Jack H. Medalie

Clinical myocardial infarction over a five-year period--III. A multivariate analysis of incidence, the Israel ischemic heart disease study.

Abstract Analysis of 5-yr incidence of clinically recognized myocardial infarction is presented. Multivariate techniques identify serum cholesterol, systolic or diastolic blood pressure, cigarette smoking and presence of diabetes and angina pectoris , in addition to age increments, as the main risk factors. M.I. incidence appears directly related to continuous levels of these factors rather than to threshold values. This seems to hold for each variable at all levels of other variables. When incidence of M.I. among non-A.P. subjects is considered alone, the remaining risk factors continue to play the major role. Age gradients of the risk associated with cigarette smoking and serum cholesterol were identified, as well as increased contribution of smoking in the multivariate context. Implications for prevention reemphasize weight control and abstinence or reduction of smoking, as ‘primary’ methods, combined with early detection and control of high levels of cholesterol, blood pressure and clinical or preclinical diabetes. With knowledge lacking regarding reversibility of the risk induced by them, and since atherosclerosis is present in age much younger than covered by this study (and others), the degree of success such prevention will achieve cannot be assessed without actual intervention trials. It was not possible to completely account for incidence difference between ethnic groups. This further enhances the need in understanding which additional differences exists between them, which are not (or not fully) reflected in the levels of the main risk factors associated with incidence.

Comprehensive follow-up of carcinoma patients

Abstract A practical recording and scoring system (Ability Index) for use in everyday practice has been developed for the comprehensive follow-up of carcinoma patients. This allows for and guides the care team to cover all the important areas necessary in the evaluation and treatment of the patient and his family. A few illustrative examples of the common problems and use of the index are described.

Serum uric acid: Correlation with biochemical, anthropometric, clinical and behavioral parameters in 10,000 israeli men☆

Abstract Serum uric acid (SUA) was measured in a group of 10,000 middle-aged male civil servants and municipal employees in Israel ( x = 4.77 mg% , S.D. = 0.96 mg% ). SUA levels did not vary appreciably by age or country of birth. There were small significant correlations between SUA and weight [absolute (0.28) and relative (0.30)], triceps and subscapular skinfolds (0.13 and 0.23), systolic blood pressure (SBP) (0.10), diastolic blood pressure (DBF) (0.20) and serum cholesterol (0.13). SUA was elevated in men with coronary heart disease (CHD) and rose with increased level of education. It was negatively correlated with high-density lipoprotein (HDL) cholesterol (− 0.10) and total fat intake (− 0.10), and was significantly reduced among cigarette smokers and in men with diabetes mellitus or peptic ulcer. Multiple regression analysis revealed that 11 variables were significantly related to SUA, together accounting for about 16% of SUA variance (multiple r = 0.40). The Quetelet index [ weight (W) height (H) 2 ] (QI) made most of the contribution. Among the other variables, only blood pressure and the presence of diabetes mellitus accounted for more than 1 % of the variance.

Diabetes and Uric Acid — A Relationship Investigated by the Epidemiological Method

The following data were obtained from a long term Epidemiological study by the Israel Ischemic Heart Disease Unit on 10,000 men aged 40 years and over which was started in 1963. A diabetes survey was carried out within the framework of this study. In the 1963 survey, 498 were found to be diabetic, of whom 296 were aware of diabetes, and 202 were newly diagnosed at the survey. Two years later, in 1965, another 144 new diabetics were discovered.

Screening for early detection: incidence and findings in rural settlements over eight years

Abstract From 1965 to 1972 an annual detection screening program was carried out, as part of the Donolo Hospital Early Detection Clinic, on the over-35-year-old members of a stable agricultural population (kibbutz). The screened individuals were of equal socioeconomic status with excellent medical services. During this period 6859 examinations were carried out. The program covered all the physically accessible sites (no laboratory assistance), and the examinations took place in the medical centers of the settlements. All adults were examined at least once with the overall coverage being 58.7%. There were 103 cancer cases found over the eight year period, both by screening and the ordinary medical care service. This gave an approximate incidence 2.2 malignancies/1000 of all ages and 6.1/1000 adults aged 35 and over. The common cancers were of the skin, breast, and prostate while 70% of all cancers over the eight year period were in sites accessible to a simple clinical screening examination. It is stressed that a screening program should be an integral part of the medical care services round the primary or family physician.

Evaluation of medical care: methodological problems in a 6-year follow up of a family and community health center.

Abstract The inherent difficulties in assessing an on-going service which did not have any pre-planning to include evaluation as part of the service has been discussed. The main method of evaluation was by comparison of the local neighborhood health-sickness rates with the national figures for the same period (1953–1958): (1) as a ‘one-time comparison’ having shown that the local neighborhood had similar characteristics to the nation, taking into consideration the factors of age, sex, country of birth, family size, size of dwelling-units and members receiving social welfare aid; (2) as a first step in the comparison which will use the national figures as a moving-indicator over the years. The results show that, in comparison with national figures the local neighborhood has a higher birth rate. Mortality data showed similar perinatal rates, a significantly lower infant mortality rate (17.6 as compared to 34.3/1000 live births), lower standardized mortality rate, similar proportional mortality, and no maternal deaths in 578 births. Morbidity for selected specific conditions showed significantly lower incidence of diphtheria, tuberculosis, and anemia during pregnancy, identical typhoid figures, and a significantly higher number of patients reported with bacillary dysentery. There were less contacts per patient per year than for members of various sick benefit insurance schemes and there was a 78.6 per cent response to mass radiography.