A Tamir

Sheba Medical Center, Gan, Tel Aviv, Israel

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Publications (44)84.65 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate sound localization ability in totally deaf patients with unilateral cochlear implants and to estimate the ability to improve this function by training. A controlled case series. Nine patients with monaural cochlear implants were asked to identify the source of 50 randomly distributed sound stimuli coming from five different directions anteriorly or laterally. After some training, patients were retested. There were two control groups. One comprised nine adults with normal hearing, and the other comprised nine adults with normal hearing but one ear plugged. The mean initial score of the study group (maximal score 100) was 41.5 (range 23-63). Patients who had used cochlear implants longer had better sound localization ability (Spearman's correlation coefficient = 0.92). On retesting, after an average of 6.3 training sessions, their mean score improved to 66 (range 32-95), (p = 0.008). The improvement was more pronounced in postlinguals than in prelinguals (p = 0.016). Spontaneous development of sound localization ability in totally deaf patients with unilateral cochlear implants is proportional to the time interval between implantation and initial testing. Improvement appears to be influenced by training, and to be greater in postlingual than in prelingual implantees.
    Cochlear Implants International 03/2005; 6(1):1-9. DOI:10.1002/cii.15
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    ABSTRACT: The neural mismatch theory assumes that the intersensory conflicts leading to motion sickness are resolved by changes in the relative weighting of the various senses that contribute to orientation. If this sensory rearrangement persists after disembarkment, it might result in mal de debarquement (MD): ataxia and a rocking sensation sometimes felt after landing. The objective of the present study was to examine possible changes in sensory organization in naval crew members with differing susceptibility to MD with computerized dynamic posturography (CDP). Cross-sectional parallel-group design. Seventeen subjects susceptible to MD (SMD) and 17 subjects nonsusceptible to MD (NSMD) (healthy male volunteers aged 18-22) participated in the study. CDP was performed twice with each subject, before and immediately after sailing, using the EquiTest system (NeuroCom, Inc., Clackamas, OR). The SMD group showed a significant reduction in their scores on sensory organization tests 3, 4, and 5 after sailing. Sensory pattern analysis revealed reduced use of inputs from the vestibular and visual systems to maintain balance. Prolonged latencies of the motor responses to unexpected pitch perturbations were also recorded in the postsailing CDP of the SMD group. Reduced performance on the presailing CDP task, which presents the greatest challenge to the vestibular system, was found to control for the presence of MD postsailing. The results show that MD is associated with postural instability, slower motor reflexes, and larger sways in response to abrupt changes in the body's center of gravity. These findings may be explained by under reliance on vestibular and visual inputs and increased dependence on the somatosensory system for the maintenance of balance.
    The Laryngoscope 04/2004; 114(3):581-6. DOI:10.1097/00005537-200403000-00036 · 2.03 Impact Factor
  • Harefuah 07/2000; 138(12):1050-4.
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    ABSTRACT: Incidence rates for malignant melanoma in Israel are rising steadily, and the kibbutz population is at increased risk for this malignancy. To assess the risk factors for malignant melanoma among kibbutz members compared to matched healthy controls. We conducted a case-control study of 168 malignant melanoma patients and 325 healthy controls, matched by age and gender. Data were collected on three categories of risk: demographic, personal (e.g., skin, eye and hair color), and environmental/behavioral (e.g., sun exposure, use of sunscreens). There were no differences between the groups regarding sociodemographic data. Significantly more patients than controls had fair, vulnerable skin (P < 0.001), light eyes (P < 0.05), and fair hair (P < 0.001). There was no difference in family history of malignant melanoma or other cancers. Patients with malignant melanoma had significantly more additional skin lesions (e.g., keratoses) (P < 0.001). More patients than controls recalled having been exposed to the sun for long periods when they were 6-13 years of age. A conditional logistic regression analysis showed that fair hair, fair vulnerable skin, and additional skin lesions were independently associated with malignant melanoma (P < 0.01). The main target population for interventions to reduce the incidence of malignant melanoma among kibbutz members should be individuals with these risk factors. A history of increased exposure to the sun from age 6 to 13 should also be taken into account as an independent risk factor.
    The Israel Medical Association journal: IMAJ 11/1999; 1(3):154-7. · 0.90 Impact Factor
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    ABSTRACT: Knowledge and practice of primary care physicians as to diagnosis and treatment of group A, b-hemolytic streptococcal pharyngitis, and the degree to which they agreed with the medical literature and current clinical guidelines were examined. The study was conducted in a group of 195 general physicians, pediatricians, and family medicine specialists and residents. The data were collected using questionnaires which included personal information and questions relating to b-hemolytic streptococcal pharyngitis and were analyzed by chi-square and t-tests, and logistic regression, as appropriate. A new dependent variable, good clinical practice (GCP), was defined as the total number of correct answers to the questions in the questionnaire. 147 of the 195 eligible physicians returned completed questionnaires, a compliance rate of 76%. 96.6% cited penicillin V as the drug of choice at a daily dosage of 1 g (43.7%) or 2 g (25.4%), for 10 days (90%). 133 physicians (90%) stated that the goal of penicillin therapy for b-hemolytic streptococcal pharyngitis is to prevent late complications. 116 physicians (82%) cited rheumatic fever as a complication of group A b-hemolytic streptococcal pharyngitis, preventable by appropriate antibiotic therapy. However, only 84 (59%) cited glomerulonephritis as a preventable complication. When the knowledge and attitudes of the respondents was analyzed in terms of the new variable, GCP, a significant association (p < 0.001) was found between physicians' attitudes and variables such as where they had studied medicine, and work seniority. Those with less seniority and or medical graduates of the Americas demonstrated greater knowledge and better clinical judgment than their more senior colleagues and graduates of European and Asian medical schools. Most primary care physicians in northern Israel treat group A b-hemolytic streptococcal pharyngitis as recommended in the medical literature. The level of medical studies in Israel and the Americas and the quality of training of residents in family medicine and pediatrics, have a positive influence on the degree of knowledge of as common a subject as b-hemolytic streptococcal pharyngitis. Emphasis should be placed on continuing medical education among primary care physicians, particularly veteran general physicians and those who studied in European or Asian medical schools.
    Harefuah 04/1999; 136(6):438-41, 515.
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    ABSTRACT: To find the optimal antibiotic treatment for ophthalmic infections in an Israeli hospital. In a retrospective study from our laboratory, which serves as both a primary and secondary referral center, we analyzed the bacteriological profile and the antibiotic sensitivity of ophthalmic infections using the computerized laboratory reports of 331 consecutive ophthlamic bacteriological cultures from patients with various ophthalmic infections. Microbiological growth was obtained in 113 samples (34.1%). The most commonly isolated organism was coagulase-negative staphylococcus (19.5%), followed by coagulase-positive staphylococcus (16.8%), Enterobacteriaceae (14.2%), Pseudomonas aeruginosa (13.3%), and streptococcal species (8.9%). Pseudomonas species were the most common isolates from the lacrimal pathways (20.0%). Streptococci were the most common isolates cultured from the conjunctiva (27.3%). Coagulase-positive staphylococcus was the most common isolate from corneal ulcers (33.3%), and coagulase-negative staphylococcus from the vitreous (30.8%). The overall antibiotic sensitivity of common ophthalmic pathogens was similar to that reported from other parts of the world. Although essentially similar to previous series, this report from the Middle East differs as follows. Firstly, Pseudomonas species were the most common isolates from the lacrimal pathways. Secondly, the overall rate of streptococcal isolates was lower than in previous reports. Thirdly, streptococcal species were rarely isolated from corneal samples. Although other studies from the region have described the causative organisms of ocular infections in specific ocular sites, this is the first study from the Middle East to summarize the full bacteriological profile of ocular infections in one medical center.
    European journal of ophthalmology 01/1999; 9(2):120-4. · 1.06 Impact Factor
  • M Shapira, A Tamir
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    ABSTRACT: Ulcerative colitis (UC) is prevalent among Jews around the world, as well as in Israel. We evaluated the incidence rates of the disease in one of the northern districts of Israel (Kinneret) by religion and by type of settlement. The population in this district is composed of Jews who have immigrated to Israel in the last century from various countries all over the world, and from Arabs. The study population included all residents of Kinneret district diagnosed with UC between 1965 and 1994. The mean annual incidence rate of UC in the 30 years covered in this survey (1965-1994) proved to be 3.5/100,000. A trend of increase in the incidence rate was observed until 1989. It was most prominent among the Jewish rural settlements. Since 1989, the rates have been declining. Prevalence rates were 87/100,000 among the Jewish population, and 27/100,000 among the Arab population. Both prevalence and incidence rates were 2.5 times higher among Jews than among Arabs. We include that (1) UC morbidity had been increasing until 1989 and has been decreasing moderately ever since; (2) the lowest morbidity was found in the Arab population; and (3) the highest morbidity was found among the Jewish rural population.
    Journal of Clinical Gastroenterology 10/1998; 27(2):134-7. · 3.19 Impact Factor
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    ABSTRACT: We aimed to analyse factors influencing referral of patients by primary care physicians to specialist consultants at the beginning of the era of direct access to specialists in Israel. We carried out a study of referrals by family physicians to specialists over a continuous period of 3 months. Twenty-four certified family physicians filled in a questionnaire detailing referrals during the study period. All patients were referred for consultation to a specialist at regional speciality clinics or hospital out-patient departments. Ten physicians met the study conditions. In 1140 of 10896 (10.5%) visits, patients were referred to specialist consultants. The percentage of referral ranged from 7.4 to 15.9%. The difference between the physicians with the lowest and highest rates of referral was statistically significant (P < 0.0001). The variance in referral rates was not explained by significant differences in physician or practice variables. The types of specialists to whom the most referrals were made were orthopaedic surgeons, ophthalmologists, dermatologists, ear, nose and throat, general surgeons and plastic surgeons. There was a significant correlation between the type of specialist and the age of the patient. Older patients were referred more frequently to urologists, cardiologists and ophthalmologists, while younger patients were referred more frequently to ear, nose and throat specialists and gynaecologists (P < 0.01). The results of this study can be used as an aid for decision makers in the health services for determining policy. Direct access to some specialties might be appropriate, but not to all. Adoption of a policy based on these findings could lead to reduced health care costs by reducing the burden on hospital emergency rooms. It might also increase patient satisfaction in that the patients will have greater freedom of choice. On the other hand, more appropriate training of family physicians and more extensive self- and peer-quality assurance will increase the primary physician's knowledge and ability to diagnose and treat a broad range of problems and improve the level of care.
    Family Practice 05/1998; 15(2):158-64. DOI:10.1093/fampra/15.2.158 · 1.84 Impact Factor
  • M. Shapira, A. Tamir
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    ABSTRACT: Ulcerative colitis (UC) is prevalent among Jews around the world, as well as in Israel. We evaluated the incidence rates of the disease in one of the northern districts of Israel (Kinneret) by religion and by type of settlement. The population in this district is composed of Jews who have immigrated to Israel in the last century from various countries all over the world, and from Arabs. The study population included all residents of Kinneret district diagnosed with UC between 1965 and 1994. The mean annual incidence rate of UC in the 30 years covered in this survey (1965-1994) proved to be 3.5/100,000. A trend of increase in the incidence rate was observed until 1989. It was most prominent among the Jewish rural settlements. Since 1989, the rates have been declining. Prevalence rates were 87/100,000 among the Jewish population, and 27/100,000 among the Arab population. Both prevalence and incidence rates were 2.5 times higher among Jews than among Arabs. We include that (1) UC morbidity had been increasing until 1989 and has been decreasing moderately ever since; (2) the lowest morbidity was found in the Arab population; and (3) the highest morbidity was found among the Jewish rural population.
    Journal of Clinical Gastroenterology 01/1998; 27(2):134-137. DOI:10.1097/00004836-199809000-00006 · 3.19 Impact Factor
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    ABSTRACT: Because Helicobacter pylori is an acid-sensitive organism, an elevation of the gastric pH by H2 inhibitors might improve the intragastric conditions for the development of this organism. We tested this hypothesis in a prospective and controlled trial including 43 patients positive for H. pylori using the rapid urease test. Twenty-six patients received 150 mg ranitidine twice daily and 17 patients received no treatment. The 14C-urea breath test was performed in both groups at the beginning of the study and 2 weeks later. Radioactive 14C in exhaled carbon dioxide was significantly increased (p = 0.045) in the patients treated with ranitidine, compared with the patients in the control group. Administration of this drug to patients infected with H. pylori is associated with an increase in the bacterial load after 2 weeks of treatment. This phenomenon might be attributed to increased bacterial growth due to the H2 blocker.
    Journal of Clinical Gastroenterology 08/1997; 25(1):323-7. DOI:10.1097/00004836-199707000-00005 · 3.19 Impact Factor
  • M Shapira, A Tamir
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    ABSTRACT: We evaluated what effect an escort present during upper endoscopy had on the attitude and anxiety level of patients and on the escorts. The study consisted of 206 patients (ages 15-85, 47% male) and their escorts. Both patients and escorts were interviewed before the procedure. Escorts were then randomly divided into two groups-on-the-spot escorts, who present throughout the procedure, as opposed to waiting-room escorts. Both groups were reinterviewed following the procedure. Before the procedure, 80% of the patients understood the nature of endoscopy. Thirteen percent believed the procedure to be dangerous, and only 33% were totally worry-free. Fifty percent preferred to be escorted during the procedure, while 17% refused. Following the procedure, 89% of the patients who were escorted in the endoscopy room expressed satisfaction. Fifty-two percent of the patients found the procedure to be mild, with a higher proportion among escorted patients. Among the escorts, 63% felt that their close presence had lessened their own fears and anxiety regarding the procedure, and 72% believed their presence to have been supportive to the patient. Having an escort present throughout endoscopy appears to be a promising approach.
    Journal of Clinical Gastroenterology 07/1996; 22(4):272-4. · 3.19 Impact Factor
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    ABSTRACT: 339 adult immigrants from Ethiopia were surveyed 1 year after arrival. They were screened for diabetes mellitus and impaired glucose tolerance by measurement of serum HgbA1C levels. The levels were higher than normal in 35 subjects (10.3%), and were significantly higher in immigrants consuming the Israeli diet, which is richer in proteins and carbohydrates, than in those on the Ethiopian diet. Oral glucose load was abnormal in 7 subjects. 3 had overt diabetes mellitus with absent serum insulin response to glucose load. 4 had glucose intolerance with normal insulin secretion. However, clinical appearance of diabetes was incidental and diabetes ketoacidosis was not detected. The overall prevalence of diabetes mellitus and glucose intolerance in this ethnic group (2.1%) is similar to that in the general population of Israel. Longitudinal studies would indicate the exact prevalence and type of diabetes mellitus among the Ethiopian immigrants.
    Harefuah 05/1995; 128(7):406-8, 464.
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    ABSTRACT: A survey study was performed to assess the prevalence of goiter and thyroid dysfunction in a population of 534 Ethiopian children, one year after arrival in Israel. The overall prevalence of goiter was 43.6%. Children in the age group 1-2 years had the lowest prevalence of goiter (6.7%). A progressive increase in goiter prevalence and size with age was observed, with peak occurrence around puberty for both boys (56.7%) and girls (72.2%). Serum FT4 levels were elevated in 4 children; elevated serum TSH levels (above 4.5 mIU/l) were found in 11 children, all of them had normal FT4 levels. Thus the prevalence of hypothyroidism and hyperthyroidism was 2% and 0.8%, respectively, with an even distribution across the various age groups. All the children were clinically normal. The high prevalence of goiter in this group of Ethiopian children with the low frequency of hypothyroidism may be attributed to the combined effects of food goitrogens and iodine deficiency prevailing in Ethiopia. The standard Israeli diet seems to be adequate in respect to iodine requirements, and no iodine enrichment is needed for children immigrating from Ethiopia.
    Journal of pediatric endocrinology & metabolism: JPEM 01/1995; 8(2):123-5. DOI:10.1515/JPEM.1995.8.2.123 · 0.71 Impact Factor
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    ABSTRACT: 1131 immigrants from Gonder, Ethiopia were surveyed a year after arrival in Israel. The overall prevalence of goiter was 46.1%; the lowest rates (6.7%) were in infants (aged 1-2 years) and the peak prevalence in males was 56.7% (in those aged 12-14 years) and in females, 77.7% (in those aged 35-40). A significant decrease in goiter prevalence was observed after the age of 60 for both men (7.2%) and women (35%). The prevalence of hypothyroidism was 1.1%, 2% in children and 0.2% in adults. That of hyperthyroidism was 1.7%, 0.8% in children and 2.4% in adults. The high prevalence of goiter and hyperthyroidism with low prevalence of hypothyroidism probably resulted from the combined effects of food goitrogens and iodine deficiency in Ethiopia, with the latter playing only a minor role. Neither factor was in effect after arrival in Israel. Genetic and hormonal factors may contribute to the low prevalence of both goiter and hypothyroidism in the adult males. In view of the high prevalence of hyperthyroidism, iodine enrichment is not recommended for Ethiopian immigrants.
    Harefuah 12/1994; 127(9):289-93, 360.
  • M Shapira, A Tamir
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    ABSTRACT: Crohn's disease has been predominant in Jewish patients in some countries (USA, UK, Sweden). The purposes of this study were: to continue to map the morbidity in Israel and the trends of the rate over time. The mean annual incidence rate in the Kinneret sub-district among Jews was 1.96/100,000 during 1960-1990 and 2.98/100,000 in the last decade. The prevalence rate in 1990 among Jews was 45.9/100,000 and was twofold among European-American-born compared to other ethnic groups. No cases were found among Arabs, although they make up about 25% of the area's population. The conclusions are: (1) morbidity rate of Crohn's disease increased over time, and (2) in the last decade incidence rates among Jews of Asian-African origin are similar to, or even higher than those of European-American origin.
    European Journal of Epidemiology 05/1994; 10(2):231-3. DOI:10.1007/BF01730377 · 5.15 Impact Factor
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    ABSTRACT: Prospective studies showed that hypersecretion of albumin in the urine of patients with type 2 diabetes mellitus is associated with high morbidity and mortality from cardiovascular disease and nephropathy. 65 type 2 diabetes from 6 family medicine practices were studied. Microalbuminuria was found in 37% and was significantly more common in men than in women (53% and 23%, respectively; p < 0.02). Uncontrolled blood glucose levels were also more common in men (p < 0.03). Using logistic regression with microalbuminuria as the dependent variable, a significant correlation was found with male gender, fasting blood glucose 155 mg/dl or more, and systolic blood pressure 159 mm Hg or higher. Among those with microalbuminuria, ischemic heart disease was significantly more common in those 65 years or older than in those younger (p = 0.02). This study strengthens the assumption that type 2 diabetics with microalbuminuria might be at greater risk for developing ischemic heart disease. Strict detection and control are recommended.
    Harefuah 05/1994; 126(7):377-80, 426.
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    ABSTRACT: The incidence of unexpected death in infancy (UDI) (2 weeks-12 months) in the Haifa area is 1.17 per 1000 live births. We found a significant interethnic difference between Israeli Jews and Arabs. The incidence among Arabs was 4 per 1000, but was only 0.77 per 1000 among Jews (p < 0.01). When the UDI Jewish group was compared to both the group of infants dying of known causes and the surviving group, the only significant factors related to UDI were found to be: young maternal age and low maternal education. No such association was evident among Arabs. Following logistic regression analysis, low maternal age and low socioeconomic status, but not ethnicity, were significantly associated with UDI as compared to the non-UDI infants. In comparison to non-UDI, UDI was significantly more prevalent during the cold season. UDI incidence has apparently been stable over the past 15 years. Demographic risk factors are similar to those reported from other communities, and ethnicity is possibly mediated through those factors.
    European Journal of Epidemiology 02/1994; 10(1):3-8. · 5.15 Impact Factor
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    ABSTRACT: We studied 257 patients scheduled for cataract surgery for possible correlation with systemic diseases, blood chemistry, and environmental exposure. We found that posterior subcapsular cataract appeared in patients 10 years younger on average than those with other types of cataract. Nuclear cataract patients had higher blood levels of uric acid and creatinine and lower blood levels of calcium. We suggest capsular insult as a possible pathophysiological explanation for cataract formation in young age groups (as well as diabetes) and a toxic effect of blood metabolites in patients with renal failure, resulting in earlier and more prevalent sclerosis of lens fibers. No effect of smoking or of exposure to sunlight on the distribution of various types of cataracts was noted.
    Metabolic, pediatric, and systemic ophthalmology (New York, N.Y.: 1985) 02/1994; 17(1-4):34-7.
  • P Shvartzman, M Caspi, A Tamir
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    ABSTRACT: This study investigates the use of a mobile intensive care ambulance (MICA) by primary care teams in a large, semi-rural health district in northern Israel. We reviewed the MICA records covering three years for all calls from a doctor or a nurse working in a community primary care clinic. Over the period studied, there were 649 such calls. Two-thirds of the patients were male, 70.5% were aged 60+ and only 2% were children under the age of one year. Of the total, 358 (55.2%) calls originated from kibbutzim (communal settlements), although only 7.5% of the district's population lives on such settlements. There were 12 calls (1.9%) from Arab villages, where 27.5% of the district population resides. The MICA personnel were more intervention prone than was the primary care team. The service was utilized mainly for cardiovascular emergencies and, in this study, children and residents of Arab villages appear to have been underserved. There was a disproportionately high representation of elderly kibbutz members. There is a need for further research to assess standards for emergency equipment in primary care clinics, and continuous training of the primary care team. Introduction of a high service technology such as the MICA might be a problem in certain populations.
    Public health reviews 02/1994; 22(1-2):47-54.
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    ABSTRACT: The incidence of unexpected death in infancy (UDI) (2 weeks–12 months) in the Haifa area is 1.17 per 1000 live births. We found a significant interethnic difference between Israeli Jews and Arabs. The incidence among Arabs was 4 per 1000, but was only 0.77 per 1000 among Jews (p
    European Journal of Epidemiology 01/1994; 10(1):3-8. DOI:10.1007/BF01717444 · 5.15 Impact Factor

Publication Stats

238 Citations
84.65 Total Impact Points

Institutions

  • 1999
    • Sheba Medical Center
      Gan, Tel Aviv, Israel
  • 1994–1999
    • Rambam Medical Center
      • Department of Ophthalmology
      H̱efa, Haifa District, Israel
  • 1993–1994
    • Ben-Gurion University of the Negev
      • Faculty of Health Sciences
      Be'er Sheva`, Southern District, Israel
  • 1990–1994
    • Technion - Israel Institute of Technology
      H̱efa, Haifa, Israel
  • 1992–1993
    • Bnai Zion Medical Center, Haifa
      H̱efa, Haifa District, Israel
  • 1989
    • Carmel Medical Center
      H̱efa, Haifa District, Israel
  • 1988
    • Western Galilee Hospital
      Nahariya, Northern District, Israel