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Objective: To evaluate whether a single national reference is appropriate for assessing prevalence of overweight in heterogeneous populations, or whether ethnic-specific references are needed., Design: A population-based study of Israeli Jewish males who underwent routine physical and clinical examinations prior to army recruitment served as the basis for the development of two types of references for body mass index (BMI): a national reference (NR) and an ethnic-specific reference (ER)., Subjects: Consecutive cohorts of all 17-y-old Jewish male recruits (n=109, 570)., Measurements: Weight, height and blood pressure values were obtained. BMI was calculated, and the 85th percentile of BMI was used as a cut-off point for overweight, using both types of references. Prevalence of hypertension among recruits was used as a biomarker to support the reliability of the ER when discrepancy in classification between the two references was found., Results: As compared to the NR, three ethnic groups had a BMI distribution shifted to the left (light sub-population) and five were shifted to the right (heavy sub-population). In the light sub-population, 7% of the inductees who were classified as having normal weight by the NR were considered overweight by the ER and had a hypertension rate similar to that of those defined as overweight by both references (3.1 per 1000). In the heavy sub-population the 4% of subjects who were overweight by NR and normal by ER had hypertension rates similar to those defined as normal weight by both references (2.7/1000), and significantly lower than that of those classified as overweight by both references (10.8/1000)., Conclusion: In heterogeneous populations, ethnic references should be used to evaluate prevalence of overweight, rather than one national reference. International Journal of Obesity (2000)24, 88-92

The relationship between height and social class, independent of the effect of ethnic background was examined. This is a population-based study of 17-year-old israeli-born Jewish males born between 1966-1969 who underwent routine physical examination prior to army recruitment. Inductees descending from 9 ethnic backgrounds-Germany, Hungary, India, Morocco, Poland, Romania, Russia, Yemen and at least 3rd-generation israeli-born were used for this analysis. Anthropometric data was abstracted from the computerized induction examination; socioeconomic status (SES) was assigned according to the residence of each recruit. Statistical analysis included analysis of variance and chi square test for linear trend. Mean height of the total (reference) group was 173.7 cm, ranging from 172.0 cm in the lowest SES level to 175.1 cm in the highest level. The proportion of individuals above the 85th percentile of height of the reference group, increased linearly from 8.7% (lowest SES) to 18.5% (highest SES) (p < 0.01). The mean height of recruits differed considerably among ethnic groups in each SES level and ranged from 170.8 cm (Yemenites) to 175.4 cm (Russian and Romanian) in the total group. In each ethnic group, height differences between extreme levels of SES were observed ranging from 2.3 cm (Morocco) to 4.3 cm (Russia). We conclude that height among 17-year old israeli-born males is positively associated with SES after controlling for ethnicity.

Background: Although the association between overweight and cardiovascular risk factors is well documented in cross-sectional and longitudinal studies, reports of adolescent morbidity associated with underweight in industrialized countries are rare., Methods: This population-based study includes approximately 110,000 17 year old Israeli Jewish males who underwent routine physical examination at army induction centres. Computerized data tapes include overall health profiles, specification of physical and mental conditions, and height and weight measurements. Medically significant conditions are those with sufficient severity to preclude service in a combat unit., Results: Functional limitation is more prevalent at both extremes of the body mass index (BMI) distribution: 149.5/1000 among severely underweight individuals and 164.3/1000 among severely overweight subjects. Overweight was associated with hypertension (14.9/1000 among the severely overweight), as well as joint conditions of the lower extremities, mainly hip, ankle and knee disorders. Functional disorders associated with underweight are bronchial and lung conditions, including asthma (14.2 and 18.9/1000 in the mildly and severely underweight), scoliosis, intestinal conditions and emotional disorders (mainly neurosis)., Conclusions: Both under- and overweight are associated with morbidity at age 17. Intervention programmes should begin at an early age.

The behavior of health care professionals is known to be influenced, in part, by their method of remuneration and the financial incentives they face. Describes how the Medical Corps of the Israel Defence Forces (IDF) went about choosing a reimbursement method to increase incentives for dentists and decrease waiting time for the public. Based on q questionnaire sent to all 23 dentists working in a unique IDF civilian dental clinic, and on other information which was available on the productivity and income of these dentists, a new method of remuneration was suggested and accepted, by which a combined method of fee-for-service and salary will be introduced. The base hourly pay and per crown fee were set on levels which provide for a larger compensation range and increase the incentive for improved productivity levels. This suggested method will be investigated further and re-evaluated one year after its implementation.

A total of 107, 636 subjects of both sexes who were drafted into the Israeli Defense Forces during 1986 to 1988 were analyzed for the presence of asthma based on questionnaire responses and the results of pulmonary function tests. Most patients (79%) had either mild or inactive disease. Lifetime prevalence increased by 21.7% from 5.3% in 1986 to 6.5% in 1988. The results of a follow-up carried out over 5 to 7 years showed no major change in severity in most patients. The incidence rate remained stable throughout 1987 to 1989 (275, 245, and 243 per 100,000, respectively), without there being any major change in the severity of the asthma during the subsequent 3 to 5 years. It was also revealed that the more physically demanding jobs were associated with a higher prevalence of job transfer. The results of this study suggest that the factors causally associated with asthma are relatively more active during early childhood.

To determine recent trends in its epidemiology and the need to reconsider prophylactic interventions, meningococcal disease in the Israel Defense Force (IDF) from 1975 through 1993 was studied. All cases of meningitis or meningococcemia were included. A considerable increase in the number of cases has been observed since 1991, with serogroup C becoming predominant (76% of cases) since then. Serogroup Y was the second most frequent serogroup during this period, while serogroup B, predominant in the civilian population of Israel, was rare. Most cases occurred during the first 6 months of military service. Seasonality was important, with most of the cases occurring between December and March, although a small summer peak was also noted. Since 1992, three small clusters of meningococcal disease were encountered in the IDF, for the first time, with all cases caused by group C meningococci. In one cluster, the emergence of rifampicin resistance resulted in failure of chemoprophylaxis. The rise in group C and Y cases since 1991, and the occurrence of rifampicin resistance, necessitate considering meningococcal vaccines and new antimicrobial agents for prophylaxis.

Physicians' medical kits (PMK) were distributed to 50 physicians, graduates of an advanced trauma life support course. The kits were always to be present in the physicians' designated vehicles, enabling them to provide advanced life support at the earliest possible stage (the "golden hour"). The kits have equipment for advanced airway intervention and management, chest trauma management (chest tube insertion, etc.) and fluid administration. To help assess the impact of the PMK and its cost effectiveness, questionnaires were sent to the physicians involved, of whom 35/50 responded. The questions included 2 subjects: the presence of the kit in the car and details of its use for injuries. The kit was present at all times in the cars of all except 1 of 31 physicians. 7 (22.5%) of them used the kit in 50 incidents which involved 74 injured persons. The injuries were caused by road accidents in 54 cases, in 17 by terrorist activity, and 3 cases involved heart attacks and cardiac resuscitation. Distribution of the PMK among army physicians appears to be valuable in the field, and before hospitalization.

Vaccination against diphtheria has essentially led to the disappearance of the disease in Israel. However, in other countries with high immunization coverage, isolated cases and small outbreaks have occurred in adults. Immunity following vaccination or natural exposure to toxigenic strains of C. diphtheriae is conferred by serum antibodies to diphtheria toxin. Since booster doses of diphtheria toxoid are recommended every ten years in adults, this raises the question of persistence of protective levels of anti-diphtheria toxin antibodies. In this study we assessed a possible age-related decline in anti-diphtheria toxin antibodies among adults in Israel. The study population comprised random samples in three age groups: 263 male recruits aged 18-19 years, 116 male reserve soldiers aged 25-35 years and 153 aged 41-51 years. Anti-diphtheria toxin antibody levels were measured by means of ELISA. Results indicate that 64.3% (95% CI = 58.5-70.1%) of those aged 18-19 had anti-diphtheria toxin levels in excess of 0.1 IU ml-1, whereas the corresponding figures for ages 25-35 and 41-51 were 32.8% (95% CI = 24.2-41.3%) and 15% (95% CI = 9.4-20.7%). However, even in the oldest age group, 95.4% (95% CI = 90.8-98.1%) had antibodies above the presumed protective level of 0.01 IU ml-1. Although these results indicate a significant age-related decline in anti-diphtheria toxin antibodies in vaccinated subjects, most had apparently protective levels. The absence of cases suggests that vaccine-induced immunity is long-lasting. However the immune status of the population should be carefully monitored.

An investigation of two Shigella sonnei shigellosis outbreaks that occurred in a communal settlement indicated that the transmission of the pathogen was restricted to day-care classes and secondary infection of family members was minimal. Development of serotype-specific immunity following S. sonnei infection was observed among infected children.

Outbreaks of meningococcal disease were observed for the first time in the Israel Defence Force (I.D.F.) in 1992 and 1993, while in previous years, cases appeared in sporadic fashion. Two episodes in the winter of 1992 involving three and two individuals, respectively, were caused by Neisseria meningitidis group C, which was nontypable and nonsubtypable (C:NT:-). Three cases in one event in early 1993 were due to group C:NT:P1.2, the two secondary cases being caused by strains completely resistant to rifampicin. While these outbreaks were small, they should be seen against a background of the emergence of relatively virulent clones of serogroup C which have caused significant outbreaks in several countries. This and the drug resistance problem will require medical decision-makers to review strategies for the prevention of meningococcal disease, taking into account alternative agents for chemoprophylaxis as well as a possible role for vaccination.

Introduction: Following animal experiments where correlations were observed between serum magnesium level and noise-induced permanent hearing threshold shifts (NIPTS), we tested the prophylactic effect of magnesium in human subjects exposed to hazardous noise., Methods: Subjects were 300 young, healthy, and normal-hearing recruits who underwent 2 months of basic military training. This training necessarily included repeated exposures to high levels of impulse noises while using ear plugs. During this placebo-controlled, double-blind study, each subject received daily an additional drink containing either 6.7 mmol (167 mg) magnesium aspartate or a similar quantity of placebo (Na-aspartate)., Results: NIPTS was significantly more frequent and more severe in the placebo group than in the magnesium group, especially in bilateral damages. NIPTS was negatively correlated to the magnesium content of blood red cells but especially to the magnesium mononuclear cells. Long-term additional intake of a small dose of oral magnesium was not accompanied by any notable side effect., Conclusion: This study may introduce a significant natural agent for the reduction of hearing damages in noise-exposed population.

We report a prospective study of 783 male Israeli recruits aged from 17 to 26 years. The risk of stress fracture was inversely proportional to age on both univariate and multivariate analysis. Each year of increase of age above 17 years reduced the risk of stress fracture by 28%.

This article reviews the characteristics and components of intervention programs that are conducted by the Israel Defence Forces (IDF) in an attempt to reduce future cardiovascular (CV) morbidity and mortality among Israeli military personnel. Various populations have been targeted for intervention, ranging from selected high-risk individuals to the entire military population. The four basic elements of the activity are educational programs, environmental changes, legislation, and enforcement of the rules. Important characteristics of the program, which probably will contribute to its success, are (1) the establishment of a standing joint committee for developing and implementing health promotion programs in the IDF; and (2) the adoption and the follow-up of the suggested intervention programs by the head of the Manpower Branch, together with commanders of the other relevant branches. The effectiveness of the intervention programs will be measured in the future mainly by a follow-up on the prevalence of CV risk factors among Israeli military personnel.

The Injury Severity Score (ISS) is a widely used measure of anatomical injury. It is the sum of squares of the highest scores on the Abbreviated Injury Scale (AIS) in each of the three most severely injured body regions. This study was designed to describe the relationship between ISS and length of stay (LOS) in hospital. The ISS was independently determined by four physicians who studied 491 war casualties, excluding dead on arrival and non-trauma patients. The study demonstrates non-linear and non-homogeneous relationships between ISS and LOS. Exclusion of fatalities resulted in biased (higher) estimates of LOS among those with ISS scores of 25-66. The patients could be grouped into five categories according to their maximal AIS (MAIS): (1) Slight injury--i.e. those with injuries appropriate for AIS scores 1 or 2 that lead to an LOS of median 5 days; (2) Moderate injury--i.e. those with injuries appropriate to AIS scores of 3, with an expected median LOS of 10 days; (3) Severe injuries--i.e. those with injuries appropriate to AIS scores of 4, with expected median LOS of about 17 days; (4) Very severe injuries--i.e. those with one injury appropriate to an AIS score of 5; and (5) Multiple severe injuries--those who are severely wounded in two or more body regions, i.e. those with two or more injuries appropriate to AIS scores of 5 and 4, with a median LOS of 39 days.(ABSTRACT TRUNCATED AT 250 WORDS)

The population of Israel comprises offspring of immigrants from countries of high and low incidence of cytomegalovirus infection. To evaluate possible ethnic differences in the prevalence of antibodies against cytomegalovirus in young adults, blood samples were taken from a random sample of 422 Israel military recruits aged 18-19 years, during 1987. Antibodies against cytomegalovirus were determined by means of ELISA. Subjects originating from North Africa or Asia had higher prevalences than those originating from Western countries (84.0% and 74.0% versus 60.0%, P < 0.001) and the differences persisted after adjustment for gender, education and socioeconomic status. The prevalence of antibodies was significantly lower in men than in women (63.1% versus 76.5%). These findings identify subpopulations who are at increased risk of primary cytomegalovirus infection during adulthood and may be candidates for future anti-cytomegalovirus vaccines.

The efficacy of treatment of overuse patellofemoral pain with an elastic knee sleeve with a silicone patellar ring was compared with a simple elastic sleeve and with no treatment in a prospective study of 395 army recruits. During 14 weeks of basic training, 84 knees were diagnosed as having overuse patellofemoral pain. Recruits treated with a simple elastic knee sleeve had a statistically significant better comfort score and more had their pain resolved by the end of training than those treated with elastic knee sleeves with a silicone patellar ring. The mean pain score at the end of training decreased more among recruits who were treated with a simple elastic knee sleeve than among recruits who received no treatment, but this difference was not significant. Among the treatment options tried, the simple elastic knee sleeve was no more effective than no treatment at all, but it was more effective than the more elaborate patellar brace.

A total of 395 male infantry recruits were evaluated in a prospective study of possible risk factors for overexertional back pain and the efficacy of drug treatment regimens for this syndrome. Recruits were classified into subgroups of lumbar or thoracic, and paraspinal or spinous process pain. Recruits were divided into three treatment groups: Ibuprofen, Paracetamol, and no drug treatment. Of the recruits, 18% were diagnosed as having overexertional back pain during the course of 14 weeks of training. By multivariate analysis low body mass index was found to be a risk factor for overexertional lumbar pain (p = 0.005) and increased lumbar lordosis a risk factor for overexertional thoracic pain (p = 0.005). Of recruits with overexertional back pain, 65% were asymptomatic by the end of basic training. There was no statistically significant difference between cure rates according to treatment groups.

The likelihood of an epidemic of measles in 1990-92 in Israel prompted us to study the immune status against measles in a random sample of 454 recruits aged 18-19 years in order to obtain data that might be used in determining vaccination policy. This cohort had received one dose of measles vaccine at 12 months of age. The measles immunity status was studied by determination of antibody values that were measured by means of an enzyme-linked immunosorbent (ELISA) IgG antibody test. Of the recruits, 84.6% were found to have positive sera for anti-measles IgG antibodies, while 13.7% had negative sera. Eight (1.7%) subjects had borderline results. The results of this study indicate the need to administer a second dose of measles vaccine at an older age in addition to the MMR (measles, mumps, rubella) vaccine that is now given in Israel at 12 months of age. This step will help achieve the World Health Organization's target of complete eradication of measles.

Objective: To determine the proportion of hospitalized patients who had stress reactions as a result of missile attacks during the Persian Gulf War and evaluate the factors that influenced their evacuation., Design: Review of medical records of patients hospitalized as a result of missile attacks., Setting: During the Persian Gulf War in the winter of 1991, Israel received 18 missile attacks involving 39 surface-to-surface Scud missiles. The uncertainty in time, place, and type of warhead, conventional or chemical, was a source of chronic stress and the immediate cause for many traumatic stress reactions at or near the missile attack sites., Participants: Data from victims who were injured after each missile attack were available through a central hookup between 12 local hospitals and the Medical Corps of the Israeli Defence Force., Main Outcome Measure: The number of persons diagnosed in the hospital as psychological casualties after each missile attack., Results: Approximately 43% of the 773 casualties evacuated to hospitals were diagnosed as psychological casualties, and an additional 27% had mistakenly injected themselves with atropine. Data also indicated that triage of psychological casualties to hospitals was more a function of the rescue team's training and preparation than the severity or extent of injury or damage., Conclusions: Optimal treatment during events that cause mass casualties requires proper preparation of rescue teams as well as reorganization of the hospital's psychiatric services. The threat of chemical warfare affected the number and nature of stress reactions.

Most casualties of the Peace for Galilee operation were hospitalized at the Rambam Medical Center. Data from the medical records of 864 casualties of the first 15 weeks of the conflict were analyzed. 75% of them were battle casualties, and the rest were injured in accidents. Since this is the major central hospital of northern Israel, most of the severe, and about a third of the minor casualties were hospitalized here. Half of the cases reached hospital within 3 hours and 20 minutes of the time of injury. The overall mortality of all casualties, battle and accident, was 2.9%. The mortality among battle casualties who arrived at the hospital alive, was 3.4%.