Hava Palti

Eating disturbances among adolescent girls: Evaluation of a school-based primary prevention program

Abstract A school-based program aimed at the primary prevention of eating disturbances was developed, implemented, and evaluated. The eating disturbances targeted included unhealthy dieting and binge-eating, which are common among nonclinical populations of adolescent girls. The program was based on social-cognitive principles for behavioral change, and the goals were to change knowledge, attitudes, and behaviors related to nutrition and weight control; improve body and self-image; and promote greater self-efficacy in dealing with social pressures regarding excessive eating and dieting. The baseline population included 341 tenth-grade girls from 16 classes at three high schools in Jerusalem. Classes were assigned to intervention or control groups and girls in the former participated in a 10-session program. Program effectiveness was evaluated with a quasi-experimental design for 269 girls who were present at follow-up assessments conducted both 6 months and 2 years after program implementation. Results indicated that the program had moderate effects on nutrition knowledge and meal patterns and on preventing the. onset of unhealthy dieting and bingeing behaviors. The effects were most consistent among overweight girls. The results suggest that school-based programs can contribute to primary prevention of eating disturbances.

Learning achievement and behavior at school of anemic and non-anemic infants

In a prospective study the learning achievement and behaviour of second grade children who were anemic in infancy (n = 20) was compared with that of non-anemic children (n = 55). All children received preventive care and were under surveillance from birth at the Community Health and Research Center of Hadassah in Jerusalem. The anemic children had a hemoglobin level of less than 10.5 g/dl whereas the comparison group had more than 11.5 g/dl at 9 months of age. The learning achievement score was significantly lower in the anemic group 9.3 S.D. 3.8, than in the non-anemic group 11.5 S.D. 2.9 (P = 0.009). The positive task orientation was also significantly lower in the anemic group, though on additional behavior scores no differences were found. Differences remained significant even after controlling for maternal education and sex of child in a multivariate analysis. It is possible that an iron deficiency state which persists during the critical period of brain development in infancy has long-lasting effects on cognitive functioning. Prevention of iron deficiency may contribute to promotion of child development and better achievement.

Blood pressure and growth at 6 years of age among offsprings of mothers with hypertension of pregnancy

The association between hypertension of pregnancy and blood pressure (BP) and physical growth of the offspring at 6 years of age has been studied in a historical prospective study. Ninety-four consecutive women who developed hypertension during pregnancy and were hospitalized with a diagnosis of pre-eclampsia and their children were included. The comparison group consisted of individually-matched normal pregnant women. Each mother-child pair was examined when the child was 6 years of age. The mean systolic BP (SBP) of the offspring was 101.3 +/- 10.2 (S.D.) mmHg and that of the controls 99.8 +/- 9.5 mmHg. The mean diastolic BP (DBP) was significantly higher among the cases than among the controls (66.2 +/- 8.3 mmHg and 63.9 +/- 8.0 mmHg, P = 0.03). Among the cases, 11 children had a DBP above the 90th centile, whereas only four among the controls. A low, but significant, correlation was found between maternal and child BP for the cases. The DBP of the children with a positive family history of high BP was significantly higher than those with a negative history. There were no differences in height, weight or obesity index between cases and controls.

Personal and socioenvironmental predictors of disordered eating among adolescent females

Abstract A model examining the associations of potential risk factors playing a role in the development of dieting and other unhealthy eating behaviors was proposed and tested using linear structural relationships in order to define risk groups and prepare an educational prevention program for high school students. Personal and socioenvironmental variables were included in the model. The overall predictive value of the model was high, with 65% of the variance in eating behaviors explained by personal and socioenvironmental variables. Body/self-image was a strong predictor of both dieting (r = .64) and binging (r = .54), while nutritional knowledge and attitudes was a strong predictor of nutritional intake (r = .42). The effect of socioenvironmental factors on behaviors was less than expected and was primarily via their effect on personal factors. The model, while comprehensive enough to explain a significant percentage of the variance in disturbed eating patterns, is also simple enough to allow for empirical testing in other populations and guide in the planning of educational programs aimed at the primary prevention of dieting and unhealthy eating patterns.

Exposure to missile attacks: The impact of the Persian Gulf War on physical health, health behaviours and psychological distress in high and low risk areas in Israel

The purpose of this study was to compare residents of an area (Tel-Aviv), which was severely afflicted by SCUD missiles during the Persian Gulf War (high risk region), to residents of a low-risk region (Jerusalem) in terms of: (a) changes in physical health, in use of medical or psychological services, and in health behaviours during the period of the war compared to the preceding month; (b) levels of psychological distress (somatization and anxiety) during the war; (c) characteristics of persons at highest risk for psychological distress. Respondents were randomly chosen and interviewed by telephone (N = 545 in Tel-Aviv, N = 406 in Jerusalem). The respondents in both regions reported significant yet similar deterioration in physical health status, and an increase in detrimental health behaviours during the Gulf War. Tel-Aviv residents had significantly higher levels of psychological distress as compared to residents of Jerusalem: in somatization 18 vs 12% respectively (OR = 2.44, CI = 1.39-4.28), in anxiety 34 vs 26% respectively (OR = 1.62, CI = 1.1-2.42). In addition to place of residence, age, ethnicity, religiosity and self-assessed health were identified as characteristics of persons at greater risk for psychological distress.

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.

Attitudes and practices of Israeli physicians toward adolescent health care: A national survey

PURPOSE To assess practices and attitudes of Israeli physicians with regard to adolescent health. METHODS Questionnaires were sent to a sample of 1050 Israeli physicians specializing in pediatrics (P) family practice (FP), and internal medicine (IM). They were requested to report their experience, perceived skills, and desire for further training regarding 16 adolescent health items grouped under four topics: medical, sexuality, risk behavior, and psychosocial problems. A scoring system was applied to assess their report. Attitudes toward confidentiality in the same topics were also surveyed. RESULTS Questionnaires were received from 306 (29%) physicians, of whom 42% were P, 35% were FP, and 29% were IM. The majority (96%) of respondents included adolescents in their practice, and adolescents comprised 33%, 17%, and 11% of the registered patient population of the P, FP, and IM, respectively. The mean scores for practice, perceived skills, and desire for further training were generally low. Analysis of variance revealed significant differences among the three physicians groups in all surveyed topics, resulting from the low scores of the IM group. A diversity regarding confidentiality was noted, in that younger FP were most willing to keep health issues confidential. CONCLUSIONS Physicians in Israel have limited experience and perceive themselves to be underskilled in dealing with adolescent health issues. Training programs in adolescent health need to be developed to meet the needs of physicians in Israel.

Advice from the obstetrician and other sources: Do they affect women's breast feeding practices? a study among different Jewish groups in Jerusalem

Breast feeding practices and the sources of advice that influenced them were studied in a sample of 276 women from North East Jerusalem. They were followed-up for 4 1/2 months and interviewed on 4 occasions during that period. It was found that 89.7% started breast feeding after parturition, 62.4% were breast feeding by 6 weeks, 40.3% were breast feeding after 3 months and 27.3% were still breast feeding by 4 1/2 months postpartum. Obstetricians advice given at the 6 weeks postpartum examination was significantly associated with duration of breast feeding (P = 0.001). Other sources of guidance were not significantly related to duration of breast feeding when controlling for social class. Analysis of variance indicated that women of higher social classes breast fed more and for a longer period of time. There was no difference in the pattern of attendance at the obstetricians examination by social class, although a very small proportion of women belonging to the lower social classes reported getting advice on breast feeding during that visit. There was a strong relation between advice of the obstetrician and percentage of women breast feeding 4 1/2 months postpartum. Country of origin of the women also affected breast feeding practices. Women of Western origin breast fed more and longer than women of Asian or North African origin. This might be explained by social movements that attempt a return to more natural life styles which are prominent in Western societies. The differential relationship between advice of obstetrician and women belonging to different social classes is discussed and key elements in the relation between obstetricians advice and womens breast feeding practices are considered.

Fighting among Jerusalem adolescents: personal and school-related factors.

PURPOSE To study the prevalence of physical fighting among youth and its association with personal and school-related factors. METHODS Pupils in the 8th and 10th grades (n = 1182, ages 13-16 years) in 11 Jerusalem secular and religious schools anonymously completed the World Health Organization questionnaire from the Health Behavior in School Children study. The unit of analysis was defined as the number of times the student was involved in physical fighting during the past year. The independent variables studied were sociodemographic characteristics, personal, and school-related factors including teachers, peers, and family. RESULTS Fighting at least once was reported by 76% of boys and 26% of girls; 6% of boys who were involved in fights at least once and 16% more than once required medical treatment. For boys, bullying others, poor health and mental health score, and perception of teachers that the pupil was a below-average student significantly increased the odds ratio (OR) for fighting more than once in the past year. Among girls, poor mental health, poor parental support on school matters, bullying, and being bullied by others increased the OR for fighting. CONCLUSIONS Fighting is a highly prevalent behavior among adolescents irrespective of their socioeconomic background. Determinants differ by gender, and intervention programs should focus on the gender-specific determinants.

Utilization of pediatric health services in Jerusalem.

The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mothers perception of her childs health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mothers perception of her childs health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.