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Biomedical subjects

D Hermoni

Publications and source records attributed to D Hermoni.

At least 19 recordsLinked to original sources
PubMed2001

[The efficacy of a doctor-patient appointment in a primary care setting dedicated to preventive medicine].

BACKGROUND: Previous data on the importance of promoting cessation of smoking, physical activity and a healthy diet exists in the literature. However, there is insufficient evidence that counseling healthy patients to change their life-styles will indeed have a positive effect on their behavior. In this study we examined whether a single doctor-patient appointment dedicated to preventive medicine can have a positive effect on cessation of smoking, promoting physical activity and weight control. METHOD: Eighty-eight patients from the "French Carmel" Clinic, aged 25-50, were summoned to a doctor-patient appointment lasting 20 minutes. The patients filled out a questionnaire and their weight and height were measured. The doctor counseled the patients to cease smoking, increase their physical activity and lose weight. The counseling was patient-oriented. Six to twelve months later the patients were interviewed by telephone and data was collected. The data was processed on a windows-based SPSS program. RESULTS: Of the 25 smoking patients, 2 (8%) stopped smoking, another 5 (20%) reduced their cigarette smoking. None of the non-smokers began smoking during the study, and there was no increase in the number of cigarettes smoked among the smokers. There was an increase in the number of patients who engaged in physical activity on a regular basis after the intervention: 56.1% as compared to 42.7% prior to the consultation. This increase was found to be statistically significant (p < 0.001). Among overweight (BMI 25-26.9) and obese (BMI > 27) patients there was a decrease in BMI following the intervention which was found to be statistically significant (p < 0.01). Among patients with normal weight (BMI 20-24.9) and underweight (BMI < 20) there was a decrease in BMI which was not statistically significant. CONCLUSION: In an era when economic considerations challenge the everyday work of the physician, we have showed in our study that a 20-minute doctor-patient appointment could influence the patient's life-style and thus promote healthy living.

Adult↗
PubMed2000

Doctor-patient concordance and patient initiative during episodes of low back pain.

Doctor-patient concordance and patient initiative were examined in a prospective network interview study, with telephone follow-up, of a cohort of 100 patients presenting with low back pain to their family physician. The average overall rate of concordance was 60% (95% CI = 53 to 66), with the highest rates for radiographic imaging studies and sick leave. No correlation was found between concordance and patient parameters. Subjects initiated an average of two (95% CI = 1.7 to 2.3) diagnostic or therapeutic procedures, the most common of which were for medications (40%), followed by bed rest (26%) and back school (22%). One out of every six subjects initiated a referral to a complementary therapist. Positive correlation was found between patient initiatives and pain severity (P = 0.022) and disability (P = 0.02). There was a negative correlation between the subjects' initiatives and their belief that the physician understood the cause of their pain and its influence on their life (P = 0.02). Overall, those patients who described more pain or disability sought more types of diagnostic and therapeutic measures, while those who felt they had been understood sought less.

Cohort Studies↗
PubMed1999

A new look at low back complaints in primary care: a RAMBAM Israeli Family Practice Research Network study.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons patients seek consultations in primary care, and it is a major cause of disability. Our research examines the natural history of LBP and the prediction of chronicity in the context of patients presenting to family medicine clinics. METHODS: We performed a prospective cohort study of new episodes of LBP within the framework of a national family practice research network. The setting was 28 primary care family practice clinics located throughout Israel. Of 238 eligible subjects, 219 (92%) completed the study. RESULTS: During the 2-month study period, 2 subjects were referred to the emergency department and discharged, and 2 others were hospitalized. Forty-five percent did not require bed rest, and 38% of the employed were not absent from work. Seventy-one percent showed improvement in functional status; however, only 37% noted complete pain relief. Clinical and demographic data usually did not predict LBP-episode outcomes. The strongest predictors of chronicity were depression, history of job change due to LBP in the past, history of back contusion, lack of social support, family delegitimization of patient's pain, dissatisfaction with first office visit, family history of LBP or other chronic pain, coping style, and unemployment. CONCLUSIONS: The cohort patients displayed a relatively benign natural history of LBP, matched by benign clinical behavior from their physicians. In Israeli primary health care, acute LBP is infrequently associated with hospitalization or prolonged work absenteeism. Although most patients have functional improvement, pain often lingers. Almost all predictors of chronicity are psychosocial.

Adult↗
PubMed1999

Chlamydia preumoniae in ischemic heart disease.

BACKGROUND: Previous work has suggested an association between Chlamydia pneumoniae infection and coronary artery disease. The infection was demonstrated by titers of antibodies--enzyme-linked immunosorbent assay or immunofluorescence, and polymerase chain reaction--and by the findings of C. pneumoniae in the atherosclerotic plaque. OBJECTIVES: To evaluate the association between chronic infection with C. pneumoniae, as measured by a high titer of IgG antibody, and CAD. Our study was designed to explore the relationship between seropositivity to C. pneumoniae and serious coronary events, and to assess whether or not there may be an additional association between established cardiovascular factors and infection with this organism. METHODS: The serum of 130 patients with proven CAD was tested for the presence of IgG antibodies to C. pneumoniae using an ELISA test. A titer < or = 1:64 using the microinfluorescence method, the recognized "gold standard," correlates with a positive result when using the ELISA method. The mean age was 57 (40-65 years). The patients, 82% male and 18% female, had either myocardial infarction (n = 109) or unstable angina (n = 21) 6 months before the investigation (range 3-24 months). The serum for the control group was obtained from 98 blood donors from the same area matched for age 52 (40-58 years) and sex. The donors had no known cardiac history. RESULTS: In the CAD group 75% of patients were positive for C. pneumoniae compared to 33% in the control group (P = 0.001). No increased correlation could be demonstrated between traditional risk factors and C. pneumoniae infection, except in those patients with diabetes mellitus. We found a lower prevalence of IgG antibody to C. pneumoniae in the diabetes subgroup than in other subgroups (P < 0.006), but a higher prevalence than in the control group. CONCLUSIONS: We demonstrated a more than twofold increase in seropositivity to C. pneumoniae among patients suffering serious coronary events, and this trend was independent of gender, age or ethnic group. These findings suggest that chronic C. pneumoniae infection may be a significant risk factor for the development of CAD, but this correlation should be investigated further.

Adult↗
PubMed1996

Age, seasonality and health.

Seasonal effects on mood and other components of functional status have been demonstrated in large segments of the general population but have received little attention in primary care patients. In the present study on adult members of a communal settlement (kibbutz) in Israel, seasonality and functional status were measured in both the winter and summer seasons in the same patients. Patients under age 65 had better overall health ratings than those 65 and over in both winter and summer. Overall health ratings were better in summer for those under 65 but were unchanged in the older group. Summer and winter seasonality scores were more constant in the younger group than in the older patients. We conclude that both age and seasonality need to be considered when measuring functional status in primary care patients.

Aged↗
PubMed1995

Talking about the pain: a patient-centered study of low back pain in primary care.

Despite considerable research, low back pain (LBP) often proves resistant to treatment. This study was designed to increase the understanding of low back pain through access to patients' perceptions, beliefs, illness behaviors and lived experiences. The findings are based on focus groups, individual interviews and participant observation conducted in primary care practices and community settings in three regions in Israel. Inclusion criteria for the interviews and groups include age greater than 18 years and a history of at least one episode of LBP. Seventy-six LBP subjects between the ages of 18 and 67 (mean 39.5) participated, 65% male and 35% female. The analytic method is content analysis, consisting of a formal, multi-step process designed to elucidate inherent patterns and meanings. This research finds that LBP subjects articulate a rich world of pain sensation, awareness and meanings. From subjects' own words and experiences we present a patient-centered classification system of backache symptoms based on typical pain intensity, dysfunction, duration and treatment. An elaborate system of explanatory models of LBP and a typology of dominant coping styles designed to either minimize pain or maximize function are also derived. Subjects choose multiple conventional and alternative treatments based on 'what works', and articulate ample criticisms of and suggestions for the medical system. In addition, we find that variations in the social construction of the back pain experience vary sharply, even between similar neighboring communities. Given the difficult state of diagnosis and treatment and the frustration of practitioners, attempts at greater understanding of patients' health beliefs, experiences, and behaviors are warranted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Depressive disorders in three primary care populations: United States, Israel, Japan.

Primary care patients in the United States, Israel and Japan received the Inventory to Diagnose Depression and the Dartmouth COOP Functional Status Charts modified for international use. Patients were classified as having major depressive disorder or minor depression. Although demographic characteristics varied by country, the rank order and frequency of the depressive symptoms were similar for both major and minor depression. Functional impairment was most severe in patients with major depression, less severe in those with minor depression and was least impaired in those not depressed. The results suggest that depressive disorders have similar presentations in the three countries studied, although the separate cultures confer different consequences on patients receiving these diagnoses.

Adolescent↗
PubMed1993

The inventory to diagnose depression (IDD) in primary care patients.

Major depressive disorder (MDD) is highly prevalent in ambulatory primary care patients. Severe functional impairment and risk of suicide are features of the condition. Although treatment can reduce morbidity, detection of MDD by primary care physicians is suboptimal. The aim of this study is to assess the inventory to diagnose depression (IDD) as compared with clinical psychiatric assessment for case finding in primary care patients. Adult members of an Israeli kibbutz (communal settlement), where all psychiatric diagnoses made by the family physician are confirmed by psychiatric consultation, were asked to complete the IDD; a 22 question, self-administered questionnaire. Patients whose scores indicated MDD, if not previously diagnosed, were also referred to psychiatrists. Patients' medical charts were reviewed for the diagnosis of MDD and response to therapy prior to the administration of the IDD. Of the sample of 312 patients, 207 (66.3%) completed the IDD. Refusers were younger (P = 0.04), more likely to be native born Israelis (P = 0.02), and had a higher prevalence of known MDD (P = 0.05) than participants. MDD by IDD scores was present in seven patients, in three of whom the diagnosis had previously been established; the other four were newly diagnosed. In the three previously diagnosed patients, one (metastatic carcinoma) refused treatment and two were receiving psychotherapy; all were clinically depressed. Four additional previously diagnosed patients whose IDD scores were insufficient for MDD had had a successful response to current therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Preventable deaths: 16 year study of consecutive deaths in a village in Israel.

The aims of this study were to examine mortality in one village in Israel and to determine which deaths could have been prevented by identifying those which were associated with avoidable factors or were caused by conditions which would have been amenable to preventive measures. The medical records of all 171 patients (91 males and 80 females) who died in the geographically defined population of 1800 during the 16 year period 1974-89 were reviewed. The mortality rate, adjusted for age, in the second eight year period (1982-89), was significantly lower for females (4.0 deaths per 1000 females per year) than for males (8.5) (P < 0.01). Downward trends in the birth rate, stillbirth rate and perinatal mortality rate were found, while there was an upward trend in both mean and median age at death. Of the 171 deaths, 36 (21%) were classified as being associated with a total of 44 factors which could be perceived as being avoidable. Twenty five of the avoidable factors were patient related and of these 17 were smoking (more than 20 cigarettes a day in patients aged less than 70 years who died of a smoking related disease). These findings confirm the need for continuous health education for patients. An audit of mortality in general practice is valuable and may contribute towards the prevention of some deaths.

Cause of Death↗
PubMed1991

Evaluation of a rapid method for diagnosing streptococcal pharyngitis in a rural community clinic.

Group A beta-hemolytic streptococcal pharyngitis is a common ailment whose accurate diagnosis is dependent on laboratory testing. Transport problems common to rural practices, for laboratory testing, could be resolved by a reliable rapid test. Laboratory evaluations of rapid streptococcal tests, performed mostly in research settings, indicate that the tests have acceptable specificity and sensitivity. This paper describes a comparison study of 248 consecutive throat swab specimens using a commercially available agglutination test with routine throat culturing. All agglutination testing was done by the office staff under actual working conditions, in a rural primary care clinic. The cultures were processed in the main regional microbiology laboratory. As a result of transportation delay, swabs were plated either within 6 h from collection or after 6 h. The test sensitivity (72%) and specificity (88%) compared well with that reported in the literature from microbiology laboratories, especially for swabs plated within six hours (80% and 93% respectively). The rapid test is an acceptable alternative to the standard culture technique in the family practice office under normal working conditions, provided that patients with negative results follow up with throat cultures.

Community Health Centers↗
PubMed1990

Failure to keep appointments at a community health centre. Analysis of causes.

The scheduled appointment system in primary care clinics became popular recently in Israel. Failed appointments created a problem for the doctors, patients and the clinic in Netivot. During 11 months, 2.317 appointments were surveyed. The survey showed 36% of failed appointments, with a decrease to 28% one year later. Rates of failed appointments were 38% for the paediatric population, 35% for adults, and 34% for pensioners. Market days and holidays predisposed to more failed appointments, representing community customs. The presence of a chronic disease that needed follow up ensured a higher rate of attendance (76%), especially among the paediatric population (92% attendance rate). By contrast, a geriatric patient with an acute disease had difficulty attending the clinic (only 16% attending). 512 people (35% of the population) were responsible for the 827 failed appointments, and among them only 12% of the population accounted for 59% of the failed appointments. These findings have important implications in the planning of an appointment system in an urban health centre, and they strengthen the assumption that a small number of patients cause a large number of failed appointments.

Adolescent↗