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PubMed2004

Aging in the shadow of the law: the case of elder guardianship in Israel.

Historically, the frail elderly, as well as other vulnerable populations who are unable to care for themselves, have been subject to legal proceedings known as guardianships. Despite changes and reforms, adult guardianship law has survived as a fundamental legal institution aimed at protecting the frail elderly as well as other incompetent adults. However, very little is known on the reality of adult guardianship under Israeli law, and the experience of the adult population under guardianship was never empirically studied in Israel. The empirical void regarding the workings of the Israeli law in this area served as the impetus for this study. The study investigated the issue of adult and elder guardianship in Israel as revealed in Family Law Courts' rulings, while focusing in particular on the profile of the wards, the reasons and motives, the legal procedure, and the outcome of the guardianship process. The study was a quantitative analysis, based on a random sample that included 523 court cases requesting legal guardianship for adults due to impaired legal competence. Rulings on these cases were provided in Family Courts from Haifa, Nazareth, and the Krayot areas in the period of the years 2000-2002. A clear but somber picture emerges from the findings of this study: Every year thousands of elderly individuals are subjected to the plenary legal authority of guardians appointed by law. This severe legal outcome takes place without providing these elderly the right to express their positions, without the provision of legal representation, and without their being seen or heard by the courts. These findings lead to the conclusion that there is urgent need in Israel to carry out extensive reform in the realm of civil legislation on the issue of guardianship for adults and the elderly.

Aged↗
PubMed2001

Type 1 diabetes environmental factors and correspondence analysis of HLA class II genes in the Yemenite Jewish community in Israel.

OBJECTIVE: The Israeli Yemenite Jewish community has displayed an exceptionally rapid increase in the frequency of type 1 diabetes, having the highest rate of all Israeli ethnic groups. We studied the role of the environment, in relation to the nature and frequency of HLA class II genes, to evaluate its possible involvement in the development of diabetes. RESEARCH DESIGN AND METHODS: We interviewed 196 elderly Yemenite women, who had immigrated to Israel as adults, in programmed encounters about signs and symptoms of type 1 diabetes, infant feeding customs, and infectious diseases in Yemen. We also performed HLA oligotyping of DRB1, DQA1, and DQB1 genes in 120 unrelated Yemenite Jews, including 44 type 1 diabetic patients and 76 healthy control subjects, and used these data in correspondence analysis comparing Yemenites with different Israeli ethnic groups. RESULTS: Interviews indicated that early exposure to cow's milk was very common in Yemen. However, none of the women could recall classical presentations of diabetes. HLA oligotyping showed that gene frequencies of non-Asp-57 (of the HLA-DQB chain) in the patients (0.94) and control subjects (0.6) were similar to those of other populations with a known high incidence of type 1 diabetes. Correspondence analysis revealed that Yemenite Jews are genetically distinct from other ethnic groups in Israel. CONCLUSIONS: The genetic distinctiveness of Yemenite Jews may explain their unusually high incidence of type 1 diabetes in Israel. Despite the presence of highly susceptible diabetogenic HL4 class II genes in this community, early exposure to cow's milk did not cause phenotypic expression of diabetes in Yemen. This finding suggests that in this population, either cow's milk does not play a crucial role in triggering diabetes, or environmentally conferred protection, such as frequent infectious disease in Yemen, was dominant.

Adult↗
PubMed1965

MEDICINE AMONG NEW IMMIGRANTS AND ARAB MINORITIES IN ISRAEL.

The reaction to modern medicine and the general health of the new immigrants and Arab populations of Israel are described. The material was gathered during a threemonth visit to Israel where the author participated in the medical care of these persons. While these peoples still share many of the traditional medical superstitions and practices, the new immigrants have progressed much more during the 16 years of Israel's existence. At present over 99% of Jewish women give birth in hospital, whereas only 65% of Israeli Arabs do. The infant mortality rate among the Jews in 1963 was about 21 deaths per 1000 live births, about one-half the rate for Arabs. The importance of understanding the cultural background and social conflicts of these people as a preliminary to the provision of proper medical care is stressed.

Arabs↗
PubMed1995

Iraqi missile attacks on Israel. The association of mortality with a life-threatening stressor.

OBJECTIVE: The imminent deadline for the 1991 Persian Gulf War and, subsequently, the 18 missile attacks by Iraq on Israel represented an unusual, short-term, life-threatening stressor for an entire nation. We studied mortality in Israel in January and February 1991 to determine whether excess deaths were precipitated on days of missile attacks. DESIGN: A time-series mortality study. SETTING: The state of Israel. PARTICIPANTS: All Israelis aged 25 years and older. MAIN OUTCOME MEASURE: Daily mortality by sex, age, region, underlying cause, and place of death. RESULTS: On January 18, 1991, the day of the first strike on Israeli cities, a 58% increment in total mortality occurred in the Israeli population (95% confidence interval [CI], 34% to 86%; P < .0001), a 77% excess (95% CI, 40% to 120%) in women and a 41% excess (95% CI, 10% to 79%) in men. This excess mortality occurred largely in the targeted Tel Aviv-central coastal plain and Haifa regions from cardiovascular causes and mainly out of hospital, significantly more so (P < .01) in women than men. Subsequently, on 16 attack days no overall excess was noted, yet a 10% increase in out-of-hospital deaths occurred. CONCLUSIONS: Likely explanations for the initial increase in mortality include acute emotional stress coupled with breathing difficulties induced by gas masks and extended stay in sealed rooms with resultant hypoxia in susceptible individuals. Women were more vulnerable than men. The absence of elevated total mortality in the subsequent attacks suggests a rapid adaptation to the circumstances surrounding the war. The policy of an unventilated sealed room may have been detrimental.

Adult↗
PubMed2003

Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel.

CONTEXT: The terrorist attacks on Israeli society have been ongoing since September 2000. However, few studies have examined the impact of terrorism on nationally representative population samples, and no study has examined the psychological impact of ongoing terrorism in Israel. OBJECTIVES: To determine the level of exposure to terrorist attacks and the prevalence of traumatic stress-related (TSR) symptoms, symptoms of posttraumatic stress disorder (PTSD), and sense of safety after 19 months of terrorism in Israel, and to identify correlates of the psychological sequelae and the modes of coping with the terrorism. DESIGN, SETTING, AND PARTICIPANTS: Telephone survey conducted April-May 2002, using a strata sampling method, of 902 eligible households and a representative sample of 742 Israeli residents older than 18 years (82% contact rate) and a final participation of 512 (57%). MAIN OUTCOME MEASURES: Number of TSR symptoms, rates of those with symptom criteria for PTSD and acute stress disorder assessed by the Stanford Acute Stress Reaction Questionnaire, self-reported feelings of depression, optimism, sense of safety, help-seeking, and modes of coping. RESULTS: Of 512 survey participants, 84 (16.4%) had been directly exposed to a terrorist attack and 191 (37.3%) had a family member or friend who had been exposed. Of 510 participants who responded to questions about TSR symptoms, 391 (76.7%) had at least 1 TSR symptom (mean, 4.0 [SD, 4.5]; range, 0-23; mean intensity, 0.8; range, 0-4). Symptom criteria for PTSD were met by 48 participants (9.4%) and criteria for acute stress disorder, by 1 participant; 299 (58.6%) reported feeling depressed. The majority of respondents expressed optimism about their personal future (421/512 [82.2%]) and the future of Israel (307/509 [66.8%]), and expressed self-efficacy with regard to their ability to function in a terrorist attack (322/431 [74.6%]). Most expressed a low sense of safety with respect to themselves (307/509 [60.4%]) and their relatives (345/507 [67.9%]). Few reported a need for professional help (27/506 [5.3%]). Female sex, sense of safety, and use of tranquilizers, alcohol, and cigarettes to cope were associated with TSR symptoms and symptom criteria for PTSD; level of exposure and objective risk were not. The most prevalent coping mechanisms were active information search about loved ones and social support. CONCLUSIONS: Considering the nature and length of the Israeli traumatic experience, the psychological impact may be considered moderate. Although the survey participants showed distress and lowered sense of safety, they did not develop high levels of psychiatric distress, which may be related to a habituation process and to coping mechanisms.

Adaptation, Psychological↗
PubMed1997

Risk of cancer in migrants and their descendants in Israel: I. Leukaemias and lymphomas.

Cancer registrations among young individuals (under age 30 years) for the 30-year period 1960-1989 were used to investigate the risk of leukaemia and lymphoma in migrants to Israel, and in their offspring, relative to Israel-born individuals with Israel-born parents. Relative risks by the father's continent of origin, and odds ratios by continent of origin of mother or both parents, adjusted for age, sex and period, were estimated. The leukaemias showed little variation in risk by birthplace, and no change between generations. For non-Hodgkin lymphoma, however, there were quite large differences in incidence, with relatively high rates in migrants from Asia and Africa. These persisted to some degree into the second generation, suggesting that inherited susceptibility may underlie some of the variation.

Adolescent↗
PubMed1997

Risk of cancer in migrants and their descendants in Israel: II. Carcinomas and germ-cell tumours.

Cancer registrations among young individuals (under age 30 years) for a 30-year period (1960-1989) were used to investigate the risk of cancer in migrants to Israel, and in their offspring, relative to Israel-born individuals with Israel-born parents. Relative risks of testis and ovarian cancer (germ cell tumours and carcinomas), melanoma, and carcinomas of nasopharynx, colorectum, breast, cervix and thyroid were calculated according to father's birthplace, and odds ratios for birthplace of mother, or of both parents. The estimates were adjusted for the effects of age, sex and time period. For 3 cancers, i.e., testis cancer, nasopharyngeal carcinoma and melanoma, there were quite large differences in incidence, which persisted to some degree into the second generation, suggesting that inherited susceptibility may underlie some of the variation. For ovarian, colorectal, cervical and thyroid cancers, differences in risk between the migrant groups had largely disappeared in their offspring, suggesting that environmental exposures, which were modified by migration, are the major causative factors.

Adolescent↗
PubMed2002

Male breast carcinoma in Israel: higher incident but possibly prognosis in Ashkenazi Jews.

BACKGROUND: Little information is available regarding male breast carcinoma. However, cumulative data have suggested a propensity for the disease among Ashkenazi Jews. Because Ashkenazi Jews comprise one of the major ethnic groups in Israel, the authors conducted a local study to shed more light on the features of this rare disease. METHODS: From 1960 to 2000, 131 men with breast carcinoma were treated at the Rabin Medical Center or the Rambam Medical Center, and, from 1980 to 1997, 470 patients with this diagnosis were recorded in the Israel Cancer Registry. These two data bases were used to analyze the epidemiologic and clinicopathologic characteristics of male breast carcinoma in Israel. RESULTS: Seventy-eight percent of the 131 Jewish patients were Ashkenazi. Most of their clinical characteristics were similar to those of their Sephardic counterparts. However, there was a statistically significant difference in the pattern of comorbidity between these groups (P = 0.000), and there was a trend toward a younger age at onset and more advanced tumor stage at the time of diagnosis for the Sephardim. It also was found that Sephardic origin was associated with poorer outcome (P = 0.03). Analysis of the Cancer Registry data base revealed an 80% increase in the risk of the disease for Ashkenazi Jews compared with Sephardic Jews (odds ratio, 1.8; 95% confidence interval, 1.4-2.3; P = 0.001). Survival analysis from this source suggested a poorer outcome for Sephardic Jews compared with Ashkenazi Jews (62% vs. 64.3% estimated 5-year survival rates, respectively; P = 0.08). CONCLUSIONS: Analyses of two independent data bases, patient charts, and a cancer registry indicate that breast carcinoma seems to be more prevalent among Ashkenazi Jewish men. At the same time, affected Ashkenazi patients may have a more favorable outcome than their Sephardic counterparts.

Adenocarcinoma↗
PubMedDate not supplied

The political economy of healthy system reform in Israel.

On June 15, 1994, the Israeli Parliament voted to enact the National Health Insurance bill (NHI). The bill marks the end of a process that lasted for virtually as long as Israel's almost 50 year history. Israel's attempts at health reform began long before the current spate of reforms in many Western countries. Faced with many of the same problems of access, equity and cost control common to many of its counterparts, Israel initiated a reform process based on the recommendations of a prominent State Commission of Inquiry into the Israeli Health System (the Netanyahu Commission) which reported to the Government in 1990. The Commission's proposals were based on a diagnosis indicating that the major problems of the system stem from the lack of clarity regarding the rights of citizens to health care, the lack of a clear allocation of responsibility and accountability among government, insurance or sick funds, and providers in the system, and undue centralization of system operations. This diagnosis led to three major planks for reform: (1) enactment of national health insurance legislation granting a basic package of care to each citizen and hence bringing most of the system's finance under public auspices; (2) divesting the Government from the organization, management and provision of care; hence integrating the management of preventive and psychiatric services provided by the government with the primary and other services provided by sick funds, and granting financial and operational independence to at least government hospitals; and (3) restructuring the Ministry of Health. As is often the case in public policy, more consensus surrounds the diagnosis than the solutions. As a result, nearly four years of implementation efforts have only recently resulted in a major breakthrough. In this paper we make an effort to outline the inherent weaknesses of the Israeli health care system that have led to the crisis in the mid 1980s, summarize the recommendations of the State Commission for structural change in the system, and review the politics of implementing the recommended reforms.

Costs and Cost Analysis↗
PubMed2001

Incidence of leukemia and other cancers in Down syndrome subjects in Israel.

Epidemiologic data have confirmed the high susceptibility of persons with Down syndrome (DS) to leukemia. The question of proneness to other kinds of cancer is still open. In this study we reassessed the incidence rates of leukemia and other malignancies in Israeli DS subjects, based on the total population. The target population consisted of all DS subjects in Israel in the period of 1948--1995. Due to incompleteness of data, the target population was not fully achieved, thus the study population was divided into 2 subgroups: subjects born in Israel between 1979 and 1995 (registry group) and currently or past-institutionalized subjects born before 1979 (institution group). The cohort was linked with the Cancer Registry, and cancer cases that had been diagnosed through December 1995 were subsequently identified. Observed incidence rates were compared with expected rates in the general population. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed for each disease category. Analyses were performed separately for each subgroup of the study population. In the registry group, 7 cancer cases were observed, compared with 1.5 expected (SIR = 4.67, 95% CI 1.9--9.6), all leukemia cases. For the institution group a total of 17 cancer cases were observed, compared with 12.8 expected. These included 4 cases of leukemia (SIR = 6.90, 95% CI 1.90--17.70). An excess of gastric cancer in male subjects (SIR = 11.9, 95% CI 1.3--42.9) was also observed. Significant excess of leukemia in DS population in Israel is in accordance with previously published data. An excess of gastric cancer in DS male subjects born before 1979, which has not been reported before, should be further explored.

Adolescent↗
PubMed1990

Cancer in Jewish migrants to Israel.

Data on the incidence of 15 cancers in the Jewish population of Israel from the period 1961-1981 have been studied with emphasis on the risk of disease in relation to birthplace, calendar time, and duration of residence in Israel. The results show wide variations in incidence by birthplace, from less than 2-fold for pancreatic cancer to a 40-fold difference for oesophageal cancer in females; the reasons for these are often little understood. The potential importance of environmental agents in aetiology for different migrant groups is discussed in relation to the size and rapidity of changes in risk related to the duration of residence in Israel.

Africa, Northern↗
PubMed1995

Serological evidence for hepatitis E virus infection in Israel.

Israel is suspected to be endemic for hepatitis E virus (HEV) because of its geographic location and the large-scale immigration from endemic countries. Although no cases of local HEV infection have been diagnosed, a serological survey would provide indirect evidence for such infection. We examined sera from 1,416 healthy subjects, including 1,139 Jews from various regions of Israel and 277 Arabs, most of whom reside in the West Bank of the Jordan River. In addition, we tested 13 non-A, non-B, and non-C viral hepatitis patients. Sera were screened for antibody to hepatitis E virus (anti-HEV) by a newly developed enzyme immunoassay (EIA) and by immunoblots for both IgG and IgM anti-HEV activity. Positive samples were confirmed by neutralization. The seroprevalence found by EIA was 2.81% and 1.81% in the Jewish and Arab populations, respectively. More than a 2-fold higher prevalence in males compared to females and an increase with age were found in both populations. However, these differences were nonsignificant. The geographical distribution was even throughout the country, except for two clusters of 3 and 4 seropositive individuals possibly reflecting past foci of infection. Eight of 37 EIA-positive sera were positive for IgG, and 3 were positive for IgM by the immunoblot assay. Among hepatitis patients (9 acute and 4 chronic), one patient with chronic hepatitis was positive for both IgG and IgM. Our study provides indirect evidence that Israel is endemic for HEV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Carcinoma of the nasopharynx in Northern Israel: epidemiology and treatment results.

Between 1968 and 1984, 49 patients with carcinoma of the nasopharynx were treated at the Northern Israel Oncology Center. There were 6 stage I-II patients (12%) and 43 stage III-IV patients (88%). According to ethnic origin, there were 27 (55%) non-Ashkenazi Jews, 9 (18%) Ashkenazi Jews, and 13 (27%) Arabs. This distribution is different from the percentages of these ethnic groups in Northern Israel. All patients received combined cobalt 60 and 8-10 MeV electron beam radiotherapy to the primary tumor and the entire neck. Twelve stage III-IV patients received three courses of chemotherapy using bleomycin, methotrexate, and cisplatin (BMP) prior to definitive radiotherapy. The following 5-yr actuarial survival figures were achieved: all patients, 42%; stage I-II, 63%; stage III-IV, 37%; Arabs, 53%, non-Ashkenazi Jews, 47%; Ashkenazi Jews, 22%; BMP+radiotherapy, 54%; radiotherapy alone, 42%. It is concluded that there is an ethnic-related pattern of nasopharyngeal carcinoma in Northern Israel. Prognosis is better in non-Ashkenazi Jews and Arabs with early-stage lymphoepithelioma or anaplastic carcinoma, younger than 45 yr old, and receiving more than 5,500 cGy. Chemotherapy by BMP improves initial control rates with questionable benefit to long-term survival.

Adolescent↗
PubMed2004

Changing practice patterns of school-based occupational therapists in Israel.

Following the enactment of the Special Education Law in Israel in 1988, school-based occupational therapists (OTs) were expected to modify their practice patterns by, providing services within the classroom or other educational settings, increasing collaboration with other team members, and implementing indirect intervention models such as monitoring and consultation. The purpose of this study was to examine the intervention patterns of school-based OTs in Israel. The study sample included 77 school-based OTs. The survey was carried out through a questionnaire which included: (1) background information, (2) implementation and perceptions towards intervention models, and (3) team-work practices of the OTs. The findings indicated that most of the time (76.9%) OTs still implement the 'direct therapy' model, working outside the classroom and focusing on improving performance components. These findings imply that school-based OTs in Israel are still in the process of changing their practice patterns, and are mostly applying the medical model. However, due to the relatively small sample, it is important to repeat this survey using a larger sample of OTs who work in different settings and with various age groups.

Adult↗
PubMed2001

Increased CCR5 and CXCR4 expression in Ethiopians living in Israel: environmental and constitutive factors.

HIV coreceptors play a major role in determining susceptibility and HIV cell tropism. The present work studied whether the high expression of these coreceptors found on lymphocytes and monocytes of Ethiopian immigrants to Israel (ETH) is the result of environmental and/or constitutive genetic factors. The study of 26 ETH shortly after their arrival to Israel (new ETH), 22 ETH in Israel over 7 years (old ETH), and 20 Caucasian Israelis (non-ETH) enabled us to address this issue. The new ETH had elevated levels of activated HLA-DR+CD4+ and CD38+CD8+ cells in comparison with both old ETH and non-ETH groups (P < 0.01), most probably related to chronic helminthic infections. Surface CCR5 expression, i.e., the percentage of CCR5+ cells and the number of CCR5 molecules/cell, was higher (2- to 3- and 8- to 31-fold, respectively) in activated than in nonactivated CD4+ cells, in all groups. However, CCR5 expression, in both activated and nonactivated CD4+ cells, was higher in both ETH groups than in the non-ETH group. CXCR4 expression was higher in nonactivated CD4+ cells in all groups and was also higher in both ETH groups, in both activated and nonactivated CD4+ cells, than in the non-ETH group. These findings suggest that constitutive factors, in addition to immune activation caused by environmental factors, account for the elevated expression of CCR5 and CXCR4 on CD4+ cells of ETH. This increased HIV coreceptor expression may make ETH more susceptible to HIV infection and may account in part for the rapid spread of AIDS in Ethiopia and the rest of Africa as well.

ADP-ribosyl Cyclase↗
PubMed2000

The contraceptive revolution in Israel: changing family planning practices among ethnoimmigrant groups.

This paper uses data from the 1974-1975 Israel Fertility Survey and the 1987-1988 Study of Fertility and Family Formation to examine trends in fertility control among ethnoimmigrant groups in Israel. From 1974 to 1988, Israel underwent extremely rapid economic growth and there occurred what might be considered a contraceptive revolution in the realm of family planning. Specifically, the nonuse of family planning and reliance on less effective techniques of fertility control (withdrawal and abortion) were largely replaced by more efficient modes (e.g., pill, IUD) of family size limitation. In addition, ethnic differences in patterns of fertility control diminished. Meanwhile, socioeconomic and cultural variables such as religiosity and income maintained their importance as determinants of variation of family planning practices among Israeli women.

Contraception↗
PubMed1994

Demographic aspects of Paget's disease of bone in the Negev of southern Israel.

In a mainly retrospective but partly prospective survey of the period 1968-1993 in southern Israel, 61 cases of Paget's disease of bone were identified. Fifty six percent were of non-Afro-Asian origin and 44% originated from Afro-Asia, which is approximately the inverse of the ratio in the local general population. The largest single groups from non-Afro-Asia and Afro-Asia originated, from Romania and Tunisia, respectively, and Australia and Argentina were also disproportionately prominent as countries of origin. Israel itself was the origin of few patients. All the patients were Jews except for one Bedouin Arab, which is far different from the distribution of Bedouins and Jews in both the surveyed area and the hospital population. The differences between these groups numerically and against the background local population may well have been statistically significant had the circumstances enabled greater randomness in the collection of the data analyzed. It is surmised that in southern Israel the prevalence of Paget's disease of bone is about 1%, similar to that in southern Europe.

Africa↗
PubMed1995

Determinants of the health and survival of the elderly: suggestions from two different experiences--Italy and Israel.

This study compares the health status and survival of the elderly in Israel and Italy. "The data used in this study derive from two sample surveys, one in Israel in 1985 and the other in Italy in the winter 1986/7.... The aim of this study was to identify the determinants of health, the use of the health care system and survival of the elderly...within the limits imposed by the data available by comparing two countries, Italy and Israel, which share similarities with regard to survival and development, but with fairly different demographic structures and cultures." (SUMMARY IN FRE)

Adult↗