MEDICAL CONDITIONS IN ADOLESCENTS

– FROM EPIDEMIOLOGICAL TRENDS TO A

NATIONWIDE HEALTH PROJECT FOR

DISEASE RISK REDUCTION

Y. Chaiter1, Y. Machluf 1, A. Pirogovsky2, A. Yona1, A. Navon1, O. Tal2, E. Ringler1, G. Abbebe-Campino1, Y.

Erlich1, and N. Ash2

1 Israel Defence Forces, Israel2 Ministry of Health, Israel

The medical process at recruitment centers

DocumentsPreliminary medical information (from family physician)

Basic measurementsAntropometric Visual analysisVital signs Urinalysis

Medical committeeSystematic anamnesis (history, habits,

psychology…)Complete physical examination

Further investigationPsychological

evaluationSpecialist

consultationLaboratory testsImaging + measuresDocumentation

Medical statusMedical profile ± Functional classification codes (FCCs)

Quality assurance and control system

GoalsTo assess components of the medical process and committees’ performances and to ensure a uniform and professional medical process at recruitment centres

Assessment1.Medical committee staff

2.Administrative medical personnel

3.Recruits

4.Physical conditions & medical equipment

5.Computer-based assessment

ToolsObservations, Sampling, Re-examination, Questionnaires, Medical files, Report & data analysis

Analysis1.Inadequacies in

anamnesis quality

2. Insufficient physical examination

3.Errors in decision-making

4.Local administrative procedures

5.Inappropriate equipment and use

6. inconsistencies in medical process

7.Variability in prevalence of medical conditions

Intervention program1.Lectures &

Instructions

2.Simulation centre

3.Manual

4.Renewal of medical equipment

5.Reports

Improvements1.Professional

performance

2.Working environment

3.Patients’ satisfaction

4.Uniform working platform

Opportunity for epidemiological research

New horizons

The medical processes for the adolescent population of

Israel present a unique opportunity to assess the health

status of the young Israeli population on a nationwide level

and to identify risk factors that can affect present and

future morbidity.

A pilot study

General characteristics

~105,000 adolescents

61427 males and 43473 females

Age of 16-19 years old, at time of medical examination

Were born between 1971-1992 (>1000 people / gender/

years)

All have basic measurements data (height, weight…)

All from 1 recruitment centreGoals

Medical conditions- trends over the years

Assess risk factors

BMI

A significant increase in average BMI was observed

(more pronounced in male recruits)

BMI

A significant decrease in the prevalence of normal BMI was observed, in both male and

female recruits

BMI

A significant increase in the prevalence of overweight BMI was observed (more pronounced

in male recruits)

BMI

A significant increase in the prevalence of obesity BMI was observed, in both female and male

recruits

BMI

A significant increase in the prevalence of underweight BMI was observed, in female but not

in male recruits

A pilot study

Data stratification – identification of risk factors

Except gender, data was stratified by religion, country of

origin, education, family-related parameters, medical

measurements (blood pressure, pulse etc.) and inter-

relations were assessed.

This approach led to the identification of novel risk factors

as well as supported known ones.

Periodic data mining

“Old data – new insights”

One way by which the control system operates is data

mining and processing from the computerized medical

database.

It is aimed at identifying discrepancies in medical profiling,

along with follow-ups and analyses of medical profiles and

FCCs assigned to recruits. Comparison of findings over the

years may uncover interesting trends…

Solid tumors

An increase in the prevalence of solid tumors in both male and female recruits

Congenital heart disease

An increase in the prevalence of both valvular and non-valvular congenital heart disease, among male

recruits

A nationwide health project

Need

A need for a nationwide intervention program to reduce

morbidity and future illness and even mortality.

Benefits

Identification of important trends in risk factors by the

quality assurance and control system.

An automated process of information sharing between

the military and civilian medical systems.

Complete communication between various medical

systems.

Future view: one medical file for the life time of a person.

A nationwide health project

IDF 1. Medical committee2. Quality assurance &

control system

Ministry of healthPsychiatric hospitalizations

Ministry of Social affairsMentally retarded

populations in special institutions

Past

Present & Future

HMOSFamily physicians in primary

clinics

Ministry of Social affairsExpansion: severely

disabled, pervasive developmental disorders, etc.

Israeli National Cancer Registry

National insuranceHandicaps

A nationwide health project

Pilot I:

A project of information sharing was started at northern Israel with family physicians at primary clinics (Clalit Health Services).Pilot phase (launched in 03/2010): 4 selected primary clinics, ~500 recruits (growing…).

Pilot II:

A project of information sharing and was started on a nationwide level, with the Israeli National Cancer Registry, The Ministry of Social Affairs and National Insurance.Pilot phase, launched in 04/2010: 24449 male (0.233%) + 21892 (0.169%) female recruits (prevalence).

IDF – CHS Pilot

Higher rate of information gathering from clinics as compared to questionnaires

Total (n=105)

Clinic – B (n=70)

Clinic – A (n=35)

62.9% 58.6% 71.4% Information - Questionnaire

74.3% 71.4% 80.0% Information – Clinics (computer)

IDF – CHS Pilot

A significant contribution to both recruits that did not return questionnaire or did return

questionnaire, indicating the importance of a complementary source of information

Total (n=105)

Clinic – B (n=70)

Clinic – A (n=35)

62.9% 58.6% 71.4% Information - Questionnaire

74.3% 71.4% 80.0% Information – Clinics (computer)

39.7% 38.0% 42.9% Novel medical findings*

46.7% 30.0% 80.0% Rate among recruits that did not return questionnaire

35.1% 43.3% 22.5% Rate among recruits that did return questionnaire

IDF – ICR Pilot

Bi-directional information sharing

Distribution of Malignancies Among Male and Female Recruits(which were born Sep-92 to Apr-93)

Summary

Quality assurance and control

system

Epidemiological pilot study

A nationwide health project

Medical process at medical

committees

Thank You!

Height

A slight but significant decrease in average height was observed in female but not in male

recruits

Weight

A significant increase in average weight was observed

(more pronounced in male recruits(