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Competing Interests: Declarations Conflict of interest Erica Cohen has received income for consulting and participating in advisory boards for Abbvie, BMS, Pfizer and Johnson and Johnson. She is on the speaker bureau for Abbvie, Johnson and Johnson, and Takeda. Raymond K. Cross has received income for consulting and participation in advisory boards for Abbvie, Adiso, BMS, Fresenius Kabi, Fzata, Janssen, Magellan Health, Option Care, Pfizer, Pharmacosmos, Samsung Bioepis, Sandoz, and Sebela, has a research grant with Janssen, is a member of the Executive Committee for the IBD Education Group, and is a Scientific Co-Advisor for the CorEvitas Registry. Kiran Motwani and John J. Liang declare no relevant funding.

Endoscopy plays a key role in diagnosis, monitoring of disease activity, assessment of treatment response, dysplasia surveillance, postoperative evaluation, and interventional therapy for patients with inflammatory bowel disease (IBD). Clinical practice patterns in the endoscopic management of IBD vary. A panel of experts consisting of IBD specialists, endoscopists, and GI pathologists participated in virtual conferences and developed this modified Delphi-based consensus document to address endoscopic aspects of IBD management., Competing Interests: Disclosure The following authors disclosed financial relationships: B. Shen: Consultant for Janssen; education and research support to Columbia University from Janssen, Takeda, Abbvie, GIE Medical, and Boomerang. M. T. Abreu: Research support from the National Institutes of Health Research, Department of Defense, The Leona M. and Harry B. Helmsley Charitable Trust, and Crohn’s and Colitis Foundation; consultant and advisory board for AbbVie, Alimentiv, Arena Pharmaceuticals Inc, Bristol Myers Squibb, Celsius Therapeutics, Eli Lilly and Company, Gilead Sciences Inc, Janssen Pharmaceuticals, Janssen Pharmaceutica NV, Pfizer Pharmaceutical, Prime CME, Takeda Pharmaceuticals, and WebMD Global LLC; speaker for Amgen Inc, Janssen Pharmaceutica NV, Prometheus Biosciences, and UCB Biopharma SRL. E. R. Cohen: Advisory board and consultant for Pfizer, Takeda, and PRIME Education; speaker for Abbvie, Eli Lilly and Company, Janssen, and Takeda. F. A. Farraye: Consultant for Avalo Therapeutics, BMS, Braintree Labs, Fresenius Kabi, GI Reviewers, GSK, IBD Educational Group, Iterative Health, Janssen, Pharmacosmos, Pfizer, Sandoz Immunology, Viatris, DSMB and Eli Lilly and Company; research support to the Mayo Clinic from BMS, Creatics, Janssen, and Takeda. M. Fischer: Consultant and advisory board for Abbvie, Bristol Myers Squibb, Janssen Pharmaceuticals, Eli Lilly, Seres, Ferring, and DSMB for Rebiotix; teacher for Bristol Myers Squibb and Eli Lilly. S. Kapur: Advisory board for Pfizer; speaker for Abbvie, Jenssen, Takeda, and BMS; Speaker for Eli Lilly and Company. G. S. Kochhar: Advisory board for Eli Lilly and Company, GIE Medical, CorVetas Research Foundation, and Phramacosmos; consultant for Olympus Endoscopy, Boston Scientific Endoscopy, and Pentax Endoscopy; speaker for Eli Lilly and Company; stock options from DigBi Health. X. Liu, Consultant for Bristol Myers Squibb. U. Mahadevan: Consultant Abbvie, Bristol Myers Squibb, Boeringher Ingelheim, Celltrion, Enveda, Gilead, Janssen, Lilly, Merck, Pfizer, Protagonist, Rani Therapeutics, Roivant, and Takeda. U. Navaneethan: Consultant and advisory board for Abbvie, Janssen, Takeda, Pfizer, BMS, Lilly, and GIE Medical; speaker for Abbvie, Janssen, Pfizer, BMS, Lilly, Celltrion, and Takeda. M. Regueiro: Advisory board and consultant for Abbvie, Janssen, UCB, Takeda, Pfizer, BMS, Organon, Amgen, Genentech, Gilead, Salix, Prometheus, Lilly, Celgene, Boehringer Ingelheim Pharmaceuticals Inc (BIPI), and Celltrion. P. Sharma: Consultant for Olympus Corporation, Boston Scientific, Salix Pharmaceuticals, Cipla, Medtronic, Takeda, Samsung Bioepis, and CDx; research support from Erbe and Fujifilm. G. R. Lichtenstein: Consultant for Abbvie, American Regent, Bristol Meyers Squibb, Eli Lilly, Kabi Fresenius, MedEd Consultants, Janssen Orthobiotech, Pfizer Pharmaceuticals, Takeda, and UCB; research support from Bristol Meyers Squibb CME, Takeda, and UCB Consultant; continuing medical education sponsored by American Gastroenterological Association, American Regent (Creative Educational Concepts), Focus Medical Communication, AbbVie, Janssen, Ferring, Pfizer, Sanofi, Salix, Takeda, Bristol Meyers Squibb, Exact Sciences, Eli Lilly, Seres Pharmaceuticals, Boehringer Ingelheim, Pennsylvania Society of Gastroenterology; Data Safety Monitoring Board for Eli Lilly; royalties from UpToDate. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

To assess parents' satisfaction with cleft child's facial appearance and function; compare these findings with orthodontist (expert) satisfaction and evaluate influence of various factors on satisfaction., Cross-sectional study., Sixty-three parents of non-syndromic patients with clefts (ages 7-20 years), and an orthodontist, completed the Cleft Hearing, Appearance and Speech Questionnaire. Two scores were produced: cleft-associated, and non-cleft-associated features. Additional open questions were presented to the parents., Both parents and orthodontist gave high satisfaction scores (mean: 8.4 & 8.2, respectively), significantly correlated, for the cleft-associated features ( P  < .001). Parents were least satisfied with appearance of teeth, then nose, then lips. Scores did not vary significantly with age and sex of patients. Higher parents' satisfaction was found in the unilateral cleft lip + alveolus (UCL + alveolus) group, compared with the unilateral cleft lip and palate (UCLP), regarding cleft-associated features, and compared with cleft palate (CP), regarding non-cleft-associated features ( P  < .05). Greater parents and orthodontist satisfaction were found when parents' education was >12 years. Parents of Jewish ethnicity showed higher satisfaction, compared with parents of non-Jewish ethnicity. Patients requiring future surgery received lower scores. Parents satisfaction was directly correlated to socioeconomic status., The following factors appear to lower parents' satisfaction: [1] cleft severity, [2] hearing or speech of CP/BCLP patients, [3] requirement for further surgery, and [4] low socioeconomic status., Severe cases may require additional explanation to parents in order to lower expectations. A more thorough explanation may be required in patients of lower socioeconomic status.

Background: Travelers to tropical areas may be susceptible to illness or injuries. This study aims to assess morbidity among travelers during their travel and compare those who became ill or were injured with those who did not., Methods: This prospective study included 400 travelers who were counselled by a physician in pre-travel clinics in central Israel between 2017 and 2018. Participants were interviewed within a month after their return regarding morbidity during travel, including health problems that started one week following their return., Results: Most travelers (N = 320, 80%) reported at least one illness or injury. Illnesses/injuries were more common among females than males (84.9% vs. 75.1%, p = 0.01), travel periods longer than 30 days (87.7% vs. 77.2%, p = 0.03), and travelers accompanied by their friends or solo travelers compared with those who traveled with their family/partner (83.8% and 70.0%, respectively, p = 0.002). The most common complaint was diarrhea (N = 159, 49.6%), followed by high-altitude sickness (N = 118, 36.9%) and fever (N = 100, 31.2%). Altitude sickness symptoms were more common in females than in males (58.9% vs. 41.0%, p = 0.006) and in those who ascended rapidly in comparison to those who ascended gradually (58.7% vs. 44.6%, p = 0.04). Animal injury was reported by 30 (7.5%) participants yet only eight (27.0%) received medical care, seven of whom (23.3%) were vaccinated against rabies., Conclusions: Being a female, traveling with friends or alone and longer travel periods were associated with illness/injury. Practitioners at pre-travel clinics should inform travelers of the possible risks including the potential severe consequences of rabies and altitude sickness., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Travelers are recommended to take antimalarial chemoprophylaxis (AMC) when traveling to endemic areas., Methods: This prospective comparative cohort study included 400 Israeli travelers to malaria-endemic areas, recruited in pre-travel clinics. They were contacted within one month following their return and asked about their actual adherence and the reasons for non-adherence., Results: Of 400 travelers with a mean age of 24.6 [SD = 4] years, 201 (50.2%) were men and 328 (82%) were singles. The majority (N = 185, 46.3%) traveled with friends, and the most common travel destination was southeast Asia (N = 267, 66.8%). Most travelers (N = 340, 85%) did not adhere to the AMC. In the multivariate analysis, non-adherence was found to be significantly associated with traveling solo or with friends, traveling to southeast Asia and longer travel duration. The most common reason for non-adherence among travelers was the perception that the risk of contracting malaria is low (N = 251, 73.8%)., Conclusion: In this study, 85% of the Israeli travelers did not adhere to the AMC, especially those traveling solo or with friends, visiting southeast Asia and for a long period. Counselors at the pre-travel clinics should stress the importance of AMC in highly endemic countries and consider alternative treatment strategies, especially in low risk areas or long duration travel, such as short-term schedule or reserve AMC for field trips., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Inflammatory bowel disease (IBD) affects many individuals of reproductive age. Most IBD medications are safe to use during pregnancy and breastfeeding; however, observational studies find that women with IBD have higher rates of voluntary childlessness due to fears about medication use during pregnancy. Understanding why and how individuals with IBD make decisions about medication adherence during important reproductive periods can help clinicians address patient fears about medication use., Objective: The objective of this study was to gain a more thorough understanding of how individuals taking IBD medications during key reproductive periods make decisions about their medication use., Methods: We collected posts from 3000 social media sites posted over a 3-year period and analyzed the posts using qualitative descriptive content analysis. The first level of analysis, open coding, identified individual concepts present in the social media posts. We subsequently created a codebook from significant or frequently occurring codes in the data. After creating the codebook, we reviewed the data and coded using our focused codes. We organized the focused codes into larger thematic categories., Results: We identified 7 main themes in 1818 social media posts. Individuals used social media to (1) seek advice about medication use related to reproductive health (13.92%, 252/1818); (2) express beliefs about the safety of IBD therapies (7.43%, 135/1818); (3) discuss personal experiences with medication use (16.72%, 304/1818); (4) articulate fears and anxieties about the safety of IBD therapies (11.55%, 210/1818); (5) discuss physician-patient relationships (3.14%, 57/1818); (6) address concerns around conception, infertility, and IBD medications (17.38%, 316/1818); and (7) talk about IBD symptoms during and after pregnancy and breastfeeding periods (11.33%, 206/1818)., Conclusions: Beliefs around medication safety play an important role in whether individuals with IBD decide to take medications during pregnancy and breastfeeding. Having a better understanding about why patients stop or refuse to take certain medications during key reproductive periods may allow clinicians to address specific beliefs and attitudes during office visits., (©Michelle Sophie Keller, Sasan Mosadeghi, Erica R Cohen, James Kwan, Brennan Mason Ross Spiegel. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.06.2018.)

Objective: To understand usage patterns and clinical efficacy of Hello Heart, an mHealth technology application designed to facilitate patient engagement in managing hypertension., Methods: In this single-arm observational study, all subjects with ≥2 blood pressure (BP) recordings were included. The cohort was divided into subgroups by weeks passed since download that patients were still recording measurements. Changes in BP were compared between subgroups., Results: Of 5115 eligible subjects, 3803 (74%) recorded BP for ≥2 weeks. In the 4-week subgroup, 23% achieved BP reduction of ≥10 mmHg versus 24% in the 22-week subgroup (p < 0.001). Among 783 subjects reporting baseline hypertension 57% of the 4-week and 69% of the 22-week subgroups achieved BP normalization (all p < 0.001)., Conclusions: We show significant decrease in BP with improved metrics over time. Higher engagement was associated with greater BP reduction and engagement was higher among those with greater clinical need of BP control., Practice Implications: Hello Heart represents an operational mHealth technology to improve patient engagement and clinical outcomes.

Hemifacial microsomia (HFM) is a rare, multisystemic congenital disease with estimated frequency of 1/26370 births in Europe. Most cases are sporadic and caused by unilateral abnormal morphogenesis of the first and second pharyngeal arches. The aim of this study is to define the types and frequency of maxillofacial and systemic malformations in HFM patients. This is a case series study of patients with HFM evaluated at a single institution. Data were acquired through history, physical examination, photographs, diagnostic radiology, and laboratory and analyzed by the FileMakerPro database on 95 patients (54F; 41M) of which 89 met the inclusion criteria. Mandibular hypoplasia was observed in 86 patients with right-side preponderance (50). One patient had bilateral mandibular hypoplasia. Seventy-four had external ear anomalies (anotia or microtia). Eleven had bilateral malformed ears. Hearing impairment, associated with stenosis or atresia of the external ear canal, was found in 69 patients (eight with bilateral canal defects). Ocular anomalies were seen in 41 (23 with dermoid cysts) and 39 had orbital malformations. Facial nerve paralysis was observed in 38 patients. Cleft lip/palate (10), preauricular tags (55), and macrostomia (41) were also described. A total of 73/86 had systemic malformations, mainly vertebral (40), genitourinary (25), and cardiovascular (28). Sixteen had cerebral anomalies (four with intellectual disability). All patients suspected of HFM should undergo a complete systematic clinical and imaging investigation to define the full scope of anomalies. Since the disease is rare and complex, affected patients should be monitored by specialized multidisciplinary team centers., (© 2017 Wiley Periodicals, Inc.)

Chronic hepatitis B is a worldwide disease, with significant burden on health care systems. While universal vaccination programs have led to an overall decrease in incidence of transmission of hepatitis B, unfortunately, there remain large areas in the world where vaccination against hepatitis B is not practiced. In addition, vertical transmission of hepatitis B persists as a major concern. Hepatitis B treatment of the pregnant patient requires a thorough assessment of disease activity and close monitoring for flares, regardless of initiation of antiviral therapy. We discuss, in this article, the current and emergent strategies which aim to reduce the rate of transmission of hepatitis B from the pregnant mother to the infant and we review the updated guidelines regarding management of liver disease in pregnant women with hepatitis B., Competing Interests: Dr. Walid S Ayoub has served as consultant for Gilead, BMS, and Abbvie. Dr. Erica Cohen has no interests related to this study.

Chronic hepatitis B infection in the female population has implications not just for the individual but for her children as well. This article discusses the natural history of hepatitis B and how it plays an important role in hepatitis B virus (HBV) transmission, the current strategies and new strategies to control HBV and reduce transmission, and the updated guidelines for the management of HBV., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Colonic diverticular disease is typically conceived as acute diverticulitis attacks surrounded by periods of clinical silence. However, evolving data indicate that many patients have persistent symptoms and diminished health-related quality of life (HRQOL) long after acute attacks. We developed a disease-targeted HRQOL measure for symptomatic uncomplicated diverticular disease (SUDD)-the diverticulitis quality of life (DV-QOL) instrument., Methods: We conducted a systematic literature review to craft a conceptual model of SUDD HRQOL. This was complemented by three focus groups including 45 SUDD patients. We developed items based on our literature search, focus groups, and cognitive debriefings. We administered the items to SUDD patients with persistent symptoms following a confirmed diverticulitis event. We created scales based on factor analysis and evaluated the scales for reliability and validity., Results: Concept elicitation revealed a range of illness experiences attributed to SUDD. Coding of 20,490 transcribed words yielded a 52-code network with four primary, condition-related concepts: (1) physical symptoms (e.g., bloating); (2) behaviors (e.g., restrictions); (3) cognitions and concerns (e.g., fear); and (4) impact and consequences (e.g., absenteeism, anxiety). Based on patient language, we developed the 17-item DV-QOL instrument. In a cross-sectional validation sample of 197 patients, DV-QOL discriminated between patients with recent versus distant diverticulitis events and correlated highly with Short Form 36 and hospital anxiety and depression scores., Conclusions: Patients with SUDD attribute a wide range of negative psychological, social, and physical symptoms to their condition, both during and after acute attacks; DV-QOL captures these symptoms in a valid, reliable manner.

Background: Prior estimates suggest that up to 40% of the US general population (GP) report symptoms of gastroesophageal reflux disease (GERD). However, symptoms in the GP versus patients seeking care for gastrointestinal (GI) complaints have not been compared. We estimated the prevalence and severity of GERD symptoms in the GP versus GI patients, and identified predictors of GERD severity. We hypothesized that similar to functional GI disorders, psychosocial factors would predict symptom severity in GERD as much, or perhaps more, than care-seeking behavior alone., Methods: We compared the prevalence of heartburn and regurgitation between a sample from the US GP and patients seeking GI specialty care. We compared GERD severity between groups using the NIH PROMIS(®) GERD scale. We then performed multivariable regression to identify predictors of GERD severity., Results: There was no difference in the prevalence of heartburn between the GP and patient groups (59 vs. 59%), but regurgitation was more common in patients versus GP (46 vs. 39%; p = 0.004). In multivariable regression, having high visceral anxiety (p < 0.001) and being divorced or separated (p = 0.006) were associated with higher GERD severity., Conclusions: More than half of a GP sample reports heartburn-higher than previous series and no different from GI patients. Although regurgitation was more prevalent in patients versus the GP, there was no difference in GERD severity between groups after adjusting for other factors; care seeking in GERD appears related to factors beyond symptoms, including visceral anxiety.

Background: African Americans have the highest incidence and mortality from colorectal cancer (CRC). Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, the CRC incidence remains high in this group., Objective: To examine the rates and predictors of CRC screening uptake as well as time to screening in a population of African Americans and non-African Americans in a health care system that minimizes variations in insurance and access., Design: Retrospective cohort study., Setting: Greater Los Angeles Veterans Affairs (VA) Healthcare System., Patients: Random sample (N = 357) of patients eligible for initial CRC screening., Main Outcome Measurements: Uptake of any screening method; uptake of colonoscopy, in particular; predictors of screening; and time to screening in African Americans and non-African Americans., Results: The overall screening rate by any method was 50%. Adjusted rates for any screening were lower among African Americans than non-African Americans (42% vs 58%; odds ratio [OR] 0.49; 95% confidence interval [CI], 0.31-0.77). Colonoscopic screening was also lower in African Americans (11% vs 23%; adjusted OR 0.43; 95% CI, 0.24-0.77). In addition to race, homelessness, lower service connectedness, taking more prescription drugs, and not seeing a primary care provider within 2 years of screening eligibility predicted lower uptake of screening. Time to screening colonoscopy was longer in African Americans (adjusted hazard ratio 0.43; 95% CI, 0.25-0.75)., Limitations: The sample may not be generalizable., Conclusions: We found marked disparities in CRC screening despite similar access to care across races. Despite current guidelines aimed at increasing CRC screening in African Americans, participation in screening remained low, and use of colonoscopy was infrequent., (Published by Mosby, Inc.)

Background & Aims: Individuals with diverticulosis frequently also have irritable bowel syndrome (IBS), but there are no longitudinal data to associate acute diverticulitis with subsequent IBS, functional bowel disorders, or related emotional distress. In patients with postinfectious IBS, gastrointestinal disorders cause long-term symptoms, so we investigated whether diverticulitis might lead to IBS. We compared the incidence of IBS and functional bowel and related affective disorders among patients with diverticulitis., Methods: We performed a retrospective study of patients followed up for an average of 6.3 years at a Veteran's Administration medical center. Patients with diverticulitis were identified based on International Classification of Diseases, 9th revision codes, selected for the analysis based on chart review (cases, n = 1102), and matched with patients without diverticulosis (controls, n = 1102). We excluded patients with prior IBS, functional bowel, or mood disorders. We then identified patients who were diagnosed with IBS or functional bowel disorders after the diverticulitis attack, and controls who developed these disorders during the study period. We also collected information on mood disorders, analyzed survival times, and calculated adjusted hazard ratios., Results: Cases were 4.7-fold more likely to be diagnosed later with IBS (95% confidence interval [CI], 1.6-14.0; P = .006), 2.4-fold more likely to be diagnosed later with a functional bowel disorder (95% CI, 1.6-3.6; P < .001), and 2.2-fold more likely to develop a mood disorder (CI, 1.4-3.5; P < .001) than controls., Conclusions: Patients with diverticulitis could be at risk for later development of IBS and functional bowel disorders. We propose calling this disorder postdiverticulitis IBS. Diverticulitis appears to predispose patients to long-term gastrointestinal and emotional symptoms after resolution of inflammation; in this way, postdiverticulitis IBS is similar to postinfectious IBS., (Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Colonic diverticulosis is the most common finding during routine colonoscopy, and patients often question the significance of these lesions. Guidelines state that these patients have a 10% to 25% lifetime risk of developing acute diverticulitis. However, this value was determined based on limited data, collected before population-based colonoscopy, so the true number of cases of diverticulosis was not known. We measured the long-term risk of acute diverticulitis among patients with confirmed diverticulosis discovered incidentally on colonoscopy., Methods: We performed a retrospective study using administrative and clinical data from the Veterans Affairs Greater Los Angeles Healthcare System, collecting data on patients who underwent colonoscopies from January 1996 through January 2011. We identified patients diagnosed with diverticulosis, determined incidence rates per 1000 patient-years, and analyzed a subgroup of patients with rigorously defined events confirmed by imaging or surgery. We used a Cox proportional hazards model to identify factors associated with the development of diverticulitis., Results: We identified 2222 patients with baseline diverticulosis. Over an 11-year follow-up period, 95 patients developed diverticulitis (4.3%; 6 per 1000 patient-years); of these, 23 met the rigorous definition of diverticulitis (1%; 1.5 per 1000 patient-years). The median time-to-event was 7.1 years. Each additional decade of age at time of diagnosis reduced the risk for diverticulitis by 24% (hazard ratio, 0.76; 95% confidence interval, 0.6-0.9)., Conclusions: Based on a study of the Veterans Affairs Greater Los Angeles Healthcare System, only about 4% of patients with diverticulosis develop acute diverticulitis, contradicting the common belief that diverticulosis has a high rate of progression. We also found that younger patients have a higher risk of diverticulitis, with risk increasing per year of life. These results can help inform patients with diverticulosis about their risk of developing acute diverticulitis., (Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Diverticular disease imposes a significant burden on Western and industrialized societies. The traditional pathogenesis model posits that low dietary fiber predisposes to diverticulosis, and fecalith obstruction prompts acute diverticulitis that is managed with broad-spectrum antibiotics or surgery. However, a growing body of knowledge is shifting the paradigm of diverticular disease from an acute surgical illness to a chronic bowel disorder composed of recurrent abdominal symptoms and considerable psychosocial impact. New research implicates a role for low-grade inflammation, sensory-motor nerve damage, and dysbiosis in a clinical picture that mimics irritable bowel syndrome (IBS) and even inflammatory bowel disease (IBD). Far from being an isolated event, acute diverticulitis may be the catalyst for chronic symptoms including abdominal pain, cramping, bloating, diarrhea, constipation, and "post-diverticulitis IBS." In addition, studies reveal lower health-related quality of life in patients with chronic diverticular disease vs. controls. Health-care providers should maintain a high index of suspicion for the multifaceted presentations of diverticular disease, and remain aware that it might contribute to long-term emotional distress beyond traditional diverticulitis attacks. These developments are prompting a shift in therapeutic approaches from widespread antimicrobials and supportive care to the use of probiotics, mesalamine, and gut-directed antibiotics. This review addresses the emerging literature regarding epidemiology, pathophysiology, and management of chronic, symptomatic diverticular disease, and provides current answers to common clinical questions.

Objective: Immigration from Third World countries to the developed world is characterized by modification of lifestyle and acculturation to local customs. This study investigated changes in nutritional status and eating behaviors in female Ethiopian immigrants in Israel., Methods: Personal interviews, two 24-h dietary recalls, and anthropometric measurements were carried out in a random sample of 53 women 32 ± 6 y of age., Results: After living in Israel for an average of 14 y, body mass index was similar to the general Israeli population, with 42% of participants with a body mass index greater than 24.9 kg/m², including 11% categorized as obese. This is in stark contrast to the body mass index measured at arrival in Israel (∼19-20 kg/m²). Less than optimal consumption of dietary fiber, calcium, folate, and B12 was documented. Analysis by food groups showed that intake of dairy products, fruits, and vegetables was negligible, whereas simple sugar intakes were high. The women continued to prepare traditional Ethiopian foods but also incorporated local, less healthy foods into their diets. Compared with the high energy expenditure in rural Ethiopia, participants reported minimal physical activity in Israel., Conclusions: This immigrant community is at high risk for developing nutrition-related chronic diseases. Culturally sensitive nutrition education programs are urgently needed., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Syndromic surveillance systems have been developed for early detection of bioterrorist attacks, but few validation studies exist for these systems and their efficacy has been questioned., Objectives: To assess the capabilities of a syndromic surveillance system based on community clinics in conjunction with the WSARE algorithm in identifying early signals of a localized unusual influenza outbreak., Methods: This retrospective study used data on a documented influenza B outbreak in an elementary school in central Israel. The WSARE algorithm for anomalous pattern detection was applied to individual records of daily patient visits to clinics of one of the four health management organizations in the country., Results: Two successive significant anomalies were detected in the HMO's data set that could signal the influenza outbreak. If data were available for analysis in real time, the first anomaly could be detected on day 3 of the outbreak, 1 day after the school principal reported the outbreak to the public health authorities., Conclusions: Early detection is difficult in this type of fast-developing institutionalized outbreak. However, the information derived from WSARE could help define the outbreak in terms of time, place and the population at risk.