Papers by Daniel Weiler-ravell
SETTING: Israel has implemented a new tuberculosis (TB) control programme in response to the rise... more SETTING: Israel has implemented a new tuberculosis (TB) control programme in response to the rise in the incidence of tuberculosis due to immigration in the last decade. It complies with World Health Organization guidelines, and also includes specific measures address- ing the needs of immigrants. We describe the new pro- gramme and compare the outcome of treatment prior and after
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The Israel Medical Association journal : IMAJ, 2006
During the last decade, Israel, a country with low tuberculosis rates, absorbed some 900,000 new ... more During the last decade, Israel, a country with low tuberculosis rates, absorbed some 900,000 new immigrants from TB-endemic countries. To analyze the specific impact of our screening procedures on active TB among children in Israel. We conducted a retrospective analysis of epidemiologic and clinical data of all children (aged 0-17) with TB notified to the Ministry of Health between 1990 and 1999. There were 479 children with TB (male/female ratio 1.36). Most cases (81.8%) were foreign born, predominantly (88.2%) immigrants from Ethiopia and, therefore, huge differences existed in TB incidence rates according to countries of origin. Some 80% were diagnosed within 3 years of arrival, mainly due to active case-finding. Pulmonary TB, with infiltrates on chest X-ray, was found in 49.5%. Extra-pulmonary TB sites were: intra-thoracic lymphadenitis (31.1%), extra-thoracic lymphadenitis (12.5%), bones (3.6%), pleura (1.3%), meninges (1%), and others (1%). Seventy percent had a tuberculin ski...
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The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2003
Right of entry may sometimes be denied to immigrants because of the threat of tuberculosis. Durin... more Right of entry may sometimes be denied to immigrants because of the threat of tuberculosis. During 1990-2000 some 1050000 immigrants, mostly from countries highly endemic for TB, arrived in Israel, a low prevalence country. Nevertheless, TB rates in Israel have remained low. To emphasise the challenge beyond technical competence for TB control for immigrants from the perspective of Israel's National Tuberculosis Programme (NTP). We defined criteria for an NTP geared to immigration, and analysed our implementation of the European Task Force recommendations on international migration and TB control. We interviewed immigrants and health care workers to identify barriers to diagnosis, prevention and treatment of TB among immigrants. We used classical epidemiology to evaluate the impact of immigration on TB rates in the host population. Until now there has been no evidence of significant spread of TB from immigrants to the host population. Successful outcome of treatment has been not...
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The Israel Medical Association journal : IMAJ, 2002
One of the measures adopted in Israel since 1959 as part of the tuberculosis control program was ... more One of the measures adopted in Israel since 1959 as part of the tuberculosis control program was screening children aged 12-13 years old. The screening comprised single-step tuberculin skin testing using the Mantoux method. To assess the efficacy of tuberculin skin screening for TB in schoolchildren in southwestern Israel as well as the compliance to treatment for latent tuberculosis infection. We retrospectively reviewed the records of children in the Ashkelon region who underwent a tuberculin skin test during the period 1995-99. Of the 28,016 eligible children, 27,232 were tested. In 923 children, mostly from the former USSR and Ethiopia, an induration of 10 mm or more was found. Only 52 Israeli-born children tested positive. Tuberculosis was found in seven children with a positive test, five of whom were from Ethiopia. All children who tested positive were referred to the local TB clinic; only 266 children (28.8%) presented. Only 151 completed the recommended treatment of isoniaz...
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Respiratory Care, 2012
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Respiration Physiology, 1991
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Public Health, 2004
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Respiration Physiology, 2000
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The Lancet, 1983
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Respirology, 2006
This study describes the features of sarcoidosis among Arab patients and compares it to Jewish pa... more This study describes the features of sarcoidosis among Arab patients and compares it to Jewish patients residing in northern Israel. All new cases of biopsy-confirmed sarcoidosis diagnosed between 1980 and 1996 in northern Israel were divided into two groups according to their ethnic origin: Jewish (n = 72) and Arabic (n = 48). Disease parameters were recorded and compared. Arabs and Jews had similar incidence rates that increased from 0.2/10(5) in 1980 to 2/10(5) per year in 1996. The peak incidence was in the sixth and seventh decades and the female/male ratio was 2 and 1.4 for Arabic and Jewish patients, respectively. Jewish patients had higher proportion stage II-IV pulmonary disease (78% vs. 51.2%) while their Arabic counterparts had higher proportion of stage I disease (70.8% vs. 41.7%). The proportion of extra-thoracic organ involvement was similar. Different disease phenotype indicated differed diagnostic procedures; higher proportion of mediastinoscopy for stage I disease among Arabic patients (47.9% vs. 20.8%, P = 0.015) and trans-bronchial biopsy for stage II-IV pulmonary disease among Jewish patients (25% vs. 8.35%, P = 0.05). Corticosteroids were used in a non-significantly higher proportion of Jewish patients (56.9% vs. 43.8%, P > 0.05). Of six sarcoidosis-related deaths (5%), five occurred in Jewish patients. This study has documented different forms of presentation, clinical manifestation, severity and prognosis of sarcoidosis present among patients of Arabic and Jewish origin residing in the area of northern Israel.
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Pediatric Research, 1985
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Pediatric Research, 1984
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Pediatric Research, 1987
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Medicine & Science in Sports & Exercise, 1988
Brachial intra-arterial blood pressure [systolic (AS) and diastolic (AD)] and cuff blood pressure... more Brachial intra-arterial blood pressure [systolic (AS) and diastolic (AD)] and cuff blood pressure [systolic (CS) and fourth- and fifth-phase diastolic (CD)] were simultaneously measured by a single observer in 13 middle-aged men during 1-min incremental cycle exercise. On the average, the mean AS exceeded the mean CS by 10 to 11 mm Hg, while the mean AD exceeded the average fourth and fifth CD by 5 and 13 mm Hg, respectively. During incremental exercise, AS, CS, AD, and fourth-phase CD increased, while fifth-phase CD decreased. We also measured intra-arterial blood pressure in nine young adult men smokers during 1-min incremental cycle exercise. In both groups, the average intra-arterial blood pressures increased in a relatively linear fashion from rest to maximal exercise: AS change = 74 +/- 5 mm Hg (SE) and AD change = 28 +/- 3 mm Hg for young men; AS change = 59 +/- 5 mm Hg and AD change = 12 +/- 3 mm Hg for middle-aged men. In this population of middle-aged smokers, intra-arterial mean blood pressure during exercise approximated diastolic plus 2/5 pulse pressure for intra-arterial measures or diastolic plus 1/2 pulse pressure for cuff measures rather than the traditional formula of diastolic plus 1/3 pulse pressure.
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Medicine & Science in Sports & Exercise, 1988
ABSTRACT ROBINSON, T. E., D. Y. SUE, A. HUSZCZUK, D. WEILER- RAVELL, and J. E. HANSEN. Intra-aite... more ABSTRACT ROBINSON, T. E., D. Y. SUE, A. HUSZCZUK, D. WEILER- RAVELL, and J. E. HANSEN. Intra-aiterial and cuff blood pressure responses during incremental cycle ergometry. Med. Sci. Sports Exerc., Vol. 20, No. 2, pp. 142-149, 1988. Brachial intra-arterial blood pressure [systolic (AS) and diastolic (AD)] and cuff blood pressure [systolic (CS) and fourth- and fifth-phase diastolic (CD)] were simultaneously measured by a single observer in 13 middle-aged men during 1-min incremental cycle exercise. On the average, the mean AS exceeded the mean CS by 10 to 11 mm Hg, while the mean AD exceeded the average fourth and fifth CD by 5 and 13 mm Hg, respectively. During incremental exercise, AS, CS, AD, and fourth- phase CD increased, while fifth-phase CD decreased. We also measured intra-arterial blood pressure in nine young adult men smokers during 1-min incremental cycle exercise. In both groups, the average intra-arterial blood pressures increased in a relatively linear fashion from rest to maximal exercise: AS change = 74 +/- 5 mm Hg (SE) and AD change = 28 +/- 3 mm Hg for young men; AS change = 59 +/- 5 mm Hg and AD change =12 +/- 3 mm Hg for middle-aged men. In this population of middle-aged smokers, intra-arterial mean blood pressure during exercise approximated diastolic plus +/- pulse pressure for intra-arterial measures or diastolic plus +/- pulse pressure for cuff measures rather than the traditional formula of diastolic plus +/- pulse pressure. (C)1988The American College of Sports Medicine
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Journal of Public Health Policy, 2004
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The Journal of Laryngology & Otology, 2002
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Journal of Hospital Infection, 2000
The objective of this study was to determine the prevalence of positive skin tests amongst the st... more The objective of this study was to determine the prevalence of positive skin tests amongst the staff of a 200 bed geriatric hospital in Haifa, Israel. By comparing the findings with those of a study performed five years previously, we hoped to ascertain the number of conversions which had occurred in the period studied. This was undertaken in order to assess a new policy from the Israel Ministry of Health regarding skin testing for health care workers. We also hoped to decide upon the frequency of skin testing required and to compare data from recent immigrants from countries with a high prevalence of TB. In 1997, we performed two-step skin testing (TSST) on 318 health care workers. We ascertained the number of positive reactions on the first and second testing and calculated the number of subjects who showed significant boosting. We also compared the results to those obtained in a study in 1992 and calculated the rate of conversion. We used multivariate analysis to examine the effects of age, gender, country of origin, years in Israel, previous BCG vaccination, previous exposure to contagious TB, work site and area of residence in the city, on the response to TSST. Between 1990 and 1996, 655 000 immigrants from the former USSR arrived; 'recent immigration' was defined from that date onward. The final number of positive reactions out of 282 subjects, who were either positive or negative on step 1 and presented for step 2, was 171 (60%). Booster effect was not significantly associated with any of the variables examined. The size of reaction in TSST was related to country of origin and recent immigration. The 83 recent immigrants from the former USSR had more frequent (61%) and larger reactions (mean (sd): 9.0 (6.46) mm) than the 114 native-born Israelis with 39% positive reactions (6.2 (5.89) P= 0.009). Comparison with 1992 revealed 26 (31%) of previous negatives as positive. Conversion was associated with age. All conversions save one were in individuals younger than 50 years (P= 0.07). In conclusion, TSST, performed to enable detection of recent infection after exposure to contagious TB, was relevant for 40% of health care workers (HCWs). Second step testing contributed an additional 23% positive reactions. New immigrants had larger initial reactions. Conversion occurred mostly in younger workers and could be either due to unrecognized TB in the hospital or to exposure in the community.
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Journal of Clinical Investigation, 1990
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CHEST Journal, 1983
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Papers by Daniel Weiler-ravell