Unexpected death in infancy. An epidemiologic study in the Haifa district, Israel

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.

Bowel habits in Israel. A cohort study

We interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)--about their bowel habits, laxative use, and beliefs about bowel action. Using stepwise logistic regression, we found that the following variables were significantly and independently related to bowel frequency: (a) sex--male > female (p = 0.0001); (b) age--young > old (p = 0.0001); (c) physical activity--high > little (p = 0.001); (d) body habitus--lean > obese (p = 0.02); (e) marital status--married > single (0 = 0.009); and (f) ethnic group--Arab > Jewish (p = 0.004). Regular use of laxatives was found in 18.4% of women and 10.8% of men (p < 0.0001). This habit was more common among Ashkenazi Jews (17%) than among Sephardi and Oriental Jews (10.7%) and Arabs (4.8%). Laxative intake was higher among the elderly (p = 0.0001) and the obese (p = 0.0004). Concerning the "ideal" bowel frequency, 12.4% of the Ashkenazis, 22.7% of the Sephardis and Oriental Jews, and 26.1% of the Arabs preferred to have at least 9 movements per week. Strikingly, 51.8% of all interviewed believed that constipation was "harmful to health;" women were more concerned than men (56.3% versus 47.5%). Subjects with a high level of education were significantly more concerned about constipation.

Didanosine (ddI) and zidovudine (ZDV) susceptibilities of human immunodeficiency virus (HIV) isolates from long-term recipients of ddI

Thirty HIV isolates, obtained from 15 patients before and after receiving single drug therapy with didanosine (ddI), were examined for sensitivity to ddI and zidovudine (ZDV) using a peripheral blood mononuclear leukocyte (PBML)-based assay. Fourteen of the patients had ARC, one had AIDS and 12 had received previous therapy with ZDV. After a median of 1 year of ddI therapy, isolates were significantly less sensitive to ddI than were isolates obtained prior to therapy (P = 0.03). A decrease in ddI sensitivity was observed in ten of the 15 isolate pairs. In contrast to ddI susceptibilities, sensitivity to ZDV increased over the same period of time (P = 0.03). Additional isolates were obtained from four patients who received ddI monotherapy for 2 years. Three of these isolates demonstrated no change in ddI sensitivity compared to baseline. No correlation could be made in this study between development of decreased ddI sensitivity and serum p24 levels, CD4 counts, or clinical outcome. Decreased ddI sensitivity occurs frequently among HIV isolates obtained from long-term recipients of ddI. This decreased sensitivity is modest in degree and is of unknown clinical significance.

[Characteristics and perceptions of physician managers in Israel]

In a survey of 120 physician managers (PM) of the Israel Ministry of Health and the General Sick Fund (Kupat Holim), demographic and managerial characteristics and perceptions of what is important for effective performance were studied. Medical directors of hospitals, districts and Kupat Holim clinics were included. The majority of the respondents had some training in medical management. 33% are family physicians, 15% are internists, 33% have degrees in public health, 17% are board certified in medical management, and 8% are pediatricians. None of the district and hospital medical directors of the General Sick Fund is a woman, but 40% of medical directors in Ministry of Health districts are women. More than 50% of PMs are not satisfied with the dualistic management that exists mainly in the General Sick Fund. 42% of the respondents stated that 8 or more years after residency is the most appropriate time to assume managerial roles. The average score of those who chose medical management from the point of view of job satisfaction was 7.4 +/- 2.3, but the rated satisfaction from performance as a PM in the health care system today is 4.2 +/- 2.6 (on a 1-10 scale). The most important managerial characteristics perceived by the respondents were credibility, ability to communicate and delegate, and leadership.

[Air pollution and morbidity in the Haifa region]

The effects of exposure to air pollution (defined by levels of SO2) were studied in a representative sample of over 3,500 households in the greater Haifa area. The sample was drawn from 16 high and low pollution neighborhoods which also represented different socioeconomic strata. A very significant relationship was found between levels of pollution in residential and work areas and self-reported respiratory symptoms and diseases. This finding was strongly supported by a statistically significant relationship between actual measured levels of pollution in the 2 weeks prior to the interview and the use of medical services by both adults and children, as well as by the number of days their activity was restricted during that period.

Lung cancer histology in Jews and Arabs in Israel, 1962-1982

Lung cancer rates in Israel are lower than in Western countries, not explainable by smoking habits. Because of the different relations of squamous cell carcinoma and adenocarcinoma to smoking it was of interest to study the histologic distribution in Israel. A total of 7,871 histologically confirmed lung cancer cases were studied in the period 1962-1982. Squamous cell carcinoma was the leading tumor type in Jewish men and adenocarcinoma in Jewish women. Rates of both adenocarcinoma and squamous cell carcinoma increased throughout the period in both Jewish men and women, but the increase in adenocarcinoma was more pronounced in the last study period than that in squamous cell carcinoma. In 1977-1982 the rate ratio of squamous cell carcinoma to adenocarcinoma among Jewish men was 1.7. In Arab men it was 2.9, and in Jewish women 0.57. The Kreyberg I/II ratio among Jewish men was about 2.7 with no clear trend throughout the study period, and among Arab men this gradually decreased from 8.1 to 3.5. Jewish women had a constant Kreyberg I/II ratio of about 1 through the whole study period, but the ratio in Arab women was significantly higher than 1, with a mean overall ratio of 3.2. Jews and Arabs in Israel are different from each other in their patterns of lung cancer histology and are different to some extent from other populations in the Western world.

Lung cancer histology in major ethnic groups among the Jews. Israel, 1962-1982

Lung cancer rates in Israel are lower than in other Western countries, not explainable by smoking habits. Due to the different relation of Squamous cell carcinoma (SqCC) and Adenocarcinoma (AC) with smoking it was of interest to study the histologic distribution in Israel. A total of 7508 histologically confirmed lung cancer cases among Jews were studied in the period 1962-82. SqCC was the leading tumor-type in Jewish men and AC in Jewish women. European-American born males in the last study period showed a decrease in SqCC rate while Asian-African born males showed a steep increase in SqCC rate, most prominent among the younger age-groups. Rates of AC increased in both, European-American and Asian-African males, but more steeply in the latter in most age-groups. Only for Large cell carcinoma were the overall rates higher in Asian-African than in European-American born males. SqCC increased in European-American born females and also steeply increased in the over 55 years old Asian-African born females. AC increased in European-American born females (both young and old), but only in the young Asian-African born females (decreasing in the older). European-American born Jews still have higher rates of both, more and less smoking related lung cancer histological types, than Asian-African born Jews. The steep increase in rates of some of the histological types in the latter with the pronounced increased in the younger age-groups is expected to cause a change in the ethnic rate-ratio which has already been demonstrated for the overall lung cancer rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality trends among Jewish and non-Jewish men in Israel, 1960-82

Until 1975 in Israel the mortality rates in men greater than or equal to 25 years old were higher in Jews than non-Jews. Since then the relationship has been reversed with higher rates in the non-Jewish group. The three main causes of death in the two groups were heart disease, cancer and cerebrovascular disease (CVA). Death rates from total heart diseases rose in the non-Jewish population during 1970-82, whereas in the Jewish men there were only slight changes. With regard to cancer, death rates were higher in the Jewish group, but from 1970 to 1978 it increased in both groups, the change being relatively higher in non-Jews. Mortality from CVA was higher among Jews at the beginning of the study period, but since 1978 the rates remained higher in the non-Jewish population. Death from heart disease, cancer and CVA can partially explain the reversal in total mortality rates in 1975. A comparison of the data of Israeli men with those of Israeli women shows that the mortality rates of the non-Jewish population of both sexes have changed dramatically over the last decade. These findings have important implications for the planning of further research and for priority determination in health care planning.

Mortality trends among Jewish and non-Jewish women in Israel, 1960-82

Until 1975 in Israel mortality rates in women aged greater than or equal to 25 years old were higher among Jewish women than non-Jewish women. Since then the relationship has been reversed with higher rates in the non-Jewish group. The three main causes of death in the two groups were heart disease, cancer and cerebrovascular disease (CVA). The proportional mortality and death rates from total heart diseases rose in the non-Jewish population during 1970-82, whereas in Jewish women there were only slight changes. With regard to cancer, the proportional mortality and death rates were higher in the Jewish group. However, from 1970 to 1982 cancer mortality in the Jewish population declined continuously, while in the non-Jewish group it rose. Mortality from CVA rose in both Jewish and non-Jewish women until 1974, but then declined. Since then, the rates remained considerably higher in the non-Jewish population. Death from heart disease, cancer and CVA can partially explain the reversal in total mortality rates in 1975.

Assessment of primary care nursing in relation to adolescent health behaviour by means of trigger films

The patterns of adolescents' behaviour place them at a risk from developing health and social pathology. In order to assess whether primary care nursing meets adolescents' health needs, the reported performance of 306 registered nurses working in different primary health care settings was studied. The research tool developed especially for the study was a video-taped trigger film. Demographic, education and work-related variables were studied by means of a questionnaire. The behaviour patterns studied were smoking, sexual activity, alcohol and drug consumption, and eating habits. The clinical issues were hypertension, obesity and anorexia nervosa. Reported performance was low--35% of the total possible score--with the lowest scores in the areas of preventive care, data gathering and recording, and somewhat higher in the areas of curative care and follow-up. The video-taped trigger films were considered to have face validity; they were found to be reliable, with an ability to assess the nurses' reported performance and to differentiate between the nurses in the three different work settings. This is the first study of its kind in Israel. The results show that primary health nursing of adolescents is insufficient, and that teenagers should get higher priority as a target population from the nursing profession in order to achieve WHO's aims of 'health for all by the year 2000'.

Incidence and prevalence of ulcerative colitis in the upper Galilee, Northern Israel, 1967-1986

An epidemiological study of ulcerative colitis was performed in the Upper Galilee, Israel, over a 20-yr period (1967-1986). The average annual incidence of ulcerative colitis was 2.23 per 100,000 population, and the prevalence on December 31, 1986, was 44.58 per 100,000. Considering the fact that strict steps were taken to include only definite cases, these figures are probably an underestimation. An increase of the average annual incidence from 0.88 in the period 1967-1976 to 3.79 in 1977-1986 was found. When the data were stratified according to ethnic groups, the highest average annual incidence and the highest point prevalence was found in Israeli-born Jews (6.9 and 138.2 per 100,000 population, respectively). When Jewish residence patterns were compared, the highest average annual incidence and point prevalence were found among Kibbutz members (5.52 and 110.39, respectively), and the lowest (1.94 and 38.76) among Moshav inhabitants. There were 10 Arab patients with an average annual incidence of 0.96 and a point prevalence of 19.27. There were 25 women and 28 men (female:male ratio of 0.89). Among the Jews, the female:male ratio was 1.04. Peak incidence was found in the 25- to 34-yr-old range. No second peak was noticed. Anemia was demonstrated in 66.6% of the women and 27.5% of the men in our study. We suggest that the increase in UC incidence and prevalence in Israeli and Asia/africa-born Jew and in Arabs in the Upper Galilee points toward environmental factors in the etiology of this disease.

Lung cancer in Israel, 1962-1982. II. Ethnic differences among Jews

Lung cancer incidence rates among Jews in Israel are significantly lower than in most developed countries in the world. A more detailed analysis of the rates among different Jewish ethnic groups also showed low rates. While Jewish males born in Europe-America (EA) had an 11% increase in rates between 1962-66 and 1977-82, Jewish males from Asian-African (AA) origin had a 45% increase resulting in current higher rates among North African than among East European Jews (the two dominant ethnic groups in Israel). In Jewish females, rates have been relatively stable from 1972 to 1982 and were almost twice as high for females born in EA than females born in AA with less prominent differences between countries. While smoking patterns probably explain the increase in rates among Asian-African Jewish males, other possible risk factors as well as the overall smoking prevalence cannot explain the low incidence in the major ethnic Jewish groups. The possibility of differed susceptibility is raised.

The care of family physicians and their families: a study of health and help-seeking behaviour

Physicians in general are at risk for the development of stress, drug and alcohol abuse, as well as for suicide. Furthermore, the treatment of the sick physician is more difficult than that of a 'regular' patient. These difficulties may cause the postponement of diagnosis and treatment to critical stages of the disease. This paper presents a study of self-rated health and health-seeking behaviour of Israeli family physicians and their families. Our major finding is that two-thirds of the physicians do not have a regular family physician, and physicians who suffer from chronic diseases are even less likely to be treated than the 'healthy' ones. Twenty eight per cent of the physicians did not use any kind of medical consultation. However, each physician's family did receive some form of medical consultation, although in some cases this was not the usual form of medical care. The physicians who treated themselves tended to treat their own families and vice versa. Eighty-eight per cent of the physicians reported stress owing to their work (work overload, poor relationships with the medical team or with the patients), and 20% said that their work as physicians negatively affected their marital life. The relationship between the help-seeking behaviour of the family physician and the quality of care they give is as yet unclear. Various alternatives are raised for changing family physicians' behaviour as well as the primary care health system in order to possibly provide better care for the physicians and their families.

Blood pressure and hypertension in an elderly population

In order to study the epidemiology of hypertension in the elderly and its relationship to other disease situations, a study was performed on 815 institutionalized elderly people indicating a statistically significant decrease of both systolic and diastolic blood pressure with age. There is a difference between the population originating in Europe and America and those from Asia and Africa; in the latter group the blood pressure values were significantly higher, specially in females. The prevalence of hypertension as a disease does not differ between younger and older age groups. The lower prevalence in the population studied (28.1%) when compared to data in the literature which indicates prevalence of about 40%, might be due to the fact that the institution population live under sheltered conditions and close medical follow up. In conclusion hypertension in the elderly serves as a major risk factor for several disease situations thus leading to a better survival for those with lower values of blood pressure.

Risk factors and causes of stroke in young women in Israel

OBJECTIVE

to identify risk factors and likely causes for stroke in young women, as a basis for designing a strategy for stroke incidence reduction.

DESIGN

retrospective chart review for comparisons between the sexes.

SETTING

general and rehabilitation hospitals.

PATIENTS

all 263 patients aged 17-45 years with stroke over a 15-year period.

EXCLUSIONS

patients seen at 14 general hospitals who were not referred to the Loewenstein.

ASSESSMENTS

data on sociodemographic, anamnestic, and clinical aspects.

RESULTS

stroke under the age of 30 years was more frequent in women, and in them the risk factors differed from those in an older population. The most frequent cause of stroke in the younger women was embolism, in the majority on the basis of a rheumatic valvular defect, whereas in young men the usual cause was atherosclerosis.

CONCLUSIONS

opportunities for preventive initiatives have not always been grasped, and more attention should be directed to such possibilities.

Antibody recognition of amino acid divergence within an HIV-1 neutralization epitope

Antibodies elicited by HIV-1 strains, and which neutralize such strains in vitro, bind to synthetic peptides of 5-8 amino acids in length. These amino acids, although variable, have a fixed location between two cysteines in the carboxyl terminus of the HIV-1 external envelope. Nine peptides of 9 amino acids corresponding to the gp120 domains of European and American (LAV-1, NY5, CDC4, SF2), Haitian (RF) and African (ELI, MAL, Z3, Z6) HIV-1 strains, were synthesized using LAV-1 and RF neutralization epitopes as models. Serum of chimpanzees infected with LAV-1, HTLV-IIIB or HTLV-IIIRF reacted predominantly with the homologous peptide, although cross-reactivity with heterologous peptides occurred: 8 out of 11 human sera with HTLV-IIIB-neutralizing activity bound the LAV-1/HTLV-IIIB peptide, and 6 out of 7 sera with HTLV-IIIRF-neutralizing activity bound the RF peptide. African sera reacted most frequently with the Z3 peptide (78%) while only 35% (p = 0.0001) of European and 20% (p less than 0.0001) of American sera recognized it. Recognition patterns of children from the USA and Europe were different. Although multiple reactivities were observed, blocking experiments favoured cross-reactivity as the explanation. Based on the antibody profiles of nonapeptide recognition, peptides LAV-1, RF and SF2 were clustered, as were NY5 and CDC4, and so were Z6, MAL and ELI. This antigenic relatedness of HIV-1 strains could not entirely be explained by the physico-chemical characteristics of the nonamers per se. Resemblance was observed with the clustering of HIV-1 strains based on the divergence of the nucleotide sequence of entire HIV-1 envelopes. This implies a role of peripheral envelope residues, in the context of infectious particles or infected cells, in determining the specificity of antibodies reactive to the V3 domain. Therefore, the neutralization domain in this variable region may be considered part of a conformational structure involving several envelope regions which appear distinct from each other in the primary sequence.

End-stage renal disease replacement therapy in Israel: demographic and regional differences

Incidence (by sex and ethnic group), prevalence and mortality rates (by age) of end-stage renal disease (ESRD) replacement therapy in Israel were calculated for the periods 1975-78 and 1979-82. Rates were higher for males (relative risk male/female 1.70 for the first period and 1.83 for the second). Incidence and prevalence rates increased with age among men; among women the maximal rates were attained by the 45-64 age-group. Incidence and prevalence rates were higher during the second period. Among the Jewish population, rates of treatment were higher in the Asian and African-born groups, and European-American and Israeli-born Jews showed the lowest rates. Mortality rates during treatment were lower among Arabs. Rates of therapy rose with age, were higher for males and had a well-defined ethnic pattern. In order to assess differences in ESRD replacement therapy between districts, rates of incidence, prevalence and mortality during treatment (for the Jewish population) were computed by district and adjusted by age and continent of birth for both periods. Significant differences in ESRD therapy coverage were detected only during the second period. Prevalence rates were considerably higher in the central, Tel Aviv and southern districts, and incidence rates were considerably elevated in the central and Tel Aviv districts and low in Jerusalem. Mortality during treatment was lowest in Haifa. It seems improbable that these findings are due to differences in accessibility to ESRD replacement therapy; however, early diagnosis and prevention of disabling kidney conditions at the primary care level may play an important role.

Incidence, mortality, and case-fatality rate of stroke in northern Israel

We studied the incidence and mortality of stroke in northern Israel to determine possible reasons for the differences previously found in mortality from this condition between the sex and ethnic groups in Israel as a whole. We identified 1,149 cases of stroke during 1984. While the age-standardized incidence was higher in men, the case-fatality rate was twice as high in women. After controlling for ethnic origin, we found that incidence was higher only in men of Western origin, while the female rates were higher in women of Asian and North African extraction. The case-fatality rate was substantially higher in women in all ethnic groups. These differences, especially in relation to the case-fatality rate, have important implications for health services in relation to both possible preventive action and to management of the acute disease phase.

Lung cancer in Israel, 1962-1982. I. Jews and Arabs

The magnitude and dynamics of lung cancer incidence in Jews and Arabs in Israel between the years 1962 and 1982 were studied. In general, age-standardized incidence rates increased consistently between the years 1962 and 1976 among Jewish (24% increase) and Arab (39%) males, and to a lesser degree among Jewish females (15%). Arab females had the highest (77%) increase. From 1977 to 1982 a general decrease in incidence rates, which was largest among Arab males (19%) and females (15%), was noted. Rates among Jewish males are currently 26% higher than among Arab males, and are 162% higher among Jewish females than in Arab females. Lung cancer rates in both males and females in Israel (Jews and Arabs) are lower than in most developed countries in the world. Among the possible reasons are differences in the population risk factors profile, availability of health care and the level of diagnosis and ascertainment of cases.

Simian immunodeficiency virus/delta-induced immunodeficiency disease in rhesus monkeys: relation of antibody response and antigenemia

Infection of the rhesus macaque (Macaca mulatta) with simian immunodeficiency virus (SIV) induces a disease similar to AIDS. We compared SIV-specific antibody and antigenemia with the progression of disease in monkeys experimentally infected with SIV/Delta isolates that varied in pathogenicity. Western blot, immunoprecipitation, and sandwich enzyme-linked immunosorbent assay of serial sera from macaques infected with attenuated virus revealed a persistent antibody response and no evidence of SIV antigenemia. Immunosuppressed macaques without central nervous system (CNS) infections responded similarly to initial infection, but antibody specific for gag or, less frequently, to gag and env determinants declined predictably before clinical disease. Monkeys with CNS infections, however, had little, if any, detectable antibody to either envelope or gag proteins, regardless of the duration of survival. SIV/Delta-specific antigenemia, evident only in immunodeficient monkeys, fluctuated reciprocally with antibody. Our data suggest that SIV/Delta-induced disease is dependent upon antigenemic episodes that, particularly in animals with CNS infection, appear coincident with diminished antibody.

Tracking of blood pressure in children: results of 7 years' follow-up. The Nahariya Study

Four hundred and seventy-five school children initially aged 7, 8 and 9 years were examined for blood pressure and risk factors at intervals over a period of 7 years (1978, 1980 and 1985). A significant correlation between successive blood pressure measurements was found after 2 years of follow-up for systolic blood pressure, with tracking coefficients of 0.16 for boys and 0.22 for girls. A similar correlation was found after 7 years, with correlations of 0.16 and 0.26, respectively. For diastolic blood pressure the correlations were 0.15 and 0.18 after 7 years. Children greater than 7 years old were more likely to be above the 90th percentile, with increasing percentiles found in the initial examination. A significant correlation was found between the initial weight, as recorded in the first examination, and the blood pressure percentiles in all three measurements. The correlation coefficient values increased progressively in the successive examinations--0.11, 0.23 and 0.25, respectively, for systolic pressure, and 0.10, 0.14 and 0.19, respectively, for diastolic pressure. There was significant correlation between the initial body mass index and the blood pressure levels in the last examination. Thus, both initial blood pressure levels and body mass appear to be valid predictors of future blood pressure levels.