Dina Pilpel

Effect of Growth Hormone Treatment on Quality of Life of Short-Stature Children

While enhanced growth velocity is a well-established benefit following the initiation of growth hormone treatment (GHT), the potential benefit of GHT on quality of life (QOL) of short-stature children has not yet been documented. We compare QOL of two groups of short-stature children who attended the Endocrine Unit (EU) and were 2 SD or more below the average for age and gender. The first group included 96 patients of whom 65 were without any underlying disease, 15 had classical GH deficiency and 16 had Turner syndrome or renal disease. These patients were on GHT for at least 2 years. The other group included 33 patients. Owing to lack of resources to include these 33 patients in a clinical trial, they did not get GHT. They were normal variant of short stature, and their height was similar to the height of the 65 children included in the first group. QOL was assessed using self-administered questionnaires, which were filled out by the patients on their regular visit to the EU. QOL was defined in terms of school achievements, leisure activities, emotional and physical self-esteem, relationships with peers and family members. No significant differences were found between the two groups. The mean scores for the different domains of QOL ranged between 2.6 and 3.8 on a scale ranging from 1 (very pessimistic view) to 4 (very optimistic view).

Coping and satisfaction with growth hormone treatment among short-stature children

The ability of children to cope with a chronic medical problem requiring prolonged treatment has an effect on the quality of life of these children and of their parents and serves as an index of the quality of treatment. This study deals with coping ability and satisfaction with treatment of children whose stature was two or more SD below the average for age and gender. The study population included 96 patients, 53 of whom were male, who were on growth hormone (GH) treatment for at least 1 year. 65 patients were without any underlying disease, 15 had classical GH deficiency and 16 had Turner syndrome or renal disease. All patients were treated with daily injections at home from 12 to 66 months. Using a self-administered questionnaire, the ability to cope and the degree of satisfaction and compliance with treatment were assessed. No significant differences were found with respect to gender, the presence of an underlying disease, age at which treatment commenced or duration of treatment. Despite the fact that the outcome of GH treatment on final height has yet to be established, satisfaction and compliance were high.

Hospitalized patients’ satisfaction with caregivers’ conduct and physical surroundings

The study examined the relative contribution of caregivers’ conduct and physical conditions of the hospital setting to patients’ global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a population of 360,000 in southern Israel. Patients were interviewed using a structured questionnaire. Inclusion criteria were patients over 17 years of age, fluency in Hebrew, and hospitalization in the internal medicine wards for 24 hours or more. The dependent variable was “global satisfaction.” The independent variables were “satisfaction with caregivers’ conduct,” “satisfaction with physical surroundings and conditions,” and “self-assessment of health.” The three independent variables accounted for 36.8% of the variation in patients’ satisfaction with care, of which 87% related to “satisfaction with caregivers’ conduct.” In conclusion, hospital patients value the caregivers’ conduct more than the physical environment.The study examined the relative contribution of caregivers’ conduct and physical conditions of the hospital setting to patients’ global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a population of 360,000 in southern Israel. Patients were interviewed using a structured questionnaire. Inclusion criteria were patients over 17 years of age, fluency in Hebrew, and hospitalization in the internal medicine wards for 24 hours or more. The dependent variable was “global satisfaction.” The independent variables were “satisfaction with caregivers’ conduct,” “satisfaction with physical surroundings and conditions,” and “self-assessment of health.” The three independent variables accounted for 36.8% of the variation in patients’ satisfaction with care, of which 87% related to “satisfaction with caregivers’ conduct.” In conclusion, hospital patients value the caregivers’ conduct more than the physical environment.

Ethical and cross cultural questions concerning pediatric clinical trials

During a clinical trial of recombinant growth hormone in a population of short stature but otherwise healthy children the following ethical problems were confronted: What are the prospective benefits compared with the foreseeable risks associated with this therapy? Can the doctor really inform the parent and/or the child about the outcomes of the treatment? Who must make the decision about participation in the trial? From which age can the child himself decide about continuing or dropping out? Since the treatment requires frequent check-ups for years, to what extent does the child become psychologically dependent upon the medical profession? Given this possibility, is the child really free to withdraw from the treatment? Is there a conflict between the doctors autonomy to propose the treatment and the patients autonomy to decide about participation? Is there a clear threshold between life-threatening problems and minor, cosmetic problems? These dilemmas are discussed in a cross-cultural context.

Young Infants' Morbidity and Exposure to Fine Particles in a Region with Two Power Plants

Abstract This study investigated the effect of fine particulate matter (PM2.5) in ambient air on hospital admissions and emergency room (ER) visits among young children (0–3 yr) residing in 4 communities in southern Israel, within an area 5–25 km from the 2 power plants, which operate within 25 km of each other. Daily records of hospitalizations and ER visits for respiratory diseases at the 3 hospitals serving the region were examined for 9 mo, October 1, 2000-June 30, 2001. Mean PM2.5 concentrations for the four communities ranged from 11.6 to 28.1 μmlg/m3. Time series analysis revealed a statistically significant association (p < 0.05) between the numbers of hospitalizations and ER visits for respiratory symptoms and concentrations of PM2.5. This effect was evaluated for 0–3 lag days, directly, and for interactions with temperatures and seasonal parameters. The respiratory health of young children may be affected by 24 hr concentrations of PM2.5 < 60 μmlg/m3, the threshold proposed by both Israel and the United States.