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PubMed1999

An unusually high prevalence of asthma in Ethiopian immigrants to Israel.

BACKGROUND AND OBJECTIVES: The past 20 years have seen a large immigration of Ethiopian Jews to Israel, primarily in 2 airlifts, one in 1984-1985 and one in 1991. Infectious and parasitic diseases were the dominant health problems in the early years. Recently, we noticed changing health patterns in this population, particularly an increase in clinic visits for asthma, which contrasted with asthma rates of 2.5% reported among Ethiopian Jews at the time of immigration to Israel. This study evaluated the prevalence and characteristics of asthma in a population of Jews of Ethiopian origin who had been in Israel for 8-17 years. METHODS: We audited 302 files of adult patients of Ethiopian origin and 604 files of age- and gender-matched patients of non-Ethiopian origin. Each file was reviewed by 2 physicians. Asthma was defined by published clinical criteria as found in the patient file. Data on allergies and eosinophilia were collected as well. RESULTS: The average age of the 2 groups of asthmatics was 44.1 +/- 16.2 and 42.4 +/- 20.7 years, respectively. The prevalence of asthma in the patients of Ethiopian origin was 51/302 (17%), compared with 35/604 (5.8%) in the control group. Thirty-three percent of the Ethiopian asthmatics and 37% of the control group suffered from various allergic diseases. Among the patients of Ethiopian origin, the prevalence of eosinophilia was 44%, with no significant difference between asthmatics and non-asthmatic patients (49% versus 43%). Eosinophilia was found in 8.4% of the control group. Asthma was more prevalent among patients with eosinophilia (22%) than without eosinophilia (6.4%). CONCLUSIONS: Asthma is 3 times as prevalent in adults of Ethiopian origin, compared with the general population in our clinics, and markedly increased above the rate reported for newly immigrated Ethiopian Jews. We conclude that the move from the rural hills of Ethiopia to the more urban and industrialized setting of Israel has resulted in an increased prevalence of asthma in this population, but the specific cause is uncertain.

Adult↗
PubMed1976

Long-lived radionuclides in food: 90Sr and 137Cs in the Israel diet.

Routine monitoring of Strontium-90 and Cesium-137 levels in the main classes of food consumed in Israel has been carried out for a number of years. Calculations have been made of the intake of these isotopes by various groups in the Israel population using Food Consumption Survey data made available by the Israel Central Bureau of Statistics. More detailed analyses have been carried out to calculate the exposure of groups selected on the basis of demographic, economic and family-size criteria. This was carried out in an attempt to detect "critical groups" in the population who might be overly exposed. Results of these data indicate that in the case of Israel the monitoring of a single food item such as milk or the extrapolation of local fallout data cannot be relied on to give an estimate of radionuclide exposure through food. The relation between high consumption groups and the intake of "average" consumers is discussed in detail and the use of the statistical models developed in these studies for the estimates of radionuclide exposure during periods of high fallout levels which occurred in the past and possible applications with regard to other environmental contaminants is discussed.

Cesium Radioisotopes↗
PubMed1999

Childhood and adolescent ovarian malignant tumors in Israel. A nationwide study.

OBJECTIVES: To determine the incidence of ovarian malignant tumors in childhood and adolescence, to ascertain the frequency distribution of the various tumor types and to assess time trends in Israel on a nationwide basis. METHODS: The study group included all Israeli Jewish patients < or = 19 years old with histologically confirmed ovarian malignancies, diagnosed in Israel from 1970 to 1994. Data were obtained from the Israel Cancer Registry. The effects of age at diagnosis and period of diagnosis were analyzed using the Poisson regression. RESULTS: Among the 82 patients identified, the most frequent tumors (72.0%) were of germ cell origin and among those about one third were dysgerminomas. Epithelial tumors were diagnosed in 26.6% of the patients and most of these were borderline malignancies. The incidence rate (IR) for the total group of ovarian malignancies in the 0-19 age group was 0.52 and for ages 5-19 it was 0.71 per 100,000. After adjustment for age, a significant linear trend for a decrease of germ cell tumors over time was found, stemming from a decrease of dysgerminomas. A significant trend for increase in the IRs with age was also found. In addition, a steep rise in the age specific IRs of epithelial borderline tumors was noted in the last 5 year period. CONCLUSIONS: The IRs of ovarian malignancies in childhood and adolescence in Israel, as in other countries, is very low as compared to adults and the most common tumors are of germ cell origin while malignant epithelial tumors are very rare. A time period effect in the germ cell tumors that resulted from an inexplicable significant decrease in the age specific IRs of dysgerminomas, was observed. A significant increase in borderline tumors was also noted and may be attributed to greater awareness of pathologists to this entity.

Adolescent↗
PubMed1999

Prevalence of antibodies to West Nile fever, sandfly fever Sicilian, and sandfly fever Naples viruses in healthy adults in Israel.

BACKGROUND: The arbovirus infections West Nile fever (WNF) and sandfly fever (SFF) are both endemic in the Middle East. Despite the fact that the mosquito and sandfly vectors of these viruses are still found in Israel, SFF has not been reported since 1948, whereas outbreaks of WNF occur periodically. It is suspected that some of the cases of nonspecific febrile illnesses in Israel may in fact be either WNF or SFF. AIM: To determine the extent of past arbovirus infections in subgroups of Israeli soldiers. METHODS: Sera from random samples of three groups of healthy soldiers aged 18-20 (n=273), 21-30 (n=497), and 40-55 years (n=285) were examined for IgG and IgM antibodies to West Nile virus (WNV), sandfly fever Sicilian virus (SFSV), and sandfly fever Naples virus (SFNV), using an ELISA method. RESULTS: The prevalence of antibodies increased with age for all three viruses examined, and ranged from 7.0%, 0, and 2.8%, for WNV, SFSV, AND SFNV, respectively, in soldiers aged 18-20 years, to 41.9%, 23.7%, and 30.8%, in those aged 40-55 years. The percentage of seropositives for IgG who were also IgM positive were 1.0%, 5.9%, and 3.4%, for WNV, SFSV, AND SFNV, respectively. 17.5% of the seropositives for WNV were also positive for SFSV, as compared with 5.7% among the WNV-seronegatives. Among the seropositives for WNV, 23.99% were positive for SFNV, compared with 9.1% of WNV seronegatives. 48.2% of seropositives for SFSV were positive for SFNV, as compared with 8.4% for SFSV-seronegatives. In the age agroup 40-55 years, there were significantly higher prevalence rates in those born in Israel compared with those born abroad. CONCLUSIONS: There is still significant exposure to WNV, SFSV, and SFNV in Israel. Arborviruses are probably responsible for many cases of non-specific febrile illness in this region.

Adolescent↗
PubMed2000

[Smoking by an Israeli general hospital staff, and attitude to smoking in hospitals. Are we in Israel ready to institute "smoke-free hospitals"?].

Smoking within hospitals is common in general hospitals in Israel. It has a strong negative educational impact, has a negative image and curing its ill effects help keep our hospitals busy. An anonymous questionnaire was answered by 128 members of our hospital staff (28%). Their distribution, according to occupation and sex was representative of the rest of our hospital staff. 19% of our workers are smokers, a much lower proportion than in our general adult population. The proportion was highest among maintenance (40%) and sanitary-help staff (36%). 23% of nurses and 15% of physicians were smokers. This situation is better than that among Italian or Japanese medical staff, but much worse than among North American medical staff. 75% of our workers who smoke declared that they smoke outside the room in which they work. 66% and 72% of the staff believe that hospital workers and visitors, respectively, should smoke outside hospital buildings. Only 19% of all workers do not believe that a "smoke-free hospital" is attainable. 34% believe that a "smoke-free hospital" is achievable, and 47% said that it is perhaps achievable. 86% of all the workers, and 41% of the smokers, expect the hospital director to implement an effective policy of enforcing the law limiting smoking within hospitals (and other public buildings) in Israel. 60% are willing to contribute actively to this effort. We believe these results strongly suggest that the time is ripe for implementation of the "smoke-free hospital" in Israel. This requires a strong and effective central policy, like that in the USA. We suggest measures that the Israel Ministry of Health take measures to successfully implement this policy.

Adult↗
PubMed2001

Epidemiological trends of pediatric emergency referrals in Israel.

BACKGROUND: In the last decade pediatric emergency medicine in Israel advanced to a stage of independent emergency pediatric departments. At the same time, injuries and childhood, trauma--a global health problem--became the main cause of mortality and emergency referrals in children over the age of one year. OBJECTIVE: To determine the extent of pediatric referrals to emergency departments and the rate of pediatric trauma referrals in Israel. METHODS: The records from EDs of Israel's 24 public hospitals for a 6 year period (1994-99) were collected. The records based on computerized ED records were used to identify the basic demographics of pediatric ED referrals. Routine data for all pediatric patients were collected from pediatric and general EDs. This study is an analysis of the accumulated anonymous ED databases. RESULTS: Pediatric referrals to EDs accounted for 2,907,912 patients, 37% of them due to trauma. The mean hospitalization rate was 21%. No significant changes were observed during the 6 years in the rate of pediatric ED referrals and in the ED hospitalization rate of children. There is a constant trend of increase in trauma referrals of children. CONCLUSIONS: The ED is a major site for the delivery of healthcare to children in Israel. One of every four children in the community is referred every year to an ED, and more than one-third of those referrals are due to trauma.

Adolescent↗
PubMed2001

Hospitalization for general medical conditions among diabetic patients in Israel.

BACKGROUND: Diabetes mellitus is a serious, costly and growing public health problem. Very few studies have been published on the economic impact of diabetes in Israel. OBJECTIVE: To estimate health fund expenditures and rates of hospitalization for general conditions among the diabetic population in Israel. METHODS: The total number of hospitalizations in Israel in 1998 of beneficiaries of the General Sick Fund (Kupat Holim Clalit) was obtained from its bureau of statistics. The diabetic and general populations were compared for age and gender distribution, days of hospitalization and cost of hospitalization. All hospitals in Israel were included. RESULTS: There were 618,317 general admissions for a total of 3,005,288 hospitalization days. The diabetic population accounted for 11.5% of all admissions and 13.7% of all hospitalization days. Analysis by age revealed that diabetic patients over age 45 represented 18.3% of all admissions and 17.5% of all hospitalization days. The average stay in hospital was 4.8 days per patient for the general population and 5.3 days for diabetic patients. The overall hospital expenditure of the GSF for general medical conditions among diabetic patients in 1998 was estimated at US $173,455,790, of which 57% accounted for the daily hospitalization cost. Of the total hospital expenditures for that year, 13.3% was allocated to patients with diabetes of whom 96.4% were over 45 years old. No significant difference was found between males and females. CONCLUSION: Hospital expenditures for diabetic people increase with patient age and represent one-fifth of the total health insurance expenditure for the middle-aged and elderly population.

Adolescent↗
PubMedDate not supplied

Posterior uveal malignant melanoma: temporal stability and ethnic variation in rates in Israel.

In a population-based study of posterior uveal malignant melanoma (755 incidence cases), the authors found a stabilized incidence in Israel from 1961-1996. Overall, Jewish immigrants to Israel had a relative rate (RR) of 2.2 [95% confidence interval [1.5-2.6] as compared to the reference population (Israeli-born Jews with Israel-born parents, i.e. third generation). Whereas individuals born in Eastern Europe or the Americas experienced the highest age adjusted incidence rates per million [for example; from 1972-1996, 8.3 for those from Poland, 8.2 from Romania, 6.4 from the former Union of Soviet Socialist Republics, 7.6 from the Americas], the lowest incidence rates were observed among immigrants from Algeria-Morocco-Tunisia (rate of 2.8), Iraq (1.7), Iran (3.2). Jews born in Israel exhibited incidence patterns similar to those individuals from the place of their parent's birth; high rates were observed among individuals born of American- or European-born parents (rate of 7.2), and low rates among offspring of parents who migrated from Africa or Asia (2.6). A low incidence was found among Israeli-born Arabs (2.6 in men, and 2.0 in women). The stable differences in incidence rates, according to populations of Jews, and the persistence of these variations within the descendants of these populations suggest that underlying susceptibility states are related to an individual's origin.

Emigration and Immigration↗
PubMed2001

The changing epidemiology of viral hepatitis A in Israel.

BACKGROUND: Between 1970 and 1979, there was an increase in the incidence of viral hepatitis in Israel with a shift of peak incidence to an older age in the Jewish population, followed by a declining trend during the early 1980s. In July 1999 universal immunization of infants against hepatitis A was introduced. OBJECTIVE: To evaluate the chan-ges in the epidemiology of viral hepatitis A in Israel during the past decade. METHODS: Viral hepatitis is a notifiable disease in Israel and cases are reported to the regional health offices, which in turn provide summary reports to the Ministry of Health's Department of Epidemiology. The data in this study were derived from the summary reports and from results of seroprevalence studies. RESULTS: Following the increase in the incidence of reported viral hepatitis (mainly due to type A) between 1970 and 1979, the rates then stabilized and around 1984 began to decline until 1992. Since then there has been a slight increase. Whereas until 1987 the rates were consistently higher in the Jewish population, since then they are higher in the Arab population. The shift in the peak age-specific incidence from the 1-4 to the 5-9 year age group observed in the Jewish population around 1970 occurred 20 years later in the Arab population. The previously described seasonality is no longer evident. Recent seroprevalence studies indicate that by age 18 years only about 30-40% of the Jewish population have anti-hepatitis A antibodies. CONCLUSIONS: The decline in the incidence of hepatitis probably reflects the changing socioeconomic condition occurring at different times in the two major population groups. Since hepatitis A accounts for almost all the acute viral hepatitis in Israel, the universal vaccination of infants introduced in 1999 should substantially lower the morbidity within the next few years.

Adolescent↗
PubMed2001

Fixed-dose combination therapy in the United States, Britain and Israel.

BACKGROUND: Fixed dose combination therapy varies among countries. OBJECTIVE: To compare the list of fixed-dose combination therapies used in the USA, UK and Israel. METHODS: The total list of drugs and FDC drugs were counted manually from a list of generic names. We also counted the number of drugs in four characteristic subgroups: cardiovascular, anti-infective, gastrointestinal, and dermatological. Data for drugs in the USA, UK and Israel were taken from the Physician's Desk Reference (PDR 1997), the British National Formulary (BNF March 1997) and the Monthly Ethical Drug Indexed Compilation (MEDIC July 1997) respectively. RESULTS: The global percentage of FDC drugs in the USA and UK was higher than in Israel (20%, 25% and 15% respectively). A similar trend was found in all subclasses of FDC drugs except for the anti-infective category in which the percentage of FDC drugs was low and similar in all countries. CONCLUSION: The list of FDC drugs varies greatly between the USA, UK and Israel, reflecting the differences in the outcome of debate between the pharmaceutical companies and the regulatory authorities.

Data Collection↗
PubMed2001

Class structure in a deeply divided society: class and ethnic inequality in Israel, 1974-1991.

Despite the fact that in many societies ethnicity plays an important role in stratification processes, a common view held by students of stratification argues that the role of ascriptive criteria in stratification processes is diminishing, and that the main axis of the modern stratification system is rooted in the division of labour in the marketplace. Despite this, most Israeli sociologists have taken the ethnic and national cleavages to be the main axes of stratification in Israel. This paper utilizes the 1974 and 1991 mobility surveys in Israel to examine changes over time in the association between ethnicity/nationality (i.e., Ashkenazi-Jews, Sephardi-Jews and Israeli-Arabs) and class position in the Israeli stratification structure. It also examines the extent to which inequality of opportunity within the Israeli class structure is affected by ethnicity/nationality. Here it is found that the ethnic/national cleavage in Israel appears to have played a less important role over time in the allocation of Israeli men to class positions. It is shown that class crystallization processes that result from the differentiation of employment contracts in the marketplace produce a relatively common level of inequality of opportunity in Israel, across sub-populations and over time. Any difference in the level of inequality of opportunity between the various sub-populations would appear to result, in part, from different historical process of, and government policy towards, the three sub-populations.

Adolescent↗
PubMed2001

Epidemiological analysis of tuberculosis treatment outcome as a tool for changing TB control policy in Israel.

BACKGROUND: Sensing an inadequacy of tuberculosis control due to an influx of TB associated with immigration, we analyzed TB treatment outcome in Israel by population groups. OBJECTIVES: To provide an epidemiological basis necessary for any new national TB control policy, and to bring it to the attention of the medical profession in Israel and abroad since its results led to a change in Israel's TB control policy. METHODS: We reviewed all TB cases notified during the period 1990 to September 1992. "New cases" (820 cases, 93.5%) and "re-treatment cases" (57 cases, 6.5%) were analyzed according to three mutually exclusive groups: "successful outcome," "death," and "potentially unsatisfactory outcome" (according to WHO/IUATLD definitions). RESULTS: Of 820 "new cases," 26.6% had a "satisfactory outcome," 68.5% had a "potentially unsatisfactory outcome" and 4.9% died; compared to 47.4%, 45.6% and 7% among 57 "re-treatment cases," respectively. Using logistic regression analysis, outcome was associated with the district health office (P < 0.0001), the TB "experience" of the notifying clinic (P < 0.0001), and the form of TB (P = 0.02). No significant relationships were obtained for population groups, gender and age, interval between arrival in Israel and TB notification, and bacteriological results. CONCLUSIONS: Non-supervised TB treatment resulted in poor outcomes regardless of population groups. Better outcomes occurred in the larger TB clinics. Therefore, in addition to measures such as adequate drug supplies, reorganization of TB laboratories and training of TB personnel, we recommend the "directly observed treatment short-course" for all cases as well as reducing the number of treatment centers thereby increasing their case load.

Adolescent↗
PubMed2001

Methylphenidate use for attention deficit hyperactivity disorder in northern Israel--a controversial issue.

BACKGROUND: The prevalence of attention deficit hyperactivity disorder and its pharmacologic treatment have increased dramatically in the past decade in the United States and Britain. We examined the use of methylphenidate hydrochloride for the treatment of ADHD in children in northern Israel. METHODS: We evaluated all prescriptions for methylphenidate filled in 1999 for children aged 5-18 years residing in northern Israel who were insured by Clalit Health Services, a health maintenance organization that covers approximately 70% of the population. RESULTS: Methylphenidate was prescribed to 1.45% of the children in northern Israel in 1999, an increase of 20% in the overall prevalence of methylphenidate use since 1992. Eighty-two percent were boys. The rate of prescription varied widely by type of settlement, from 0.2% in Arab cities and towns to 5.7% in kibbutzim. Primary care physicians wrote 78% of all the prescriptions. CONCLUSIONS: The increase in methylphenidate use was much smaller in northern Israel than in most other developed regions and countries. More efforts at diagnosis and treatment of attention deficit disorders may need to be directed at Arab populations and those with inadequate medical services.

Adolescent↗
PubMed2001

Folk, traditional and conventional medicine among elderly Yemenite immigrants in Israel.

BACKGROUND: Migration leads to changes in almost all areas of life including health. But how far are health beliefs also preserved, and how far are they affected by the process of acculturation to the host society? OBJECTIVES: To examine the difference between behavior and attitudes towards conventional and traditional medicine among elderly Yemenite immigrants. METHODS: A community-based study was conducted in the Yemenite neighborhoods in the city of Rehovot. All inhabitants of Yemenite origin over the age of 70 were identified from the population register, excluding those who were institutionalized or demented. Social work students interviewed them at home. The questionnaire inquired after health problems in the preceding month. For each of these problems, the respondent was asked whether any mode of treatment had been employed--Yemenite folk remedies, conventional medical care, or other. Their attitudes towards Yemenite folk medicine and conventional medicine were recorded. Socioeconomic data included their current age, age at immigration, year of immigration, marital status, gender, religiosity, and education. RESULTS: A total of 326 elderly people were identified who fulfilled the selection criteria, of whom 304 (93%) agreed to be interviewed. Of these, 276 (91%) reported at least one health problem in the preceding month, providing 515 problems of which 349 (68%) were reported to a conventional medical doctor while 144 (28%) were treated by popular folk remedies. Fifty-nine problems (11.5%) were treated by specifically Yemenite traditional remedies, mostly by the respondents themselves (38/59) rather than by a traditional healer. Immigrants who arrived in Israel over the age of 30 years, as compared to respondents who immigrated at an earlier age and grew up in Israel, were more likely to use traditional Yemenite remedies (24.4% vs. 8.2%, P < 0.005). CONCLUSION: Aged Yemenite Jews in Israel prefer modern medicine. The earlier the immigrant arrived in Israel, the more positive the attitude towards modern medicine and the less use made of traditional Yemenite healing.

Age Factors↗
PubMed2001

A review of environmental and occupational exposure to asbestos in Israel.

The case for a total ban on manufacture and use of asbestos products is stated by the history of asbestos use, exposures, and risks in Israel. Manufacture and use of asbestos began in Israel in the 1950s, rising to a peak in the mid-1970s, and dropping gradually thereafter until reaching minimal levels in the 1990s. Following heightened public concern regarding the carcinogenic effects of asbestos products, there were reductions in use, manufacture, and persons exposed. Since the 1960s, asbestos-related diseases have been diagnosed in hundreds patients nationwide, including asbestos workers and users, as well as individuals living proximally to the manufacturing facilities. Exposures to asbestos in place remain, and patients with asbestos-related disease from environmental exposure are expected to appear for at least another 20-30 years. In the 1980s, an advisory committee appointed by the Ministry of Health of Israel outlined a comprehensive approach towards prevention, control, management, and compensation for health risks from asbestos exposures. As certain areas are still contaminated with asbestos waste and as environmental exposure persists, continued and improved medical monitoring and compensation programs are urgently needed in order to reduce the suffering of exposed individuals and their families. The ban on asbestos prevents risks from new exposures, but does not undo the damage from past manufacture, use, disposal, and dumping. In this paper, we review the history of Israel's import and use of asbestos, and the management of occupational and environmental exposures. We also address policy, practice, and the need to protect future victims of asbestos-related disease.

Asbestos↗
PubMed2002

Suicide in Israel: 1985-1997.

OBJECTIVE: To examine trends in suicide rates in Israel over a 13-year period. METHOD: All cases of autopsy-confirmed suicide in Israel from 1985 to 1997 were retrospectively reviewed. RESULTS: An overall annual increase in suicide rates, with rates in men 3 times higher than those in women, was observed. Suicide rates were highest in the second and third decades of life. Unlike Western countries where gunshot wounds are the most common method of suicide for men and poisoning is most common for women, asphyxiation by hanging was the most common method used by men in Israel, followed by firearm wounds and jumping from heights. In women, however, jumping from heights was the most common method, followed by hanging and poisoning. CONCLUSION: Increasing rates of suicide may be associated with waves of immigration to Israel, increased substance abuse and depression and the political and social climate. Further study to examine the precipitating factors is warranted.

Adolescent↗
PubMed2003

[Adolescent pregnancy in Israel: a methodology for rate estimation and analysis of characteristics and trends].

PROBLEM: Teenage pregnancies are frequently unplanned, the young pregnant woman being often unmarried. These pregnancies occasionally end in induced abortion. Teenage pregnancy, especially when unintended, is correlated with negative effects for the child and the mother. Despite the need to reduce the magnitude of this phenomenon, there is no reliable database on teenage pregnancy. Such a database could help define populations at risk, and could help in designing prevention programs. Birth rates, fetal deaths, and induced abortion are reported, but there is no uniformity or merging of the data. OBJECTIVES: The aims of the paper are to present a methodology for the estimation of pregnancy rates and to use it for the analysis of characteristics and trends in adolescent pregnancies in Israel. METHODS: The pregnancy rate was calculated as the sum of three outcomes: live birth, induced abortion, and fetal loss, at all stages of pregnancy. RESULTS: Based on these computations, the teenage pregnancy rate in Israel was estimated as 32 per 1,000 adolescent girls. This rate was three times higher among Moslems as compared to Jews. From 1988 through 1998, the rate decreased by 12%. The pregnancy rate in Israel is similar to the rate of most Western-European countries, and is three times lower than the US rate. CONCLUSION: There is a need to improve the means for collecting the data on which the computations are based, to build an algorithm specifically adapted to Israel, and to publish detailed pregnancy rates on a regular basis.

Adolescent↗
PubMedDate not supplied

Profile of a pediatric rheumatology practice in Israel.

BACKGROUND: Several studies from Western countries have analyzed the profile of pediatric rheumatology practices. Due to differences in demography and health care systems the profile in Israel may differ from those countries. OBJECTIVE: To describe the profile of a pediatric rheumatology practice in Israel. METHODS: All new patients seen during the course of 2000 as part of my pediatric rheumatology practice in Northern Israel were registered at their initial encounter. Recorded were demographic data, referral patterns, diagnoses, and disease-related data. Diagnoses were grouped together by types of condition. RESULTS: 242 new patients were seen. 39% of the patients had a rheumatic condition, 39% had non-inflammatory conditions, 12% had periodic fever syndromes and for 10% no definitive diagnosis was determined. 14% had chronic rheumatic diseases. The time until diagnosis was significantly greater and more physicians were involved in the evaluation of periodic fever syndromes than in other disease groups. Seventeen (7%) patients had juvenile rheumatoid arthritis (JRA). The minimum estimated incidence of JRA was 8.8 per 100,000 children. CONCLUSIONS: Most patients seen did not have classic inflammatory rheumatic diseases, similar to data from other Western countries. Distinctive to Israel and the Middle East, periodic fever syndromes comprise a large proportion of the pediatric rheumatology practice. These syndromes are relatively difficult for community physicians to diagnose.

Adolescent↗