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Objective: To describe the secular trends in the prevalence rates of iron-deficiency anemia (IDA) in infants in Israel, identify population group differences and assess the effectiveness of the 1985 Public Health directives on iron supplementation and avoidance of cow's milk in the first year of life. Design: A systematic analysis of published and unpublished cross-sectional studies. Methods: IDA rates in 1-y-old infants between 1946 and 1997 were assessed from published papers and reports. Rates for Arab infants were available from 1984. Data on routine hemoglobin tests on 1-y-old infants for Arabs and Jews separately were obtained from four health districts for the period 1987 to 1997. Analyses were done for the periods prior to and following the Public Health directives. Results: The prevalence of IDA in Jewish infants declined from 68% in 1946 to 50% in 1985 at an average annual rate of - 1.43%. Following the iron supplementation directives, the average annual rate of decline increased to -4.0% and reached a prevalence of about 11% in 1996. IDA rates in Arab infants declined by an annual average of -3.7%, and were consistently almost twice as high as for Jewish infants. Conclusions: Despite the contribution of the iron supplementation program to the reduction in IDA, the persistently high rates indicate inadequate iron content in the diet. This emphasizes the important role of a national food fortification program, using staple foods commonly consumed. Descriptors: iron deficiency anemia; iron supplementation; iron fortification; Israel; Arabs; Jews, Introduction Iron deficiency is one of the most common nutritional deficiencies in the world (Demaeyer, 1989), and is manifested in its more severe form as iron deficiency anemia (IDA). The [...]

Health service utilization patterns during pregnancy were studied among 780 women from selected neighborhoods of Jerusalem who delivered between December 1, 1985 and June 30, 1986. Factors affecting the choice of care-provider, the timing of the first contact with the prenatal care centers were studied with respect to several demographic, socio-economic and needs variables. About one half of the women visited the Family Health Centers, the traditional site for delivery of prenatal care. Forty percent visited their regular doctor during pregnancy while about 30% sought private care. In all, fifty two percent of women consulted more than one source of medical care service during pregnancy. Logistic regression analysis showed that the choice of care was determined by the type of insurance, need factors and education. The timing of the first visit depended on origin, level of education and parity. The frequency of visits was related to the type of insurance and to perceived health. [ABSTRACT FROM AUTHOR]

The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel healthcare systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mother's perception of her child's health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services. [ABSTRACT FROM AUTHOR]

The food intake of two samples of children born five years apart were determined in 1975 and 1980 at three years of age in a low and middle class neighbourhood of Jerusalem. The 24-hour recall method was used. No deficiency in caloric intake was noted. The protein intake was twice the recommended dietary allowance (RDA). 3.7 gr/kg in the study group interviewed in 1975 and 3.3 gr/kg in those interviewed in 1980. The mean daily iron intake was only 40% of the RDA. The main sources for protein were milk and milk products, poultry and eggs. Significantly higher mean caloric and protein intakes were noted for the upper as compared to middle and low social class in 1980. Children from Asian origin had the lowest caloric and protein intake in 1975 and 1980 whereas those of European-American origin had the highest. Severe inflation and the resulting tenfold increase in food prices in Israel were not reflected in marked changes in dietary intake. The percentage expenditure on food was 25% of total income during both periods. The possible factors influencing the stability in dietary intake are governmental subsidy for the essential foods, correction of wages and increase in social security payments thus maintaining the buying power, as well as the educational effect of the preventive services—the Mother and Child Health Stations on feeding practices. [ABSTRACT FROM PUBLISHER]

The growth pattern of infants from birth to 2 years of age was studied in a homogenous Moslem semirural community near Jerusalem. The weight of the study population was compared with that of children from a western neighbourhood in Jerusalem and the National Centre of Health Statistics standard. The Abu Ghosh children are lighter than the Jerusalem and the National Centre of Health Statistics populations at birth and subsequently at 1, 6, 12, and 24 months of age. The percentage of weight gain between any two measurements at the various ages is slightly lower than that of the Jerusalem population. There is no decline in percentage of weight gain after weaning. Birthweight has accounted for a high percentage of explained variance of weight at 6 months (14.4%), but explained only 1.2% of variance at 24 months. The percentage of girls below the 10th centile was less than that of boys. The genetic and environmental effects on growth as well as the effect of the mother and child health services on the child rearing patterns of the populations are discussed. [ABSTRACT FROM PUBLISHER]

Differences were analysed between growth patterns and determinants of physical growth in two groups of normal infants at 24 months. Longitudinal data routinely collected in a mother and child clinic were analysed. At 24 months, 26% of cohort infants were at or below the 10th percentile for length (= 'small' infants); 98 of these were compared with 83 'medium' infants (between the 50th and the 75th percentile, for example). Excessive downward deviation of length percentiles was seen in 80% of 'small' infants. In 20% their birthweight was on the 10th percentile or below; 50% had a mother less than 155 cm tall; maternal stature was closely linked with socioeconomic factors. Of mothers with less than nine years of schooling, 70% had 'small' infants. In 95% of both groups growth attainment at two years could be predicted from data at 12 months. The known factors influencing deviant physical growth overlap with those of mental and social development. Growth deviation by itself may identify infants open to multiple risks, especially if their mothers have a low educational level. Further narrowing of the target group for specialised intervention strategies should be attempted. [ABSTRACT FROM AUTHOR]

The physical growth pattern of infants aged from one month to two years was studied in a lower middle class community in Jerusalem. Weight and length were measured at one month and at three, six, 12, and 24 months. In each age and sex group there were at least 200 children. At one month and 24 months the percentage of children below the 10th percentile for weight and also for length was higher than expected, although severely impaired linear growth was observed in only 0.5% of males and 1.3% of females at 24 months. The percentage of overweight infants was highest at three months (6.2% of males and 5.2% females). In the light of these findings, we discuss the feasibility of accurate monitoring of physical growth in maternal and child health clinics; the possibility of an association between maternal stature and the high percentage of children below the 10th percentile for length; and the association between food intake and growth pattern. [ABSTRACT FROM PUBLISHER]

The records of 425 school children entering first grade were reviewed in order to determine their health status and the effectiveness of the medical entrance examination in detecting new conditions. The study population consisted of children from low and middle class families from a neighborhood of West Jerusalem. Thirty-nine percent of the children had at least one pathological condition of which 61 percent had been diagnosed previously. Eighty-four percent of the unknown conditions were diagnosed by the nurse by screening or interview. Since only very few new conditions needing treatment were detected by the school health service physician it is recommended that the physicians' examination be discontinued with respect to the routine health surveillance; that the screening be performed by the nurses; and that a report on the health status of the child be requested from the family physician or pediatrician. This procedure would allow allocation of school physicians' time to health promotion and health education activities. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: To carry out process evaluation and surveillance in a community oriented primary care program for injury prevention among children 0-2 years old (n = 306). SETTING: Mother and child health clinic in a defined area of Western Jerusalem. METHODS: An injury prevention program was integrated into the routines of the mother and child health clinic. The program consisted of injury surveillance and counselling using a developmental approach, regarding car safety and the prevention of falls, burns, suffocation, poisonings, cuts, drowning, and electrocution. Process evaluation and surveillance were based on records integrated into the child's personal file in the clinic. RESULTS: Process evaluation indicated that counselling coverage was 73% in the 0-5 month age group and decreased to 48% in the second year of life. The mean number of topics discussed with the parents was 6.6 (out of nine) for the 0-5 months age group, 13.6 (out of 18) for the 6-11 month group, and 15.7 (out of 18) for those 1-2 years old. Injury surveillance activities were complete for 66% of the children, incomplete in 32%, and not done in 2%. CONCLUSIONS: The results indicate that it is feasible to integrate an injury prevention program into primary care, and that process evaluation is important in detecting problems and improving performance of the program's activities. [ABSTRACT FROM AUTHOR]

Presents information on the work published in Vol. 27 of Journal of Nutrition Education, on prevention of eating disturbances in adolescent girls.

This study examines recurrent psychosomatic symptoms and symptom clusters among 5th and 6th grade Israeli school children. A questionnaire which asked about the frequency of eight psychosomatic and eight organic complaints was administered to 259 students. The most frequently reported psychosomatic complaints were abdominal pain, experienced often by 21%, and headache, experienced often by 20% of the pupils. There were statistically significant differences between the sexes, girls having a higher prevalence than boys for eight of the symptoms, and with more girls than boys reporting more than one symptom in each category: 23% of the students had more than one psychosomatic symptom and 16% had more than one organic symptom. Multiple psychosomatic complaints were common, with 28% of those with back or limb pain and 27% of those suffering from 'bad mood' reporting an additional three to five complaints. Abdominal pain and headache were each reported as an accompanying complaint in more than 40% of cases for almost every other psychosomatic complaint. The significance of these symptom clusters needs to be explored further as they may have important implications as markers for psychosocial stress. [ABSTRACT FROM AUTHOR]