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Biomedical subjects

E Kahan

Publications and source records attributed to E Kahan.

At least 19 recordsLinked to original sources
PubMed1996

Monitoring blood lead levels in workers overexposed to occupational lead: an analysis of Israeli data.

In a retrospective cohort study, we followed the blood lead [Pb(B)] and zinc protoporphyrin (ZPP) determinations of 292 workers found to have Pb(B) levels above the biological exposure index (BEI) during 1987-1993. The results indicated that (a) 22.6% of these workers were never retested for Pb(B) during the follow-up period; (b) 38.5% of the workers tested in the first year of the follow-up continued to exhibit Pb(B) levels above the BEI (84.7% of them also had ZPP > or = 100 micrograms/dl); (c) about 25% of the remaining cohort had at least one more result above the BEI during the fourth, fifth, and sixth years of follow-up; and (d) the incidence density rate of recurrence of Pb(B) concentrations above the BEI was 0.236. We recommend the establishment of a target value lower than the BEI that should be reached before the reinstatement of the overexposed worker. In our view this target value, combined with an efficient control of industrial hygiene conditions, will decrease the rate of recurrence of overexposure.

Cohort Studies↗
PubMed1996

Constipation: a different entity for patients and doctors.

BACKGROUND: Medical definitions of constipation vary. Some are specific, based on the interval between defecations, with three days or twice weekly as the upper limit of normality. Others are vague. OBJECTIVE: This study investigates patients definitions, attitudes and management of 'constipation' and compares their definitions with physicians' criteria. METHODS: Survey of 1) 531 randomized patients of family clinics of the sick Fund of the General Federation of Labor of Israel, and 2) 100 randomized specialists and residents in family medicine. RESULTS: The present survey showed that constipation is more common in women and in the older (> 40 years) age group. The most important finding of this investigation was the wide discrepancy in the criteria used by doctors and patients to diagnose constipation. Fifty per cent of the patients defined constipation differently from accepted medical definitions--27% of the patients defined it as defecation every 2 days or less and 25% as hard stool alone. All 57 doctors who were asked the same question defined constipation as defecation every 3 or 4 days or less, sometimes in combination with hard stool. CONCLUSIONS: This study suggests that patients and doctors refer to different entities when they talk of 'constipation'. It is the doctor's responsibility to ensure that this misunderstanding is avoided so that unnecessary tests and treatment are not undertaken and, patient-doctor acrimony is avoided.

Adult↗
PubMed1996

Attitudes of primary care physicians to the management of asthma and their perception of its relationship to patients' work.

The results of a questionnaire on the attitude of family physicians and general practitioners to the management of asthma, and their perception of the relationship between working conditions and asthma are reported. Family physicians were three times more likely than general practitioners to treat asthmatic patients themselves, without referral to a specialist. However, there were no other major differences between these two groups regarding the weight they attributed to the occupational factor in asthma. Overall, both groups routinely asked patients about their job (78%) and exposure at work (75%), but at least in half the cases this issue was not followed-up to determine if occupation-related counselling or problem management were necessary. Differences in the primary care of asthmatics were also noted between physicians in Israel and America. In Israel, physicians tended to explain everything to the patients at the initial visit, and then leave them to cope on their own unless the episodes remained uncontrolled, whereas their American counterparts continued their educational activities in subsequent visits as well. We conclude that family medicine residency training in Israel, despite the inclusion of courses and lectures on occupational health in general and on respiratory diseases in particular, does not sufficiently emphasize this subject. Clinicians should be trained to take a more in-depth and active approach to this problem in order to avoid misdiagnosis and improve prevention.

Adult↗
PubMed1996

Risk factors associated with the severity of systemic insect sting reactions.

To evaluate risk factors associated with the severity of systemic insect sting reaction and to determine the type of insect responsible for systemic anaphylaxis, we conducted a cross-sectional study of 498 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. Data were collected by questionnaire and review of patient records. Eighty percent of the patients were treated with honeybee venom, which was used as a single therapy in 60% of the group. In a multivariate logistic model the major factors identified as significantly influencing the probability of a more severe systemic reaction were short time of onset of reaction after stinging (<30 min), high number of prior stings (> or = 4), and age (> or = 18 years). A total of 79.3% of the patients had been stung outdoors, and 50% had lived all their lives in rural areas as compared to 10% in the general Israeli population. This study reports clinically valuable risk factors for the severity of systemic sting reaction. A practical finding was that the honeybee is the insect mostly responsible for sting reactions in Israel, but the type of insect is not a significant predictor of the severity of the reaction.

Adolescent↗
PubMed1995

Should nurses in Israeli primary care clinics be expected to manage streptococcal throat infections?

INTRODUCTION: Legal regulations in Israel allow nurses to perform only limited clinical procedures. OBJECTIVE: To determine the probability of streptococcal infection in adults with sore throat, as assessed clinically by standard nursing procedures. DESIGN: Using throat culture as the standard, the contribution of various clinical findings (fever, exudate, erythrocyte sedimentation rate (ESR), white blood count) to the determination of the diagnosis of streptococcal infection was assessed, using logistic regression analysis. SETTING: Israeli general practice. PATIENTS: 100 consecutive adult patients presenting with a red, sore throat. RESULTS: Six patients showed the full clinical picture of exudate, increased ESR and leukocytosis, with an 82% probability of streptococcal infection. Forty-nine patients showed none of these three findings, and only one of them (among the three patients with rhinitis) had a positive throat swab. Forty-five patients showed an intermediate clinical picture which did not provide a reliable basis for the diagnosis or exclusion of streptococcal infection. Fever alone did not significantly (P < 0.05) predict streptococcal infection. CONCLUSIONS: Nurses may safely discharge adult patients with a red, sore throat without antibiotic treatment only if they have no additional signs or symptoms. The few patients with all the clinical findings may be treated with antibiotics without a throat swab. All other patients should be referred for examination by a doctor.

Adolescent↗
PubMed1995

Determination of consumer satisfaction: a basic step for quality improvement of an occupational hygiene service.

In order to define priorities for improvement of the Occupational Hygiene Service, Institute for Occupational Health, Tel Aviv University, consumer satisfaction was evaluated by postal questionnaire. The questionnaire covered items on service accessibility and quality, including staff courtesy and respect for the consumer, cost, satisfaction with the service in general over time, and satisfaction with the last service received, and was sent to all 144 regular clients of the institute during the years 1990 and 1991. Satisfaction items were rated from 1 (not at all satisfied) to 5 (completely satisfied). Multivariant analysis showed that: (i) satisfaction with the waiting period for the last service report and satisfaction with the courtesy of the last service and respect for the consumer had the strongest influence on general satisfaction with the service over time; (ii) satisfaction with the waiting period for the last service report was also the most important component in satisfaction with the last service received. Despite the increasing interest in Israel in health service costs, and because the price of the service is subsidized (50%), this item was not found to be significant with regard to satisfaction with the service. In conclusion, we recommend the use of this relatively easy and inexpensive methodology which allowed us to define precisely the key factor for service improvement, ie the waiting period for the service report.

Consumer Behavior↗
PubMed1994

Consultants' complaints about the quality of referrals from primary care physicians: tempest in a teapot?

OBJECTIVE: To determine whether consultants' general impressions of the quality of referrals from family physicians are consistent with their evaluations of the quality of specific referrals. METHODS: Data were gathered using two questionnaires, completed separately by the same group of consultants working in a Health Maintenance Organization (HMO). Both questionnaires contained the same items and were designed to cover the following topics: (a) the general impression of the consultants about the quality of referrals received from family physicians; (b) their specific evaluation of all consecutive patient referrals by family physicians over a one-week period. Forty consultants employed in an outpatient regional multidisciplinary clinic of the largest HMO in Israel participated in the study. Of the 3136 referrals received over a one-week period, 1466 fulfilled the inclusion criteria, and 1416 were evaluated (response rate, 97%). RESULTS: Most of the estimates of the number of unnecessary/inappropriate referrals obtained in the general impression questionnaire were 2 to 5 times higher (p < or = 0.001) than those obtained in the consultants' evaluation questionnaire about specific referrals. CONCLUSIONS: This study suggests that consultants' complaints of unjustified and inappropriate referrals from family physicians must be taken with great reservation, at least within the framework of health systems that do not encourage physicians to produce a large number of services.

Family Practice↗
PubMed1994

Knowledge and attitudes of a group of South African mine workers towards noise induced hearing loss and the use of hearing protective devices.

The study aimed to explore the knowledge and attitudes of a group of mine workers regarding noise induced hearing loss and the use of hearing protective devices. These aims were investigated via a questionnaire administered in a group setting to 55 underground mine workers. The main finding that emerged from the study was that respondents were poorly informed regarding the fact that noise was a health hazard. Furthermore, the knowledge that respondents did possess, appeared to have been derived from the personal experience of working in noisy environments for many years, rather than from educational input. Contrary to expectations, respondents did not view deafness as a status symbol but rather as a negative attribute. Consequently, they were motivated to protect themselves from hearing impairment and to be educated about hearing and the effects of noise. The mine workers complained about discomfort when wearing hearing protective devices as well as feelings of insecurity due to inhibition of communication and the inability to hear warning signals. For these reasons, noise protection was mainly worn in situations perceived as noisy by workers themselves. These results are discussed in terms of their implications for the clinical practice of audiology; hearing conservation in the mining industry; further research; and the training and education of speech-language pathologists and audiologists.

Ear Protective Devices↗
PubMed1992

Adverse health effects in workers exposed to cadmium.

One hundred fifty-two workers who had been exposed to different levels of cadmium (Cd) absorption (blood Cd mean 16.34 micrograms/L, median 11.0 micrograms/L) in a factory making nickel-cadmium batteries were studied. A physical evaluation, as well as blood and urine cadmium and N-acetyl-beta-D-glucosaminidase (NAG), and other routine laboratory tests were performed in order to assess the relationship between different levels of exposure to occupational cadmium and potential cadmium-induced renal damage and other adverse health effects. We found significant correlation between levels of cadmium exposure and a selected group of symptoms and signs. The best predictor of this group of symptoms and signs was an indicator called internal dose index (Cd x exposure time). This indicator appears as the strongest, even after control by confounding factors, such as age and smoking. It is concluded that this index can be used for biological monitoring.

Adult↗
PubMed1992

Prognostic factors in node-positive operable breast cancer patients receiving adjuvant chemotherapy.

A retrospective analysis of prognostic factors in 214 consecutive node-positive (N+) operable breast cancer patients, receiving Melphalan + 5-fluorouracil adjuvant chemotherapy between 1980 and 1984 was performed. Median follow-up was 95 months. Actuarial disease-free interval (DFI) and survival (S) were determined according to age, menopausal status, histology, size of primary tumor (T), multifocality, tumor location, hormonal receptor status, number of N+, size of N+, tumor spread in axillary fat, and interval between surgery and onset of adjuvant chemotherapy. On univariate analysis two factors were prognostic for DFI and S: number of N+ and T size. A comparison between traditionally classified T1 and T2 patients revealed no significant difference, but when the cut-off point was shifted from 2 cm to 3 cm, T size represented a highly significant prognostic factor. In patients with T less than or equal to 3 cm 5-year DFI was 54% and 5-year S was 76%, while in patients with T greater than 3 cm the respective values were 23% (p less than 0.001) and 41% (p less than 0.001). These significant DFI and S differences persisted after adjustment for number of N+ by bivariate analysis. Multivariate analysis supported the importance of T greater than 3 cm as a strong adverse predictor. Four adverse variables, T greater than 3 cm, number of N+ greater than or equal to 4, multifocality, and tumor spread in axillary fat were used to divide our patients into three subsets with significantly different DFI: Group I, with none of the above factors; Group II, with only one factor present; and Group III, with more than one factor present (5 years DFI 66%, 45%, and 21%, respectively; p less than 0.001).

Breast Neoplasms↗
PubMed1992

Assessment of the extent of implementation of the recommendations made in occupational hygiene survey reports.

The extent of implementation of recommendations contained in field reports from the Occupational Hygiene Unit of the Institute for Occupational Health at the Tel Aviv University, was investigated. The results show that 33% were not carried out at all and 16% were only partially carried out. A number of factors influenced the extent of implementation, in particular the degree of involvement of the management in worker health and welfare, an active safety system in operation, the professional skill and seniority of the person in charge of safety, awareness by the workers of health and safety matters, the existence of a specific budget for health and safety and a regulatory system concerning occupational exposure.

Health Knowledge, Attitudes, Practice↗
PubMed1992

Normal fluctuations of leucocyte counts and the response to infection in benign familial leucopenia.

In a long-term follow-up of 47 Yemenite patients with benign familial leucopenia, the mean white-cell count was 4,578 with a standard deviation of 940. During bacterial infections, the average leucocyte increment was the same in leucopenic as in non-leucopenic subjects, leading to total leucocyte counts in the normal range in previously leucopenic subjects. The marked degree of variability makes clinical interpretation difficult when leucocyte counts are found between levels standardised as normal in sick patients previously known to be leucopenic.

Adult↗
PubMed1992

Follow-up appointments at consultation clinics: consultants fail in knowing their own practice.

In National Health Care Systems excessive reappointments at consultative clinics can result in over utilization of those services and/or too much retention of patients which frustrates family physicians in their interest for continuity of care for chronic patients. In order better to understand many consultants' complaints about overwork, we examined the proportion of patients who were given follow-up appointments by type of specialty in 2840 consecutive services requested in a multispecialist centre of a prepaid system in Israel, analysing as well the suspected disparity between this proportion and the consultants' perceptions on this subject. The results of this study show that 44.7% of patients at consultant clinics were given follow-up appointments, and that there was a marked disparity between the real and the subjectively estimated rates of follow-up in surgical specialties (rate-ratio 2.4). This suggests that a problem exists in the knowledge that consultants have of the structure of their own practices.

Ambulatory Care Facilities↗
PubMed1992

Rowatinex for the treatment of ureterolithiasis.

A prospective, randomized, double-blind study was performed on 87 patients with ureterolithiasis, assessing the effect of the essential oil preparation Rowatinex (Rowa Pharmaceuticals, Ireland) for the treatment of ureterolithiasis. Forty-three patients were treated with Rowatinex and 44 patients with placebo. Despite the larger average diameter of calculi in the group of patients treated with Rowatinex, the overall stone expulsion rate was significantly higher in the Rowatinex group as compared to placebo: 81% and 59%, respectively (0.025 > p > 0.01). This higher rate of stone expulsion is observed in patients with disappearance of pretreatment ureteral dilatation (when patients with expelled stones are excluded) (0.05 > p > 0.001). Seven patients in the Rowatinex group had mild to moderate gastrointestinal disturbances; no other significant side effects were noted during the treatment in either group. We conclude that early treatment with Rowatinex for patients with ureteral stones is indicated before other more aggressive measures are considered.

Adult↗
PubMed1991

Necrosis and lymphocytic infiltration in choroidal melanomas.

Patient survival, tumor lymphocytic infiltration and tumor necrosis were studied and evaluated in 43 enucleated eyes with the same histological diagnosis of spindle 'B' malignant melanoma of the choroid. A significant difference (P less than 0.05) was found between the survival rate of melanoma patients with no evidence of lymphocytic infiltration and/or necrosis in the tumor, compared to those with any evidence of of lymphocytic infiltration and/or tumor necrosis.

Choroid Neoplasms↗