New weight-reducing medication: the patient's request and the doctor's prescription.
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Adolescent↗
Biomedical subjects
E Kitai
Publications and source records attributed to E Kitai.
Primary care physicians' attitudes to battered women and feelings of self-competence regarding their care.
BACKGROUND: Previous descriptive studies have demonstrated the problematic nature of physicians' attitudes toward battered women. However, little empirical research has been done in the field, especially among the various medical specialties. OBJECTIVES: To compare the approach and feelings of competence regarding the care of battered women between primary care and non-primary care physicians. The non-primary care physicians who are likely to encounter battered women in the ambulatory setting are gynecologists and orthopedists. METHODS: A self-report questionnaire formulated for this study was mailed to a random sample of 400 physicians working in ambulatory clinics of the two main health maintenance organizations in Israel (300 primary care physicians, 50 gynecologists and 50 orthopedists). RESULTS: In both physician groups, treating battered women tended to evoke more negative emotional states than treating patients with infectious disease. The most prevalent mood state related to the management of battered women was anger at her situation. Primary care physicians experienced more states of tension and confusion than non-primary care physicians and had lower perceived self-efficacy and self-competence in dealing with battered women. CONCLUSIONS: Though both physician groups exhibited negative feelings when confronting battered women, the stronger emotion of the primary care physicians may indicate greater sensitivity and personal awareness. We believe that more in-service training should be introduced to help physicians at the undergraduate and postgraduate levels to cope both emotionally and professionally with these patients.
Adult↗
Better care needed for battered women.
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Battered Women↗
An unusually high prevalence of asthma in Ethiopian immigrants to Israel.
BACKGROUND AND OBJECTIVES: The past 20 years have seen a large immigration of Ethiopian Jews to Israel, primarily in 2 airlifts, one in 1984-1985 and one in 1991. Infectious and parasitic diseases were the dominant health problems in the early years. Recently, we noticed changing health patterns in this population, particularly an increase in clinic visits for asthma, which contrasted with asthma rates of 2.5% reported among Ethiopian Jews at the time of immigration to Israel. This study evaluated the prevalence and characteristics of asthma in a population of Jews of Ethiopian origin who had been in Israel for 8-17 years. METHODS: We audited 302 files of adult patients of Ethiopian origin and 604 files of age- and gender-matched patients of non-Ethiopian origin. Each file was reviewed by 2 physicians. Asthma was defined by published clinical criteria as found in the patient file. Data on allergies and eosinophilia were collected as well. RESULTS: The average age of the 2 groups of asthmatics was 44.1 +/- 16.2 and 42.4 +/- 20.7 years, respectively. The prevalence of asthma in the patients of Ethiopian origin was 51/302 (17%), compared with 35/604 (5.8%) in the control group. Thirty-three percent of the Ethiopian asthmatics and 37% of the control group suffered from various allergic diseases. Among the patients of Ethiopian origin, the prevalence of eosinophilia was 44%, with no significant difference between asthmatics and non-asthmatic patients (49% versus 43%). Eosinophilia was found in 8.4% of the control group. Asthma was more prevalent among patients with eosinophilia (22%) than without eosinophilia (6.4%). CONCLUSIONS: Asthma is 3 times as prevalent in adults of Ethiopian origin, compared with the general population in our clinics, and markedly increased above the rate reported for newly immigrated Ethiopian Jews. We conclude that the move from the rural hills of Ethiopia to the more urban and industrialized setting of Israel has resulted in an increased prevalence of asthma in this population, but the specific cause is uncertain.
Adult↗
Medical investigations requested by patients: how do primary care physicians react?
BACKGROUND AND OBJECTIVES: We investigated the characteristics of patients who request medical investigations and the type of tests requested to study the manner in which primary care physicians react to these requests. METHODS: The study was conducted within the framework of a national health insurance system. Twelve primary care practices from three randomly chosen clinics with different population characteristics participated in the study. The attending physicians were instructed to ask all patients who presented to the clinics within a 7-month period and requested a medical test to complete a questionnaire, indicating the type of test(s) requested and the reason. The physicians were asked to rate the manner in which the patient made the request, their own reaction to the request, and whether they ordered the tests that were requested. RESULTS: During the survey period, 12,322 patients visited the clinics, of whom 295 (2.4%) were reported by a physician to have requested a medical investigation. More-educated patients were more likely to request tests for disease prevention. The types of tests requested were imaging scans, laboratory (blood) tests, and others. The main reason for the request was symptoms (60%), followed by disease prevention (25%). More than 30% of the requests generated self-reported negative feelings in the physician. Physician compliance with patient requests was not significantly correlated with the reason for the request. Laboratory tests were ordered significantly more often than other types. There was a strong correlation between physicians' compliance with the request and physicians' feelings about the request. CONCLUSION: Our findings raise questions about the frequency with which physicians order tests solely in response to patients' requests and provide information about circumstances in which patients make requests for medical investigations.
Adult↗
Correlation of work structure and job satisfaction among Israeli family physicians.
BACKGROUND: Physicians need a professional environment that is conducive to efficient and satisfying work. Little has been published about the effect of work structure on the satisfaction that family physicians derive from their work. OBJECTIVES: To assess the structure and the positive and negative job components of family physicians in Israel, as well as the effect of these components on their satisfaction with their work. METHODS: A questionnaire was sent to a random selection of members of the Israel Society of Family Physicians (n = 225). RESULTS: Altogether 183 questionnaires were returned. Specialist family doctors, practice medical directors and salaried doctors were involved in more activities than non-specialist doctors, trainees and self-employed doctors. Overall satisfaction was highest for specialists and lowest for non-specialists. Work overload, insufficient resources and abundant paperwork were most frequently cited as negative work components. The opportunity to utilize medical knowledge, challenging work and work variety scored highest as positive components. CONCLUSIONS: The more professionally active physicians were also the more satisfied. Clinical work and teaching provided the most satisfaction, while administrative work and lack of time were the main causes of dissatisfaction.
Adult↗
[The new family physician in the clinic].
The content of all consultations of a family physician during the first 2 months in a new practice and again in the same 2 months, 2 years later were analyzed. The workload did not change between the 2 periods, but in the first period there were relatively more men over the age of 60 years, and a more marked predominance of women in the 45-59 year age-group. There were more follow-ups of pre-existing conditions during the first period, but in both periods the main reason for visits was an acute condition; a quarter of visits required only simple counseling without further investigation or prescribing of medication. During the first period 9% of visits were for the explicit purpose of getting to know the new physician, usually by women. Thus the initial period in a new practice is not excessively burdensome, but involves seeing a number of patients who come either simply to get to know the new doctor, or to present non-chronic problems without expectation of further investigation.
Adolescent↗
[Treatment of battered women--a diagnostic and intervention challenge for the primary physician].
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Battered Women↗
Referrals of patients by family physicians to consultants: a survey of the Israeli Family Practice Research Network.
OBJECTIVE: We aimed to analyse factors influencing referral of patients by primary care physicians to specialist consultants at the beginning of the era of direct access to specialists in Israel. METHODS: We carried out a study of referrals by family physicians to specialists over a continuous period of 3 months. Twenty-four certified family physicians filled in a questionnaire detailing referrals during the study period. All patients were referred for consultation to a specialist at regional speciality clinics or hospital out-patient departments. RESULTS: Ten physicians met the study conditions. In 1140 of 10896 (10.5%) visits, patients were referred to specialist consultants. The percentage of referral ranged from 7.4 to 15.9%. The difference between the physicians with the lowest and highest rates of referral was statistically significant (P < 0.0001). The variance in referral rates was not explained by significant differences in physician or practice variables. The types of specialists to whom the most referrals were made were orthopaedic surgeons, ophthalmologists, dermatologists, ear, nose and throat, general surgeons and plastic surgeons. There was a significant correlation between the type of specialist and the age of the patient. Older patients were referred more frequently to urologists, cardiologists and ophthalmologists, while younger patients were referred more frequently to ear, nose and throat specialists and gynaecologists (P < 0.01). CONCLUSIONS: The results of this study can be used as an aid for decision makers in the health services for determining policy. Direct access to some specialties might be appropriate, but not to all. Adoption of a policy based on these findings could lead to reduced health care costs by reducing the burden on hospital emergency rooms. It might also increase patient satisfaction in that the patients will have greater freedom of choice. On the other hand, more appropriate training of family physicians and more extensive self- and peer-quality assurance will increase the primary physician's knowledge and ability to diagnose and treat a broad range of problems and improve the level of care.
Adult↗
Use of complementary and alternative medicine among primary care patients.
OBJECTIVE: Complementary and alternative medicine use is increasing worldwide, and the expenses are high while its effectiveness is still in debate. The aim of this survey was to evaluate the utilization of complementary and alternative medicine in Israel. METHOD: Four-hundred and eighty patients in two primary care clinics have participated in the survey and answered an anonymous questionnaire. RESULTS: Ninety patients (18.7%) have consulted an alternative medicine therapist at least once in the past. Both younger (0-19) and older (65 and older) age groups were associated with a low rate of complementary and alternative medicine utilization. In the adult population, an academic education was associated with a higher utilization rate. The most frequently used methods were homeopathy (34.6%) and reflexology (18.7 %). Musculo-skeletal (20.6%) and respiratory (15.9%) complaints were the most frequent causes for complementary and alternative medicine consultation. The subjective outcome of complementary and alternative medicine treatment was considered beneficial in almost half of the cases and partially beneficial in another 34.6%. CONCLUSIONS: Utilization of complementary and alternative medicine is as widespread in Israel as in other Western countries. Utilization rates were found to be associated with age and education but not with gender or origin.
Adolescent↗
[Background music in the family physician's surgery: patient reactions].
Music is a universal language, and its effects on pain relief and stress reduction are well known. We evaluated patients' opinions of the effects of background music in their family doctors' surgery. Low volume, background, classical music was played in the doctors' surgery on 5 consecutive clinic days. All patients were asked to fill a short anonymous questionnaire on leaving. Among the 135 consecutive patients offered the questionnaire, there was 87.4% compliance. Among the 118 who completed the questionnaire, 95% said that the background music did not disturb them, 89% thought it made them feel better and 80% thought that it aided the doctor's performance. We conclude that low volume, background music in the doctors's surgery may contribute to better doctor-patient interaction, although larger studies are needed to confirm our findings.
Family Practice↗
Factors associated with family physicians' involvement in research in Israel.
OBJECTIVES: To identify the factors that encourage or deter family medicine physicians and residents in Israel from participating in research. METHOD: In October 1995, a questionnaire containing items on demographic variables, research attitudes, and academic and research activities in primary care settings was mailed to a random sample of 200 family medicine physicians and residents (out of approximately 600) employed by the General Sick Fund, the largest health maintenance organization in Israel. The questionnaire also contained items regarding difficulties in participating in research and asked for opinions about several general statements about research in family practice. RESULTS: In all, 190 physicians responded, for a response rate of 95%. Based on their responses, the respondents were divided into four groups by amount of research involvement. Univariate analysis using the chi-square test was used for the comparison of variables among the four groups. The respondents reporting greater knowledge of and involvement in research were, by and large, men (p = .01) who were qualified specialists with academic status (p < .00001). They also taught students (p = .0005) and residents (p < .0005), participated in more conferences (p < .0005), and while in residency training had had a mentor who encouraged involvement in research (p = .0001). CONCLUSION: Research is essential to family medicine with regard to both primary care practice and academic activities, its development, however, has been inhibited. Given the results of this preliminary study, family medicine residency programs would be well advised to assign a research mentor to every resident; also, time and resources should be devoted to research in postgraduate training programs. Perhaps more important, women physicians in Israel should be encouraged to participate more actively in research, and support for them in their special needs should be made available.
Adult↗
[A case of Job's syndrome].
An 8-year-old boy had been followed in our clinic for recurrent abscesses of his thigh and buttocks. Serum levels of IgE greater than 2000 IU/ml and impaired leukocyte chemotactic response led to the diagnosis of Job's syndrome (hyperimmunoglobulin E syndrome), which is characterized by markedly elevated serum IgE, impaired neutrophil chemotaxis, chronic dermatitis, and recurrent pyogenic infections. Children with this syndrome are much more likely to develop opportunistic infections. An accurate etiological diagnosis and treatment of this specific infection in these children is mandatory. We report the first successful treatment of this syndrome with cyclosporin A. We therefore suggest that to diagnose this syndrome, quantitative IgE levels be routinely performed in children with recurrent skin or other suppurative infections.
Child↗
Women's attitudes towards menopause and hormone replacement therapy.
OBJECTIVES: To determine how women aged 50 years or more feel about menopause, and their knowledge, use of and attitude toward hormone replacement therapy (HRT). METHODS: All study participants resided in a single urban community in central Israel and were selected at random from the computerized government registry. Responses were collected by either telephone interview (n = 171) or mailed questionnaire (n = 41) and were analyzed for the group as a whole and by different demographic and attitudinal factors. RESULTS: Most (80%) of the women had a positive or neutral attitude to menopause. More than 80% had heard of HRT, 55% of whom from a physician. Of these, 12% were currently using HRT and 9.5% had done so in the past. Varied reasons were offered for starting or stopping treatment. CONCLUSIONS: Although the great majority of the participants had heard of HRT, and most of these had spoken about it with a doctor, only a small percentage were currently under therapy or had been in the past. We believe gynecologists should devote more effort to public education, in that those women who had discussed HRT with their physician were more likely to use it.
Aged↗
Community screening to reveal iron deficiency in healthy menstruating women in Israelian suburbs.
OBJECTIVE: To determine the incidence of iron deficiency among healthy women of child-bearing age, study the predictive value of blood hemoglobin level for this condition and assess the efficacy of a community screening program. METHOD: All healthy women aged 18-45 years registered with one community outpatient clinic were requested to complete a questionnaire on present and past medical history; one-third also completed a second questionnaire on symptoms related to anemia. All underwent a blood test for hemoglobin, serum-saturated transferrin and ferritin levels. RESULTS: Of the 163 women who complied (83% of the targeted population), 25.8% were diagnosed as having iron deficiency; of these 40.5% had a hemoglobin level of 12 g% or higher. The most sensitive indicator proved to be serum ferritin level. Iron deficiency was more prevalent in women with a personal history of anemia. Only 34.1% of the study group completed follow-up. CONCLUSION: There is a high incidence of iron deficiency among women of childbearing age. However, because of the surprisingly low compliance with follow-up visits, preventive periodic screening of healthy menstruating women using routine blood tests is not recommended at this time, except for those with specific complaints or who are at high risk.
Adolescent↗
Low dose estrogen replacement therapy in early postmenopausal women effect on urinary magnesium and calcium: creatinine ratios.
The purpose of this study was to investigate whether treatment for prevention of osteoporosis by means of postmenopausal hormone replacement therapy (HRP) and daily exercise, had any effect on ratios of urinary calcium:creatinine (Ca:Cre) and magnesium:creatinine (Mg:Cre). A group of 33 early postmenopausal women (menopause onset 12-18 months previously), mean age 49.12 years, were treated during 6 months with low doses of transdermal estrogen (Estraderm TTS 25 micrograms, Ciba-Geigy) opposed by oral progestogen (Duphaston 10 mg, 10 days every month), and daily exercise (walking for 1 hour). Despite HRT's statistically significant lowering effect on Ca:Cre and Mg:Cre ratios, these returned to pretreatment levels 6 months after withdrawal from HRT. The mechanism by which HRT affects magnesiuria and calciuria is discussed.
Administration, Cutaneous↗
[Tuberculosis in the community: viewpoint of the family physician].
In 1991, 3 patients of an overall patient population of 1400 were found to be suffering from active tuberculosis (TB). They were long-time residents of Israel and were not of Ethiopian origin. 2 had TB of the lymph-nodes of the head and neck and the third had pleural TB with involvement of the ribs. In each case TB was diagnosed retroactively; the original presumptive diagnosis was malignancy. This relative increased incidence of TB should increase our awareness of this disease.
Aged↗
The bone sparing effect of oral contraceptive use in non-smoking women.
In a group of 30 women, mean age 23.7 years, we have examined the urinary calcium: creatinine ratio (Ca:Cr) as an indicator of bone resorption, before and 6.8 months after oral contraceptive (OC) use. Fasting Ca:Cr decreased significantly during OC use, being more pronounced in nonsmokers. We agree with those who propose the use of OC in women also after 35 years of age, in view of their good effect on bone density.
Adolescent↗