Jacob Urkin

The effect of voluntary dehydration on cognitive functions of elementary school children

Aims: (1) To describe the occurrence of voluntary dehydration in two classes of elementary school students as expressed by their morning and noon‐time urine osmolality; and (2) to determine the relationship between the childrens scores on cognitive tests and their state of hydration.

Hubble Bubble Equals Trouble: The Hazards of Water Pipe Smoking

A Narghile, one of the names for a water pipe, is an instrument for tobacco smoking that has became a trend among the youth in Israel. The mistaken opinion that smoking a Narghile is not as dangerous as smoking cigarettes makes the youngsters and their parents take it lightly and contributes to the expansion of its use. The objective of this paper was to review the literature on the health risks of Narghile smoking. A literature search of Medline (PubMed) and the Internet on the health hazards of Narghile smoking was conducted. The health hazards that the Narghile smoker is exposed to include interference with oxidation, damage to genetic compounds, increased risk of developing malignancies, infectious diseases, damage to the fetus and newborn, and exposure to commonly abused chemicals. It is concluded that increased awareness of the expanded use of the Narghile is imperative and education programs about the prevention of cigarette smoking and substance abuse should also include Narghile smoking.

Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases

To describe how physicians manage acute pharyngitis with respect to the clinical guidelines.

Evaluation of student attitudes and knowledge in a new program in international health and medicine

Ben-Gurion University (BGU) in collaboration with Columbia University inaugurated a medical school in 1998, with the expressed purpose of training physicians in International Health and Medicine (IHM). The Beer-Sheva Survey of Attitudes and Knowledge in International Health and Medicine was given to the first graduating class and three control groups. The graduates of the new program retained their positive attitudes toward IHM and increased their knowledge of the subject. Further studies are necessary to document the effect of the program on the clinical practice of its graduates.

Promoting resiliency for interprofessional faculty and senior medical students: Outcomes of a workshop using mind-body medicine and interactive reflective writing

ABSTRACT Background: Health care professions faculty/practitioners/students are at risk for stress and burnout, impacting well-being, and optimal patient care. Aims: We conducted a unique intervention: an interprofessional, experiential, skills-based workshop (IESW) combining two approaches: mind-body medicine skills and interactive reflective writing (RW) fostering self-awareness, self-discovery, reflection, and meaning-making, potentially preventing/attenuating burnout and promoting resiliency. Methods: Medical and nursing faculty and senior medical students (N = 16) participated in a 2-hour workshop and completed (1) Professional Quality of Life measure (ProQOL) and (2) a questionnaire evaluating understanding of professional burnout and resiliency and perceived being prepared to apply workshop techniques. Thematic analyses of anonymized RWs exploring meaningful clinical or teaching experiences were conducted. Results: Participants reported better understanding of professional burnout/resiliency and felt better prepared to use meditation and RW as coping tools. RW themes identified experiencing/grappling with a spectrum of emotions (positive and negative) as well as challenge and triumph within clinical and teaching experiences as professionally meaningful. Conclusions: Positive outcomes were obtained within a synergistic resiliency skills building exercise. Successful implementation of this IESW provides good rationale for studying impact of this intervention over a longer period of time, especially in populations with high rates of stress and burnout.

Reducing health disparities: The social role of medical schools

Abstract Introduction: Medical education based on the principles of social medicine can contribute toward reducing health disparities through the “creation” of doctors who are more involved in community programs. Purpose: This study compared the social medicine orientation of graduates from various medical schools in Israel. Methods: The authors conducted an online cross-sectional survey in May 2011 among physicians who are graduates of Israeli medical schools. Results: The study included 1050 physicians practicing medicine in Israel: 36% who are graduates from the Hebrew University, 26% from Tel Aviv University, 22% from the Technion and 16% from Ben-Gurion University. A greater percentage of physicians who studied either at the Technion or Ben-Gurion are working or have worked in the periphery (∼50% vs. ∼30% at the Hebrew and Tel Aviv Universities). Among Ben-Gurion graduates, 47% are active in social medicine programs vs. 34–38% from other schools. Among physicians active in social medicine programs, 32% of Ben-Gurion alumni estimated that their medical education greatly influenced their social medicine involvement vs. 8–15% from other schools. Hebrew University alumni described their studies as more research-oriented. In contrast, Ben-Gurion graduates described their studies as more social medicine-oriented and they exhibited more positive attitudes about the role of physicians in reducing health disparities. Discussion: Social medicine-oriented medical education induces a socialization process reinforcing human values regarding doctor–patient relationships and produces positive attitudes among future doctors about social involvement. Findings emphasize the need to develop educational programs with this orientation and to strengthen medical schools in the periphery.

Development and validation of a new measure of student attitudes and knowledge of international health and medicine

There is increasing awareness of the importance of international health and medicine (IHM) but there is a paucity of data regarding medical students’ attitudes towards and knowledge of the subject. To the best of our knowledge there is currently no validated measure to assess this. The aim of the present study was to develop a validated measure of medical students’ attitudes and knowledge of IHM and examine its correlates. A panel experienced in IHM formulated attitude and general knowledge items and clinical cases based on personal experience, literature review and texts. The survey was piloted and then administered to 82 students of the Ben Gurion University—Columbia University MD program in IHM, and 59 students from programs without specific IHM focus. Cronbachs α was 0.87. Test-retest reliability of attitudes was r = 0.87. Correlation of openness to experience with attitudes was r = 0.376, showing construct validity. Third-year IHM students scored higher than incoming students on IHM knowledge and clinical cases, demonstrating sensitivity. General IHM knowledge was positively correlated to clinical IHM knowledge r = 0.36, but not attitude or openness to experience. Those with previous IHM work experience showed greater openness and positive attitude. Women showed more positive attitudes towards IHM than men. Attitude was negatively correlated with number of languages spoken r = −0.198. The survey may be a reliable and valid tool to assess and compare medical students’ knowledge and attitude toward international health. This survey can be used to evaluate curricular innovations in the field.

Enhancement of Pediatric Ophthalmologic Diagnosis With a Handheld Polarized Dermatoscope

Objective. In pediatric primary care, an adjunct for ophthalmology diagnosis and monitoring of treatment could be of great advantage. The portable polarized dermatoscope can readily fit the purpose as an alternative to the classic slit lamp device. Methods. We describe and demonstrate our clinical experience using the dermatoscope for diverse ocular conditions. Main message. Beyond its effective primary role as an examination tool for detecting dermatopathology, the dermatoscope proves its worth in a variety of separate ophthalmologic clinical states where intricate details need recognition. From corneal or subtarsal foreign body identification, to tear gutter assessment, this instrument can facilitate our work whenever magnification and illumination is beneficial. Conclusion. The technique described raises the option of using a substitute for usually lacking, cumbersome equipment for many therapeutic situations, rural clinics and home visits, easily available for the busy pediatrician, demanding little training, and at a reasonable cost.

Should We Consider Alternatives to Universal Well-Child Behavioral-Developmental Screening?

The prevalence of developmental disabilities in the young age is of the order of 15%. When behavioral and social-emotional disorders, physical impairments, and sensory disorders are included, the need for special intervention increases to one out of four children. As the sensitivity and specificity of the best screening tests are in the range of 70–80%, their predictive value is controversial. The cost of conducting definitive tests and repeat screening for those who fail the screening tests is high. Children with severe disorders can be identified clinically without a screening test. The poor predictability, difficulty in implementation, and the high costs of developmental testing suggest that children, particularly those in high-risk communities, might be better served by implementing intervention programs for all, instead of trying to identify the outliers through screening.

Who accompanies a child to the office of the physician

The arrival of a minor, unaccompanied by a parent, for a clinic visit, is challenging to the physician with legal, ethical, and practical implications. This prospective study, conducted in three community pediatric clinics, examined the relationship of accompanying persons to the minors visiting the clinics. About 90% of the 1,104 visits were with an accompanying parent, mostly a mother. Over 9% of minors, especially adolescents, arrived at the clinic unaccompanied by a parent. A regression analysis demonstrated that for each increase of one month in age there was a 2% increased chance for a visit without a parent (p < .0001). Adolescents were more likely to be among the 6% of minors, who visited the clinic alone, with a rate 0.066 per 1,000 visits in the more affluent community, compared to 0.019 and 0.016 in the middle and low income communities (p < .001). Physicians as well as parents should be made aware of the regulations regarding accompaniment of minors on a visit to the clinic. Policies regarding unaccompanied visits should take into account the risk posed by the absence of a parent versus the right of adolescents for independence and privacy.