[Dental manpower prediction in Israel for 2017]

A recent study published by the authors indicated that according to the Israeli Central Bureau of Statistics in 2008, Israel had 5800 active dentists, a figure well below the publication by the Ministry of Health. Based on this figure, using the manpower to population ratio method, the following results were obtained: The predicted number of dentist in 2017 would be 6090, based on, the estimated number of Israel: graduates, the estimated number of dentists who would arrive in Israel as immigrants or Israelis who studied abroad, based on an attrition rate of 3% and on the assumption that the number of dentists leaving the country is negligible. Table 2, based on manpower to population ratio, indicates that by 2017, Israel would have 1 dentist per 1400 population, a ratio which is still far above what many countries present, but high for Israel. This might reflect a dramatic change, from employment in public clinics, back to private practices. The results clearly indicate that a shortage of dentists is predicted in the near future and a major brainstorming is urgently required to evaluate these results.

[Dental practitioners in Israel: past, present and future]

Since 1980 various studies have been published in Israel dealing with dental manpower issues, utilizing several methods such as manpower to population ratio. The dental literature pointed out that dentistry in Israel has an over supply of dentists and that manpower to population ratio is one of the highest in the world 1:770. All studies were based on the information provided by the Ministry of Health which showed that Israel has over 9500 dentists. The Israel Central Bureau of Statistics figures showed a much smaller number which was 5700 active dentists. This enormous gap in between two sources of information, following strict examination of the data revealed that the Bureau of Statistics information is reliable and hence, the real manpower to population ratio in Israel in 2008 was 1:1271. Prediction of manpower is extremely important and the base line information is crucial for future evaluations.

Core Symposium: Suicide Across Europe. A GP-based Suicide Prevention Program in Hungary

Suicide, particularly in the case of current major depression, is quite common among patients who contact their GPs some weeks or months before their death. However, prior studies have shown that GP’s education, regarding the diagnosis and treatment of depressive disorders, can reduce suicide mortality in the given area served by trained GPs. The aim of our present study was to evaluate the effectiveness of a depression-management educational program for GPs in a region with a very high suicide rate (over 50 per 100.000) in Hungary. Twenty-eight GPs and their lead nurses, servicing 73,000 inhabitants in the region of Kiskunhalas, participated the 5-year educational program together with estabilishment of a Depression Outpatient Clinic and psychiatrist telephone consultation service. The annual suicide rate in the Kiskunhalas region decreased from 59.7/100.000 (5-year preintervention average) to 49.9/100.000. This decrease was significantly greater than both the county and whole Hungary (p=0.001 and p=0.001, respectively). However, the increase of antidepressant prescription was greater in the intervention region compared with both the county and whole Hungary and in women compared with men (p=0.02). There was no change in alcohol-related deaths or rate of unemployment in the intervention region during the whole study period (1996-2000 vs 2001 and 2005). The findings support earlier studies showing that continuous GP education on diagnosis and treatment of depression is an effective method of suicide prevention. The high importance of alcoholism in local suicides was unanticipated and not addressed, suggesting that optimal suicide prevention plans must also consider major local risk factors.

Universal intermittent properties of particle trajectories in highly turbulent flows

We present a collection of eight data sets from state-of-the-art experiments and numerical simulations on turbulent velocity statistics along particle trajectories obtained in different flows with Reynolds numbers in the range R{lambda}in[120:740]. Lagrangian structure functions from all data sets are found to collapse onto each other on a wide range of time lags, pointing towards the existence of a universal behavior, within present statistical convergence, and calling for a unified theoretical description. Parisi-Frisch multifractal theory, suitably extended to the dissipative scales and to the Lagrangian domain, is found to capture the intermittency of velocity statistics over the whole three decades of temporal scales investigated here.

[Acute renal failure in patients with liver cirrhosis--what to do? An update]

A lot of patients suffering from liver cirrhosis show a decreased renal perfusion and glomerular filtration rate. An impaired renal function is the result of complex e.g. hemodynamic disturbances, resulting of the chronic liver disease. This explains its disposition to renal dysfunction and the higher incidence of acute renal failure in liver cirrhosis. In the case of renal failure hepatorenal syndrome, apart from prerenal, renal and postrenal causes, should be included in the differential diagnosis especially when signs of portal hypertension are apparent regarding its high mortalityand fatal prognosis requiring an immediate therapeutically approach. Special attention must be due to preventive strategies to avoid renal deterioration. This includes simple steps e.g. a careful election of medication but also an adequate therapy of infection-associated complications in patients with liver cirrhosis.

[Satisfaction survey of the dental treatment project of Hadassah and the "International Fellowship of Christians and Jews" among the family and the professional servant]

Social inequalities in health are a serious public health problem. In Israel dental treatment is not included in the national health insurance. Low socio-economic groups are therefore significantly inferior in oral and dental health. Health for all is one of the WHO aims for the 21st century. This project, which was described in a previous article, intended to upgrade dental health of those belonging to a low socio-economic group and to minimize the inequality in dental health by providing care to children 6-12 years of age free of charge. This survey investigated the satisfaction of the children's family, the social workers and the dental team, involved in this project.

METHODS

The study population included 124 parents of children who were treated. These were chosen by a randomized sample from the entire population that was treated in the project. Interviews were conducted in Hebrew, by one interviewer who read the questions and all possible answers. The other satisfaction's interview was targeted at the professional team including the entire dental team and the welfare department's workers.

RESULTS

55 providers were interviewed and 124 parents. There satisfaction from the project was very high although there were concerns regarding the range of the ages that had been chosen. The satisfaction among the children's family was high but there were significant differences between the clinics in the various cities. The parents from Jerusalem and Bet -She'an were more satisfied than the others (P = 0.011).

DISCUSSION

Overall, the parents, the dental team and the social workers, expressed high levels of satisfaction with the project. The differences between the clinics could be due to the character, the background, the knowledge and the professionalism of the clinic and the dental team on the one hand and, the environment and the culture on the other hand. The project was very successful among all the participants the care givers, social workers and patients. The treatment improved quality of life of the children and brought some hope and light to their lives.

Impact of ramipril on the incidence of atrial fibrillation: results of the Heart Outcomes Prevention Evaluation study

OBJECTIVES

We evaluated the effect of angiotensin-converting enzyme (ACE) inhibitor ramipril on the incidence of atrial fibrillation (AF) in patients enrolled in the Heart Outcomes Prevention Evaluation trial.

BACKGROUND

Atrial fibrillation is the most common arrhythmia affecting the general population and is associated with increased morbidity and mortality. Retrospective secondary analyses of some of the large trials of ACE inhibitors have suggested that ACE inhibitors may prevent AF.

METHODS

We evaluated the occurrence of AF by reviewing the electrocardiogram tracings at entry, at 2 years, and at the end of the study, as well as hospitalizations among 8335 high-risk participants from the Heart Outcomes Prevention Evaluation study, > or = 55 years, without known heart failure or left ventricular (LV) systolic dysfunction and followed for a median period of 4.5 years. We compared the impact of ramipril and matched placebo on occurrence of AF. The results were compared to similar trials.

RESULTS

Over the 4.5 years follow-up, the incidence of new AF was low (2.1%, 177/8335), and ramipril did not significantly reduce the rate of new AF compared with placebo (86/4291 [2.0%] vs 91/4044 [2.2%]) with an odds ratio of 0.92 (95% confidence interval, 0.68-1.24; P = .57). These results added to the previous ACE inhibitor trials (excluding trials in patients with LV dysfunction) showed no significant reduction in new AF among patients treated with these agents (1088/20,930 [5.0%] vs 1343/22,878 [5.9%]; relative risk, 0.92; 95% confidence interval, 0.80-1.05).

CONCLUSION

Although the incidence of AF was low, treatment with ramipril in this population without known LV systolic dysfunction did not significantly reduce this dysrhythmia.

[Drug-related disorders of water and electrolyte metabolism]

Pharmacologic treatment may lead to diverse disturbances of water and electrolyte metabolism as adverse drug events. Diuretics are particularly likely to cause these complications typically including volume depletion, metabolic alkalosis, hyponatremia, and hypokalemia. Salt and water retention with edema formation is most frequently elicited by antihypertensives, steroid hormones, and nonsteroidal anti-inflammatory drugs. Drug-induced disorders of Na+ concentration may usually be attributed to altered antidiuretic hormone (ADH) effects, either as diabetes insipidus or as the syndrome of inappropriate ADH secretion. With hyper- and hypokalemia, redistribution between intra- and extracellular fluid as well as renal excretion play a role. Strategies to prevent these adverse drug reactions include careful consideration of risk factors and clinical and laboratory controls in the course of treatment.

Darbepoetin alfa once every 2 weeks for treatment of anemia in dialysis patients: a combined analysis of eight multicenter trials

AIM

Darbepoetin alfa has a longer half-life than epoetin-(EPO) alfa or beta, allowing administration at less frequent intervals for the treatment of renal anemia. The aim of the present analysis was to evaluate the efficacy and tolerability of an every-2-week (Q2W) schedule of darbepoetin alfa in a large cohort of dialysis patients.

METHODS

Data were combined from eight similarly designed 24-week phase 3b European studies, in which patients receiving EPO alfa or beta once-weekly were converted to Q2W darbepoetin alfa. Darbepoetin alfa dosage was titrated to maintain hemoglobin (Hb) between 10 and 13 g/dl and efficacy was evaluated during a 4-week evaluation period.

RESULTS

In the 1,101 patients assigned to Q2W darbepoetin alfa (i.v., n = 196, s.c., n = 905), mean (SD) Hb levels were 11.53 (0.77) g/dl at baseline and 11.35 (1.04) g/dl at evaluation (mean change in Hb -0.27 g/dl, 95% confidence interval 0.34, -0.20). Hb levels were maintained between 10 and 13 g/dl during evaluation in 85% of patients. Darbepoetin alfa doses were similar at baseline and evaluation, and the i.v. and s.c. routes were associated with similar efficacy and dose requirements. Darbepoetin alfa was well-tolerated.

CONCLUSIONS

Q2W darbepoetin alfa is effective in maintaining Hb levels in dialysis patients switched from weekly rHuEPO, regardless of the route of administration and with no notable increase in the weekly equivalent dose.