Vita Barell

The role of starches in the etiology of gastric cancer

A case control study revealed a higher consumption frequency of starches among gastric cancer patients than in three matched control groups. This finding was not due to a higher consumption frequency of a few items. For every food item eaten less frequently by the gastric cancer patients there were approximately three items eaten more frequently. The finding was not related to a socioeconomic differential. It is suggested that long‐term consumption of starchy foods may affect the mechanics of gastric acid secretion and thus render the gastric mucosa more susceptible to an exogenous carcinogen.

Epidemiology of suicide in Israel: a nationwide population study.

Abstract  Background: In Israel, some population characteristics and lifestyle patterns make epidemiological research on suicide of particular interest. The Israeli population is characterized by ethnic diversity, with a multi-religious, multi-national mosaic of Jews and Arabs. These subgroups also vary in their suicidal behavior. The aims of the present study were to examine the trends in suicide incidence rates in Israel from 1984 to 1994, to identify sub-populations at high risk for suicide and to identify suicide methods associated with increased risk. Methods: Suicide rate trends in Israel over the period from 1984 to 1994 were examined for four subgroups: Jewish men and women, and Arab men and women. Cases of undetermined external cause (UEC) of death were also considered. Mortality data were obtained from the computerized data files of the Israeli Central Bureau of Statistics, which includes cause of death and sociodemographic variables. Suicide was classified according to the ICD-9 codes. Results: Suicide rates were higher for Jews than for Arabs, and higher for men than for women. The rates among both population and sex groups increased directly with age. A significant increase over the years studied was found for Jewish men, particularly in the 18- to 21-year-old age group. An increase in the use of firearms was noted, mainly in the groups in which total suicide rates increased. Conclusions: The findings of this study highlight the need for further studies to identify both sub-populations at high risk for suicide, and societal trends such as lifestyles, immigration, military service, and media exposure to violence, as first steps toward planning of intervention programs to reduce suicide rates.

Using a Health Concerns Checklist as a Bridge From Reason for Encounter to Diagnosis of Girls Attending an Adolescent Health Service

Objective. We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap between the reason for encounter (RFE) described by girls entering an adolescent health service and the ultimate diagnosis. Methods. The sample, 547 consecutive 12- to 18-year-old girls visiting an adolescent health service, first underwent a structured intake procedure, including a self-administered form on which they described their RFEs and other health concerns, as well as a psychosocial interview and medical evaluation performed by staff members. The RFEs, HCC items, and diagnoses, grouped into somatic, sexuality-related, and psychosocial categories, were then compared. Results. Among the 399 girls expressing specific RFEs on entering the clinic, one-third were diagnosed with psychosocial disorders and one-fifth with sexuality-related concerns. Of the patients receiving a sexuality-related diagnosis, 57% presented with a sexuality-related request; another 26% noted it on the checklist. For those diagnosed with psychosocial problems, 22% stated this as the RFE, and another 50% indicated it on the HCC. The contribution of the HCC to the diagnosis was higher among adolescents not stating a specific RFE. Conclusion. The findings highlight the HCCs contribution in identifying health problems, especially among adolescents who find it difficult to verbalize sensitive issues.

Cause-specific mortality among Israeli adolescents in the 1980s

PURPOSE Considerable mortality occurs during adolescence despite it being a relatively healthy period of life. Nationwide analysis of adolescent mortality data helps identify those sub-groups with higher-than-expected death rates, that may be amenable to preventive intervention programs. METHODS Adolescent mortality in Israel during 1981-1986 is examined by age (10-14, 15-19 years), sex, population group (Jews, non-Jews), and cause of death. Data were abstracted primarily from special publications for 1981-1986. Recently available mortality updates for 1987-1989 were inspected and significant changes in mortality during the latter period have been included. RESULTS Among an average of approximately 800,000 adolescents aged 10-19 years living in Israel during 1981-1986, the majority (77%) were Jews. Overall mortality was 36.7 per 100,000. Death rates were almost twice as high for males as for females, increased with age for all population subgroups, and were 63% higher for non-Jews compared with Jews. Accidents were the major cause of death among Israeli adolescents (37.7% of total mortality), with male-to-female rate ratio of 3.4. Mortality from all external causes, including accidents, suicide, homicide, and other external causes accounted for 50.6% of all deaths. Neoplasms were the next major cause of death. Israel and U.S. adolescent mortality rates were compared and showed similar trends. CONCLUSIONS The non-Jewish minority adolescents, and most particularly the males, are at the highest risk of death. Preventive intervention programs should be targeted to the high-risk populations described.

A method of macro-auditing and assessing the preventability of infant mortality using large volume computerized files

We present a method for auditing and evaluating infant mortality with the aid of a preventability grading system, based on national computerized files of livebirths and infant deaths. Diagnostic categories and specific causes of deaths were classified into one of the following three preventability grades: Preventable (P), Possibly Preventable (PP) and Non Preventable (NP). This classification was then applied to two different scales: Preventability of Condition (PC) and Preventability of Death (PD) from which a third scale--Preventability of Mortality (PM)--was derived. The method was then applied to matched records of 39,786 livebirth and 452 infant death certificates between 1977 and 1984, in a semi-urban region in Israel encompassing 220,000 inhabitants. Comparison of mortality rates, according to the proposed preventability scores, demonstrated that higher infant mortality rate in non-Jewish population, or in Jewish mothers with a lower educational, was present only in the preventable categories (P or PP), while death rates due to non preventable causes were identical for all groups. The suggested macro-auditing method facilitates the assessment of large scale infant mortality rates in terms of preventability.

Evaluating improvements in multistaged health care: the risk-care-outcome cycle.

A new method of program evaluation was developed in Israel to assess the impact of improved care on the health of mothers and infants. Care before conception and during the prenatal, intrapartum, and postpartum periods form an interrelated sequence. The method, therefore, evaluates the interplay among risks, health care quality improvements, and outcomes within each stage of care, and measures the impact of improved outcomes on subsequent stages. The expansion or modification of pilot maternal and infant health efforts in 42 Israeli communities will be based on the results of this evaluative effort. The concepts employed in this assessment are applicable in many other situations that involve sequences of health services (eg, preoperative, operative, and postoperative care) where the success of each phase of care affects the risks of the succeeding stage.