and phytoestrogens consumption and health policy hesitation or certitude].

Soy and phytoestrogens are controversial as to their beneficial effects on health and the prevention of disease. To date, dietary recommendations in Israel do not specify a diet rich in soy and phytoestrogens. In order to establish a policy on this issue, we carried out a comprehensive, updated review of the relevant scientific literature. Data on the role of these substances in the primary and secondary prevention of cancer are limited. As yet, there is no conclusive evidence on the efficacy of phytoestrogens and soy in the prevention of osteoporosis. Their effect on fertility in animals and humans is still unclear. There are no data on the long-term risks or benefits of using soy-based formulae in infancy. Therefore, for those who cannot be breast-fed, cow-milk based formulae are recommended. Currently, the most supportive evidence for health benefits of soy can be found in studies on the prevention of cardiovascular diseases.

Estrogens, Non-Steroidal↗
PubMed2002

[Tuberculosis in Israel--main epidemiological aspects].

BACKGROUND: In the last decade, tuberculosis (TB) has re-emerged as a major worldwide disease and also as a significant disease in Israel, particularly in the context of public health. In 1993, TB was declared a "global emergency" by the World Health Organization and in 1996, it was declared a "dangerous infectious disease" by the Israeli Ministry of Health. AIM: This article aims to provide an epidemiological update on TB to the practicing physician in Israel. We present the perspective of the global situation together with relevant data on TB in Israel for use in clinical decision making. METHODS: All local data are from the ongoing epidemiological surveillance of TB conducted by the Department of Tuberculosis and AIDS in the Israeli Ministry of Health. Other data are cited from international sources. RESULTS: TB is greatly influenced by immigration (some 80-90% of TB cases are foreign-born and at least 65% are among new immigrants). Between 1989-1996 the incidence of TB by cohort analysis for year of immigration ranged from 38-172/100,000 (for new immigrants from the Former Soviet Union) to 500-3,000/100,000 (for new immigrants from Ethiopia). During this period incidence in the veteran population (Israeli-born and immigrants at least 5 years in the country) was, at the most. 4/100,000. Some 80% of TB cases were pulmonary. The rate of drug resistance is increasing some 20% of the isolated strains were resistant to at least one drug and some 8% were resistant to both Isoniazid and Rifampicin. (MDR, multi-drug-resistant). Tuberculosis associated with AIDS has increased in the last decade due to immigration from sub-Saharan Africa. Contrary to the belief existing in the general public, the number of TB cases among foreign workers was relatively low (7.6% of the cases reported in 1998). CONCLUSION: In the clinical context, a practicing physician is most likely to diagnose TB in a recent immigrant. Thus since the symptoms of early TB are non-specific, diagnostic efforts (which are labor intensive and expensive) should be guided by a high index of suspicion in that particular population group. Furthermore, this epidemiological data provided the rationale for determining TB control policy as described in the second article on this subject.

Africa South of the Sahara↗
PubMed2002

[The new national program for tuberculosis elimination in Israel].

BACKGROUND: The rise in the incidence of TB in Israel, mostly due to immigration from endemic areas, led to the establishment of a new TB control program which follows the guidelines of the World Health Organization (WHO). Reorganization of the TB infrastructure was enabled by specific legislative, administrative and budgetary measures initiated by the Ministry of Health (MOH) in conjunction with the Sick Funds. AIM: To present the theoretical and practical aspects of this new program to the physicians of Israel. PROGRAM OUTLINE: The essence of this program is the use of directly observed therapy (DOT) for all patients together with centralization of TB care in nine national centers, closely supervised by the MOH. This centralization allows a critical mass of patients to be seen in each clinic, thus enabling the labor-intensive task of modern TB treatment, including the supervision and/or the administration of DOT, to be performed in a cost-effective manner. Day to day treatment is conducted by general community clinics and supervised by District Health Offices. Hospitalization, a relatively rare necessity in the new program, is available in two dedicated centers with modern isolation facilities. Centralized laboratory services provide timely susceptibility testing. Billing is simplified according to disease categories, using a global assessment of costs negotiated with the Sick Funds. Management and quality control of the program are carried out on an ongoing basis by the Department of TB and AIDS at the MOH. PRELIMINARY OUTCOME: In the first two years that have elapsed since the inception of the program, almost 93% of cases have documented evidence of completion of treatment (under DOT), compared to 54% (without any treatment supervision) before the program came into effect.

Government Agencies↗
PubMed2002

[Air pollution, particulate matter and human health].

Air pollution in Israel is an increasing problem, mainly due to the sharp rise in the number of motor vehicles, and in particular diesel engined vehicles. It has become a focus of interest for the general public, as part of the rising awareness of Israelis to environmental matters, and for the medical community in particular, due to the associated rise in the incidence of asthma. The present review deals with the importance of the role of fine particulate matters (PM10 and PM2.5), while more classical pollution parameters, such as Sulfate and Nitrate Oxides, currently seem to be less relevant in predicting associated health effects. There is a need for an intensification of applied research in this field in Israel, in orders to establish a better data platform required for defining the national health policy in this field.

Air Pollution↗
PubMed2002

The epidemiologic pyramid of bioterrorism.

Recent events have drawn world attention to "mythological diseases"--such as anthrax, plague and smallpox--which have been out of the spotlight for some decades. Much of our current knowledge of epidemic intervention and disease prevention was acquired over history through our experience with these diseases, such that the sudden panic over the reemergence of these historically well-known entities is perplexing. Over time, changes in the balance of the epidemiologic triangle have driven each of these disease systems towards a new equilibrium with which we are not familiar. While the pathogens may be similar, these are not the diseases of the past. These new disease systems are insufficiently described by the classic epidemiologic triangle, which lacks a dimension necessary for providing a valid model of the real-world effects of bioterror-related disease. Interactions within the classic epidemiologic triangle are now refracted through the prism of the global environment, where they are mediated, altered, and often amplified. Bioterror-associated diseases must be analyzed through the epidemiologic pyramid. The added dimension represents the global environment, which plays an integral part in the effects of the overall disease system. The classic triangle still exists, and continues to function at the base of the new model to describe actual agent transmission, but the overall disease picture should be viewed from the height of the fourth apex of the pyramid. The epidemiologic pyramid also serves as a practical model for guiding effective interventional measures.

Anthrax↗