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Biomedical subjects

Eyal Zimlichman

Publications and source records attributed to Eyal Zimlichman.

At least 19 recordsLinked to original sources
PubMed2006

Autoimmune diseases in asthma.

BACKGROUND: Previous research has suggested an inverse relationship between T-helper 2-related atopic disorders, such as asthma, and T-helper 1-related autoimmune diseases. One controversial hypothesis postulates that asthma provides a protective effect for the development of autoimmune-related disorders. OBJECTIVE: To assess the rate of newly diagnosed autoimmune disorders in a large cohort of young adults. DESIGN: Using cross-sectional data from the Israeli Defense Force database, the authors analyzed the prevalence of autoimmune disorders in asthmatic and nonasthmatic military personnel between 1980 and 2003. A follow-up study traced newly diagnosed autoimmune disorders among asthmatic and nonasthmatic individuals from the time of enrollment in military service until discharge (22 and 36 months for women and men, respectively). SETTING: General community. PATIENTS: 307,367 male and 181,474 female soldiers in compulsory military service who were between 18 and 21 years of age. MEASUREMENTS: Cases of type 1 diabetes mellitus, vasculitis, immune thrombocytopenic purpura, inflammatory bowel disease, rheumatoid arthritis, and the antiphospholipid syndrome. RESULTS: Of 488,841 participants at enrollment, significantly more women than men had autoimmune disorders. Compared with asthmatic women, nonasthmatic women had a significantly higher prevalence of all autoimmune disorders except for the antiphospholipid syndrome. Type 1 diabetes mellitus, vasculitis, and rheumatoid arthritis were less prevalent in men with asthma than in those without. During the follow-up period, vasculitis and rheumatoid arthritis were more frequently diagnosed in nonasthmatic persons of both sexes. There was a significantly higher incidence of immune thrombocytopenic purpura, inflammatory bowel disease, and the antiphospholipid syndrome in nonasthmatic women and a statistically significantly higher incidence of type 1 diabetes mellitus in nonasthmatic men. LIMITATIONS: The study was limited to a population of young military recruits; therefore, its findings are not necessarily applicable to the general population. Because of the noninterventional nature of the study, it describes associations but cannot prove causality. CONCLUSIONS: Asthma status may affect the prevalence of major autoimmune disorders. Preexisting asthma seems to protect against the development of autoimmune disorders to varying degrees in men and women.

Asthma↗
PubMed2005

Smoking habits and obesity in young adults.

AIMS: The aim of this work was to study the association between obesity and smoking habits in young adults. Specifically, we tested the hypothesis that obesity does not prevent young adults from smoking and conversely smoking does not protect against obesity. DESIGN AND SETTING: Trained nurses interviewed participants concerning demographic data and health behaviors such as smoking. At the time of the interview, weight and height were measured. Data were analyzed retrospectively. PARTICIPANTS: A representative sample of Israel Defense Force (IDF) personnel upon discharge from compulsory service, usually at the age of 20-21 years. FINDINGS: Overall, 29 745 participants were included during the 13-year study (16,363 males and 13,382 females). Smoking rates were higher among obese participants than among overweight and non-obese participants (34.9%, 37.1%, 43.6% for non-obese, overweight and obese, respectively; P < 0.001). Mean number of cigarettes smoked per day were also higher among smokers that were obese and overweight compared to the non-obese (15.2 +/- 9.2, 15.6 +/- 10.7, 18.0 +/- 9.8, respectively; P < 0.001). Overweight and obesity were associated with the father's lower academic educational level. In logistic regression analysis, obesity, year of study and parental academic education were correlated independently with smoking (P < 0.001). CONCLUSION: The positive association between obesity and smoking suggests that obesity is not a deterrent to smoking and also that smoking does not help to prevent obesity.

Adult↗
PubMed2005

The role of primary care physicians in the Israel Defense Forces: a self-perception study.

BACKGROUND: The health system of the medical corps of the Israel Defense Force is based primarily upon primary healthcare. In recent years, health management organizations have considered the primary care physician responsible for assessing the overall health needs of the patient and, accordingly, introduced the term "gatekeeper." OBJECTIVES: To describe and analyze how PCPs in the IDF view their roles as primary care providers and to characterize how they perceive the quality of the medical care that they provide. METHODS: We conducted a survey using a questionnaire that was mailed or faxed to a representative sample of PCPs. The questionnaire included demographic background, professional background, statements on self-perception issues, and ranking of roles as a PCP in the IDF. RESULTS: Statements concerning commitment to the patient were ranked higher than statements concerning commitment to the military organization. Most physicians perceive the quality of the medical care service that they provide as high; they also stated that they do not receive adequate continuous medical education. CONCLUSIONS: Our survey shows that PCPs in the IDF, like civilian family physicians, perceive their primary obligation as serving the needs of their patients but are yet to take on the full role of "gatekeepers" in the IDF's healthcare system. We conclude that the Medical Corps should implement appropriate steps to ensure that PCPs are prepared to take on a more prominent role as "gatekeepers" and providers of high quality primary medical care.

Adult↗
PubMed2005

Measurement of electrical skin impedance of dermal-visceral zones as a diagnostic tool for inner organ pathologies: a blinded preliminary evaluation of a new technique.

BACKGROUND: As complementary and alternative medicine is gaining popularity among health consumers, diagnostic screening tools based on neuroreflexology are also being developed. These techniques, which are based on the rationale that measurement of electrical impedance of specific dermatomes reflects corresponding internal organ pathologies, have not yet been the subject of conventional scientific research. OBJECTIVES: To determine the effectiveness of a neuroreflexology-based screening test, specifically the Medex device (Medex Screen Ltd.), for diagnosing patients undergoing conventional internal organ assessment, in a hospital setting. METHODS: Patients admitted to an internal medicine department, who met the inclusion criteria and agreed to participate, underwent conventional medical evaluation that included past medical history and physical examination. Another examination was conducted by a second physician using the Medex device to determine internal organ pathologies. A third researcher compared the actual "conventional" diagnosis with the Medex device output using standard statistical analysis. RESULTS: Overall, 150 patients participated in the study. Correlation was significant for all categories (P < 0.01) except for blood and lymphatic disease. A high sensitivity (>70%) was measured for cardiovascular, respiratory, gastrointestinal and genitourinary diseases. The highest measure of agreement, as represented by the Cohen-Kappa factor, was found for respiratory disease (0.57). CONCLUSIONS: Although the exact mechanism is not entirely clear, measurement of electroskin impedance of dermal-visceral zones has the potential to serve as a screening tool for inner organ pathologies. Further research should be conducted to create more evidence to support or dispute the use of this technique as a reliable diagnostic tool.

Complementary Therapies↗
PubMed2004

Smoking habits in adolescents with mild to moderate asthma.

To study the impact of mild to moderate asthma on smoking habits in adolescents. Specifically, we tested the hypothesis that asthma does not prevent adolescents from smoking. A research questionnaire, filled by a systematic sample of military personnel upon enrollment to service in the Israeli Defense Force (IDF), was analyzed. Conscripts were asked to voluntarily fill (after obtaining a signed informed consent) a research questionnaire about their medical history, and several health related topics including smoking. This database was matched with the military medical profile of the soldier, which includes the patient asthma status. Overall, 38,047 young adults were included in this study. There was a significant increase in the rate of mild to moderate asthma, from the mid-1980's to date. During the 1980's and early 1990's, asthmatics smoked significantly less frequently (20-22%) than non-asthmatics (25-27%). In the mid- to late-1990's, the smoking rates increased relatively more in asthmatics, to the point that in the last 8 years of this study, they were found to be almost identical in both groups, at a rate of approximately 30%. The presence of asthma is not a powerful motivating agent to prevent from smoking. It is likely that smoking asthmatic teenagers are at risk for suboptimal lung growth, and as young adults, they will become at greater risk of lung function deterioration. We suggest that primary care physicians, caring for asthma in children, adolescents, and young adults, should explain the particular risks generated by tobacco smoking.

Adolescent↗
PubMed2004

The effect of prophylactic treatment with risedronate on stress fracture incidence among infantry recruits.

When subjected to strains or strain rates higher than usual, the bone remodels to repair microdamage and to strengthen itself. During the initial resorption phase of remodeling, the bone is transitorily weakened and microdamage can accumulate leading to stress fracture. To determine whether short-term suppression of bone turnover using bisphosphonates can prevent the initial loss of bone during the remodeling response to high bone strain and strain rates and potentially prevent stress fracture, we conducted a randomized, double-blind, placebo-controlled trial of 324 new infantry recruits known to be at high risk for stress fracture. Recruits were given a loading dose of 30 mg of risedronate or placebo daily for 10 doses during the first 2 weeks of basic training and then a once a week maintenance dose for the following 12 weeks. Recruits were monitored by biweekly orthopedic examinations during 15 weeks of basic training for stress fractures. Bone scans for suspected tibial and femoral stress fractures and radiographs for suspected metatarsal stress fractures were used to verify stress fracture occurrence. By the intention-to-treat analysis and per-protocol analysis, there was no statistically significant difference in the tibial, femoral, metatarsal, or total stress fracture incidence between the treatment group and the placebo. We conclude that prophylactic treatment with risedronate in a training population at high risk for stress fracture using a maintenance dosage for the treatment of osteoporosis does not lower stress fracture risk.

Etidronic Acid↗
PubMed2004

Height-related changes in body mass index: a reappraisal.

OBJECTIVES: To study the relationship between body mass index (BMI) and height in 20-22 year-old patients. METHODS: A research questionnaire filled by a representative sample of military personnel upon discharge from service was analyzed. At the same time, weight and height were measured, and BMI was calculated (BMI = weight (Kg)/height(2)(m(2))). RESULTS: There were 35,951 participants in the study, including 16204 females and 19747 males. There was a positive correlation between BMI and height in men (regression slope = 0.00717, r = 0.015, p = 0.03), while the correlation was negative in women (regression slope = -0.02811, r = -0.05, p < 0.0001). In multiple regression analysis, when BMI was used as the dependent variable and height, gender, ethnic origin, smoking, oral contraceptive use, and level of recreational exercise as the independent variables, only height, gender, and ethnic origin remained significant in the final analysis (R-square 0.0205, p < 0.0001). CONCLUSION: In young adults, BMI is affected in a subtle, but opposite manner in males and females. In males, BMI increases with increasing height, while in females, BMI decreases with increasing height.

Adult↗
PubMed2004

Quality assessment program in primary care clinics: a tool for quality improvement.

BACKGROUND: Assessment of quality of health care is a major ongoing project of the Israeli Defense Forces (IDF) medical corps. OBJECTIVE: (i) To describe mechanisms of quality assessment (QA) in IDF primary care clinics; (ii) to compare quality of care in different types of primary care clinics; and (iii) to test the hypothesis that implementation of the QA program results in improved quality of care. RESEARCH DESIGN: A prospective, single-blinded, uncontrolled, non-randomized study. MEASURES: Teams of two physicians carry out the QA process once or twice a year according to clinic size. Five areas were evaluated: (i) physician-patient interaction; (ii) medical chart evaluation; (iii) high-risk patients management; (iv) medical care provided by specialists; and (v) medical staff guidance. Clinics were classified in two groups: single-physician clinics (battalion troop clinics) and multi-physician clinics (home-front base clinics). General Linear Models were used for analysis. A P-value <0.05 was considered significant. RESULTS: In 2000 and 2001, 99 primary clinics and 162 primary care physicians were assessed. Seventy-four (45%) physicians were evaluated twice. Single-physician clinics scored higher than multi-physician clinics on most QA parameters. Physicians had significantly better QA results at the second encounter, regardless of the type of clinic. CONCLUSIONS: A primary care medicine QA system is feasible in the IDF. It allows for standardized, reliable, and comprehensive assessment of primary care across the military clinics. We postulate that the increase in QA assessment scores from one examination to the next one indicates an improvement in quality due to the QA program.

Ambulatory Care Facilities↗
PubMed2004

Age at menarche and body mass index: a population study.

OBJECTIVE: To test the hypothesis that age at menarche is inversely related to body mass index (BMI). POPULATION AND METHODS: A questionnaire was filled in by 11,293 young women at the time of discharge from compulsory military service, in order to determine the self-reported age at onset of menarche. The participants were weighed and measured and BMI was calculated. Obesity was defined as BMI >30 and leanness as BMI <20. RESULTS: The age at menarche was significantly and inversely correlated with BMI (R = -0.11, p <0.001). The age at menarche of obese women (12.9+/-1.3 years) was significantly lower than that of non-obese, non-lean women (13.3+/-1.4 years), who themselves had a lower age at menarche than lean women (13.5+/-1.4 years) (p <0.001). CONCLUSIONS: We conclude from our data that the relationship between BMI and pubertal development in girls appears to be a continuum.

Adult↗
PubMed2004

Army personnel satisfaction in different settings of primary health care clinics.

PURPOSE: To analyze patient satisfaction in Israeli Defense Forces primary care clinics (PCCs), and to compare different satisfaction indices that best correlate with general satisfaction index. METHODS: Large-scale patient satisfaction survey throughout all PCCs, classified as active front clinics, training schools clinics, and home front clinics. RESULTS: Participants (5,103) filled out standardized questionnaires. Patients in active front clinics were more satisfied with their PCCs than in the other two settings. Patients showed the highest satisfaction level in the environment questions and the lowest satisfaction level in the accessibility questions. In training school clinics and home front clinics, accessibility questions were most important, whereas in active front clinics, health outcome questions prevailed. CONCLUSIONS: Overall patient satisfaction is the highest in active front clinics, lower in training school clinics, and lowest in home front clinics. Accessibility is the most important factor in patient satisfaction in training school and home front units, and is less important in active front units.

Ambulatory Care Facilities↗
PubMed2004

Oral contraceptive use and smoking habits in young Israeli women: a cross-sectional study.

BACKGROUND: Oral contraceptive users are at increased risk for both arterial and venous thrombosis, some of which can be fatal. Studies are consistent with the existence of a synergism between cigarette smoking and OC use in the pathogenesis of myocardial infarction in young women. OBJECTIVES: To study the relationship between OC use, cigarette smoking and other cardiovascular risk factors among young women. METHODS: A systematic sample of military personnel, upon discharge from service in the Israel Defense Forces, was asked to complete a research questionnaire. Body weight and height were measured and body mass index computed. RESULTS: Overall, 16,258 questionnaires were collected and analyzed during this 20 year study. There was a gradual, significant increase in OC use until the mid-1980s, from approximately 45% to 60% (P < 0.001), followed by steady rates of 58-64% since then. In contrast, the rates of smoking decreased significantly in the mid-1980s, from approximately 42% to a nadir of 22% in 1991. Since then, the rate of smoking has increased slowly but steadily to reach a level of 35% in 1999. The OC users were more often of western (Ashkenazi) origin and came from families with more education and fewer siblings. They were more often smokers than non-OC users, and started smoking at a younger age. They had significantly lower BMI than non-users. OC use was nearly identical in groups with or without multiple cardiovascular risk factors (smoking, obesity, family history). CONCLUSIONS: Smoking and OC use are strongly associated. Other cardiovascular risk factors (smoking, obesity, family history) do not prevent OC users from smoking or smokers to use OC. We suggest that primary care physicians discourage smoking among adolescent females who wish to start using OC. A thorough medical history should be obtained in order to recognize all risk factors for cardiovascular disease and to provide for appropriate contraception counseling.

Adult↗
PubMed2003

Evaluating delivery of primary health care to military personnel during low-intensity conflict using a patient satisfaction survey.

The delivery of medical health care to soldiers serving in active front units in the Israeli Defense Forces requires the ability to adjust to different military activity settings. This study was conducted to compare patient satisfaction, as a tool for assessing quality of care, in different activity settings: training and Low-intensity conflict setting. A patient satisfaction survey was conducted simultaneously in battalions during low-intensity conflict and training activities. Data analysis showed that patients' perception of the quality of care they received and of medical staff attitude was higher in the conflict setting. Correlation analysis revealed that patients during conflict perceived outcome of care and accessibility as most important in evaluating overall satisfaction. We suggest that perception of high-quality medical care can be obtained during conflict conditions. Interestingly, in the conflict setting, the physical environment of the clinics appears to be less crucial to patient satisfaction than physician availability and medical outcome. These results may serve as a basis for changing health delivery systems by health policy makers.

Adolescent↗