Contributions of different lipoprotein fractions to variations in total cholesterol between Israeli origin groups and social classes

Total cholesterol, triglycerides and high-density lipoprotein (HDL)-cholesterol were measured in 2,306 boys, 1,716 girls, 2,479 fathers and 2,822 mothers examined on Visit 1 of the Jerusalem Lipid Research Clinics Prevalence Study in 1976-79. Low-density lipoprotein (LDL)-cholesterol levels were estimated from the other three measurements. Using multiple regression analysis to control for body mass index, social class, season of the year and (in parents) age, we compared the three origin groups (Asian, North African and European, depending on the birthplace of the parents) with the Israeli-born group. In both fathers and mothers, the lower total cholesterol levels in the North African group, and to a lesser extent in the Asian, were explained mainly by lower LDL-cholesterol in these groups. In youngsters, the origin groups were characterized by differences not only in LDL-cholesterol, but also in other lipoprotein fractions. Social class in youngsters and mothers was associated mainly with the HDL-cholesterol fraction; in fathers it was associated only with triglycerides. Possible relationships of these findings to smoking, alcohol, exercise and female sex hormones are discussed.

The early breast cancer detection program of the Israel Cancer Association: a retrospective evaluation

Between 1 January 1965 and 31 December 1975 82,262 women visited an early breast cancer detection center at least once. Subsequent to the visit 1,295 women were found to have breast cancer. The observed survival of these 1,295 patients (the study group) was compared to that of two control groups: 1) all breast cancer patients diagnosed in Israel in the five years preceding the start of the Early Detection program (2,402), and 2) all breast cancer patients diagnosed while the Early Detection Program was in progress, but who never visited an early detection center (6,315). The stage distribution of the study group showed significantly more early-stage cases than controls. The observed survival of the study group was significantly longer than that of the control groups, irrespective of mode of referral of the former to the Early Detection Program (by invitation, self-referral, or doctor-referral). The observed survival of study patients was longer than that of controls within each stage group, although most differences were not statistically significant and relatively large number of "unknowns" in key variables may have introduced bias into the study results. Future programs of the Israel Cancer Association should have clearly stated and measurable objectives and built-in mechanisms for ongoing evaluation.

Prevention of post weaning mastitis in ewes

The efficacy of a dry cow cerate in protecting the dry ewe against mastitis was tested in three flocks. Of 931 ewes, 462 were infused, shortly after their lambs were weaned, with a dry cow cerate containing 1 g procaine penicillin and 0.5 g dihydrostreptomycin sulphate. The remaining 469 served as untreated controls. At tupping, when the sheep were examined for clinical evidence of mastitis, 21 cases (4.5 per cent) were recorded among the controls but only seven (1.5 per cent) among the treated ewes. There was variation in the distribution of cases between individual flocks but overall the incidence of mastitis in the treated sheep was lower and significantly different from that among the control ewes.

Complications of pregnancy and labor in former oral contraceptive users

Complications of pregnancy and delivery, and obstetric interventions, were studied in a sample of Israeli women questioned post-partum about contraceptive use. The 2,953 women who had used the pill were compared with 13,630 controls. There were no significant differences between users and controls in the frequencies of bleeding in pregnancy, premature rupture of membranes, placenta previa, placental abruption, fetal distress or asphyxia, ABO incompatibility, hydramnios, transverse lie, cephalopelvic disproportion, and persistent occipitoposterior or post-partum hemorrhage. New cases of hypertension, varicose veins, thrombophlebitis, urinary tract infection, and cervicitis were reported in primigravidae and multigravidae without past histories of these conditions; there were no differences between oral contraceptive users and controls other than an excess of cervicitis in primigravidae among former users. There was a slight decrease in normal deliveries in former oral contraceptive users due to an increase in inductions of labor. On the other hand, rates of forceps and vacuum deliveries, caesarian sections, and interventions in the third stage did not differ between former oral contraceptive users and controls. These results indicate that former oral contraceptive users can anticipate the same frequency of complications of pregnancy and labor as women who have used other, or no, methods of contraception.

Scoring newborns for the risk of subsequent hospital admissions: comparative findings in Jerusalem and Haifa

Six demographic and health characteristics of newborn infants were used to develop an additive risk score for predicting first admissions to hospitals during their first two years of life. The scoring system, developed for a cohort of 5,243 infants in Haifa, identified an at-risk group comprising 23% of the population, in whom 43% of hospital admission events occurred. The same scores, applied to a cohort of 5,800 infants in Jerusalem, identified an at-risk group comprising 22% of the population and predicted 35% of hospital admission events. Possible reasons for the differences between the two cities are discussed.

The effect of abortion method on the outcome of subsequent pregnancy

Infants born to women following a previous induced abortion, primarily by the D&C method, showed an excess of low birth weight. However, when women with medical illnesses were excluded, the excess was very slight. The data suggested that the greater the dilatation at D&C, the lower the birth weight. Women requiring induced abortions should have them as early as possible to minimize cervical damage and its consequences.

Health status and use of health services as reported by the older residents of the Baka neighborhood, Jerusalem

The large increase in the aging population in Israel, particularly of people over 75, requires the upgrading of health services and their integration into comprehensive social support systems, which will help reduce the need for admission to institutions for long-term care. In our study, interviews were conducted with 77% of the residents of the Jerusalem neighborhood of Baka aged 60 and over and the data were supplemented by partial information on a further 20%. Our findings are similar to those reported from other surveys of the aged in Israel and indicate a high degree of unmet health needs in this population. Many of the problems of the elderly relate more to their social and cultural backgrounds than to objective measures of morbidity and they can only be partially solved by classical health services, even efficient ones. There is an urgent need for the development of integrated health, social and community service and support systems to meet the needs of this rapidly growing community.

Influence of nerve growth factor on the embryonic mouse trigeminal ganglion in culture

Developing trigeminal ganglia have been excised from mouse embryos of 9, 10, 11 and 12 days gestation and grown in tissue culture. A quantitative method was used to assess the effect of nerve growth factor (NGF) and an antiserum to NGF (anti-NGF) on fiber outgrowth from the explanted ganglia. Fiber outgrowth from 9-day ganglia (E9 ganglia) appeared to be unaffected by the presence of NGF. However, the ganglia became increasingly responsive to NGF from embryonic day 10 through 12. The increased responsiveness to NGF in vitro coincided with the establishment of fiber contacts with peripheral target tissues in vivo. Anti-NGF produced no significant reduction of fiber outgrowth from E9 ganglia, but from later ganglia significant reduction were observed.

Neurite outgrowth from murine sensory ganglia cultured in a serumless medium

Trigeminal and dorsal root ganglia were excised from mouse embryos of 10 and 18 days in utero age, respectively, and grown in tissue culture. A quantitative method was used to assess the extent of neurite outgrowth from the explants after 24 and 48 h in culture. Outgrowth from ganglia grown in a serumless medium was compared with that from ganglia in a medium supplemented with serum. There was no significant difference between the extent of outgrowth in either medium after 24 h in culture; however, after 48 h there was significantly greater outgrowth in the serum-supplemented medium.

Cryosurgery in cervical intra-epithelial neoplasia

A study undertaken to assess the reliability and effectiveness of cryosurgery in cervical intra-epithelial neoplasia is described. During 1 5-year period a total of 416 patients were so treated and the records were studied retrospectively. This study demonstrated that 34% of patients were lost to follow-up, and that 24% of those followed up had residual disease of the cervix. It was therefore concluded that this form of treatment was inadequate for the hospital population concerned. An additional prospective study was undertaken, as a result of which cryosurgery is recommended only if adequate long-term follow-up is ensured, if skilled colposcopic evaluation is available throughout, and if the disease is limited to mild or moderate dysplasia in younger patients.

Breast cancer in Israel: laterality and survival

Laterality was examined in 10,702 cases of breast cancer in Israeli Jewish women. The overall left-right ratio was 1.04 and was higher in women over 60. The only population group with a left-right ratio less than 1 was the group of women born in Asian and Middle Eastern countries outside of Israel. There were no differences between the survival curves of women with right- or left-sided breast cancers at any stage. It is concluded that laterality of tumor is not an indicator of survival in breast cancer.

Demography, morbidity and mortality in Israel: changes over 30 years

The last 30 years have seen vast changes in the size and composition of the Jewish and Arab populations of Israel. The Jewish population has increased 4 1/2 times but the proportion of aged has increased 10-fold. Infant mortality has decreased considerably and life expectancy has increased for both sexes and both populations. Patterns of morbidity and mortality have changed from those characteristic of the Middle East to those commonly seen in developed countries, with ischemic heart disease, cancer and stroke the leading causes of death.

Breast cancer in Israel: incidence and mortality, 1960-75

Between 1960 and 1975, the incidence of breast cancer in Israel rose 20%. A steady rise in incidence was seen for women aged 60 or more years, whereas for women younger than 60 years, the incidence pattern was less regular, showing a definite rise only in the period 1970-75. Mortality from breast cancer also rose among women aged 60 or more years, but much more slowly than incidence. Among women younger than 60 years, breast cancer mortality was essentially unchanged. When mortality rates from a disease rise more slowly than incidence rates, it can be inferred that a greater proportion of new cases are being cured or are experiencing longer survival. It would appear that this is the case with breast cancer in Israel, and this trend, probably the result of earlier diagnosis, is encouraging.

The effect of transition metal ions on the resistance of bacterial spores to hydrogen peroxide and to heat

The presence of 10 microM-Cu2+ increased the lethal effect of hydrogen peroxide on spores of Clostridium bifermentans but not on those of Clostridium sporogenes PA 3679, Clostridium perfringens, Bacillus cereus or Bacillus subtilis var. niger. Cu2+ at 100 muM also increased the lethal effect of heat on spores of C. bifermentans but not on those of B. sutilis var. niger. The rate and extent of Cu2+ uptake by spores of C. bifermentans and B. subtilis var. niger were similar, but examination of unstained sections of spores by electron microscopy suggested that Cu2+ is bound by the protoplasts of spores of C. bifermentans but not of B. subtilis var. niger.

Epidemiology of the hypertensive disorders of pregnancy

Disorders associated with hypertension during pregnancy, which are often linked with oedema and/or proteinuria and are variously termed toxaemia of pregnancy, EPH gestosis, pre-eclampsia, and eclampsia, are of unknown etiology, although they have been known for a long time and many attempts have been made to classify and explain them. In this paper, the author draws attention to the problems of standardizing values for blood pressure, proteinuria, and oedema and of determining their value in the diagnosis of the disorder. Different classification schemes are described and the problems of comparison between them are stressed. The frequency of the hypertensive disorders of pregnancy in different countries and groups at special risk are discussed. Finally, recommendations are made on the types of research and health care needed to combat the problem.

Requests for abortion and outcomes of pregnancy in Jerusalem, Israel

Outcomes of pregnancy were examined for 480 women who requested abortions at a Jerusalem hospital during the years 1972 to 1975. Of 149 women denied abortions, 80 apparently obtained illegal ones. Since illegal abortions performed by physicians are easily and safely obtained in Israel, the liberalization of Israel's abortion laws will not have a major impact upon Israel's population growth.

Patient recall of induced abortion

15 of 92 women who underwent induced abortions and subsequently gave birth denied their abortions in a medical interview. Religious women and women with fewer children were more likely to deny than others. Obstetricians as well as investigators examining the effects of induced abortions must be aware that women may fail to provide accurate abortion histories.

Carnosine and anserine content of turkey breast and leg muscles

1. Carnosine and anserine have been measured in samples of breast and leg muscles from three turkeys. 2. The results show that there is a large difference in the dipeptide content between the two types of muscle.

Bound quinic acid as a measure of coupling of leaf and sunflower-seed proteins with chlorogenic acid congeners: loss of availability of lysine

Changes were studied in the bulk protein of tobacco leaves, lucerne shoots and sunflower‐seed kernels subjected to aerobic autolysis at room temperature. Bulk‐protein fractions from cigar and from commercial sunflower‐seed meal were also examined. Quinic acid, released by cold alkaline hydrolysis, was used as a measure of binding of chlorogenic acid residues to the proteins. On aerobic autolysis, the proteins of the leafy materials underwent some proteolysis; chlorogenic acid residues became bound to the protein, with concomitant diminution of free chlorogenic acid. The proteins showed browning, increased ultraviolet absorption and diminished content and “chemical availability” of lysine. However, during aerobic autolysis, the bulk protein of sunflower‐seed kernels did not couple appreciably with the chlorogenic acid congeners present; the above accompanying phenomena were also largely absent. It is concluded that, when protein‐rich plant materials are to be fed to monogastric animals, and particularly when their lysine content is critical, more attention should be paid to effects of the polyphenols and polyphenol oxidases present in the original plant.

The Jerusalem perinatal study: the first decade 1964--73

This paper summarizes the main findings concerning Jewish births in the record-linked Jerusalem Perinatal Study. In the decade 1964--73 there were 63,638 births in which the birth weight was at least 1,000 g. The late fetal mortality rate was 9.1/1,000, and the neonatal and infant death rates were 10.1 and 15.5/1,000, respectively. The demographic characteristics of births changed over the decade, with a decrease in the proportion of high birth orders, of mothers with little education, of immigrants from Asia and North Africa, and of marriages within the same group of origin. Fertility fell, especially at the extremes of reproductive life. Illegitimacy was 1.2%. Year-by-year variations in mortality are discussed and the relationship of mortality to maternal age and education, birth order, social class, group of origin and birth weight are described. Frequencies of specific congenital malformations, infant and child admissions to hospital and various obstetric complications are also reported. Changes in obstetric interventions over the decade included an increasing proportion of induced labors, cesarean sections, forceps and vacuum deliveries, and interventions in the third stage of labor. The paper briefly indicates ways in which the data bank of the Jerusalem Perinatal Study is being exploited for a wide variety of health studies.

Maternal, perinatal and infant health in Bedouin and Jews in southern Israel

A study has been made of 3,745 Bedouin and 9,422 Jewish babies born in 1972-73 to residents of the Beersheba district of southern Israel (the Negev). Newborn infants weighing less than 1 kg were excluded. Thirty-seven percent of the Bedouin babies were born at home; their mothers tended to be older and of higher parity than those choosing to deliver in hospital. Less than 6% of Bedouin mothers had been to school, compared with 90% of the Jews; 30% were aged under 20 or over 34 years, compared with 18% of the Jews, and 23% were having their seventh or later baby, compared with 12% of the Jews. Mean birth weight of babies born in hospital was about 200 g lower in Bedouin than in Jews, and 11.4% of Bedouin and 6.5% of Jewish infants weighed less than 2.5 kg. There was little variation in complications of labor between the 1,959 Bedouin and 8,877 Jewish women delivered in Beersheba's Soroka Medical Center. The cesarean section rate was 1.8% in Bedouin and 4.3% in Jews, while in 0.3% of Bedouin and 1.4% of Jews labor was induced. Monozygous twinning rates were similar in the two ethnic groups (4.8 and 4.5 sets/1,000 deliveries, respectively) but dizygous twinning was twice as common among the Bedouin as among the Jews (13.0 vs 6.0 sets/ 1,000). Male births accounted for 0.526 and 0.512 of the total in Bedouin and Jews, respectively. Perinatal mortality rates for hospital births were 31.1 and 18.3/1,000 in Bedouin and Jews, respectively. Infant deaths among Bedouin (31.0/1,000) were underreported; the rate was 16.8/1,000 for Jewish infants. Although rates of all specific causes of death were higher in Bedouin than in Jews, patterns of mortality in subgroups based on birth weight, sex, twinning and maternal age were quite similar in the two ethnic groups. There were six reported deaths from tetanus among Bedouin babies. For the cohort of babies born in 1972, admissions to the Soroka Medical Center pediatric wards were recorded in 366 (195.5/1,000) Bedouin and 787 (174.3/1,000) Jewish babies younger than the age of one year. Bedouin admission rates were higher than those of Jews for gastroenteritis (119.1 and 64.5/1,000 respectively), infectious and parasitic diseases (29.4 and 21.9), malnutrition (25.6 and 8.0) and external causes (10.1 and 4.4). Admission rates for bronchitis and pneumonia were, however, lower among Bedouin than Jews in the first six months of life.

Fertility and perinatal and infant mortality in the Jewish population of Beersheba and the Negev, 1972

There were 4,569 Jewish births in the Negev (southern Israel) in 1972, the first year of birth registration by the Unit for Evaluation and Planning of Kupat Holim and the Ben-Gurion University center for Health Sciences. The crude birth rate was 28.8 per 1,000 population, with 130.7 live births per 1,000 women aged 15 to 44 years. Total fertility was 3.9 per woman, varying from 3.4 in the kibbutzim and 3.5 in Beersheba to 5.2 in the moshavim (collective settlements) and 3.7 to 6.3 in the development towns. Late fetal and perinatal death rates were 9.4 and 19.0/1,000, and the neonatal and infant mortality rates, 11.0 and 18.1/1,000 respectively. The proportion of males was 0.51, the twinning rate was 9.5/1,000 women delivered, and 1.1% of babies were illegitimate. Low birth weight (less than 2.5 kg) was recorded in 6.9% of births. Fifty-three percent of births were to immigrant mothers from North Africa; the remainder were divided equally among mothers born in Israel, the Asian Near East, and Western countries. The Asian immigrant group was at high risk for infant death, with a rate of 3.64/1,000 as compared with 14.8, 14.2 and 5.8 recorded for the offspring of mothers born in Israel, North Africa and Western countries, respectively. Patterns of mortality in relation to maternal age, birth order and education were similar to those reported for developed countries.

Toxemia of pregnancy in Jerusalem. II. The role of diet

A dietary history was obtained from 180 patients with preeclampsia and eclampsia, representing 92% of all cases occurring in the pregnant population of West Jerusalem over a defined period. The intake of nutrients and 78 items of diet was compared for each patient and two healthy control subjects who were matched for country of origin, parity, month of delivery, age, year of immigration and years of schooling. All diagnoses were made by the same research team and dietary histories were elicited by one of two experienced dieticians. Comparisons between the 180 patients and their respective control pairs showed a significantly reduced intake of calories, proteins and fats and an increase in consumption of sugar and sweets by the patients. The food items involved, including cheese, eggs, olives and nuts, did not appear consistently, however, in population subgroups defined by age, period of immigration and country of origin. Sixty-six patients reported not having changed their diets during pregnancy and these showed no significant differences in consumption of any of the foods or nutrients at the 1% level, when compared with their matched control subjects. All differences observed were confined to the 114 patients who, for one reason or another, had changed their diets. It is concluded that the differences in diet between patients and control subjects are the result, and not the cause, of the toxemia of pregnancy. Supporting and contradictory evidence in the literature is analyzed, and possible sources of the discrepancies are pointed out.

Late sequelae of induced abortion: complications and outcome of pregnancy and labor

The effects of previous induced abortion on pregnancy, labor and outcome of pregnancy were measured in a prospective study of 11,057 pregnancies to West Jerusalem mothers who were interviewed during pregnancy and who subsequently delivered a single live or stillborn infant. The 752 mothers who reported one or more induced abortions in the past were more likely, at the same interview, to report bleeding in each of the first 3 months of the present pregnancy. They were subsequently less likely to have a normal delivery and more of them needed a manual removal of the placenta or other intervention in the third stage of labor. In births following induced abortions, the relative risk of early neonatal death was doubled, while late neonatal deaths showed a 3- to 4-fold increase. There was a significant increase in the frequency of low birthweight, compared to births in which there was no history of previous abortion. There were increases in major and minor congenital malformations, but no significant changes in stillbirth or post-neonatal death rates, nor in mean birthweight or sex ratio. When the effects of other variables were taken into account, there were no significant changes in frequency following an induced abortion as to: ABO and rhesus isoimmunization, toxemia, hydramnios, premature rupture of membranes, induction of labor, breech or vacuum delivery, cesarean section, breech presentation, placenta previa, placental abruption, cord prolapse, cord anomalies, fetal distress or asphyxia, post-partum hemorrhage.

Characteristics of pregnant women who report previous induced abortions

Associations between previous induced abortion and demographic and health factors in pregnancy were measured in 9 874 women who gave birth and who had been interviewed during pregnancy. Previous abortion was most rare among women having their first baby and increased with increasing birth order up to the fourth, thereafter decreasing. It was positively correlated with maternal age and negatively with age at marriage. There was no effect of years of schooling, when other variables were taken into account, but there were significant differences between ethnic groups, abortion being commonest among Jewish women from North African countries and more prevalent in those from western and Asian countries than in the second-generation Israel-born or in Arab women.Women who reported abortions were less likely to be strict as regards religious observance and less likely to have had a previous stillbirth or child death, other variables being equal. They were more likely to be smokers or former smokers and to be delivered of their babies in certain obstetric units. They more often reported vomiting, bleeding, and medication in early pregnancy. On the other hand, there was no significant association with diabetes, anaemia, blood groups, or season of birth.The findings show that women reporting previous induced abortions differ significantly from other pregnant women in a wide range of demographic and health characteristics. Such women may also be biased for complications of pregnancy and outcome, particularly if selected from a clinic population. Observations that indicate a deleterious effect of induced abortions on subsequent pregnancy outcomes must therefore be interpreted with considerable caution.

Birth weight in Israel, 1968-70. I. Effects of birth order and maternal origin

An analysis of 96% of Israeli live births, 1968–70, gives a mean birth weight of 3299 ± 543 g with 5·7% weighing less than 2500 g. The mean values increased from 3193 ± 510 g for first born to 3469 ± 604 g for tenth and subsequent births.

There were significant differences between the mean birth weights, adjusted for birth order, of the different ethnic-origin groups. Infants of Jewish immigrants from North African countries weighed 3356 g followed by Christian Arabs (3337 g), Israeli-born Jews (3310 g), immigrants from Western countries (3303 g), Moslem Arabs (3251 g), Druze (3244 g) and immigrants from countries of Asia (3223 g).

For the Jewish groups, the differences were diminished in the second generation of Israeli-born but those descended from Asian immigrants continued to be the lighter group.

In order to determine the extent to which these differences are truly ‘ethnic’ further analyses of more homogeneous groups will be necessary taking into account a number of other demographic and socio-economic variables. (Summary in Hebrew, p. 58.)