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Biomedical subjects

Itamar Grotto

Publications and source records attributed to Itamar Grotto.

At least 37 records · Page 2Linked to original sources
PubMed2005

Comparison of stress fractures of male and female recruits during basic training in the Israeli anti-aircraft forces.

BACKGROUND: In military basic training, stress fractures are a common orthopedic problem. Female recruits have a significantly higher incidence of stress fractures than do male recruits. Because the Israeli Defense Forces opened traditionally male roles in combat units to female recruits, their high risk for stress fractures is of concern. OBJECTIVE: To compare the prevalence of stress fractures during Israeli Defense Forces anti-aircraft basic training among otherwise healthy young male and female recruits, in terms of anatomic distribution and severity. DESIGN: Ten mixed gender batteries, including 375 male recruits and 138 female recruits, carried out basic training in the Israeli anti-aircraft corps between November 1999 and January 2003. Each battery was monitored prospectively for 10 weeks of a basic training course. During that time, recruits who were suspected of having an overuse injury went through a protocol that included an orthopedic specialist physical examination followed by a radionuclide technetium bone scan, which was assessed by consultant nuclear medicine experts. The assessment included the anatomic site and the severity of the fractures, labeled as either high severity or low severity. RESULTS: Stress fractures were significantly more common among female recruits than among male recruits. A total of 42 male (11.2%) and 33 female (23.91%) recruits had positive bone scans for stress fractures (female:male relative ratio, 2.13; p < 0.001). Pelvic, femur, and tibia fractures were significantly more common among female recruits than among male recruits (p < 0.005). Female recruits had significantly more severe fractures in the tibia (p < 0.05). However, there was no significant difference in the severity of stress fractures in the femur or metatarsals between male and female recruits, as assessed by radionuclide uptake. CONCLUSIONS: We recommend that different training programs be assigned according to gender, in which female recruits would have a lower level of target strain or a more moderate incline of strain in the training program throughout basic training.

Adolescent↗
PubMed2005

[Smallpox vaccination techniques: considerations and unresolved issues].

The smallpox vaccine is the oldest--and was, for 90 years, the only--vaccine known to man. Many vaccination techniques have been used over time, with no fewer than ten employed during the 20th century alone. In Israel, two main techniques were used prior to smallpox eradication in 1978--multiple punctures using a standard needle, and jet injection--while most other countries adopted the bifurcated needle as the method of choice. Despite the vaccination experience gained over time, doubt remains today as to the preferred vaccination technique. During 2002, when Israel became the first country to conduct large-scale smallpox vaccination in the 21st century, multiple standard needle puncture was adopted as the method of choice, while at the same time the bifurcated needle was readopted in the United States. The article reviews the various smallpox vaccination techniques, the supporting scientific data, and the current lacunae in knowledge related to the subject. Together, these factors will most likely influence the adoption of a preferred vaccination technique during a smallpox emergency.

Humans↗
PubMed2005

[Antiviral prophylaxis following possible sexual exposure to HIV].

In Israel, as in certain European countries, national health guidelines exist for preventive treatment after possible post-coital exposure to the HIV virus. Scientifically, this treatment is still regarded as experimental, though over the past years there is a mounting level of evidence of its efficacy. The administration of prophylaxis for HIV after unprotected coitus may be justified by the similar risk of HIV transmission for certain sexual and occupational exposures. Other considerations include: biological plausibility, the effectiveness of post-exposure prophylaxis in animal studies and occupational exposures in humans, efficacy in the prevention of vertical HIV transmission, and cost effectiveness studies. The preventive post-exposure treatment bears many side effects and possible complications, and therefore, each case should be cautiously analyzed before starting such treatment. This article reviews the scientific evidence on this topic, the considerations taken by the physician in initiating post coital HIV exposure treatment, and the guidelines available in Israel and throughout the world.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Clinical and immune responses after revaccination of israeli adults with the Lister strain of vaccinia virus.

BACKGROUND: During the winter of 2002-2003, the Israeli health authorities launched a campaign to vaccinate first responders against smallpox. METHODS: In an open study, 159 healthy, preimmunized adults, 24-52 years old, who participated in the campaign were vaccinated with the Lister strain of vaccinia virus by the multipuncture technique. The safety, immunogenicity, and reactogenicity of the vaccine were assessed. RESULTS: Successful vaccination rates were 61% and 56%, on the basis of clinical take and seroconversion, respectively. Adverse events among the vaccinees were minor. Seventy-nine (88%) of the 90 vaccinees with clinical take also seroconverted ( kappa =0.779). The level of preexisting antibodies inversely correlated with the rates of clinical take and seroconversion (P</=.0098). In the group of vaccinees with the lowest preexisting levels of antibodies, 89% and 86% developed clinical take or seroconverted, respectively. The time since last vaccination was significantly associated with the rates of clinical take and seroconversion (P</=0.001). CONCLUSIONS: These rates of successful vaccination in previously immunized individuals are consistent with the historical experience of use of this vaccine in Israel. The rate of occurrence and the severity of local and other reactions in the vaccinees were within the expected range. Levels of preexisting antibodies and the time since last vaccination played a major role in determining success rates.

Adult↗
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

Susceptibility of the influence of weight on blood pressure in men versus women: lessons from a large-scale study of young adults.

BACKGROUND: Weight and blood pressure (BP) are closely related. The aim of this study was to quantify this relationship and compare it to other factors in a population of relatively young adults, with particular focus on the possible role of gender. METHODS: We conducted a cross-sectional analysis of the Young Adult Periodic Examinations in Israel (YAPEIS) database of healthy people aged 25 to 45 years undergoing routine periodic examinations. Between 1991 and 1999, 38,558 subjects (88.1% men, mean age 36 +/- 8 years) were examined. The correlation between BP and weight was evaluated with adjustments for age, sex, physical activity, cigarette smoking, and fasting blood glucose levels. RESULTS: Blood pressure correlated positively with body mass index (BMI), spanning the spectrum of BMI values. Weight accounted for 8% to 10% of BP variance. The odds ratio for hypertension increased by 16% for each additional unit of BMI, compared to 6% for each year increase in age. The relative propensity of men toward hypertension, typical of this age group, was less pronounced at higher BMI values (male:female ratio = 2.2 at BMI <25 kg/m(2), and 1.28 at BMI > or =35 kg/m(2)). CONCLUSIONS: The association between BP and body weight is at least as strong as that between BP and age and is especially prominent in women.

Adult↗
PubMed2004

Meta-analysis of autologous bone marrow transplantation versus chemotherapy in adult patients with acute myeloid leukemia in first remission.

In the present study, we have conducted a meta-analysis comparing autologous bone marrow transplantation (ABMT) and intensive chemotherapy in adult acute myeloid leukemia (AML) patients in first remission. Combined results of the six appropriate randomised controlled studies indicate that ABMT had no advantage over chemotherapy or no further treatment concerning death rate (overall rate ratio (RR)-0.95, 95% CI, 0.81-1.11), while was superior to chemotherapy concerning event rate (overall RR--0.82, 95% CI, 0.71-0.94). In conclusion, ABMT did not improve survival but it improved event-free survival (EFS) when compared with chemotherapy or no further treatment in patients with AML in first complete remission.

Acute Disease↗
PubMed2004

Declining seroprevalence of rubella antibodies among young Israeli adults: a 12-year comparison.

BACKGROUND: In March 2000, the Israel Defense Force (IDF) experienced an outbreak of rubella. No population-based rubella seroepidemiologic data were available for the 13-year period preceding the epidemic. METHODS: We conducted a population-based seroprevalence study of rubella antibodies among 289 IDF recruits drafted in 1999. RESULTS: We found that 69.2% of males and 90.8% of females in service were seropositive at recruitment in 1999, immediately before the outbreak. These rates were significantly lower than those last measured in 1987 (88% among males and 98.1% among females). CONCLUSIONS: Our findings indicate that this rubella outbreak among young adults was facilitated by a decrease in immunity to levels below those required for herd immunity, at which epidemic virus transmission was no longer blocked. This is most likely due to widespread pediatric vaccination coverage with incomplete catch-up immunization among adolescents and young adults. These findings serve as a reminder that changes to childhood vaccination programs may affect the epidemiology of disease among older segments of the population several years after the change is implemented.

Adult↗
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

Twenty-year trends in illicit drug use among young Israelis completing military duty.

AIM: This study examines patterns of illicit drug use in a national sample of young men and women in Israel over a 20-year period. DESIGN: Annual cross-sectional data are analysed from an ongoing systematic sample of soldiers being discharged from active military service during the years 1982-2001. SETTING: An anonymous questionnaire is self-administered to soldiers on the day of discharge in an unsupervised setting. PARTICIPANTS: Between 1200 and 2800 individuals participated in the survey annually. A total of 40 518 people were included in the analysis. This sample frame is reflective of all Israel Defense Forces (IDF) releasees below the rank of Captain. Military recruits in Israel comprised about 80% of the country's 18-year-old Jewish male cohort in any given year, and about two-thirds of the female population of this age. FINDINGS: Time-trends of drug use in Israel parallel those in the United States and European countries, although at much lower rates. Several indicators suggest a recent increase, particularly among women. Drug use is strongly inversely related to education level. Marijuana accounts for 65-75% of drug use in this young adult population. CONCLUSION: Jewish cultural background and the military policy of zero tolerance are assumed contributors to the low drug use levels. Recent upward trends suggest that intensified prevention, surveillance and research efforts are in order.

Cross-Sectional Studies↗
PubMed2004

Higher rates of cigarette smoking in male adolescents before the onset of schizophrenia: a historical-prospective cohort study.

OBJECTIVE: The prevalence of cigarette smoking among schizophrenia patients is significantly higher than in the general population; this may reflect self-medication of symptoms and/or adverse effects of neuroleptics. The authors examined the prevalence of cigarette smoking in apparently healthy adolescents later hospitalized for schizophrenia. METHOD: Each year, a random sample of male Israeli military recruits, who have been screened and found not to be suffering from major psychopathology, complete a smoking questionnaire. Through the Israeli National Psychiatric Hospitalization Case Registry, 14,248 of these adolescents were followed to determine later psychiatric hospitalization. RESULTS: Of the 14,248 adolescents assessed, 4,052 (28.4%) reported smoking at least one cigarette a day. Over a 4-16-year follow-up, the prevalence of schizophrenia in the entire cohort was 0.3% (N=44). Smokers were at greater risk for later schizophrenia; the adjusted relative risk was 1.94, and the 95% confidence interval (CI) was 1.05-3.58. The number of cigarettes smoked was significantly associated with the risk for schizophrenia. Compared to nonsmokers, adolescents who smoked 1-9 cigarettes/day were 1.38 times (95% CI=0.48-4.00) as likely to be hospitalized later for schizophrenia, and adolescents who smoked 10 cigarettes/day or more were 2.28 times (95% CI=1.19-4.34) as likely; the latter difference was statistically significant. CONCLUSIONS: Taken together with the existing data on abnormalities in nicotinic transmission in patients and their relatives, this higher prevalence of smoking in future schizophrenia patients, before the onset of their illness, might indicate that impaired nicotinic neurotransmission is involved in the pathophysiology of schizophrenia.

Adolescent↗
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

No need to tax the sick: clinical guidelines for rofecoxib as an alternative effective method to the copayment policy in the advent of increasing pharmaceutical expenditures.

BACKGROUND: Over the last few years, major health care systems have been trying to control increasing pharmaceutical expenditures by a variety of methods, such as the controversial copayment policy, as essential health expenditures were being jeopardized. OBJECTIVE: To analyze the regulatory intervention of preauthorization on a rofecoxib model in the medical corps of the Israeli Defense Forces (IDF) in terms of indications for prescription, consumption, and cost. INTERVENTIONS: Guidelines established by the medical services branch based on current literature and communication with diverse specialists and hospitals were implemented by a general practitioner who checked each rofecoxib prescription that was written for IDF personnel by a specialist. The intervention was initiated in November 2000 and continued until August 2001 and after the study. DESIGN: The study was divided into two parts. The first part was a retrospective monthly, preintervention analysis of computerized medical records of IDF personnel (N = 247) for whom rofecoxib was prescribed. The second was a prospective monthly, postintervention analysis of filled-out guideline forms (N = 250) of approved rofecoxib prescriptions. PARTICIPANTS: Patients, were IDF personnel, age 18 to 45, treated in military and civilian outpatient clinics for whom rofecoxib was prescribed. SETTING: The study took place at the Medical Service Branch of the IDF between August 2000 and August 2001. RESULTS: We demonstrated a significant decrease in average monthly consumption (43.0%) and estimated monthly expenditures (40.84%) of rofecoxib, as well as significant shifts (p < 0.001) in indications for whom rofecoxib was approved. These shifts (from pre- to postintervention) include the following: others/nonspecified (80 to 12%), known peptic disorder (7 to 32%), peptic complaints (4 to 22%), and rheumatic (8 to 19%). CONCLUSION: This type of intervention can be cost-effective, can provide quality care, and may be a viable alternative to the controversial and problematic copayment policy.

Adolescent↗
PubMed2004

Cycle ergometry estimation of physical fitness among Israeli soldiers.

We evaluated the level of fitness among a large population-based sample of Israeli men and women ages 18-25 years, within the framework of an ongoing survey of personnel discharged from military service in the Israel Defense Force. Aerobic capacity was predicted with the Astrand-Rhyming 6-minute cycle ergometer test and maximal oxygen uptake (VO2 max) was estimated using the Astrand-Rhyming nomogram based on cardiac response to 6 minutes of constant submaximal cycle work. Mean +/- SD VO2 max values were 41.05 +/- 10.52 mL/kg/min for men (range, 15-81 mL/kg/min) and 33.84 +/- 7.60 mL/kg/min for women (range, 16-65 mL/kg/min). Smoking was found to be associated with lower VO2 max among both men and women, whereas type of military service unit was unexpectedly not associated with physical fitness level.

Adult↗
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↗
PubMed2004

[Vaccination policy in the IDF--past, present and future].

The Army Health Branch of the Medical Corps in the Israel Defense Forces (IDF) maintains responsibility for the IDF's troop vaccination policy. This policy has undergone many changes and adaptations over time, due to shifting trends in civilian and military morbidity; technological advances and the introduction of new vaccines; changes to the cost-effectiveness ratio of specific vaccines; and other causes. The evolution of the IDF vaccination policy has not been reviewed to date, and can well serve as an example of the various considerations influencing public health policy in general, and specifically vaccination policy. Furthermore, questions are often raised by health care professionals as to discharged soldiers' military vaccination history, especially in the context of travel clinics. The authors present an historical review and current update of the IDF vaccination policy.

Health Policy↗