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PubMed2006

Trends in adrenaline (EpiPen) dispensing in Israel in 1997-2004.

BACKGROUND: The prevalence of allergic diseases has increased over the last 20 years in the Western world. Reports on the growing use of adrenaline auto-injectors (EpiPen and EpiPen Jr) in several countries may point to increased rates of anaphylactic reactions, increased awareness of the risk of anaphylaxis or both. OBJECTIVES: To evaluate the dispensing rate of EpiPen units in Israel from 1997 to 2004. METHODS: The database of the General Health Services (Clalit) was searched to determine the number of EpiPen units dispensed each year from 1997 to 2004. Data on mortality from anaphylaxis were derived from the Central Bureau of Statistics using International Classification of Diseases, 10th revision codes. RESULTS: The dispensing rate of EpiPen units rose gradually from 1689 in 1997 to 2981 in 2004; an overall increase of 76%. No case of death from anaphylaxis was reported from 1998 to 2000. CONCLUSIONS: The dispensing rate of adrenaline auto-injectors has increased considerably over the last 8 years in Israel, although to a lesser degree than in other countries. This is probably a reflection of updated medical policies, in accordance with the clinical guidelines for the management of anaphylaxis and improved public education. Further studies are needed to determine the prevalence of anaphylactic reactions in Israel.

Anaphylaxis↗
PubMed2006

Low seroprevalence of antibodies to Neospora caninum in wild canids in Israel.

The role of domestic dogs in the epidemiology of Neospora caninum as well as the relationship between N. caninum infection of farm dogs and cattle were demonstrated, however, evidence is scarce regarding the role of wild canids in domestic animal neosporosis. The present study was undertaken to evaluate the role of wild canids in the epidemiology of bovine neosporosis in Israel by analyzing the prevalence of antibodies to N. caninum in wild canids. Sera samples were collected from 114 free ranging wild golden jackals (Canis aureus), 24 red foxes (Vulpes vulpes) and nine wolves (Canis lupus), which were collected in Israel during the years 1999-2004. Of a total of 147 wild canids tested antibodies to N. caninum were only found in two golden jackals with IFAT titers of 1:50, and in one red fox and one wolf with IFAT titer of 1:400. The low seroprevalence found in this study (2.7%) indicated that wild canids probably do not have an important role in the epidemiology of N. caninum in Israel. However, since the diet of different species of wild canids and even diverse populations of the same canid species vary, it is possible that other results might be obtained from specific wild canids populations, which scavenge in the vicinity of infected bovines.

Animals↗
PubMed2006

Prevention of lysosomal storage disorders in Israel.

Prevention programs for the detection of heterozygotes of relatively prevalent autosomal recessive diseases in various ethnic groups are available in recent years in Israel. Several lysosomal storage disorders (LSD) are included in this program. The goal of the program is the ascertainment of high risk couples before the birth of affected offspring. This is performed by a population screening program that addresses the specific needs and requirements of various population groups in Israel. The programs are supervised and designed by medical/clinical geneticists and are accompanied by genetic counseling prior to and after testing. Three types of population screening programs are in operation. The first type is offered to the general population and is directed to premarital and married couples. High risk families mostly opt for prenatal diagnosis. The second type is performed for diseases with a frequency of about 1:1000. This occurrence is common in Israel only in various Arab communities due to the high rate of consanguinity. The third type is a premarital screening performed by the Orthodox Jewish community and is operated by a nonprofit organization--"Dor Yeshorim". Two heterozygotes for a particular disease are advised not to proceed with the marriage and thus avoid the dilemma of prenatal diagnosis. Founder mutations of the relevant genes for each ethnic group are tested and the testing is tailored for each individual according to his/her ethnic background. Genetic counseling presents family planning options to high risk couples. These programs have resulted in a significant reduction in the birth of affected patients of the tested LSD a well as other recessive diseases in recent years.

Genetic Carrier Screening↗
PubMed2000

Globalization in road safety: explaining the downward trend in road accident rates in a single country (Israel).

A theoretical model is proposed in which road safety in a single country depends upon parochial considerations, such as police enforcement, and upon global considerations, such as international road safety technology. We show that there is a non-spurious relationship between the downward trend in the rate of road accidents in Israel and the road accident rate abroad. We suggest that this reflects the international propagation of road safety technology as it is embodied in motor vehicles and road design, rather than parochial road safety policy. Recent developments in the econometric analysis of time series are used to estimate the model using data for Israel. We make no direct attempt to explain the downward trend in the rate of road accidents outside Israel.

Accidents, Traffic↗
PubMed2002

Prevalence of cystic echinococcosis among Muslim and Jewish populations in southern Israel.

Following a review of records at the Soroka University Medical Center (SUMC) showing a recent increase in the annual incidence of hydatidosis among the Bedouin population of southern Israel, a seroepidemiological survey was conducted. A total of 1439 blood samples were collected from Bedouins and Jews living in the Negev area in southern Israel. An enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G, indirect haemagglutination (IHA) and immunoelectrophoresis (IEP) were used to detect anti-Echinococcus granulosus antibodies. The seroprevalence in the Bedouin group was 0.68% (7/1026), including two children under the age of 10. Among Jews, a seroprevalence of 0.5% was recorded in patients over 60 years of age only. A high rate of infection was shown in goats and sheep slaughtered in abattoirs in Bedouin localities. The results indicate that echinococcosis is a common disease in the Muslim communities of southern Israel.

Adolescent↗
PubMed2003

Population attributes affecting the prevalence of BRCA mutation carriers in epithelial ovarian cancer cases in israel.

OBJECTIVE: The objective was to evaluate the prevalence of BRCA1/2 mutations in selected categories of ovarian cancer patients in Israel. METHODS: Blood samples and specimens of ovarian tumors were obtained in the course of a national case control study of women with ovarian cancer in Israel. Eight hundred ninety-six patients with epithelial ovarian cancer, 40 cases with nonepithelial ovarian cancer, and 68 with primary peritoneal cancer were tested for the BRCA mutations. Analysis of the three common BRCA mutations in Israel (185delAG, 5382insC in BRCA1, and 6174delT in BRCA2) was done using a multiplex polymerase chain reaction assay. A multivariate logistic regression model was used to assess the association of mutation carrier status and other factors (age, origin, family history, and clinical variables). RESULTS: Of the 779 invasive epithelial ovarian cancer cases, 29.4% were mutation carriers. The prevalence of the mutations was higher among women below age 60 and in more advanced cases. The prevalence was low in mucinous tumors. There was almost a twofold excess of mutations among women with positive family history (45.7%), but still 26.5% of the family history negative cases were carriers. As expected, we found a higher rate of mutation carriers among the Ashkenazi group (34.2%) and 55% among Ashkenazi women with positive family history. No subjects born in North Africa were mutation positive. CONCLUSION: BRCA mutations are strongly associated with ovarian cancer and they are present in variable rates in distinct age, ethnic, and histopathologic categories.

Epithelial Cells↗
PubMed2002

Sexual harassment in Jewish and Arab public schools in Israel.

OBJECTIVE: Current empirical literature on sexual harassment in schools is mostly based on nonrepresentative samples of middle-class high-school Caucasian female students. Thus the scope of research regarding gender, age, and cultural differences is very limited. This article reports on findings on sexual harassment in Jewish and Arab schools in Israel with regard to gender, age, and cultural differences. METHOD: The study is part of the first national survey on school violence in Israel. The representative sample includes 10,400 students in grades 7 through 11 attending public schools in Israel. Students were asked to report whether they were victims of specific acts of sexual harassment in school during the month before the survey. RESULTS: Overall, 29.1% of the students were victims of at least one act of harassment. The more common acts were to show offensive pictures or to send obscene letters, to take off or to try to take off part of the student's clothing, and to try to kiss a student. The most vulnerable groups are the Arab boys and 8th grade students. Report rates were the lowest among Arab girls. CONCLUSIONS: Sexual harassment is prevalent in Israeli schools. The pattern of victimization is different for boys and girls and for students in Jewish and Arab schools. These patterns are a complex phenomenon that must be considered in the intervention and policy measures addressing sexual harassment at school.

Adolescent↗
PubMed2001

Implementing managed competition in Israel.

As of January 1, 1995, Israel's National Health Insurance (NHI) Law laid the foundations for regulating competition among the country's four private, not-for-profit sick funds. Prior to NHI the sick funds (SFs) had competed without governmental control. Extensive research on NHI implementation and the behavior of the sick funds (SFs) after passage of NHI reveals a paradoxical development: The NHI bill drew on the rhetoric of managed competition and did indeed establish a legal and structural framework for regulating competition among the SFs. Nevertheless, in practice, SF autonomy was constrained and competition over provision of statutory care was limited. Rather than fostering competition, the main thrust of the NHI reforms was to enhance central government's control over SF expenses in order to constrain government expenditures. The NHI reforms did encourage the SFs to cut costs and make visible service improvements. However, the reforms did not lead the SFs to reorganize, expand the scope of their services, or improve clinical quality, as the reformers had hoped. Nor did the reforms help eliminate the SF's operating deficits or insure financial stability for the whole health system. Furthermore, the reforms had unanticipated and undesired outcomes, including aggressive and illegal marketing by SFs and collaboration among SFs to restrict the extent of care provided under compulsory insurance. The Israeli case suggests that the theory of managed competition contains unrealistic assumptions about the types of competitive behavior that result from exposure to managed competition and the capacity of government and health providers to monitor quality. In addition to stemming from universal limitations to the managed competition model, the implementation pattern in Israel reflects local, historical forces and the interplay of Israel's powerful health system actors.

Facility Regulation and Control↗
PubMed1998

The drinking of earlier and more recent Russian immigrants to Israel: comparison to other Israelis.

OBJECTIVES: Russia has a high level of per capita alcohol consumption, while the level in Israel is low. Since 1989, over 820,000 Russian Jews immigrated to Israel. In the 1970's and early 1980's, a smaller wave of immigration from Russia to Israel occurred (approximately 170,000). The drinking of earlier immigrants was compared to recent immigrants and other Israelis. METHODS: Data came from a 1995 national survey of Israeli household residents. Of 4984 Israeli respondents, 292 were Russian immigrants who arrived since 1989 and 131 were Russians who immigrated earlier. Groups were compared with logistic regression. RESULTS: Recent Russian immigrants were more likely to drink in the last 12 months, to drink frequently and to get drunk than other Israelis. The earlier Russian immigrants were not more likely than other Israelis to report drinking in the last 12 months or frequent drinking, but were more likely to report 30-day drinking and getting drunk. In direct comparison of recent and earlier Russians, recent immigrants reported more frequent drinking than earlier immigrants. CONCLUSIONS: The results for drinking and frequency of drinking are consistent with acculturation effects as well as other explanations. Further investigation in studies with appropriate designs will be necessary to clarify the meaning of these results.

Acculturation↗
PubMed1993

An epidemiological study of mental disorders in a 10-year cohort of young adults in Israel.

This is an overview of a two-phase epidemiological study of mental disorders among young adults in a ten-year birth cohort (1949-58) conducted in Israel. A sample of 4914 Israel-born offspring of Jewish immigrants was obtained by full probability sampling procedures and screened for caseness using psychometric symptom scales from the Psychiatric Epidemiology Research Interview (PERI). Those screened positive and almost a fifth of the negatives (N = 2741) were interviewed by psychiatrists using the Schedule for Affective Disorders and Schizophrenia, Israel version (SADS-I), in order to determine prevalence rates of specific disorders as defined by the Research Diagnostic Criteria (RDC). The completion rates for each interview phase were 94.5% and 90.7% respectively. Six-month prevalence rates are presented by gender, ethnic origin, and education. Approximately one-fifth of the birth cohort met current RDC criteria for a disorder at the definite level, excluding the RDC category of 'other psychiatric disorder'. Generalized anxiety disorder and major depressive disorder were the most commonly found types. The striking findings centre on alcoholism and drug use disorder which were exceedingly rare, and the unusually similar rates of major depression for males and females. The results from this study are discussed in comparison with those obtained from other epidemiological studies.

Adult↗
PubMedDate not supplied

Ethical aspects of genetic screening in Israel.

Advances in genetic research make it possible to identify carriers of a growing number of genetic diseases. The World Health Organization (WHO) published several preconditions for community carrier screening. This paper aims to present some of the dilemmas about screening in Israel and the difficulties in following the WHO's helpful criteria. Some of the genetic diseases that are rare in the world are relatively common among several communities in Israel, and one of the dilemmas is for which of them screening is justified. Consensus exists among professionals and among the public about screening for a severe disease like Tay-Sachs, but the justification for screening for a disease with a widely variable expression, like Gaucher disease, is debatable. Another dilemma is whether to offer screening to the general population when the options to solve the problem are still not clear, as is the case of screening for carriers of BRCA1 and BRCA2. The author also explains why geneticists in Israel cooperate with a screening program in the ultra-orthodox community, although it is done according to unusual rules.

Breast Neoplasms↗
PubMed1998

Emergence of multidrug-resistant Salmonella enterica serotype Typhimurium phage-type DT104 among salmonellae causing enteritis in Israel.

The relative frequency of salmonella strains isolated from hospitalized and non-hospitalized patients in Southern Israel changed during the period, 1994-6. Salmonella enterica serotype Typhimurium definitive phage-type 104 (DT104) appeared in Israel in 1994 and became the most prevalent strain in 1996. An outbreak of enteritis due to Salmonella enterica serotype Agona occurred in Israel, in October 1994 and lasted for 4 months. The relative frequency of Salmonella enterica serotype Enteritidis remained almost constant during these years, with seasonal fluctuations only. The importance of the increase in the prevalence of Typhimurium DT104 has been the epidemic spread of a multiresistant strain of R-type ACT (A, ampicillin; C, chloramphenicol; T, tetracycline) belonging to this phage-type. Since 1995 the frequency of Typhimurium DT104 isolates that possess, in addition to the above R-type, a chromosomally encoded resistance to the quinolone drug, nalidixic acid, increased tenfold. In 1996, 27% of the Typhimurium DT104 isolates were of R-type ACTN. S. Enteritidis exhibited over 95% susceptibility to at least eight of the most commonly used antibiotic drugs, and none of the isolates was resistant to quinolone or fluoroquinoline.

Bacteriophage Typing↗
PubMed2002

K-ras mutations in sporadic colorectal tumors in Israel: unusual high frequency of codon 13 mutations and evidence for nonhomogeneous representation of mutation subtypes.

Colorectal cancer is one of the most common malignancies in the western world, including Israel. An important step in progression includes induction of activating mutations in the protooncogene K-ras. This event is very frequent and is detected in about 40% of colorectal carcinomas. Previous studies of a variety of genetic disorders revealed unique gene mutation prevalence in Jewish populations, attributed both to differences in genetic background and to variability in environmental exposure. To determine the incidence and molecular subtypes of K-ras mutations in colorectal cancer in Israel, compared with other countries, DNA was isolated from a random collection of 105 colorectal carcinoma samples, and K-ras mutations were detected by an improved designed RFLP and direct sequencing. K-ras sporadic mutations in colorectal cancer in Israel are relatively frequent, with a higher fraction in codon 13 than reported thus far. Comparison with other countries shows a vast heterogeneity in terms of the relative abundance of the affected K-ras codon and in type and representation of specific mutations. The heterogeneous distribution found may be due to a variable genetic background and different environmental factors involved in the initiation and propagation of sporadic colorectal cancer.

Adult↗
PubMed2003

Second primary breast and thyroid cancers (Israel).

OBJECTIVE: To evaluate the risk for developing second primary thyroid cancer (TC) following breast cancer (BC) and second primary BC following TC on a nationwide basis. METHODS: All BC and TC Jewish females diagnosed in Israel during 1960-1998 were identified through the Israel Cancer Registry. The expected second primaries were calculated using cancer incidence rates stratified by age, country of birth and period of diagnosis among the Jewish population in Israel. Standardized incidence ratios (SIRs) were estimated using Poisson regression. RESULTS: A total of 49,207 breast and 4911 thyroid neoplasms were identified. After the exclusion of concomitant disease (diagnosed within 1 year), 59 and 70 second primaries TC and BC yielded SIRs of 1.34 (95% CI: 1.03, 1.72) and 1.07 (95% CI: 0.84, 1.34), respectively. Younger age and earlier calendar year of first primary diagnosis and shorter follow-up period were associated with increased risk for developing second primary neoplasm. CONCLUSIONS: Considering the long latency required for carcinogenesis, excess risk of second primary diagnoses soon after the first cancer, argues against the hypothesis of first primary treatment as an initiator for the second cancer. A detection bias of meticulously followed cancer patients, early exposure to common risk factors or genetic susceptibility of certain subpopulations for both malignancies seem plausible.

Adult↗
PubMed2002

Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel.

OBJECTIVE: To determine the prevalence, importance, and the order of frequency of IgE-mediated food allergens among infants and young children in Israel. STUDY DESIGN AND PATIENTS: In a cross-sectional study, the prevalence of IgE-mediated food allergy was investigated in 9070 infants and young children (0-2 years) who were followed-up at 23 Family Health Centers (FHCs) in central Israel. Patients with suspected IgE-mediated food allergic reactions, were recruited for further evaluation (detailed questionnaire and skin-prick test (SPT)). RESULTS: We identified 150 out of 9070 (1.7%) patients with suspected IgE-mediated food allergy. Among them, 102/150 (67%) [59 males, 43 females; mean age 10.3 months] completed a detailed questionnaire and underwent SPT. Evaluation revealed 131 positive SPTs in 78/102 (76.5%) patients. Twenty-seven positive SPTs in 18 patients were considered clinically irrelevant based on previous consumption of the relevant foods without clinical symptoms. Thus, there were 104 relevant positive SPTs in 78 patients. The overall prevalence of clinically relevant IgE-mediated food allergic reactions among these patients is estimated to be 1.2% (104/9070). The most common food allergens were egg, cow's milk, and sesame. Anaphylaxis was the presenting symptom in 14/78 (18%) including six sesame-induced cases. A history of other atopic diseases was reported in 27 (35%) patients. In addition, 22 (28%) had a history of atopy in first-degree family members. CONCLUSIONS: We found sesame to be a major cause of IgE-mediated food allergy in Israel. In fact, it is second only to cow's milk as a cause of anaphylaxis. We recommend that testing for food allergens be tailored to each community based on local experience and should include sesame in appropriate populations.

Child Welfare↗
PubMed2000

Prevalence of asthma in 13-14 yr-old schoolchildren across Israel.

There is evidence that the incidence and severity of asthma are increasing worldwide, but there are limited data on asthma in Israel. The aim of this study was to investigate the prevalence and severity of asthma and asthma symptoms in 13-14 yr-old schoolchildren in Israel. The self-completed questionnaire used was a modified version of that developed by the International Study of Asthma and Allergies in Childhood (ISAAC), and was administered to a national sample of 12,918 children. The prevalence of asthma ever, wheezing ever and wheezing in the last 12 months were 13.7, 23.8 and 17.9% respectively. Significantly higher rates of a history of asthma and asthma symptoms were observed in Jews compared with Arabs. Although asthma ever was more prevalent in males than in females, asthma symptoms were significantly more common in females. The type of area of residence had no effect on the prevalence of wheezing. The ethnic differences in the prevalence of asthma persisted after controlling for sex, district of residence and level of urbanization. The prevalence of both asthma and asthma symptoms in Israel are slightly above the mean reported from 10 other countries in Europe and the Far-East.

Adolescent↗
PubMedDate not supplied

Human T-cell lymphotropic virus type-I antibodies in Falashas and other ethnic groups in Israel.

Epidemiological studies of the human T-cell leukaemia/lymphoma virus type I (HTLV-I), a type-C retrovirus of the human T-lymphotropic virus family, have used serological surveys to identify population subgroups possessing a high prevalence of naturally occurring HTLV-I-specific antibodies. Studies carried out to delineate the global distribution of the virus have demonstrated natural antibodies to HTLV-I in the serum of healthy donors from specific geographical areas, and have defined viral endemic areas in Japan, the Caribbean basin, Africa and the southeastern United States. Such studies have suggested that the prevalence of HTLV-I antibodies is directly correlated with age, is associated with the clinical syndrome of adult T-cell lymphoma, and is associated with transmission from mother to child. A separate subtype of the human retrovirus, HTLV-II (refs 21, 22), has also been identified. The population of Israel in part comprises groups of immigrants of various ethnic and geographical origins. Because of this, and the fact that Israel has a highly developed public health system, we surmised that the ethnic groups in Israel could be used in a seroepidemiological survey of HTLV infection. The serological survey reported here demonstrates a high prevalence of HTLV-I antibodies in new immigrants from Ethiopia. This previously ethnically and geographically isolated group, the 'Black Jews' or 'Falashas', from the Gondar region in the northern rural highlands of Ethiopia, has the highest endemic rate of HTLV-I yet reported outside Japan.

Adult↗
PubMed2000

Rabies in Israel: decades of prevention and a human case.

Animal rabies is endemic in Israel, with 50-80 laboratory-confirmed cases being diagnosed annually. Despite the high incidence among animals, human rabies has not occurred in Israel for almost four decades. This is likely due to the highly effective prevention policy implemented by the Ministry of Health, based on pre-exposure vaccination of populations at risk, post-exposure treatment, and updated rules. Notwithstanding the previous success, a human case occurred in 1996 when a soldier was bitten, while asleep, by an unidentified small animal, which according to his description was a rat or a mouse. Since injuries by these rodents do not require antirabies treatment, no antirabies post-exposure prophylaxis was administered. Five weeks later the soldier complained of fever and nausea with interchanging periods of rage and calm, confusion, and water aversion. His condition deteriorated gradually, leading to deep coma and death. Immunofluorescence examination of a skin biopsy was positive for rabies, and PCR of saliva revealed Lyssavirus genotype 1. We review the changes in the epizootiology of rabies in Israel, the trends of human exposure to animals, and the pre- and post-exposure prophylaxis guidelines, and discuss possible measures that could have been undertaken to prevent the eventuality of this case. This case of rabies, the first after a long period without human disease, accentuates the importance of strict adherence to prevention guidelines. Considerations of geography, epidemiology, and the circumstances of exposure are crucial in the treatment decision-making process.

Adult↗