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Biomedical subjects

V Barell

Publications and source records attributed to V Barell.

At least 37 records · Page 2Linked to original sources
PubMed1997

Height and social class in male adolescents from different ethnic backgrounds in Israel.

The relationship between height and social class, independent of the effect of ethnic background was examined. This is a population-based study of 17-year-old israeli-born Jewish males born between 1966-1969 who underwent routine physical examination prior to army recruitment. Inductees descending from 9 ethnic backgrounds-Germany, Hungary, India, Morocco, Poland, Romania, Russia, Yemen and at least 3rd-generation israeli-born were used for this analysis. Anthropometric data was abstracted from the computerized induction examination; socioeconomic status (SES) was assigned according to the residence of each recruit. Statistical analysis included analysis of variance and chi square test for linear trend. Mean height of the total (reference) group was 173.7 cm, ranging from 172.0 cm in the lowest SES level to 175.1 cm in the highest level. The proportion of individuals above the 85th percentile of height of the reference group, increased linearly from 8.7% (lowest SES) to 18.5% (highest SES) (p < 0.01). The mean height of recruits differed considerably among ethnic groups in each SES level and ranged from 170.8 cm (Yemenites) to 175.4 cm (Russian and Romanian) in the total group. In each ethnic group, height differences between extreme levels of SES were observed ranging from 2.3 cm (Morocco) to 4.3 cm (Russia). We conclude that height among 17-year old israeli-born males is positively associated with SES after controlling for ethnicity.

Adolescent↗
PubMed1996

Relationship between morbidity and extreme values of body mass index in adolescents.

BACKGROUND: Although the association between overweight and cardiovascular risk factors is well documented in cross-sectional and longitudinal studies, reports of adolescent morbidity associated with underweight in industrialized countries are rare. METHODS: This population-based study includes approximately 110,000 17 year old Israeli Jewish males who underwent routine physical examination at army induction centres. Computerized data tapes include overall health profiles, specification of physical and mental conditions, and height and weight measurements. Medically significant conditions are those with sufficient severity to preclude service in a combat unit. RESULTS: Functional limitation is more prevalent at both extremes of the body mass index (BMI) distribution: 149.5/1000 among severely underweight individuals and 164.3/1000 among severely overweight subjects. Overweight was associated with hypertension (14.9/1000 among the severely overweight), as well as joint conditions of the lower extremities, mainly hip, ankle and knee disorders. Functional disorders associated with underweight are bronchial and lung conditions, including asthma (14.2 and 18.9/1000 in the mildly and severely underweight), scoliosis, intestinal conditions and emotional disorders (mainly neurosis). CONCLUSIONS: Both under- and overweight are associated with morbidity at age 17. Intervention programmes should begin at an early age.

Adolescent↗
PubMed1994

Cause-specific mortality among Israeli adolescents in the 1980s.

PURPOSE: Considerable mortality occurs during adolescence despite it being a relatively healthy period of life. Nationwide analysis of adolescent mortality data helps identify those sub-groups with higher-than-expected death rates, that may be amenable to preventive intervention programs. METHODS: Adolescent mortality in Israel during 1981-1986 is examined by age (10-14, 15-19 years), sex, population group (Jews, non-Jews), and cause of death. Data were abstracted primarily from special publications for 1981-1986. Recently available mortality updates for 1987-1989 were inspected and significant changes in mortality during the latter period have been included. RESULTS: Among an average of approximately 800,000 adolescents aged 10-19 years living in Israel during 1981-1986, the majority (77%) were Jews. Overall mortality was 36.7 per 100,000. Death rates were almost twice as high for males as for females, increased with age for all population subgroups, and were 63% higher for non-Jews compared with Jews. Accidents were the major cause of death among Israeli adolescents (37.7% of total mortality), with male-to-female rate ratio of 3.4. Mortality from all external causes, including accidents, suicide, homicide, and other external causes accounted for 50.6% of all deaths. Neoplasms were the next major cause of death. Israel and U.S. adolescent mortality rates were compared and showed similar trends. CONCLUSIONS: The non-Jewish minority adolescents, and most particularly the males, are at the highest risk of death. Preventive intervention programs should be targeted to the high-risk populations described.

Accidents↗
PubMed1994

Variation in mortality rates in Tel Aviv region municipalities.

Age, sex and cause-specific mortality rates in 1982-86 for eight municipalities in the Tel Aviv region were compared to comparable rates of a reference population--the 1984 Jewish population of Israel. Residents of Or Yehuda, Tel Aviv, Holon and Bat Yam had an elevated risk of dying. Of particular interest is the elevated risk among adult residents of the Tel Aviv municipality. Males and females aged 30-44 had excess mortality from heart disease and external causes of death, and males aged 45-64 from ischemic heart disease and external causes. Tel Aviv females aged 30-44 also had excess mortality from cerebrovascular disease and females aged 45-64 from malignancy. High mortality rates in these age groups contribute considerably to years of life lost, and it is suggested that local health service or governmental action should be taken to investigate and reduce the disparities. Small area analysis, as shown here, may provide considerable information for monitoring community health.

Adolescent↗
PubMed1993

[Health profile of children without medical insurance].

Lack of medical insurance is a health risk factor. Underutilization or postponement of medical services, as well as lack of planning for long-term care are common among the uninsured, project was implemented within the framework of the Or Yehuda Intervention Program to assess the health status of children from birth to 17 years of age in 72 families without health insurance. Information on medical status and service utilization was summarized for 169 of the 217 children in these families. These families constituted a substantial burden on the health system, both in the form of hospitalization debt (636 hospital-days owed to a nearby hospital) and as uncompensated primary care clinic visits. Half of the visits were made by 12% of the children, while a quarter of the study children had not visited the clinic at all during the preceding year. Among families uninsured for over 2 years, the trend of underutilization was even more pronounced. Significant morbidity and signs of neglect were found among the study children, nearly 60% of whom suffered from health problems and a similar proportion had been hospitalized. The most common diagnoses were infections, congenital anomalies, and musculoskeletal and hematological problems; a third of the children had 2 or more conditions. Over 40% of the study children were referred for specialist consultation or treatment--about half of them to the pediatric subspecialties and the other half to surgical clinics. Signs of medical neglect were noted in 42.6% of study children and among 60.4% of those with 2 or more medical problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Mortality among Moslem, Christian and Druze infants].

Infant mortality in 3 heterogeneous non-Jewish religious groups in Israel was examined (1977-80). Risk factors contributing to infant mortality were identified and their effects assessed by logistic regression analysis. Mortality among Moslems and Druze was 26.0/1000, compared to 17.2/1000 among Christians and 12.7/1000 among Jews. These differences between the populations were mostly evident after the first month of life. Unexpected excess mortality rates were observed among female infants, compared to males, in the postneonatal period in all 3 groups. This excess was present mainly in Christian and Druze infants born to fathers with few years of education. The trend persisted after accounting for birth weight, maternal age, birth order and place of birth. The female mortality in the postneonatal period was twice that of males in Christians and 1.5 times higher than that of males in Druze. Congenital malformations and immaturity-related conditions were the main causes of neonatal deaths, while infections were the major cause of postneonatal deaths. Among the Druze the postneonatal death rate due to infections reached 8/1000. In the non-Jewish groups 42% of postneonatal deaths occurred out of hospital, compared to 15% among Jews.

Christianity↗
PubMed1991

A criterion for a standardized definition of low birthweight.

A criterion for the definition of low birthweight (LBW) which is tailored to each population group is presented. The suggested criterion is based on an assumption according to which the distribution of birthweight is actually a mixture of the following two components: the predominant (including about 95% of the newborns and is normally distributed) and the residual (assumed to be mainly composed of newborns under extreme risk for perinatal mortality). The LBW category is defined to include a small but equal (for all groups) percentage of the predominant component. Thus, population groups which differ with respect to their specific predominant birthweight distribution are comparable with respect to the perinatal mortality risk. Application of the suggested definition is demonstrated using data from two ethnic groups in Israel. Results show a smaller percentage of female LBW than males in both population groups when using the suggested criterion. The reverse is observed (i.e. more male than female LBW), using the standard criterion (less than 2500 gm). The suggested criterion is shown to reduce the sex and ethnic differences in perinatal mortality among the respective LBW categories.

Asia↗
PubMed1990

Falls and subjective health rating among the elderly: evidence from two Israeli samples.

Prevention and treatment of falls in the elderly is one of the challenges facing practitioners today. Falls are known to be associated with health status and demographic variables, however relatively little is known about how falls affect the health perceptions of elderly persons. Data from two Israeli samples were analyzed to examine the relationship between reported falls and self-rated health. The first sample was collected in 1978 in home interviews from 96% of residents aged 65 and over of the town of Kiryat Ono (N = 1276). The second sample was collected from a national probability sample of 3494 urban Israelis in 1985, in home interviews. One-year incidence of falls was estimated from both samples at 23-24% for those over 65. Data from both samples showed that recent falls are negatively associated with subjective health rating. In Kiryat Ono, falls interacted with reported chronic conditions, so that the effect of a fall on subjective health status was only apparent in those with few chronic conditions. Among those who reported 4 or more chronic conditions, the occurrence of a fall had no independent effect on subjective health rating. In multivariate analyses of the national data, falls, and particularly those that happened in the home, or that required a visit to the emergency room had a negative effect on subjective health rating, after adjustment for age, sex, education, mobility and visual impairments and use of sleeping pills.

Accidental Falls↗
PubMed1990

A method of macro-auditing and assessing the preventability of infant mortality using large volume computerized files.

We present a method for auditing and evaluating infant mortality with the aid of a preventability grading system, based on national computerized files of livebirths and infant deaths. Diagnostic categories and specific causes of deaths were classified into one of the following three preventability grades: Preventable (P), Possibly Preventable (PP) and Non Preventable (NP). This classification was then applied to two different scales: Preventability of Condition (PC) and Preventability of Death (PD) from which a third scale--Preventability of Mortality (PM)--was derived. The method was then applied to matched records of 39,786 livebirth and 452 infant death certificates between 1977 and 1984, in a semi-urban region in Israel encompassing 220,000 inhabitants. Comparison of mortality rates, according to the proposed preventability scores, demonstrated that higher infant mortality rate in non-Jewish population, or in Jewish mothers with a lower educational, was present only in the preventable categories (P or PP), while death rates due to non preventable causes were identical for all groups. The suggested macro-auditing method facilitates the assessment of large scale infant mortality rates in terms of preventability.

Congenital Abnormalities↗
PubMed1990

Childhood mortality from accidents in Israel, 1980-84.

There were on average 1.5 million children aged 0-17 in Israel during the period 1980-84, with an average accidental mortality rate of 10.9/100,000. Although 77% of the children were Jewish and 23% non-Jewish, 45% of the accidental deaths occurred in the non-Jewish population. The accidental mortality rate among non-Jewish children was 20.9/100,000, which was 2.6-fold greater than that among Jewish children (7.9/100,000). Among both population groups, the male death rates were considerably higher than the female rates (10.5 vs. 5.1 among Jewish males and females, respectively, and 25.1 vs. 16.5 among non-Jewish children). The non-Jewish death rates were highest among infants less than 1 year of age, with females outnumbering males. Inspection of the male to female rate ratios showed a greater disparity between the sexes in both population groups as age increased. The proportion of motor vehicle accident (MVA) deaths was 52.7% among Jews and 40.4% among non-Jews. Drowning was the second ranking cause of accidental death (approximately 15%) in Israeli children, followed by falls (approximately 8%). The age distribution of MVA mortality was strikingly different in the two Israeli population groups. Among the Jews the rates peaked in the 15-17 age group in both sexes; however, among the non-Jews the rates peaked in the 1-4 age-group, with most of these deaths probably representing pedestrian deaths. On the average, the MVA serious injury rates were about ten times greater than the MVA mortality rates. Variations of mortality from accidents in different age, sex and population groups clearly indicate that preventive intervention programs must be targeted specifically to each age-sex-population group.

Accidental Falls↗
PubMed1988

Subjective state of health and survival in elderly adults.

The relationship between subjective state of health and 5-year survival in an elderly cohort was examined. During the 1978 study of the elderly population of Kiryat Ono, a suburban community in the central coastal area of Israel, respondents were asked to evaluate their general health status on a four-level scale, and their vital status was updated until 1983. A multivariate analysis of survival was conducted using the Cox Proportional Hazards Model. Self-rating of health was an independent predictor of survival after controlling for age, sex, continent of origin, number of conditions and medications reported, heart disease and activities of daily living (ADL). The self-rating of health was found to be an important psychosocial parameter in the evaluation of health status, in determining the prognosis of an elderly person, and in analyzing survival.

Aged↗
PubMed1988

Maternal education as a modifier of the association between low birthweight and infant mortality.

Both low birthweight (LBW) and infant mortality rate (IMR) have been consistently shown to be associated with maternal level of educational attainment. This paper examines the mortality risk attributable to LBW in different levels of maternal education. Comprising the study population were 18,715 singleton live births to Jewish mothers ages 20-39, during the years 1977-1980 in the Negev (the southern part of Israel). Data were obtained from a linked record of birth and death certificates. As expected, proportions of LBW (less than 2500 grams) were inversely related to level of maternal education (12.2% in the lowest educational level, 7.9% and 8.0% in the two intermediate levels, and 7.2% in the highest educational level). The mortality risk attributed to LBW was found to be modified by maternal level of education. Mortality ratios standardized for maternal age and parity were computed, using educational level 3, where the lowest mortality rates were observed, as the standard population. Among LBW infants no significant differences were found across educational levels, except for the lowest educational level where only 69% of the expected number of deaths were observed. The survival advantage of LBW infants in the lowest educational level was observed both in the neonatal and the postneonatal periods. Among normal birthweight (NBW) infants, a statistically significant excess mortality was detected both in the highest and the lowest educational levels. The excess mortality of NBW infants in the highest level of maternal education was due to neonatal mortality (SMR = 2.2), while the excess mortality in this birthweight category in the lowest educational level occur mainly in the postneonatal period (SMR = 2.4).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Analysis of geographic differentials in infant mortality rates. The Or Yehuda community.

Comprehensive evaluation of matched infant death certificate data and livebirth certificate data for 1977-1980 was performed for two areas in Israel: Or Yehuda, a small, low socioeconomic status community which had an infant mortality rate of 19.1 per 1,000, and the rest of Ramat Gan district, which had an infant mortality rate of 10.3 per 1,000. A method is presented which illuminates the role of statistical models in analyzing small area data, in evaluating twofold observed differences in crude and factor-specific mortality rates in two areas, in assessing heterogeneity in population stratum-specific mortality rate ratios, and in identifying causes for inter-area differences in infant mortality rate. Identical logistic models were fitted to each of the areas independently, and these were used to investigate effects due to birth weight, sex, parity, maternal age and education, and parental occupation. The differences in the distribution of risk level (number of risk factors) present in each population (or the proportion of multi-problem families) were identified as a single factor that can explain most of the disparity between the areas. The direction and magnitude of the relation between risk level and infant mortality rate were similar in both communities: the greater the number of risk factors, the higher the rate. Identification of a target population for intervention through only one or two specific risk factors would be unprofitable in reducing the overall community infant mortality rate since too many families with multiple risk would be excluded, and too many with single risk factors would be included.

Adult↗
PubMed1986

Evaluating improvements in multistaged health care: the risk-care-outcome cycle.

A new method of program evaluation was developed in Israel to assess the impact of improved care on the health of mothers and infants. Care before conception and during the prenatal, intrapartum, and postpartum periods form an interrelated sequence. The method, therefore, evaluates the interplay among risks, health care quality improvements, and outcomes within each stage of care, and measures the impact of improved outcomes on subsequent stages. The expansion or modification of pilot maternal and infant health efforts in 42 Israeli communities will be based on the results of this evaluative effort. The concepts employed in this assessment are applicable in many other situations that involve sequences of health services (eg, preoperative, operative, and postoperative care) where the success of each phase of care affects the risks of the succeeding stage.

Academic Medical Centers↗
PubMed1985

Reported health of the elderly: the Kiryat Ono census.

The reported diseases and health problems of 1,276 persons over the age of 65 interviewed in the 1978 census of the elderly in Kiryat Ono are presented here. More than half of the respondents reported having either heart disease, hypertension or diabetes, and one in five indicated that they had more than one. A strong relationship was found between the total number of conditions reported, drug-taking and the subjective feeling of health.

Activities of Daily Living↗
PubMed1983

A planning cycle in the development of a community health program. An intervention program in mother and child care.

The Or Yehuda Intervention Program was developed in accordance with a planning cycle that includes a situation analysis, formulation of objectives, selection of strategies, development of an operational plan, implementation and evaluation, which lead, in turn, to a new situation analysis. The primary aims of the program are to reduce the infant mortality rate in Or Yehuda to the level prevailing in the rest of the area and to promote continuity of care and proper medical management during pregnancy, delivery and the first year of life. Problems in implementation, especially those related to coordination and integration of the several medical facilities involved, the information tools developed, and preliminary results are presented.

Child Health Services↗
PubMed1977

Evaluation of electrocardiogram in emergency room as a decision-making tool.

The contribution of the electrocardiogram to the clinical judgment used by the physician in the emergency room to determine the necessity for hospitalizing patients was evaluated. Thirty-five percent of all 1,578 patients with presumed myocardial infarction referred to the Chaim Sheba Medical Center, Tel Hashomer, Israel, for a one-year period had subsequently diagnosed myocardial infarctions. The ECG in the emergency room detected only 65 percent of these. The physician's clinical judgment was impressive in his decision to admit to the hospital almost all of the remaining 35 percent, while not admitting very many of the patients who did not have subsequently diagnosed myocardial infarctions. When the myocardial infarction was not evident on the ECG and the abnormalities on the tracings were identical for patients with subsequent myocardial infarctions and those without, again the physician made the right choice more often than the wrong. The follow-up ECG also attested to the good judgment of the physician in the emergency room. Of the emergency room ECGs of patients without subsequent myocardial infarctions who were admitted to the hospital, 17 percent showed myocardial infarction by follow-up, while this happened to only 2 percent of those denied admission.

Decision Making↗