Shimon Scharf

Eradication of Helicobacter pylori infection equally improves chronic urticaria with positive and negative autologous serum skin test.

Background:  The aim of the study was to examine effects of Helicobacter pylori eradication on chronic idiopathic urticaria (CU) with and without positive aulogous serum skin test (ASST).

Ten‐year trends in obesity among Israeli schoolchildren: 1990–2000

AIM To analyze trends in childhood body mass index (BMI) in Israel between 1990 and 2000, and to determine the proportion of obese children using US and population-specific reference values. METHODS Cross-sectional data from 13 284 second- and fifth-grade schoolchildren were collected, including age, sex, height, weight, country of birth, and time since immigration. Age- and sex-specific BMI means and centiles were calculated, and the prevalence of obesity was determined using Israeli and US reference values. RESULTS BMI values at the 95th centile increased monotonously over time in all age and sex categories. Between 1990 and 2000, 95th centile values increased by 12.7% and 11.8% among second-grade boys and girls, respectively. Among fifth-grade children, 95th centile values increased by 10.2% and 8.4%, respectively. Among second graders in 2000, 11.4% of both boys and girls exceeded the BMI value recorded at the 95th centile in 1990. Among fifth-graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference value (p for all comparisons < 0.001). The proportion of obese children increased over time using both Israeli and US reference values. CONCLUSION This substantial increase in childhood obesity poses a serious health threat, and requires implementation of suitable public health interventions.

BiPAP Ventilation as Assistance for Patients Presenting with Respiratory Distress in the Department of Emergency Medicine

AbstractBackground: Noninvasive ventilatory support (NIVS) is intended to provide ventilatory assistance for a wide range of respiratory disturbances. The use of NIVS for treatment of respiratory distress may be applicable in the emergency department (ED). It may prevent endotracheal intubation and, likewise, may favorably influence the course of the patient’s hospitalization, depending on the primary disease or ventilatory disturbance. Objective: To evaluate the efficacy of bilevel positive airway pressure (BiPAP) ventilation in patients with acute respiratory distress presenting in the ED. Methods: A prospective, uncontrolled, nonrandomized, nonblind study enrolled 30 patients. They were cooperative and hemodynamically stable, aged over 18 years, and presented with acute respiratory distress as defined by predetermined criteria. They were connected to a BiPAP machine through a face mask, using an initial pressure of 8/3cm H2O, which was gradually raised to 12/7cm H2O inspiratory positive airway pressure/expiratory positive airway pressure. Standard drugs, inhalation and oxygen therapies were administered as needed. The BiPAP was disconnected either upon relief of respiratory distress or on deterioration of the patient’s condition. Results: Of the 30 patients in the study, 19 had cardiogenic pulmonary edema, four had acute asthma, three had exacerbation of COPD, three had pneumonia and one had malignant pleural effusion. BiPAP was instituted subsequent to failure of standard therapies. Twenty-six patients were classified as responders to the BiPAP ventilation and four as nonresponders (three patients were intubated after 1 hour and one patient 24 hours, post BiPAP). The total length of stay (LOS) in the ED was 3–5 hours and the mean LOS in hospital was 4.1 ± 1.5 days, versus 6.5 ± 1.2 days in LOS reports of similar patients in the same hospital during 1999, who did not undergo BiPAP ventilation. No other complications were observed. Conclusions: We found BiPAP ventilation simple, safe, effective and well tolerated by patients in respiratory distress. The rate of endotracheal intubation after successful BiPAP ventilation was low. In carefully selected patients with respiratory distress, BiPAP ventilation may successfully replace endotracheal intubation.

Appropriateness of US and international BMI-for-age reference curves in defining adiposity among Israeli school children

Effective surveillance of trends in paediatric overweight and obesity requires the establishment of valid cutoff values to identify children at risk. In Israel, standard values for childhood BMI-for-age are currently based on growth charts published by the US Centers for Disease Control and Prevention. However, the appropriateness of using US reference values in populations outside the US is questionable, due to inherent differences in ethnicity, culture and socioeconomic status. We recorded data from 9,988 children aged 6–12 selected by random cluster sampling within the framework of school-based health surveys conducted in Israel during the years 1997 and 2000. We constructed population-specific centile BMI-for-age curves valid for Israeli children, and compared these curves to current standard US and international reference values. Curves were constructed using LMS statistical curve smoothing methods. The data set of Israeli schoolchildren produced reference centiles substantially different than those based on US children. Israeli reference values were closer to centile curves published by the International Obesity Task Force. In conclusion, local and national health planners should recognize the intrinsic limitations associated with the use of “standard” reference values in defining paediatric overweight and obesity in dissimilar populations. The results of this large population-based study highlight the need for population-specific BMI-for-age reference values, in order to accurately describe the prevalence of paediatric overweight and obesity.

Circadian Variation of the Efficacy of Thrombolytic Therapy in Acute Myocardial Infarction—Isn’t the Time Ripe for Cardiovascular Chronotherapy?:

This study was designed to assess the circadian variation of the efficacy of thrombolytic therapy (TT) in 163 patients with acute myocardial infarction. Statistical analysis of the results suggests the existence of circadian variation in the efficacy of thrombolytic therapy with marked early morning resistance and significantly better late daytime results. There is a strong relationship between the normal physiologic rhythms of biochemical, hemodynamic, and hematologic parameters, observed in patients with CAD and the circadian fluctuations of efficacy of TT. Obviously the efficacy of TT is influenced by more evident impact of chronorisk factors during the early morning hours.

Epidemiology of childhood tuberculosis in the Ashkelon region in Israel, 1958–1994

The incidence rates of tuberculosis (TB) in Israel decreased steadily up to 1984, but rose again between 1985 and 1991, mainly due to immigration waves from Ethiopia. The epidemiology of TB in children was surveyed in the Ashkelon region. The regional TB register of Barzilai Medical Centre, kept since 1958, was used as the source for our data. Two hundred and fifty TB cases in children were reported between 1958 and 1994, constituting 9.7% of the total 2565 cases reported in the whole population of Israels southern Mediterranean coast. While in the late 1950s and early 1960s the majority of reported cases occurred in children of North African origin, reflecting the large wave of immigration from North Africa at that time, in 1985‐94 at the time of the Ethiopian immigration wave, Ethiopian children constituted the majority of the patients. They were diagnosed up to 9 years after arrival. None of the reported cases was HIV‐positive.

Validity of childhood adiposity classification in predicting adolescent overweight and obesity

OBJECTIVE Identification of children at risk for adolescent overweight can assist in targeting interventions. Uncertainty remains regarding the validity of current body mass index (BMI) reference values in predicting future risk on a population basis. This study aimed to assess the validity of current childhood adiposity classifications in predicting adolescent overweight and obesity among Israeli youth. DESIGN Historical cohort study. SETTING School-based childhood health studies and adolescent physical examinations. PARTICIPANTS A total of 3 163 subjects surveyed first at age 8-15 and again at age 17-19. OBSERVATIONS Age, sex, height, weight and BMI. OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values, and relative risk of childhood adiposity classification. RESULTS Childhood overweight and obesity showed low sensitivity and high specificity for predicting adolescent overweight and obesity. Positive predictive values were low and varied by age and sex, but negative predictive values were consistently high in both sexes and all ages (range 0.85-0.99). After adjusting for age and sex, both childhood overweight and obesity substantially increased the risk of adolescent overweight (relative risk [RR] 7.03 and 7.20, respectively) and adolescent obesity (RR 24.34 and 28.41, respectively). CONCLUSIONS Childhood overweight and obesity are strong risk factors for adolescent overweight and obesity among Israeli youth. Normal weight children were at very low risk for adolescent overweight. These findings suggest that population-based health promotion aimed at maintaining normal weight among children should be given preference over risk-guided approaches targeting weight reduction among obese children.

Ten-year trends in obesity among Israeli schoolchildren: 1990-2000: Obesity trends in Israeli schoolchildren

Aim: To analyze trends in childhood body mass index (BMI) in Israel between 1990 and 2000, and to determine the proportion of obese children using US and population‐specific reference values. Methods: Cross‐sectional data from 13 284 second‐ and fifth‐grade schoolchildren were collected, including age, sex, height, weight, country of birth, and time since immigration. Age‐ and sex‐specific BMI means and centiles were calculated, and the prevalence of obesity was determined using Israeli and US reference values. Results: BMI values at the 95th centile increased monotonously over time in all age and sex categories. Between 1990 and 2000, 95th centile values increased by 12.7% and 11.8% among second‐grade boys and girls, respectively. Among fifth‐grade children, 95th centile values increased by 10.2% and 8.4%, respectively. Among second graders in 2000, 11.4% of both boys and girls exceeded the BMI value recorded at the 95th centile in 1990. Among fifth‐graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference value (p for all comparisons < 0.001). The proportion of obese children increased over time using both Israeli and US reference values.

Conclusion: This substantial increase in childhood obesity poses a serious health threat, and requires implementation of suitable public health interventions.