A longitudinal study of cognition in asymptomatic and mildly symptomatic bipolar disorder patients

Bipolar disorder (BD) is characterized by cognitive deficits that impair patients' functioning and quality of life. Most of the earlier studies assessing changes in BD patients' cognitive functioning over time utilized a cross-sectional research design. The few longitudinal studies that were conducted tended to have methodological limitations such as very short follow-up periods, recruitment of acutely ill patients, and lack of assessment of practice effects. The current study aimed to assess changes over time in the cognitive functioning of typical BD outpatients. For this purpose, asymptomatic and mildly symptomatic BD outpatients were assessed at baseline and after two years (n=31). At baseline, the cognitive functioning of the BD patients was compared to that of gender- and age-matched healthy controls. Practice effects were estimated by re-assessing the controls one week after their first assessment. Compared to the controls, BD patients had deficits in psychomotor speed, sustained attention, and one domain of executive functioning (cognitive planning). No evidence was found of a decline in their cognitive functioning over the two year time interval. These findings support a developmental model of cognitive impairment in BD. Studies using longer follow-up periods and larger sample sizes, however, are needed before these conclusions can be stated confidently.     

Immune response to an intercalated enhanced inactivated polio vaccine/oral polio vaccine programme in Israel: impact on the control of poliomyelitis

A combined enhanced inactivated polio vaccine (EIPV) and oral polio vaccine (OPV) programme was introduced in Israel in 1990, with the purpose of providing a solution to the persistent polio morbidity in spite of a 30 year long OPV programme. The schedule comprised two doses of EIPV administered at the age of 2 and 4 months, intercalated with two doses of OPV at 4 and 6 months, followed by a reinforcing dose with the two vaccines simulltaneously administered at 12 months. The 5-year evaluation of the programme included: the assessment of clinical suspicions of polio, early immune response in successive cohorts administered the new schedule, dynamics of the immune profile in a cohort followed up to the age of 5, and monitoring of wild poliovirus excretion in sewage specimens collected in 25 permanent sites throughout Israel as well as from the Palestinian Authority. No paralytic polio cases associated with a wild or vaccinal poliovirus strain were detected since the introduction of the programme. At the age of 4 months, one week after administration of the second EIPV and first OPV dose, 100% seropositivity and high geometric mean titres (GMTs) of neutralizing antibody (NA) to the three vaccinal and to the wild poliovirus type 1, responsible for the 1988 polio outbreak, were observed. No change in percent of seropositivity occurred between the age of 6 and 12 months. Thirty days after the IPV and OPV reinforcing doses, GMTs to each of the four poliovirus strains were ≥3037. Up to the age of 5, the seropositivity was unchanged. After a 2.5–10-fold decline in the first year following the completion of the programme, GMTs to the three vaccinal and the wild poliovirus strain levelled off at rather high values, considered protective. Between 1990 and 1995, 16 wild poliovirus type 1 strains were isolated in three separate episodes in Gaza Strip sewage and once only in one Israeli site very close to Gaza City. The rapidly established, high and persistent NA titre to the vaccinal and wild poliovirus strains and the presence of immunological memory are indicative of high individual protection throughout the first 5 years of life. The only one-time introduction, without circulation, of a wild poliovirus strain in a single Israeli settlement suggests community protection. The intercalated programme offers a contribution to polio eradication by providing a solution to the primary and secondary failure associated with POV, as well as to the control of vaccine-associated paralytic poliomyelitis.     

Failure of Mass Antibiotic Prophylaxis to Control a Prolonged Outbreak of Meningococcal Disease in an Israeli Village

 In January 1994 mass antibiotic prophylaxis was undertaken in the contiguous villages of Deir el-Asad and B'ine in northern Israel (combined population of 11 600) in response to a prolonged outbreak of serogroup B meningococcal infection with an overall annual rate of 37.4 cases of infection per 100 000 residents. The average case fatality rate in the villages was 23% compared with 11% in Israel during the same period. Neisseria meningitidis group B was identified in 9 of 13 (69%) cases. Seven of these were subtype P1.7,16. The persistence of the outbreak with its accompanying public reaction prompted the establishment of an intervention programme that included antibiotic prophylaxis for the whole community with monitoring for pharyngeal carriage of meningococci in a stratified sample of the population. The objectives were to achieve a reduction of carriage of the outbreak strain and to reduce morbidity and mortality. A total of 1036 pharyngeal swabs were taken 1 day before and 6 weeks after treatment. Antibiotic prophylaxis was administered in one dose: children under 5-years-old received ceftriaxone i.m.; all others received oral ciprofloxacin. Overall, 96% of the population received treatment. The carriage rate was 8.3% prior to treatment (three serogroup B:14 : P1.7,16), and 1.3% afterwards (one serogroup B:14 : P1.7,16). The intervention failed to eradicate carriage of the putative outbreak strain, or to reduce the incidence and fatality rates in the villages. The outbreak finally terminated in late 1996. Public health professionals should bear this experience in mind when faced with prolonged, localized, non-explosive outbreaks of meningococcal disease associated with low carriage rates of the outbreak strain.     

Characteristic Expressions of Combat-related Posttraumatic Stress Disorder among Israeli Soldiers in the 1982 Lebanon War

Abstract

This study assessed the clinical picture of two groups of Israeli soldiers: front-line soldiers who had been treated for combat stress reaction during the 1982 Lebanon War (n = 382); and matched control front-line soldiers who did not sustain combat stress reaction (n = 334). Subjects were screened one year after the war for posttraumatic stress disorder (PTSD) and psychiatric symptomatology using the symptom checklist-90 (SCL-90). Results indicated that anxiety, depression, hostility, and obsessive-compulsive problems were the most salient features of PTSD among combat stress reaction casualties. The contribution of DSM-III criteria as well as their limitations in the diagnosis of PTSD are discussed.     

The long-term implications of war captivity for mortality and health

The current study aims to (1) assess the long-term impact of war captivity on mortality and various health aspects and (2) evaluate the potential mediating role of posttraumatic stress disorder (PTSD) and depressive symptoms. Israeli ex-prisoners of war (ex-POWs) (N = 154) and a matched control group of combat veterans (N = 161) were assessed on health conditions and self-rated health 18 years post-war (1991: T1). The whole population of ex-POWs, and the T1 sample of controls were then contacted 35 years after the war (2008: T2), and invited to participate in a second wave of measurement (ex-POWs: N = 171; controls: N = 116) Captivity was implicated in premature mortality, more health-related conditions and worse self-rated health. PTSD and depressive symptoms mediated the relationship between war captivity and self-rated health, and partially mediated the relationship between war captivity and health conditions, and these effects were amplified with age. Aging ex-POWs who develop psychiatric symptomatology should be considered a high-risk group entering a high-risk period in the life cycle. It is important to monitor ex-POWs and provide them with appropriate medical and psychological treatment as they age.     

Minimizing complications in pancreaticobiliary endoscopy

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable tools in the diagnostic and therapeutic evaluation and management of a variety of pancreatobiliary disorders. Along with a significant refinement in the equipment and techniques used has come a recent trend toward aggressive therapeutic interventions. Because of the technical nature of these procedures and the characteristics of the patients, postprocedural complications may occur, ranging from minor (requiring brief hospitalization) to severe (causing permanent disability or death). This review summarizes these complications and outlines strategies to minimize them.     

The “Koach” project for treatment of combat-related PTSD: Rationale,aims, and methodology

The Koach project was designed and implemented by the Mental Health Department of the IDF (Israel Defense Forces) Medical Corps as a treatment program for chronic PTSD veterans, aimed at reducing the prevalence and severity of PTSD and accompanying psychiatric symptomatology and improving functioning in the military, the family, and the community. It was comprised of a 1-month residential phase on an army base, followed by mutual self-help groups in the veterans' communities. The project combined behavioral, cognitive, and group approaches into an integrated therapeutic program. This article presents the rationale behind the project and describes the treatment approaches that were utilized.     

The prostaglandin inhibitor effect of antiinflammatory drugs in the therapy of male infertility

The effects of various doses of indomethacin and ketoprofen as compared with placebo were examined in 100 oligospermic patients who participated in this study. It was found that the treatment increased sperm count, sperm motility, and fertilizing capacity. The radioimmunoassay examination showed an increase in plasma follicle-stimulating hormone and luteinizing hormone but a decrease in testosterone. The results show that the influence of indomethacin was better in the dose of 75 mg daily. The mechanism of those changes is not clear. Treatment should be at least 60 days.