Mary Rudolf

• MB BS BSc DCH FRCPCH
• Public health at Bar Ilan University

Background War and collective trauma significantly affect children’s physical and mental well-being. Pediatricians, as frontline healthcare providers, play a critical role in mitigating these impacts. However, many lack the training necessary to effectively address the complex needs of children affected by war. This study assesses the state of pedi...

Objective: To investigate primiparous women’s partners for knowledge, attitudes, and practices regarding the physical home food environment (PHFE), and to assess if the first pregnancy provides a teachable opportunity to enhance the PHFE of first-time pregnant couples. Design: This was a two-phase longitudinal in-depth qualitative study involving q...

Background Rising mental health challenges among children and adolescents are a global concern. However, a shortage of professionals, inadequate competence and lack of resources hamper necessary care, presenting a major challenge to health service provision. Community pediatricians, frequently the initial contact for mental health issues, are in a...

Objective: To investigate primiparous women’s knowledge, attitudes, and practices regarding the physical home food environment (PHFE) and to assess if the first pregnancy provides a teachable opportunity to enhance the PHFE of first-time pregnant couples. Design: Longitudinal in-depth qualitative study involving questionnaires and individual interv...

Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in...

Background There are ongoing changes around the world in the training and practice of pediatricians who work in the community. These changes are driven by the understanding that pediatricians are required to provide not only acute primary care but also to address more comprehensive concerns, particularly the ‘new morbidities’. The present study exa...

Background In 2017, the Bipartisan Policy Center called for inclusion of lifestyle medicine (LM) in undergraduate medical education. Recognizing the requirement that lifestyle medicine should be an integral and integrated part of the curriculum, we undertook an in-depth mapping process to determine the extent of LM teaching at our Faculty, staff pe...

Background: There is consensus that medical schools have a duty to educate students about social determinants of health (SDOH) and equip them with skills required to ameliorate health disparities. Although the National Academy of Medicine (NAM) urged the development of experiential long term programs, teaching is usually conducted in the pre-clini...

Background Child home injuries prevention interventions have rarely been implemented in hospitals. The SHABI program (“Keeping our Children Safe”; in Hebrew: “SHomrim Al BetIchut Yeladenu”) recruits at-risk families arriving with child injury to the Emergency Department. Medical/nursing students conduct two home visits four months apart, providing...

Background: Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many doctors feel unskilled and medical schools lack its inclusion in their curricula. The impact of a novel elective lifestyle course is described, where students provided 3 months' coaching to at-risk patients. Methods: Students' attitudes, competence an...

Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk famili...

Background Future practitioners need to learn to communicate with culturally diverse patients, understand their perspectives on disease and provide individually tailored guidance. SHABI (Keeping our Children Safe in Hebrew) is a program set up with a dual purpose of improving families' home-safety and providing students with experience-based learni...

Background Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important point in time for intervening. The SHABI program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits, four months apart and provide safety eq...

Health Exercise Nutrition for the Really Young (HENRY) is a UK community-based early childhood obesity prevention intervention that was adopted and implemented in Israel between 2013 and 2018. The aim of this study was to explore the implementation process in Israel and compare it with that of the 'parent' programme in the UK, in order to throw lig...

Background Eating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the...

Background Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, whil...

Background: Bottom-up approaches to disparity reduction present a departure from traditional service models where health services are traditionally delivered top-down. Raphael, a novel bottom-up social incubator, was developed in a disadvantaged region with the aim of 'hatching' innovative health improvement interventions through academia-communit...

The published version of the book had unclear figures in chapter 8. This has been corrected, and the Figures 8.1, 8.2 and 8.3 have been updated in the book.

Background The Arab population in Israel is a minority ethnic group with its own distinct cultural subgroups. Minority populations are known to underutilize genetic tests and counseling services, thereby undermining the effectiveness of these services among such populations. However, the general and culture-specific reasons for this underutilizatio...

Medical education needs to continuously evolve to accommodate and address new challenges and advances in medicine. While medical students tend to embrace new technologies and treatments, they are often less enthusiastic about newer concepts of health, particularly if they demand the acquisition of skills that they believe are less relevant. A class...

Objective The purpose of this study was to assess the impact of a new experience-based educational program aiming to teach social determinants of health (SDH) and health disparities, through a post-discharge home-visit conducted with patients recruited in hospital. Methods 105 clinical-year students visited 177 patients living in disadvantaged cir...

The ‘First Thousand Days’ refers to the period from conception to the child’s second birthday. It is increasingly gaining traction as a concept to guide public health policy. It is seen as a crucial window of opportunity for interventions that improve child and population health. This review outlines the origin and growth of the First Thousand Days...

White Rose Research Online The impact of HENRY on parenting and family lifestyle: Exploratory analysis of the mechanisms for change Bridge, GL, Willis, TA , Evans, CEL et al. (2 more authors) (2019) The impact of HENRY on parenting and family lifestyle: Exploratory analysis of the mechanisms for change. Child: Care, Health and Development, 45 (6)...

Background: Childhood obesity is a major public health concern. In the UK, a quarter of children are overweight or obese at age five years. Overweight and obese children are more likely to develop serious health issues such as diabetes later in life. Consequently, there is an urgent need for effective, early obesity prevention and intervention. Th...

Guided by the psycho-social environment approach to explaining health inequalities, this cross-sectional study aimed to assess the contribution of individual and community factors to explaining ethnic inequalities in overweight and obesity between Arab and Jewish mothers of young children in Israel. Data (N = 946, 371 Jewish, 575 Arab mothers) were...

Background The prevalence of obesity in childhood is of high concern, especially in deprived populations. We explored trends in obesity following the introduction of a citywide strategy focused on preschool children. Methods Analysis of obesity prevalence using the National Child Measurement Programme 2009 to 2017 for primary‐school children in Le...

Objective: Existing research on recurrent unintentional injury (UI) focuses on the individual child rather than family risks. This study developed a statistical model for identifying families at highest risk, for potential use in targeting public health interventions. Study design: A retrospective birth cohort study of hospital and emergency room (...

ABSTRACT Background: Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 livebirths in Tel Aviv, Israel. Methods: Longitudinal exposure to mean of greenne...

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI). Background: High maternal BMI is associated with negative body image and restrained eating, wh...

Background and Aims: Scientific evidence regarding protective factors that contribute to healthy weight in childhood is limited and is particularly scarce in lower socio-economic populations in different ethnic groups. This study aimed to assess the prevalence of biological, behavioral and psychosocial factors for child overweight/obesity in Jewish...

Promoting healthy lifestyle from early childhood is a key objective in public health, yet health behaviors are often culturally driven, especially in closed-religious communities. This study aims to reveal key cultural-religious aspects of attitudes and behaviors regarding lifestyle in one such closed community—the ultra-orthodox Jewish community....

Objectives: Teaching the social determinants of health using classroom methods and medical settings is not effectual, yet few institutions require students to undertake placements in non-clinical settings. We sought to understand through qualitative investigation how non-clinical community placements contributed to students' understanding of healt...

Trends in birthweight and abnormal fetal growth, namely term low birthweight (LBW), macrosomia, small-for-gestational age (SGA) and large-for-gestational age (LGA), are important indicators of changes in the health of populations. We performed this epidemiological study to evaluate these trends among 2,039,415 singleton live births from Israel over...

Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these...

Background. Doctors have a special role in helping patients make lifestyle changes, and they are more credible and effective if they are role models. Yet few medical schools have incorporated lifestyle medicine into their curricula. We ascertained the influence of a lifestyle medicine curriculum during the first year of medical school. Methods. The...

Background: The unique characteristics of the next generation of medical professionals in Israel and the current model of physician employment in the country may pose a real threat to the high quality of both public clinical care and medical education in the near future, and to the continued flourishing of clinical research. According to the Israe...

Objectives: One in five children in England are overweight/obese at school entry. Tackling obesity is therefore a priority. Right from the Start with HENRY is a widely-commissioned programme delivered by trained facilitators to small groups of parents over eight weekly sessions. It is designed to provide parents of infants and preschool children w...

Background Definitions of social accountability describe the obligation of medical schools to direct education, research and service activities towards addressing the priority health concerns of the population they serve. While such statements give some direction as to how the goal might be reached, it does not identify what factors might facilitat...

The Bar Ilan Faculty of Medicine places public health as a priority in its medical curriculum, emphasizing its importance by strategically placing the required course as first on entry into medical school. Students are introduced to the importance of population health and community engagement through participatory community learning experiences. Th...

This study examined the relationship between self-esteem, restrained eating, body image and body mass index during pregnancy. A total of 110 pregnant Israeli and UK women completed the Rosenberg Self-Esteem Questionnaire, the Dutch Eating Behaviour Questionnaire, scales to assess body image and demographics. Body mass index was calculated from ante...

We examined mealtime interactions to assess whether they varied according to maternal body mass index, country and mode of feeding in 41 Israeli and UK mother-infant dyads. Feeding behaviours were coded using the Simple Feeding Element Scale. Significantly, more UK mothers breastfed during the filmed meal compared to Israeli mothers. Mealtime inter...

The role of medical schools is in a process of change. The World Health Organization has declared that they can no longer be ivory towers whose primary focus is the production of specialist physicians and cutting edge laboratory research. They must also be socially accountable and direct their activities towards meeting the priority health concerns...

To investigate whether children with obesity experienced more erosion and caries than children with normal weight. This study involved children aged 7-15 years. The study and control group comprised 32 children with BMI > 98th centile and 32 healthy children with normal BMI-for-age, respectively. O'Sullivan Erosion Index and WHO Caries Index were u...

This study examined the relationship between self-esteem, restrained eating, body image and body mass index during pregnancy. A total of 110 pregnant Israeli and UK women completed the Rosenberg Self-Esteem Questionnaire, the Dutch Eating Behaviour Questionnaire, scales to assess body image and demographics. Body mass index was calculated from ante...

Background: One-quarter of children in England are overweight/obese at school entry. We investigated the impact of a programme designed to provide parents of infants and preschool children with the skills required for a healthier family lifestyle. Method: A cohort of families was followed across the 8-week HENRY (Health Exercise Nutrition for th...

Childhood obesity has reached epidemic levels, yet many health professionals lack confidence in working with parents around lifestyle change. HENRY (Health Exercise Nutrition for the Really Young) aims to tackle this through training practitioners to work more effectively with parents of preschoolers around obesity and lifestyle issues.We evaluated...

Background: Childhood obesity has significant impact on future health and economic consequences. Evidence of effectiveness of interventions is developing, although little is known about costs. Therefore, the direct costs to health care and other public sector agencies of a pilot community-based childhood obesity treatment programme were estimated....

A promising but costly approach In the United Kingdom, a quarter of children are already overweight by the time they start school at the age of 5 years.1 Primary prevention therefore needs to start well before school age, particularly because heavy babies and rapid weight gain at this time are associated with the development of obesity later in li...

This expert opinion provides detailed guidance on assessing obesity in secondary paediatric practice. This guidance builds on existing recommendations from National Institute of Health and Clinical Excellence in the UK, and is evidence based where possible. Guidance is provided on which obese children and young people are appropriate to be seen in...

Background and aims Assessing growth around puberty is difficult and children with later onset of puberty may be mislabelled as abnormal. When designing new school age charts a lower pubertally adjusted (PA) 0.4th centile was added to the prototype chart for children aged 8-13 still in pre-puberty, with shading between this and the standard 0.4th c...

Body mass index (BMI) is the pragmatic measure to assess children's obesity clinically and BMI charts are widely used for counselling families about children's weight management over time. To explore the variability in clinicians' interpretation of BMI patterns and to ascertain the diagnostic accuracy of their judgement by relating it to change in...

Background: Many obese children attending weight management interventions experience positive changes; however, not all are successful and little is known about what factors influence treatment outcome. The present study aimed to assess which baseline characteristics may predict unsuccessful treatment outcome in a weight management intervention for...

Background: One in four children in England is overweight/obese upon starting school. HENRY (Health Exercise Nutrition for the Really Young) offers a novel, preventive approach to this problem by training practitioners to work more effectively with the parents of preschool children around obesity and lifestyle issues. The programme is being deliver...

Treatment for childhood obesity is characterised by high attrition rates and failure to achieve weight maintenance. It is therefore important to develop more effective programmes. The aim of the present qualitative study was to explore the views of parents, children and health trainers to identify issues which can inform the development of more eff...

Increased understanding of the risk factors for childhood obesity has raised the possibility of identifying infants who are at risk of becoming overweight or obese, enabling early intervention for infants at high risk. This paper considers the known risk factors, describes statistical work aimed at identifying risk, and considers the ethical and pr...

In the evaluation of childhood obesity interventions, few researchers undertake a rigorous feasibility stage in which the design and procedures of the evaluation process are examined. Consequently, phase III studies often demonstrate methodological weaknesses. Our aim was to conduct a feasibility trial of the evaluation of WATCH IT, a community obe...

Background: Despite epidemic numbers of obese and overweight pre-school children, professionals report a lack of confidence and self-efficacy in working with parents around lifestyle change. HENRY--Health Exercise Nutrition for the Really Young--trains health and community practitioners to work more sensitively and effectively with parents of babi...

Infant growth and lifestyle are now recognized as being critical determinants of later obesity. EMPOWER (Empowering Parents to Prevent Obesity at Weaning: Exploratory Research) was developed as an intervention for parents whose babies are at high risk. Delivered by specially trained health visitors, it is underpinned by the Family Partnership Model...

Child health issues are of high importance in the occupied Palestinian territories, where half of the population are children. The Royal College of Paediatrics and Child Health have developed a comprehensive paediatric training programme for primary healthcare providers with the aim of improving child health in the area. The course has taken 8 year...

Paediatric referrals for obesity are increasing. The paediatric literature provides good guidance for the management of older children, but there is little relating to obese babies and toddlers. This article offers a guide for paediatricians encountering obese infants and preschool children in the paediatric outpatient setting. The paediatricians'...

The UK Department of Health for England and Wales has issued guidance to all local Primary Care Trusts (PCTs), who have responsibility for school nursing services, for the annual weighing and measuring of all children on entry to primary school and in Year 6 (age 5 and 11 years respectively), known as the National Child Measurement Programme. The g...

The aim of this study was to ascertain whether health care professionals are able to accurately identify overweight and obese children by observation alone. Eighty health care professionals were asked to view photographs of 33 children and assign each into one of six categories, ranging from "very underweight" to "obese". The health care profession...

This article explores the impact that schools have on their pupils' obesity and so identify those where targeted input is most needed. A modelling process was developed using data that had been collected over 2 years on a socio-economically and ethnically representative sample of 2367 school pupils aged 5 and 9 years old attending 35 Leeds primary...

To develop and evaluate "Families for Health", a new community based family intervention for childhood obesity. Programme development, pilot study and evaluation using intention-to-treat analysis. Coventry, England. 27 overweight or obese children aged 7-13 years (18 girls, 9 boys) and their parents, from 21 families. Families for Health is a 12-we...

To determine the effectiveness and cost-effectiveness of height screening (of children aged 4 to 11) to identify height-related conditions. Systematic review and economic modelling. We included published and unpublished screening studies of any design, except case reports, conducted in any setting that measured children's height as part of a popula...

The UK Government has set a target of halting the rise in childhood obesity by 2010. However, at the time the target was set, no monitoring process existed. The English Department of Health has now issued guidelines to primary care trusts for the annual weighing and measuring of all children on entry to primary school and in year 6. Development of...

Obese children are at high risk of developing co-morbidities, with a prevalence of abnormal tests ranging from 30 to 58%. Recent guidance recommends that all children with a body mass index (BMI) above the 95th centile be investigated. This study aimed to determine the prevalence of abnormal results in an urban paediatric population and to compare...

The present study followed a group of 608 children, aged 7-11 years from six primary schools, for whom detailed dietary information was available. These children were traced four years later when they were in secondary school. The aim of the study was to investigate the relationship between the original dietary pattern, current dietary pattern, too...

To clarify the role of growth monitoring in primary school children, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes. Electronic databases were searched up to July 2005. Experts in the field were also consulted. Data extraction and quality assessment were performed on studies...

Continuity of care would result in a better standard of care As doctors working in a busy clinic alongside colleagues, we often encounter a number of patients whom we have never met before. Within the allocated time, we have to become rapidly acquainted with the patient’s previous history, develop a rapport and move on to address the patient’s pre...

Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screen...

Waist circumference is a measure of potential value in paediatrics, given its relation to cardiovascular risk in adults. However, three different methods of measurement are currently in use, giving potential for confusion. This study was undertaken to assess consistency across the measures in a population of overweight and normal weight children. W...

The alarming increase in the worldwide prevalence of childhood obesity is now recognised as a major public health concern. Failure to isolate and understand the external and internal factors contributing to successful weight loss may well be contributing to the ineffectiveness of current treatment interventions. To identify the physical and psychol...

The WATCH IT programme was developed to address the needs of obese children from disadvantaged communities in Leeds and has been running since January 2004. Results of the pilot phase, prior to a randomised controlled trial, are presented. A process evaluation to assess success of implementation was conducted in December 2004. User views (parent an...

The government has set a target to halt the rise in childhood obesity in those aged under 11 by 2010, but no system is in place to ascertain if this has been achieved. We aimed to develop a simple and reproducible methodology to monitor trends in childhood obesity. A purposive sample of 10 primary schools and three secondary schools was selected. C...

Childhood obesity has become a major concern of public health over the last decade. Obesity prevention programmes show limited success and the evidence base is weak. Experience with school-based obesity prevention research in Leeds highlighted the felt needs of children who were already obese, and a project was set up to attempt to meet those needs...

To ascertain the long term outcomes in children diagnosed as having failure to thrive (FTT). Systematic review of cohort studies. Medline, Psychinfo, Embase, Cinahl, Web of Science, Cochrane, and DARE databases were searched for potentially relevant studies. Inclusion criteria: cohort studies or randomised controlled trials in children <2 years old...