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Biomedical subjects

S Noy

Publications and source records attributed to S Noy.

At least 19 recordsLinked to original sources
PubMed2003

Generalized cognitive impairment in male adolescents with schizotypal personality disorder.

Schizotypal Personality Disorder (SPD) shares common genetic and biological substrates with schizophrenia, and patients with SPD have been reported to suffer both from specific cognitive impairments, and from a generalized cognitive dysfunction, similar to those found in schizophrenia. The aim of this cross-sectional, population-based study was to assess general cognitive functioning in adolescents with SPD. The Israeli Draft Board systematically assesses cognitive functioning and administers psychiatric screening in all 16-17-year-old males in the population. Of 341,511 males assessed, the cognitive test scores of adolescents with SPD (N = 326) were retrieved, and compared to the scores of adolescents diagnosed as suffering from schizophrenia (N = 901), and adolescents with no neurological or psychiatric diagnosis (controls, N = 293,820). Male adolescents with SPD or with schizophrenia scored lower on all measures compared to healthy individuals (effect sizes ranging from 0.6-0.88, all P < 0.001). The SPD patients scored significantly higher than the schizophrenia patients on the sub-tests of similarities and Ravens Progressive Matrices, tests that reflect abstract reasoning. On the sub-tests of arithmetic and instruction comprehension, tests that rely on concentration, SPD and schizophrenia patients' scores did not differ significantly from each other. These results might be interpreted to imply that a generalized cognitive impairment, in the presence of schizotypal personality traits and in the absence of psychosis, might be conceptualized as being the core of the schizotaxia syndrome. The greater impairment in abstract reasoning in the schizophrenia patients might be correlated with the psychotic symptoms that differentiate schizophrenia from SPD.

Adolescent↗
PubMed2002

A comparative study of Mini-Mental Test, Clock Drawing task and Cognitive-FIM in evaluating functional outcome of elderly hip fracture patients.

OBJECTIVE: To compare the clock drawing task with other cognitive tests used for the prediction of discharge functional outcome, in elderly hip fracture patients. DESIGN: Cohort study. SETTING: A department of geriatric-orthopaedic rehabilitation of a tertiary hospital. PATIENTS: One hundred and forty-three consecutive patients undergoing inpatient comprehensive rehabilitation following hip fracture. MEASUREMENTS: Cognitive status was assessed by the Clock Drawing Task, Mini-Mental State Examination (MMSE) and the Cognitive-FIM (cognFIM). Functional status outcome was evaluated by the Functional Independence Measure (FIM), using absolute and relative parameters of efficacy and efficiency. RESULTS: Correlation coefficients (Pearson correlation) between the three cognitive tests resulted in values ranging from 0.607 to 0.732 (p < 0.001). Similar correlation coefficients were observed for all cognitive tests when correlated with relative efficacy and efficiency outcome parameters (p < 0.001), but not with absolute outcome parameters. CONCLUSIONS: Clock Drawing Test is similar to Mini-Mental and Cognitive-FIM with respect to the evaluation of functional status outcome following rehabilitation of hip fractures. The similar correlations with functional outcome parameters as well as the simplicity of administration favour the use of either Clock Drawing Task or MMSE in the initial assessment of elderly patients with hip fractures.

Aged↗
PubMed2001

A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services.

The number of discharges (63,303) from a university-affiliated medical center in Israel were reviewed. Eight percent of cases in three departments rcceivcd social work services. Patients experiencing inappropriate hospital stay (discharge delay) and who received social work services were characterized and compared with social work clients not experiencing delay. Discharge delay patients differed from other social work clients on key sociodemographic variables. Patients admitted because of "injury" were significantly more likely to experience delay than patients admitted because of "illness." "Waiting for community/institutional resources" was the most common reason for delay and discharge to an institutional setting increased the likelihood of delayed discharge. High risk factors were department-specific and should be studied in context. Results suggested the limited but positive impact of hospital-community collaborative strategies in reducing the incidence of delay over time.

Adult↗
PubMed2001

Prevalence of psychological, somatic, and conduct casualties in war.

Combat stress reactions (CSR) have been a common occurrence in the wars of this century. This article reviews data and research on CSR and summarizes the different factors, which correlate with the frequency and the type of CSRs seen. Suggestions for planning for weapons of mass destruction events that are made based on the projected similarities between CSRs seen during combat and those that might be expected following a weapons of mass destruction event.

Combat Disorders↗
PubMed2000

Quality of life in multiple sclerosis: development and validation of the 'RAYS' scale and comparison with the SF-36.

OBJECTIVE: To develop a self-administered rating scale for quantifying quality of life (QoL) in multiple sclerosis (MS) patients. METHODS: The RAYS scale items were derived from a source of 600 questions composed by our Centre's experts from commonly used instruments that assess physical, psychological, and social-familial dimensions. Prior to finalization of the RAYS QoL, candidate items were administered to 15 health rehabilitation professionals. Clarity, importance, relevance and specificity were graded for each item by every professional independently. Items chosen for the final version were graded as good or excellent on all these aspects. The Medical Outcome Study Short Form-36 (SF-36) was used to compare health appraisal with the RAYS scale. RESULTS: Each of the three subscales of the RAYS covers a different dimension (physical, psychological, and social-familial) and each includes 15 self-report items scored from 1 (best) to 4 (worse), focusing on the preceding week. Validation was achieved through administration of the scale to 50 randomly selected MS patients and to 50 age, sex-, education- and family status-matched healthy controls. All RAYS dimensions among MS patients reached a Cronbach's coefficient alpha > 0.8. Mean values for all dimensions were greater in patients than in controls (P < 0.002). Patients scored below norms for the general population in the majority of the SF-36 subscales (on average 32% lower). Significant correlation was found between the two scales especially in the physical and social functioning subscales. CONCLUSION: The RAYS scale demonstrated high internal consistency and significant discriminative value, and is thus a suitable disease-specific tool for measuring QoL in MS.

Activities of Daily Living↗
PubMed1999

Newly implemented health system reform in Israel: physicians' attitudes.

OBJECTIVE: To explore the attitudes of Israeli physicians towards the feasibility and potential consequences of the newly implemented health care reform. DESIGN: Physicians' attitudes were examined soon after the enactment of a National Health Insurance Law, the first element of the reform to be implemented. SETTING: A nationwide mail survey. SUBJECTS: A random sample of 2000 practicing physicians. MAIN OUTCOME MEASURES: Attitudes towards the health care system prior to the reform; predicted effects of the reform on health care and medical practice. RESULTS: Most of the respondents think that the system requires a change. Quality of community-based care is expected to increase, in contrast to hospital care. The reform is believed to exert an adverse effect on medical practice. Attitude is significantly influenced by practice setting and speciality: community setting and general practice correlate with less desire for a major change. Specialists believe that reform elements which will shift the balance towards the hospitals will have the greatest benefit on the health system. GPs, compared to specialists, are more optimistic regarding quality and accessibility of services (P<0.01). CONCLUSIONS: Our survey suggested that Israeli physicians favor a change in the health care system, despite a perceived adverse effect of the reform on medical practice. Since the reform is believed to shift the balance from the hospitals to the community, respondents support changes that will compensate for the imbalance.

Attitude of Health Personnel↗
PubMed1999

Pregnancy and multiple sclerosis: a 2-year experience.

OBJECTIVE: To present our experience with management of parturients with multiple sclerosis and to examine the role of intravenous immunoglobulin (IVIg) in the prevention of postpartum exacerbations of the disease. METHODS: Fifteen patients with multiple sclerosis with a relapsing-remitting course were followed during pregnancy and 6 months postpartum. To prevent postpartum exacerbations, 14 of the patients had received IVIg after delivery. RESULTS: None of the patients who received postpartum IVIg relapsed during the 6 months after delivery. None of the observed obstetric complications nor the operative deliveries could be related to the coexistence of multiple sclerosis. CONCLUSION: Postpartum IVIg treatment is beneficial in preventing acute childbirth-associated exacerbations in patients with relapsing-remitting multiple sclerosis. Furthermore, this disease does not seem to increase obstetric complications.

Adult↗
PubMed1999

Fluoxetine treatment for weight reduction in steroid-induced obesity: a pilot study in myasthenia gravis patients.

To evaluate the weight reducing effect of fluoxetine on steroid-induced obesity, we conducted an open, clinical intervention study of 20-40 mg/day fluoxetine, 24 weeks duration. Thirteen myasthenia gravis, overweight, long-term steroid-treated patients [age: 31-59, body mass index (BMI): 29-54 kg/m2] were included. Measurements of weight, BMI, and routine laboratory tests, were undertaken at baseline, 12 and 24 weeks. Muscle strength and fatigue parameters were assessed at 4 week intervals. Fluoxetine induced mean weight loss of 7.7+/-2.6 kg and 10.3+/-2.9 kg over a period of 12 and 24 weeks respectively, (P<0.05). Mean BMI decreased from 35.8 to 32.2 kg/m2 over the study period. No significant side effects were noted. We conclude that patients suffering from steroid-induced obesity respond to fluoxetine treatment of overweight by significant weight loss.

Adult↗
PubMed1998

Preadmission psychosocial screening of older orthopedic surgery patients: evaluation of a Social Work Service.

A preadmission social work intervention was evaluated for impact on length of hospital stay (LOS) and patient satisfaction. Psychosocial issues related to function and post-discharge needs were assessed at an exploratory level. A modified post-test only control group design was used. Study group patients were screened before hospitalization and offered services on admission. Control group patients received standard care. Study group patients were significantly more satisfied with services but impact on length of stay was not demonstrated with one possible exception. Post-operative complications were significantly related to longer LOS; however, unlike control group patients, study group patients with complications did not have significantly longer LOS. Women and those limited in preadmission physical function were most likely to report insufficient help after discharge. A more intensive preadmission intervention is recommended to improve impact on LOS and informal support system involvement, while future outcome studies would clarify the nature of service gaps and high risk groups.

Aged↗
PubMed1997

Electrical sensation during Tai-Chi practice as the first manifestation of multiple sclerosis.

We report a patient with a 3-year history of brief episodes of electrical sensations over her back and upper limbs that occurred during Tai-Chi practicing. This appearance of Lhermitte's sign was later followed by additional neurologic symptoms, and the patient was diagnosed as suffering from multiple sclerosis. Though the patient related the Lhermitte's sign to her ability to achieve full relaxation in Tai-Chi exercise, we think it was the first manifestation of the disease.

Adult↗
PubMed1997

The dynamics of patient visits to a public hospital ED: a statistical model.

Using a public hospital's computerized database, we formulated a statistical model to explain emergency department (ED) patient volume for better staffing and resource allocation. All patients visiting the ED over a 3-year period were included in this retrospective study. Each observation described the total daily number of referrals and was defined by the following variables: day of the week, month of the year, holiday/ weekday, relative order in a 3-year sequence, and number of visits to the ED on that day. The statistical method used to build the model was analysis of covariance. Periodicity in average number of daily visits existed for each of the seasonal factors that were examined, repeating every year during the study period. Based on a graphic analysis, the model was defined and explained 65% of the variance during the 3-year study, with a relatively low standard deviation of error. A statistically significant correlation existed between time-related factors and the number of visits to the ED. This statistical model may prove to be of value for planning emergency services, which operate under stressful, unpredictable situations.

Analysis of Variance↗
PubMed1997

Salaried physicians' intent to retain hospital membership: the effects of position and work attitudes.

This study examined the anticipation of salaried hospital physicians in Israel to retain hospital membership for a long term until their retirement. Examined are attitudinal and position factors, as well as hospital standing personal and situational factors that relate to this anticipation. The data collected from 195 full-time salaried physicians in Israeli hospitals indicated that about one-third of the physicians anticipate to retain hospital membership until retirement. It was found that factors reflecting the physician's standing within the hospital were the main predictors of this anticipation, whereas work-related attitudes had little or no effect on it. The implications of these finding to hospital-physician integration strategies in the United States are discussed.

Attitude of Health Personnel↗
PubMed1996

Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study.

Acute exacerbations frequently occur after childbirth in patients with relapsing-remitting multiple sclerosis (MS). The present pilot study was initiated in an attempt to reduce the number of childbirth-associated acute exacerbations in the postpartum period. We treated nine MS patients with a history of 12 childbirth-associated acute exacerbations that had occurred 2-9 weeks after previous deliveries. The patients were administered intravenous immunoglobulin (IVIg) at a dose of 0.4 g/kg per day for 5 consecutive days during the 1st week after childbirth and at 6 and 12 weeks thereafter. None of the treated patients relapsed during the 6-month period after delivery. However, three patients had a remote relapse, two at 8 months and one at 10 months after childbirth, but these probably represented the natural course of disease and were not associated with childbirth. We conclude that IVIg treatment may prevent acute childbirth-associated exacerbations in relapsing-remitting MS patients.

Adult↗
PubMed1996

T cell subsets in obsessive-compulsive disorder.

Stress can produce immunosuppression leading to increased susceptibility to infection, tumor growth or autoimmune disease. It has been recently noted, however, that certain kinds of stress need not increase the risk of immune pathology. The present study looked for immune pathology in an anxiety-related disorder. Acute exacerbation of obsessive-compulsive disorder (OCD), an anxiety spectrum disorder, served as a model for stress. Seven OCD subjects in acute exacerbation, and 9 healthy age-matched control subjects participated in the study. T cell subsets were determined at baseline in both OCD and control groups, and after 6 weeks on clomipramine in the OCD group. No statistically significant changes in lymphocyte subsets were found between the control and the untreated patient groups. Likewise, no statistically significant changes were found in patients before and after treatment. The negative findings of the present study supports the view that stress need not compromise immunologic function. Various aspects of stress, which may turn the immune system vulnerable, are discussed as well.

Adult↗
PubMed1996

Intravenous immune globulin in multiple sclerosis: clinical and neuroradiological results and implications for possible mechanisms of action.

Extensive evidence exists indicating that immunoregulatory mechanisms are involved in the pathogenesis of Multiple Sclerosis (MS). Several possible mechanisms by which intravenous immune globulin (IVIG) modulates the course of the disease are related to limiting the inflammatory process and repairing the damage by enhancing remyelination. Presently, the evidence for the effect of IVIG in MS is based on the results of small open trials, some of which have been encouraging. In the current study, the positive impact of IVIG treatment on arresting disease progression was evident by decreased brain Magnetic Resonance Imaging (MRI) scores of the lesion area. In an effort to extend these findings, the authors initiated a multicentre, prospective, randomized, double-blind, placebo-controlled study. The trial was designed to compare the efficacy of IVIG treatment with placebo in relapsing-remitting patients (ages 20-55 years) with definite MS, disease duration of 2-10 years and frequency of exacerbations 1-3/year during the 2 years prior to the study. Patients were examined monthly and brain MRI studies scheduled at entry, and after the first and second years of the trial. The primary endpoints included the number of acute exacerbations and neurological disability. The secondary endpoints included change in the MRI lesion burden, evaluated by the number and area of lesions. The trial ended in June 1995.

Adult↗
PubMed1996

Reactions of salaried physicians to hospital decline.

OBJECTIVE: To examine the Exit, Loyalty, Voice, and Neglect (ELVN) reactions of full-time salaried physicians to the decline of their employing hospital, and to explore factors possibly associated with the choice of reactions. DATA SOURCE: The study analyzes data collected in a larger survey of work attitudes of 703 hospital physicians, constituting a representative national sample of (every tenth) salaried hospital physicians in Israel. DATA COLLECTION: Data were collected through a self-administered mail questionnaire with return envelopes attached. STUDY DESIGN: A survey design was used. Survey questionnaires included composite measures of the ELVN reaction as well as of the main predictors of reaction choice: job satisfaction, hospital commitment, job investment, alternatives, tenure, and managerial and senior positions. PRINCIPAL FINDINGS: The reactions of salaried physicians to hospital decline include the whole range of ELVN reactions. The choice of each reaction was found associated with a different set of disposition, situation, and position predictors. CONCLUSIONS: The ELVN typology is relevant for examining physicians' reactions to hospital decline, which appear to extend beyond the simple stay/leave dichotomy commonly used. The reactions of Exit, Loyalty, Voice, and Neglect are different in nature, and appear to reflect the different sets of circumstances that salaried physicians may face. Implications of these results for coping with hospital decline, hospital-physician relationships, and integration strategies are discussed.

Attitude of Health Personnel↗
PubMed1996

Sexual dysfunction in relapsing-remitting multiple sclerosis: magnetic resonance imaging, clinical, and psychological correlates.

The purpose of this study was to examine the sexual complaints and severity of sexual dysfunction in relapsing-remitting multiple sclerosis patients and to correlate them with psychological, neurological, and radiological variables. Frequency and characteristics of sexual disturbances were reported by 41 multiple sclerosis patients (32 females, 9 males; mean age 35.4 +/- 10.2 y). Clinical neurologic variables tested were disease duration, exacerbation rate, and disability; psychological variables tested were anxiety and depression. All patients underwent a brain magnetic resonance imaging (MRI) scan at the time of this study. The sexual dysfunction questionnaire included items based on the 3 phases of human sexual response: loss of libido, excitement (arousal difficulties, impotence, premature ejaculation), and anorgasmia. Five males (55.5%) and 16 females (50.0%) reported at least 1 sexual disturbance. The most frequent dysfunctions were loss of libido (26.8%) and arousal difficulties (19.5%). Females rated their difficulties as more severe. Sexual dysfunctions correlated with depression, (r = 0.68, P = 0.001). No correlation between MRI score and depression was found. Anorgasmia correlated with brain stem and pyramidal abnormalities (r = 0.56, P = 0.011; r = 0.56, P = 0.012, respectively). The total area of lesions (plaques) on the brain MRI scan also correlated with anorgasmia (r = 0.41, P = 0.02). Sexual dysfunctions in multiple sclerosis patients are frequent, are mild to moderate in severity, correlate with depression and in some cases central nervous system (CNS) demyelinating process, and thus may be related either to the psychological impact of this disease or to specific organic lesions in the brain.

Adult↗