Barry Knishkowy

Effect of otitis media on development: a community-based study

Otitis media history until age 3 years were recorded for 233 children as part of the surveillance in a Community Program for Promotion of Growth and Development (PROD) conducted in a western neighborhood of Jerusalem. Recurrent otitis media (6 or more episodes) occurred more frequently among children who were of North African or Asian origin, of lower social class and maternal education, and whose duration of breast feeding was less than 26 weeks. Children with recurrent otitis media also failed the 7-month hearing test more frequently than other children. The mean Developmental Quotient score at 2 years and the mean Stanford Binet score at 3 years were statistically significantly lower among children with recurrent otitis media, even after controlling for maternal origin and length of breast feeding. These findings underscore the importance of early identification and early intervention for otitis media.

A follow-up study of adiposity and growth of Jerusalem schoolchildren from age 6 to 14 years

This study evaluated growth and change in adiposity from childhood to early adolescence in 587 Jerusalem schoolchildren examined in both the first and eighth grades. Mean body mass index, height, and weight were determined according to demographic variables and menstrual status and were compared to international reference populations. Menstruating females were taller and heavier than nonmenstruating females at both ages and were more overweight at age 14 years. Height and weight were positively correlated with social class for boys, and few differences were found among ethnic groups. Study subjects were shorter than reference subjects, and study girls were more overweight than reference girls at age 14 years. Our findings suggest that previously demonstrated ethnic differences in growth and adiposity among Israeli children are disappearing. Adolescent girls appear to be at greatest risk for developing obesity. The relationship of pubertal status to body size and obesity at and between the two ages is discussed.

Seat belt use among teenagers in two Israeli family practices

Motor vehicle accidents are the leading cause of deaths among Israeli teenagers. Despite the efficacy of seat belt use in reducing mortality, and legislation requiring seat belt use in all car positions, a large proportion of Israeli adolescents do not consistently use seat belts. Differential data regarding front and rear seat belt use in this population are not available. The objective of this study was to determine the rates of front and rear seat belt use among a sample of Israeli teenagers in the primary care setting. Seventy-eight teenagers attending preventive adolescent health visits in two Israeli family practice clinics completed questionnaires that included questions regarding seat belt use. Structured counseling by the family nurse was provided following completion of the questionnaire. Sixty-four percent of the teenagers reported using front seat belts all of the time, while only 8% used rear seat belts all of the time. Infrequent or non-use of rear seat belts was more prevalent among 10th than among 7th graders. It is concluded that public health strategies in addition to legislation are needed to optimize seat belt use among Israeli teenagers. Health education regarding seat belt use--with an emphasis on rear seat belts--can and should be incorporated into adolescent preventive health visits in the primary care setting.

Screening physical examinations in 25,000 Israeli schoolchildren

Abstract Physical examinations in childhood and adolescence have been recommended by various professional organizations. In order to assess the value of periodic physical examinations in identifying previously undetected conditions, we analyzed the results of school screening examinations of approximately 25,000 Israeli students. Methods: Entire student populations in the 1st, 5th, 7th, and 10th grades in the Tel Aviv-Yafo public school system were offered physical examinations during the 1996–1997 and 1997–1998 school years. Nine physicians performed these examinations. Referrals to the primary care physician were made for abnormal findings. The frequencies of the leading referrals were determined, and comparisons were made according to gender and grade. Results: A total of 24,846 students were examined. The overall referral rate was 7.8 per 100 examinations. Leading referrals included “overweight”, “heart murmur”, and “spinal structural abnormalities” at all grade levels, and “nevi” in grades 5, 7, and 10. Referral rates increased between various grade levels for “spinal structural abnormalities”, “nevi”, and “varicocele”, and decreased for “short stature” and “overweight”. Of the 196 diagnoses documented after referral, 182 (93%) fell into three categories, namely, spinal, hernia and scrotal, and short stature. Conclusions: A wide range of physical findings were detected or referred at each of the grade levels in this large population of schoolchildren. Many of these were triggers for preventive health counseling, while approximately 1% of the examinations yielded important findings requiring intervention. These results provide a measure of justification for the American Academy of Pediatrics’ recommendations for periodic physical examinations in childhood and adolescence.

Reaching Jewish ultra-orthodox adolescents: results from a targeted smoking prevention trial

Abstract Background: Ultra-orthodox, Jewish adolescent boys are considered to have relatively high smoking rates, but are generally not targeted by Israel’s smoking prevention programs. Objective: The objective of this trial was to test the effectiveness of a religion-based tobacco control intervention in reducing smoking prevalence among these youth. Methods: The study population participants were 340 boys from 63 religious boys’ schools in Jerusalem. The intervention consisted of a mailing that included a pamphlet describing the health effects of and rabbinical prohibitions on smoking. A cluster randomized trial was conducted between March and May, 2005. The primary endpoint was current smoking status. Secondary endpoints were future intent to smoke and attitudes towards smoking. Generalized estimating equations and mixed models of analysis of variance were used to perform the analyses. Results: The intervention did not significantly affect current smoking, intent to smoke or attitudes towards smoking. Prevalence of smoking and future intent to smoke were higher in schools without enforced smoking regulations [odds ratio (OR) 2.74, p=0.026, OR 3.38, p=0.018]. Increased smoking prevalence was associated with a high prevalence of smoking among friends (p=0.031) and not finding smoking repulsive (p=0.024). Conclusions: This study adds to the public health literature linking smoke-free schools and peer influences to adolescent smoking. Pamphlets containing rabbinic prohibitions on smoking initiation did not affect smoking behavior or intent to smoke.