Cesarean Sections and Family Planning Among Ultra-Orthodox Israeli Jews

The elevated frequency of Cesarean sections (C-sections) in OECD countries not only burdens health systems financially but also heightens the risks for mothers and infants. This study explores the feasibility of reducing C-section rates by examining the Israeli ultra-Orthodox population, noted for its large families and low C-section rates. We analyze birth data from an Israeli hospital, focusing on ultra-Orthodox mothers with husbands who are yeshiva students compared to other mothers. Our findings reveal that all else being equal, mothers married to yeshiva students exhibit a lower likelihood of undergoing a C-section and a higher propensity to seek private medical services to avoid this procedure. This behavior is attributed to their preference for large families and the desire to minimize C-sections, which may restrict the number of possible future pregnancies. These insights underscore the potential effectiveness of initiatives encouraging mothers to opt for vaginal deliveries, thereby reducing healthcare costs and maternal-infant risks.

What is the optimal country for minimum COVID-19 morbidity and mortality rates?

The SARS-CoV-2 is a deceptive virus. Despite the remarkable progress in genetic sequencing and subsequent vaccine development, the world continues to grapple with the ominous threats of rapidly appearing SARS-CoV-2 variants. The objective of this manuscript is to rank world countries based on the anticipated scope of COVID-19 morbidity and mortality, measured in terms of prevalence per 1 million persons, from the lowest to the highest. The ranking of 162 countries is based on predictions of empirical models, which include three explanatory variables: hospital beds per thousand persons, population density, and the median age of the country's population. Referring to the COVID-19 scope of morbidity, the lowest likelihood of infection is obtained in Niger and Mali, where the dominant characteristic is the young median age (15.1-16.4 years). Referring to the COVID-19 scope of mortality, the lowest likelihood is obtained in Singapore. For Singapore, the dominant feature is the high population density. The optimal solution is intensive vaccination campaigns in the initial phase of the pandemic, particularly among countries with low GDP per capita. Yet, vaccinations may work only where the personal immune system is healthy and thus respond by creating antibodies to the SARS-CoV2 virus. Referring to populations that lack the natural protection of the healthy immune system and thus cannot be vaccinated (e.g., old people, cancer patients undergoing chemotherapy treatments), a complementary solution might be coordination between countries and the establishment of field hospitals, testing laboratories, isolation of areas, humanitarian aid-in the same manner of treatment in other disasters like earthquakes.

Is obesity a risk factor for melanoma?

OBJECTIVES

Are twofold: 1) to estimate the relationship between obesity (BMI ≥30) and the prevalence of melanoma in different US states and 2) to examine the possibility of defining a new risk group. This might enhance the possibility of detection, which in turn, might increase the survival rates of patients.

STUDY DESIGN

A cohort Study, based on data at the US statewide level in 2011-2017, where the dependent variable (the annual new melanoma cases per 100,000 persons) is adjusted for age.

METHOD

Quadratic regression analysis. This model permits a non-monotonic variation of obesity with new melanoma cases adjusted for age, where the control variable is the level of UV radiation.

RESULTS

Demonstrate a negative correlation between obesity and incidence of melanoma. This outcome is further corroborated for Caucasians.

CONCLUSIONS

We should continue to establish primary prevention of melanoma by raising photo protection awareness and secondary prevention by promoting skin screening (by physician or self) among the entire population group in all BMI ranges. Advanced secondary melanoma prevention including noninvasive diagnosis strategies including total body photography, confocal microscopy, AI strategies should focus the high-risk sub group of Caucasians with BMI < 30.

Do Ultra-Orthodox Israeli Jews Suffer more than Secular Israeli Jews from Obesity? Gender, Cohort Effect and the Yule-Simpson Paradox

The Yule-Simpson paradox indicates contradicting statistical outcomes for the pooled sample and for each stratified group separately. The objective of the current study is to demonstrate this paradox. The sample is based on a 2015-2016 longitudinal survey carried out by the Israeli Central Bureau of Statistics. The sample includes 1194 individuals, where the responses of 1140 individuals were assessed twice (in 2015 and 2016) and the responses of 54 individuals were recorded only once. This gives a total sample of 2334 observations × years. The sample includes 609 females and 585 males. We use the limited dependent binary probit regression model. The dependent variable is a dummy variable that equals 1 if the individual is obese (BMI ≥ 30, where BMI = WEIGHT ÷ (HEIGHT²), WEIGHT is measured in kilograms and HEIGHT is measured in meters) and zero otherwise. The independent variables are the denomination (secular vs. ultra-Orthodox) and age in years. Findings suggest that on the one hand, for the pooled sample of 21-50-year-old females and males, results clearly support the conclusion that compared with secular Israeli Jews, projected probability of obesity (BMI ≥ 30) among ultra-Orthodox Israeli Jews is higher (p = 0.0128). On the other hand, when stratified by gender, one cannot reject the opposite conclusion, according to which projected probability of obesity is equal for all cohorts among ultra-Orthodox and secular Israeli Jews. Research findings thus stress the importance of cautious and rigorous statistical analysis and robustness tests prior to statistical inference.

Valvular changes following anthracycline therapy: is it time to look beyond ejection fraction?

Background

Advancements in early detection and treatment of breast cancer have improved survival, but with the costs of side effects, with cardiotoxicity being the most significant one. Anthracycline (ANT) is the most recognized therapy leading to cardiotoxicity, mainly manifested as left ventricle (LV) dysfunction. While the changes in LV ejection fraction (LVEF) are well studied, little is known about the effect of ANT on valvular function. We aimed to evaluate the change in valvular function following ANT therapy in patients diagnosed with breast cancer.

Methods

The study population is part of the Israel Cardio-Oncology Registry (ICOR). All patients performed serial echocardiography; before (T1), during (T2), at the end (T3), and following (T4) ANT therapy, assessing valvular changes. Exclusion criteria included age below 18 and baseline LVEF &lt;55%.

Results

The study included 141 female patients diagnosed with breast cancer and treated with ANT with a mean age of 51±12 years (Table 1). During a median follow-up of 255 [IQR 214–313] days, from T1 to T4, we observed a significant increase in the portion of patients developing new mitral regurgitation (MR) (3.5% to 18.7%, p&lt;0.0001), with a trend for developing moderate and above MR (0.7% to 3.3%, p=0.13). While a statistically significant reduction in mean LVEF (60.2%±1.5 to 59.2%±2.7, p=0.0004) and median LV global longitudinal strain (LV GLS) (−21.6% [−20.0 to −23.0] to −20.0% [−19.1 to −21.1], p&lt;0.0001) was observed (Figure 1), the values remain within the normal range with no significant clinical change. In a multivariate binary logistic regression model, age (OR 1.06, 95% CI: 1.01–1.11) and trastuzumab therapy (OR 5.59, 95% CI: 1.95–16.6) were strong independent predictors for MR development, while medical history was not.

Conclusions

MR development following ANT exposure is frequent, increasingly after the completion of ANT therapy. The parallel reduction in LV function might imply a functional mechanism. Larger trials are needed to evaluate the MR prognostic clinical role in cancer patients.

Funding Acknowledgement

Type of funding sources: None.

The median age of a city's residents and population density influence COVID 19 mortality growth rates: policy implications

Background

SARS-CoV-2 is an infectious virus, which has generated a global pandemic. Israel was one of the first countries to vaccinate its population, inaugurating the program on December 20, 2020. The objective of the current study is to investigate the projected daily COVID19 mortality growth rate with higher median age and population size of cities under two scenarios: with and without the BNT162b2 Pfizer vaccination against the SAR-COV2 virus.

Methods

This study employs a panel data-set. We follow the COVID19 mortality growth rate in each of the 173 Israeli cities and towns starting from March 21, 2020 (10 days after the first documentation of COVID19 cases in Israel) until September 21, 2021, where the BNT162b2 Pfizer vaccinations were available starting from December 20, 2020.

Results

Referring to the median age of municipal residents, findings suggest that the BNT162b2 Pfizer vaccinations attenuate the rise in anticipated daily mortality growth rate for cities and towns in which the median population age is 30 years old (the range in median age among the residents in the municipalities surveyed is 11–41 years). Moreover, referring to population size of cities, findings demonstrate that while under the scenario without vaccination, the daily mortality growth rate is anticipated to rise, under a comparable scenario with vaccination, daily mortality growth rate is anticipated to drop.

Conclusions

In crowded cities, where the median age is high, two perspectives of early and intensive public policy interventions are clearly required. The first perspective is extensive medical treatment, namely, extension of availability of medical physical and online services; dispensing designated medications; expansion of hospitalization facilities and information services particularly to susceptible populations. All measures will be taken with attention to age accessibility of these means. The second perspective is prevention via establishment of testing and vaccination complexes; elevation of dedicated health services, generating selective lockdowns; education for increasing awareness to social distancing, wearing masks and other preventive means.

Can smoking prevalence explain COVID-19 indicators (cases, mortality, and recovery)? A comparative study in OECD countries

There are many risk factors associated with the spread of the COVID-19 pandemic, including low wind speed, fossil fuel energy production, air pollution, and smoking. Several studies argue that smoking is not a risk factor for COVID-19 morbidity among males or any other sub-group. The study aims to analyze the following research questions: (1) can smoking prevalence explain COVID-19 indicators (cases, mortality, and recovery)? Are these relationships monotonically increasing or decreasing? In an attempt to test the counter-intuitive possibility of a non-linear relationship, the proposed empirical model relaxes the assumption of monotonic change by applying the quadratic design and testing which one of the two competing models (quadratic or linear) better fits the data. Findings suggest more complex relationships between corona indices and prevalence of smoking than previously thought. These patterns might be explained by several conditions such as the attenuation of hypercytokinemia for mild levels of smoking prevalence compared with non-smokers, elevated social distancing of smokers in countries with lower smoking prevalence, and unidentified factors that should be examined in future research.

Can the Regime Type (Democracy versus Autocracy) Explain the COVID-19 Recovery Rates?

COVID-19 is an example of worldwide and unanticipated global crisis. This study provides an example of crisis management in different countries and regime types. Previous studies provide evidence supporting reduced infant mortality as well as increased life expectancy with higher levels of democracy. These findings lead to the conventional wisdom that democracies provide conditions that promote better health for their citizens. The current study seeks to investigate health–democracy relationship in the context of recovery from COVID-19 disease. Unlike the conventional wisdom and based on 169 countries and regions around the world, for which information regarding accumulated recovery rates from coronavirus and Freedom House measures of democracy are available, findings suggest better projected prospects of recovery from COVID-19 disease in more “autocratic” countries. These findings may be explained on the grounds of (1) inefficient law enforcement in more democratic countries and (2) stronger autoimmune response (a cytokine storm, associated with COVID‐19 severity) in Western countries due to excessive hygienic environmental conditions and, consequently, lack of exposure to different pathogens.

Covid 19 vaccination: Accessibility or literacy? Israel as a case study

Israel is ranked as the leading country in terms of prevalence of vaccination against SARS-COV-2 virus (persons vaccinated divided by total population). Based on updated data as of January 19, 2021, the objective of the current study is to assess the relationship between the prevalence of vaccination and population density. A-priori, given the better infrastructure of health services (more physicians and nurses per 1000 persons), one would anticipate a higher level of vaccination in denser cities. Surprisingly, the outcomes demonstrate an opposite relationship: a lower level in the per capita level of vaccination with higher population densities from 0.2144 for 2 persons per sq. Km. to a minimum of 0.007191 for 16,642 persons per sq. Km. Given the relatively good accessibility to vaccination centers and high spread of clinics and health centers in Israel, research findings thus stress the major importance of promoting the benefits of vaccination (vaccination literacy) to diversified populations.

To lockdown or not against COVID19: Can the power of education provide the answer?

Global education is a well-known positive externality associated with children-parents knowledge spillover. More education may also lead to increased communication among family members regarding health knowledge and skills acquired at or after school, positively affecting health behavior. One important aspect that should be considered by policy makers is the potential promotion of social behavior adapted to the COVID2019 pandemic via the education system. The current study attempts to investigate the relationships between infection and recovery rates from coronavirus and the educational achievement of the population at the US statewide level. Based on the ranking of US States (including US sponsored areas) according to the percent of the population that completed high school and above from the top (93%) to the bottom (68.9%), findings suggest that as the level of educational achievement drops, projected infection rates rise and projected recovery rates drop. Research findings demonstrate the importance of educational achievement in addressing the coronavirus pandemic. Specifically, avoiding closings and opening the school systems under the appropriate limitations may have the long-run effect of children-parents knowledge spillover regarding the COVID19 pandemic. This, in turn, might promote public re-education and spread the adoption of desirable social behavior under conditions of COVID19 pandemic, such as, social distancing and wearing masks.

Do COVID19 infection rates change over time and space? Population density and socio-economic measures as regressors

The COVID19 pandemic motivated an interesting debate, which is related directly to core issues in urban economics, namely, the advantages and disadvantages of dense cities. On the one hand, compact areas facilitate more intensive human interaction and could lead to higher exposure to the infection, which make them the potential epicenter of the pandemic crisis. On the other hand, dense areas tend to provide superior health and educational systems, which are better prepared to handle pandemics, leading to higher recovery rates and lower mortality rates. The objective of the current study is to test the relationship between COVID19 infection rates (cases÷population) as the dependent variable, and two explanatory variables, population density and socio-economic measures, within two timeframes: May 11, 2020 and January 19, 2021. We use a different methodology to address the relationship between COVID19 spread and population density by fitting a parabolic, instead of a linear, model, while controlling socio-economic indices. We thus apply a better examination of the factors that shape the COVID19 spread across time and space by permitting a non-monotonic relationship. Israel provides an interesting case study based on a highly non-uniform distribution of urban population, and diversified populations. Results of the analyses demonstrate two patterns of change: 1) a significant rise in the median and average infection-population ratio for each level of population density; and 2) a moderate (a steep) rise in infection rates with increased population density on May 11, 2020 (January 19, 2021) for population densities of 4000 to 20,000 persons per square kilometer. The significant rise in the average and median infection-population ratios might be as attributed to the outcome of new COVID19 variants (i.e., the British and the South African mutants), which, in turn, intensify the virus spread. The steeper slope of infection rates and the rise in the standard deviation of the infection-population ratio may be explained by non-uniform spatial distribution of: dissemination of information in a variety of language; different levels of medical infrastructure in different parts of the country; varying levels of compliance to social distancing rules; and strict (limited) compliance to social distancing rules. The last factor of limited compliance might be the outcome of premature optimism due to extensive scope of the vaccination campaign in Israel, which is located in first place globally.

Can Obesity Prevalence Explain COVID-19 Indicators (Cases, Mortality, and Recovery)? A Comparative Study in OECD Countries

SARS-CoV-2 virus disease (COVID-19) is declared a global pandemic with multiple risk factors. Obesity is considered by several researchers as one of the serious risk factors for SARS-CoV-2 virus complications based on recent empirical studies. Yet, other scholars argue in favor of the existence of an obesity survival paradox and criticize the former group of studies on the grounds that they lack controls for race, socioeconomic status, or quality of care. The objective of the current study is to analyze the potential relationships between different SARS-CoV-2 virus indicators and obesity on a country-wide level based on an OECD report. In an attempt to test the counterintuitive possibility of an obesity survival paradox, the proposed empirical model relaxes the assumption of monotonic change by applying the quadratic design and testing which one of the two competing models (i.e., quadratic or linear) better fits the data. Findings suggest more complex relationships between SARS-CoV-2 virus indices and obesity rates than previously thought. Consequently, ethical guidelines referring to priority in intubation and intensive care treatments-published by the Israeli Ministry of Health in April 2020-should account for these complex relationships between obesity and SARS-CoV-2 virus. Indeed, there is a linear increase in mortality rate from SARS-CoV-2 virus with an elevated prevalence of obesity. Yet, other indicators, such as the number of infected per 10,00,000 persons, rates of severe SARS-CoV-2 virus cases, rates of recovered SARS-CoV-2 virus patients, and SARS-CoV-2 virus, as the cause of death exhibit quadratic, rather than linear, patterns. The reasons for these nonlinear patterns might be explained by several conditions such as increased metabolic reserves, more aggressive treatment, other non-SARS-CoV-2 virus complications for obese persons, and unidentified factors that should be examined in future research.

Can Increased Recovery Rates from Coronavirus be explained by Prevalence of ADHD? An Analysis at the US Statewide Level

Previous research demonstrates that ADHD is considered a risk factor for COVID-19. The current study attempts to investigate the relationships between infection, mortality and recovery rates from coronavirus and the prevalence of ADHD at the US statewide level. Based on information from 2011 regarding the prevalence of ADHD across the US by state, findings suggest that, while there are no correlations between ADHD and population size, infection and mortality rates from coronavirus, recovery rates (recovery-population ratio) rise with the prevalence of ADHD. Consequently, a possible explanation is that in coping with the disease, ADHD might provide an evolutionary advantage. An example of this phenomenon can be found in the gene that causes sickle-cell disease, which, as a non-dominant gene, helps cope with infection from malaria. If corroborated, research findings may support the conclusion that coronavirus limitations in special educational frameworks for ADHD would not be required or could be relaxed.JEL Codes: H75, I12.

Right ventricle strain changes in patients with breast cancer during anthracycline therapy

Background

Cardiotoxicity has become a significant adverse effect of cancer therapy, with Anthracyclines (ANT) in particular. There is a crucial need for the early subclinical detection of cardiotoxic effect. We aimed to evaluate Right ventricle (RV) two-dimensional speckle tracking echocardiography (2D-STE) changes during ANT therapy and to assess the correlation between RV 2D-STE and the routine echocardiographic RV parameters.

Methods

Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). All female patients with breast cancer, planned for ANT therapy were included. All patients underwent serial echocardiography exams including baseline RV 2D-STE (before chemotherapy, T1) and shortly after the completion of ANT therapy (T3). RV 2D-STE was evaluated using the apical 4 chamber (4C) RV-focused view, assessing both the combined RV free wall and inter-ventricular septum (RV GLS) and solely the RV free wall strain (RV FWLS). Significant reduction in both RV GLS and RV FWLS was determined by either a relative reduction of &gt;10% or an absolute value of &gt;−25% for RV GLS and &gt;−29% for RV FWLS.

Results

From September 2016 to June 2019, 40 patients were evaluated with a mean Doxorubicin (type of ANT) dose of 238.5±9.4 mg/m2. RV FWLS showed significant correlation to Tricuspid annular plane systolic excursion. At T3, significant reduction in both RV GLS and RV FWLS was observed among 77% and 62% of the patients with a mean RV GLS and RV FWLS reduction from −26.8 (±4.7) % to −21.5 (±4.4) % and −28.9 (±5.1) % to −25.6 (±5.9) % (p&lt;0.001, p=0.002), respectively. Left ventricle (LV) ejection fraction and LV GLS were within the normal range.

Conclusions

RV GLS and RV FWLS reduction are frequent and occur early in the course of ANT therapy, preceding LV dysfunction, which may imply for the role of RV 2D-STE in the detection of early cardiotoxicity.

Funding Acknowledgement

Type of funding sources: None.

Do population density, socio-economic ranking and Gini Index of cities influence infection rates from coronavirus? Israel as a case study

A prominent characteristic of the COVID-19 pandemic is the marked geographic variation in COVID-19 prevalence. The objective of the current study is to assess the influence of population density and socio-economic measures (socio-economic ranking and the Gini Index) across cities on coronavirus infection rates. Israel provides an interesting case study based on the highly non-uniform distribution of urban populations, the existence of one of the most densely populated cities in the world and diversified populations. Moreover, COVID19 challenges the consensus regarding compact planning design. Consequently, it is important to analyze the relationship between COVID19 spread and population density. The outcomes of our study show that ceteris paribus projected probabilities to be infected from coronavirus rise with population density from 1.6 to 2.72% up to a maximum of 5.17-5.238% for a population density of 20,282-20,542 persons per square kilometer (sq. km.). Above this benchmark, the anticipated infection rate drops up to 4.06-4.50%. Projected infection rates of 4.06-4.50% are equal in cities, towns and regional councils (Local Authorities) with the maximal population density of 26,510 and 11,979-13,343 persons per sq. km. A possible interpretation is that while denser cities facilitate human interactions, they also enable and promote improved health infrastructure. This, in turn, contributes to medical literacy, namely, elevated awareness to the benefits associated with compliance with hygienic practices (washing hands), social distancing rules and wearing masks. Findings may support compact planning design principles, namely, development of dense, mixed use, walkable and transit accessible community design in compact and polycentric regions. Indeed, city planners should weigh the costs and benefits of many risk factors, including the COVID19 pandemic.

The cause and effect problem: Is there mutual obesity among Arab Israeli couples?

The influence of the health-related behavior of one spouse on that of the other is an important research question with public policy reprecussions. Yet, we are unaware of any previous study, which considered endogeneity problems between couples. Moreover, only a few studies considered ethnic origin differences among couples. Based on the 2016 wave of the Israeli longitudinal survey, we observe the cross-sectional correlation between the married couples' BMI, age, and accumulated wealth. The BMI (= [Formula: see text]) is a conventional measure of obesity, where BMI≥25 is considered overweight. Using a 3SLS methodology (in an effort to correct the endogeneity problem associated with BMI couples), the analysis tests the mutual obesity hypothesis among married couples. This hypothesis states that the BMI of the male influences that of a female and vice versa. Results indicate that on the one hand, a one-percent BMI increase among Arab Israeli males is associated with a projected 0.969 percent BMI increase among Arab Israeli females (p = 0.017); and in the case that an Arab Israeli male suffers from overweight, the projected probability of his Arab Israeli female counterpart to suffer from overweight as well rises (p = 0.050). On the other hand, one cannot reject the null hypothesis that projected BMI of the Arab Israeli male is unaffected by that of his Arab Israeli female counterpart (p = 0.907 and p = 0.853). As for the Jewish Israeli population, in the case that the 3SLS methodology is employed, so that the endogeneity problem among couples is considered, a one-percent BMI increase among Jewish Israeli females is associated with a projected 0.639 percent BMI increase among Jewish Israeli males (p = 0.091). Unlike Arab Israeli couples, no support is found to indicate the influence in the other direction, namely, the BMI of the male influences that of the female spouse. Research findings may thus be of relevance to public health and policy planners. Two limitations of this research lie in: 1) the self-reported BMI (which might be different from the measured BMI); and 2) missing confounders, such as regional dummies, which are not available in the dataset.

The effect of task difficulty on feedback processing in children

The study evaluated the effect of task difficulty on feedback processing as measured by the feedback related event related potentials (ERPs) in 7-11-years-old children. Children completed two declarative learning tasks that differed in the number of object-name pairs they were required to learn, deeming the task with twice as many pairs as more difficult. EEG was recorded during the tasks, and event related potentials time-locked to the feedback presentation were analyzed. Additionally, Accuracy was measured in test block at the end of each task. Behaviorally, children achieved better accuracy on the easy task than on the difficult task. In line with previous findings in adults, the FRN was not found sensitive to task difficulty. However, a feedback-related P300 and a fronto-central positivity that followed the FRN were found sensitive to task difficulty such that their amplitudes were larger in the easy task. This pattern is opposite to that reported previously in adults and may reflect the effect of motivation on attention allocation in children.

Gender differences in the effect of employee-manager friendships on salary dynamics in CPA firms

We study the effect of employee-manager relations on salary increases. We use data obtained from a longitudinal survey, carried out among auditing team members in leading Israeli CPA firms (which are subsidiaries of American firms). Our main findings suggest that the degree of friendship with the team manager is positively correlated with the rate of the salary increase, particularly among female workers whose team manager is also a female. We also find that upon being hired to the job, male workers gain a higher return to experience compared with female workers.

The Association of Pension Income with the Incidence of Type I Obesity among Retired Israelis

Previous studies have identified obesity and overweight as the fourth leading risk factor for global mortality. The objective of the current study is to investigate gender differences and the impact of wealth and income from pensions, sociodemographic variables, and self-assessment of health conditions on the projected probability to become obese in the postretirement age (67 years and older). We are unaware of previous studies, which explored the direct relationship between obesity, monetary income from pensions, wealth, and self-assessment of health conditions. To conduct this research, we make use of an extensive questionnaire concerning the economic and sociodemographic features and health and housing conditions of individuals administered within the framework of the 2015-2016 longitudinal survey conducted by the Israeli Central Bureau of Statistics (CBS). The survey is representative of the Israeli population and also includes information regarding the weight, height, gender, and age of each household member. Results of our study demonstrate that while for the female respondents older than 67, the projected probability of type I obesity (BMI ≥ 30) drops by 0.41% (p=0.0021) to 0.52% (p=0.0001) with an incremental 10,000 NIS (about $2,500) rise of gross annual income from a pension, for the male respondents above 67 years, the projected probability remains unchanged (p=0.4225). This outcome remains robust even when the 2015 BMI measurement of type I obesity (BMI ≥ 30) is controlled. This drop among women attenuates with a cutoff point increase from BMI ≥ 25 (overweight) to BMI ≥ 30 (type I obesity) to BMI ≥ 35 (type II obesity). Further results indicate that for both genders above 67 years and for men above 62 years, the projected BMI drop of one year decreases with income from a pension (p=0.013, p=0.039, and p=0.007, respectively), although the spread around the projection becomes wider. Compared with other martial status categories, for widowed females, the projected probability of obesity and self-reporting on improved health conditions drops by 6.58% (p=0.0419) to 11.28% (p=0.0048) and 6.55% (p=0.0190) to 7.47% (p=0.0036), respectively. For females older than 67, family status divorced drops the projected probability of obesity by 9.25% (p=0.0319). For males older than 67, results show a rise in projected obesity with car ownership by 6.10% (p=0.0897) to 6.41% (p=0.0469) and a drop in projected obesity with academic degree status by 9.93% (p=0.0106) to 10.14% (p=0.0118) and immigration status from American-European countries by 7.67% (p=0.0821) to 8.99% (p=0.0398) and Asian-African countries by 11.63% (p=0.0245) to 11.99% (p=0.02). Research findings stress the differences and similarities in male-female patterns of obesity after the retirement age of 67 years and may be of assistance to welfare and public health experts.

[Necrotizing ulcerative diseases in military population]

Necrotizing ulcerative diseases were prevalent in military personnel throughout history. Nowadays, its prevalence declined substantially in industrialized countries. Studies among immunocompromised patients suggest it is still a reason for concern among this population. We present two cases diagnosed and treated at our department. It seems that necrotizing ulcerative diseases are still a relevant entity in the Israeli Defense forces therefore it is of great importance to conduct proper diagnosis, treatment and follow up of the patients.

[Dental care to military dogs]

Oketz is a military special unit that operates different dog species for various missions. The dogs get routine medical and dental treatments in order to maintain their health and function. The dental treatment is based on the principles of contemporary dentistry for small animals. Furthermore, these working dogs need special care due to higher risk to trauma and attrition. The dogs go through routine dental examination and prophylactic dental cleaning. Each dental procedure is performed under general anesthesia; therefore it is well planned ahead including all the pre-operative workup needed. The article presents the current concepts of dental treatment of dogs especially in respect to their activity.

Determination of pollution and recovery time of karst springs, an example from a carbonate aquifer in Israel

This work combines the monitoring of two incidents of spring water pollution in the Western Galilee region of Israel, together with artificial tracer tests that provided valuable information regarding karst system connections and direct estimation of groundwater velocities. Almost simultaneous contamination of seven springs endangered the water supply for the region. The variations over time in contaminant concentration in the different springs were not similar, indicating more than one contamination source. Tracer tests revealed two different pollution sources that contributed to two different conduit pathways in the karst system. Breakthrough data for the tracers were modeled by a two-region non-equilibrium transport model, which provided the transport parameters of the karst conduit. Groundwater velocities in the conduits were found to be in a range of 2-3 km/day. The rapid response of the system was also demonstrated by the short recovery time of the springs, where, after the elimination of the pollution source, most water quality parameters reverted to their background concentrations in less than 3 months. The coexistence of highly polluted springs and uncontaminated groundwater in boreholes penetrating into the same aquifer demonstrates the complexity of groundwater flow in karst systems. In such systems, the fast groundwater flow in localized karst conduits seems to coexist with a slower flow within other portions of the aquifer.

Physical and psychological stressors linked with stress fractures in recruit training

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor-stress model. Forty-four male combat recruits (18.7 ± 0.7 years) participated in a 6-month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO(2)max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11-week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi = 36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796 ± 157 km, twofold the distance planned of 378 km (P < 0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866 ± 136 and 744 ± 161 km, respectively, P < 0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor-stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development.

Optimizing the P300-based brain-computer interface: current status, limitations and future directions

This paper summarizes the presentations and discussions at a workshop held during the Fourth International BCI Meeting charged with reviewing and evaluating the current state, limitations and future development of P300-based brain-computer interface (P300-BCI) systems. We reviewed such issues as potential users, recording methods, stimulus presentation paradigms, feature extraction and classification algorithms, and applications. A summary of the discussions and the panel's recommendations for each of these aspects are presented.

Sexual activity and erectile dysfunction in elderly men with angiographically documented coronary artery disease

We studied the prevalence of erectile dysfunction (ED) in elderly men, aged 65 years or above, with coronary artery disease (CAD) documented by coronary angiography. A total of 123 men (112 men with CAD and 11 men without CAD), mean age 74.6+/-5.9 years, was included. To detect ED and assess its severity, all participants were asked to complete the Sexual Health Inventory for Males (SHIM) questionnaire. Lack of sexual activity was more prevalent among men with CAD relative to men without CAD (31.3 vs 0.0%). Among the sexually active men, ED was more prevalent among men with CAD relative to men without CAD (85.7 vs 72.7%). A general linear model showed that age was the only factor associated with SHIM scores among the sexually active men with CAD (P=0.001). Other factors, such as the number of occluded coronary arteries, diabetes mellitus, hypertension, smoking, various medications and marital status, were not associated with SHIM scores in elderly men with CAD. We conclude that lack of sexual activity and ED are very common in elderly men with CAD. Among the sexually active men with CAD, ED severity is associated only with age.

Lack of difference in the intimal medial thickness between the left and right carotid arteries in the young

BACKGROUND

Carotid intimal medial thickening (c-IMT) is an established surrogate marker for atherosclerosis. There have been sporadic reports about an increase of c-IMT on the left carotid artery among populations with a mean age of +/-50 years.

OBJECTIVE

The purpose of this study was to evaluate whether there is a difference in c-IMT between the two carotid arteries in a group of young healthy adults.

METHODS

Ninety-eight healthy adults with a mean age of 28 years underwent blood tests to evaluate various cardiovascular risk factors as well as automated ultrasonic measurements of their c-IMT on both carotid arteries.

RESULTS

No significant difference was noted between c-IMT on both sides. In fact, the c-IMT on left carotid artery in men (n = 52) was 0.625 +/- 0.078 mm while on the right carotid it was 0.626 +/- 0.075 mm (P = 0.884). The values for women (n = 46) were 0.615 +/- 0.059 mm and for men 0.622 +/- 0.0618 mm (P = 0.582), respectively.

CONCLUSION

As opposed to a noted increase of c-IMT on the left carotid artery in older individuals, we did not find this difference in a group of young and relatively healthy adults. It is possible that if mechanical stress forces contribute to an enhanced left c-IMT, it takes a relatively long time to become evident.

Rheological consequences of acute infections: the rheodifference between viral and bacterial infections

The aim of the present study was to explore the difference between viral and bacterial infections regarding the intensity of erythrocyte aggregation in the peripheral venous blood. Although a rheodifference in terms of erythrocyte aggregation between viral and bacterial infections has been shown by us in the past, the time from onset of disease was not included. We have presently included the time from the onset of disease in a group of 133 patients with an acute bacterial infection who showed a significantly enhanced erythrocyte aggregation as opposed to a group of 23 with viral ones and no increased erythrocyte aggregation despite of there being no significant difference in the time from onset of disease (55.7+/-55.6 hours in the bacterial group versus 50+/-35.2 in the viral one). In addition, we could match 22 patients with viral infections who presented the same fibrinogen concentrations (338+/-78 mg/dl) as those with acute bacterial ones (338+/-79 mg/dl). Although of borderline (p=0.06) significance, patients with an acute bacterial infection presented enhanced (vacuum radius=12.6+/-6.4 microns) erythrocyte aggregation as opposed to their isofibrinogenemic counterparts (vacuum radius=9.4+/-6.5 microns). Again, both groups presented no difference regarding the time from onset of disease. We conclude therefore that patients with acute bacterial infections present higher levels of erythrocyte aggregation. This is not a result of a shorter time interval from disease onset of the viral group. The known detrimental effects of increased erythrocyte aggregation regarding capillary slow flow, endothelial dysfunction and reduced tissue oxygenation might be therefore relevant in the context of patients with an acute infection, especially the bacterial ones.

Common endometrial decidual reaction in postmenopausal breast cancer patients treated with tamoxifen and progestogens

In order to assess endometrial reaction to the combined treatment of tamoxifen and progestogens in asymptomatic postmenopausal breast cancer patients, we evaluated all such patients by vaginal ultrasonography and by histological examination of endometrial samplings. All patients were initially treated with tamoxifen, and progestogens were then added when metastases became evident. Of 12 patients included in the study, eight (66.66%) showed evidence of strong endometrial stromal decidualization, while three (25%) had decidual reactions in endometrial polyps. Overall, 11 (91.66%) of the patients had decidual reactions, and all were treated with progestogens for > or = 3 consecutive months. One patient, treated with progestogens for 1 months, had an inactive endometrium. All but three had thickened endometria (> 10 mm) on ultrasonographic evaluation. These data show that postmenopausal breast cancer patients who received progestogens for < or = 3 months, and who concomitantly took tamoxifen, had a uniform decidual reaction in all uteri.

Antibiotic for cesarean section: the case for 'true' prophylaxis

OBJECTIVES

To assess prospectively the efficiency and safety of two extended spectrum cephalosporins used as pre-operative prophylaxis in nonelective cesarean sections, and compare the results to those of a third group of patients that received cefamezine post cord clamping.

METHODS

Two hundred and forty one patients undergoing a nonscheduled cesarean section were assigned to receive either cefonicid or ceftriaxone prior to skin incision. These patients were followed prospectively for infectious and fetal complications. The outcome of these patients was also compared with another group of 194 patients that received cefamezine prophylaxis post cord clamping, and whose data were collected retrospectively. Chi-square analysis of variance were performed with P < 0.05 considered significant.

RESULTS

There were no significant differences in the febrile complications among the two groups of patients that received pre-operative prophylaxis. However, these patients had significantly less wound infections (P = 0.008) and a significantly shorter hospital stay (P < 0.001) than the patients who received their prophylactic antibiotics post cord clamping.

CONCLUSIONS

Extended-spectrum cephalosporins, when given pre-operatively, are both effective and safe, and may have an advantage over intra-operative first generation cephalosporins in the reduction of post cesarean section infectious morbidity.

Maternal and fetal serum and tissue levels of ceftriaxone following preoperative prophylaxis in emergency cesarean section

The use of antibiotic prophylaxis in emergency cesarean section has become the standard of care. Concern over fetal exposure has been the reason that antibiotics are traditionally given post cord clamping, but this does not allow adequate antibiotic levels in maternal blood and tissue to be achieved at the stage of incision and during surgery. We evaluated by bioassay maternal and fetal serum and placental ceftriaxone concentrations following the intravenous administration of 1.0 g of ceftriaxone upon the decision to perform cesarean section. The preoperative prophylaxis with ceftriaxone resulted in adequate protective levels in the mother and very low fetal blood levels.

Transvaginal ultrasonographic quantitative assessment of accumulated cul-de-sac fluid

Preoperative quantitative assessment of pelvic fluid is an important diagnostic tool in clinical decision making. In this study, we used high-frequency transvaginal ultrasonography in 10 healthy women to assess both the correlation between various amounts of fluid installed in the cul-de-sac and ultrasonic imaging and to determine whether correct estimation of fluid volume can be reached. No fluid could be ultrasonically detected when the volume was less than 35 to 40 ml. Between 35 and 100 ml there was a clear image of accumulated fluid in the cul-de-sac with good correlation between volume and image, whereas with larger amounts no clear correlation between the amount of fluid introduced and size of fluid area visualized by ultrasonography was possible. Transvaginal ultrasonography may enable quantitative evaluation of certain volumes of pelvic fluid, although amounts less than 35 ml cannot be visualized.

Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians

The Iraqi missile attack on Israel provided a unique opportunity to study the effects of fright due to a perceived threat of annihilation on the incidence of acute myocardial infarction (MI) and sudden death among the civilian population. During the first days of the Gulf war we noted a sharp rise in the incidence of acute MI and sudden death in our area compared with five control periods. Patient population in the various study periods did not differ significantly in age, sex ratio, hospital mortality, or proportion of patients in whom the acute event was the first presentation of coronary disease. However, during the first period of the war there were more cases of anterior wall MI and more patients received thrombolytic therapy than during control periods. Despite the continuing missile threat, the incidence of acute MI reverted to normal after the initial phase of the Gulf war.