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Extended family studies for the identification of allogeneic stem cell transplant donors in Jewish and Arabic patients in Israel.

HLA-identified donors are the best source of allogeneic hematopoietic stem cell transplants, and are available in approximately 40% of cases. If no HLA-identical core family member is found, an extended family search may be performed. The aim of the study was to summarize the 10-year (1990-1999) experience of our tertiary care center with extended family donor search. During this period, 356 patients and 2659 of their family members were tissue-typed; 239 patients were Jewish (67%) and 117 were Arabic (33%). An HLA-identical core-family donor was identified for 168 patients (47%): 95 Jewish (40%) and 73 Arabic (62%) (p < 0.0001); 49 patients (14%) had more than one potential donor. An extended family search (grandmother/grandfather, aunts, uncles, etc.) was performed in 38 of the remaining families, which were found to be consanguineous: five Jewish and 33 Arabic. One HLA match was found in the Jewish families (20%) and 21 in the Arabic families (64%). The odds ratio for an Arabic patient to find a donor in the extended family search was 8.75, as opposed to a Jewish patient. Overall, HLA-matched donors were found by core and extended family search for 53% of the patients. The rate for Arabic patients was 80% and for Jewish patients, 40% (p < 0.001). This difference may be explained by the greater number of siblings and higher rate of consanguinity in the Arabic population. In conclusion, an extended family search for potential HLA-matched donors is worthwhile, especially in distinct ethnic populations with high consanguinity, such as Israeli Arabs.

Arabs↗

The aging of Israel's Arab population: needs, existing responses, and dilemmas in the development of services for a society in transition.

The Arab population of Israel is relatively young. However, a significant increase is expected in the number of elderly Arabs in the coming years. At the end of 2001 there were 38,500 Arab elderly, but their number is expected to reach 92,100 by 2020. This will represent a nearly 2.5-fold increase in absolute numbers. As the population ages, the number and percentage of people with chronic diseases and related disabilities will rise significantly. While the Arab elderly are much younger than the Jewish elderly, they are more disabled and therefore have greater medical and nursing needs. An extremely important measure of the need for formal services is an elderly person's functional ability, especially the ability to live independently. The percentage of Arab elderly who are disabled and need help with activities of daily living is twice as high as that of the Jewish elderly population. At present, 30% of the Arab elderly (39% of the women and 20% of the men), compared to 14% of Jewish elderly (17% of the women and 11% of the men), need help in at least one ADL (bathing, dressing, eating, mobility in the home, rising and sitting, getting in and out of bed). Concomitant with demographic changes are forces that affect the ability of informal support systems to provide care. For example, the rising number of Arab women in the labor force together with changes in elderly peoples' living arrangements have increased the need for formal services to share responsibility for the elderly with families. As services are developed, questions arise regarding the extent to which they have been adapted to the culture and norms of Arab society and meet that society's unique needs. This paper elaborates on some of these issues.

Aged↗

Hemoglobin S/O(Arab): thirteen new cases and review of the literature.

Hemoglobin S/O(Arab) (Hb S/O(Arab)) is a rare compound heterozygous hemoglobinopathy characterized by the presence of two variant beta-globin chains: beta6Glu --> Val (Hb S) and beta121Glu --> Lys (Hb O(Arab)). The diagnosis of Hb S/O(Arab) requires electrophoresis on both cellulose acetate and citrate agar, since Hb O(Arab) co-migrates with Hb C at alkaline pH and close to Hb S at acidic pH. To date only case reports and small series of patients with Hb S/O(Arab) have been described. To better characterize the clinical and laboratory aspects of this unusual disorder, we reviewed the Duke University Medical Center experience. We identified 13 African-American children and adults with Hb S/O(Arab) ranging in age from 2.7 to 62.5 years. All patients had hemolytic anemia with a median Hb of 8.7 gm/dL (range 6.1-9.9 gm/dL), and a median reticulocyte count of 5.8% (range 1.2-10.3%). The peripheral blood smear typically showed sickled erythrocytes, target cells, polychromasia, and nucleated red blood cells. All 13 patients have had significant clinical sickling events including acute chest syndrome (11), recurrent vasoocclusive painful events (10), dactylitis (7), gallstones (5), nephropathy (4), aplastic crises (2), avascular necrosis (2), leg ulcers (2), cerebrovascular accident (CVA) (1), osteomyelitis (1), and retinopathy (1). Four patients have died, including two from pneumococcal sepsis/meningitis at ages 5 and 10 years, one of acute chest syndrome at age 14 years, and one of multiorgan failure at age 35 years. We conclude that Hb S/O(Arab) disease is a severe sickling hemoglobinopathy with laboratory and clinical manifestations similar to those of homozygous sickle cell anemia.

Adolescent↗

Serum cholesterol (total, low-density lipoprotein, and high-density lipoprotein cholesterol), triglyceride levels, and fat consumption among Jerusalem Arab and Jewish schoolchildren.

As part of initial health screening for the "Know Your Body" Program-based comprehensive health education program, 841 Jerusalem first- and second-grade schoolchildren were tested for total serum cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. The same population, which included 643 Jewish (76.5%) and 198 Arab children (23.5%), had their nutritional habits evaluated by means of a parent-completed food-frequency questionnaire. Arab schoolchildren had significantly lower total, high-density lipoprotein, and low-density lipoprotein cholesterol levels and higher triglyceride levels than the Jewish children studied (total cholesterol: Arab mean, 153.1 mg/dl, Jewish mean, 170.3 mg/dl; high-density lipoprotein cholesterol: Arab mean, 46.4 mg/dl, Jewish mean, 48.5 mg/dl; low-density lipoprotein cholesterol: Arab mean, 90.7 mg/dl, Jewish mean, 108.5 mg/dl; triglycerides: Arab mean, 77.9 mg/dl, Jewish mean, 66.3 mg/dl). No significant differences in consumption level of foods high in saturated fats and/or cholesterol were found between populations, although the Arab children showed a tendency to eat more of these foods. Significant differences in total cholesterol values were also found among Jewish children of different origins, but no significant differences were found in consumption levels of saturated fats and cholesterol. Further studies are needed to determine the reasons for the differences in total cholesterol and lipoprotein levels found between Jewish and Arab schoolchildren.

Child↗

Evaluating changes in health status: sensitivity to change of the modified Arabic Health Assessment Questionnaire in patients with rheumatoid arthritis.

OBJECTIVE: To test the correlation between clinical improvements in patients with rheumatoid arthritis (RA) as defined by the American College of Rheumatology (ACR) response criteria and functional improvements as assessed by functional measures in the modified Arabic version of the Health Assessment Questionnaire (Arabic-HAQ) and to estimate the sensitivity to change of the Arabic-HAQ, in a prospective study. METHODS: Eighty-two patients with active RA were given methotrexate and followed up prospectively for 12 months. ACR response rates and score improvements on the modified Arabic-HAQ were compared. RESULTS: The Arabic-HAQ scores showed significant sensitivity to change after 6 and 12 months and were significantly correlated with the ACR response. Percentages of agreement with ACR response levels were high after 6 months and higher still after 12 months. Standardized effect sizes were 2.34 and 2.84 after 6 and 12 months, respectively. Relative efficiency of the total Arabic-HAQ score in relation to the tender joint count was greater than 1. CONCLUSION: The Arabic-HAQ is valid and sensitive to functional status changes in patients with RA. The results are comparable to those of the original HAQ. Thus, the Arabic-HAQ can be used to evaluate treatments and to identify changes that are important to RA patients.

Adult↗

The characteristics of arabic orthography slow its processing.

The present study was designed to evaluate whether the complexity of Arabic orthography increases its perceptual load, thus slowing word identification. Adolescent Arabic speakers who mastered Hebrew as a second language completed oral and visual versions of the Trail Making Test (TMT; J. E. Parington & R. G. Lieter, 1949) in both languages. Oral TMT required declaiming consecutive numbers or alternation between numbers and letters. Visual TMT required connecting Arabic or Indian numbers and alternation between letters and numbers. Performance in Hebrew and Arabic oral TMT did not differ. Performance was significantly slower in Arabic visual TMT. These results indicate that Arabic speakers process Arabic orthography (1st language) slower than Hebrew orthography (2nd language) and suggest that this is due to the complexity of Arabic orthography.

Adolescent↗

Breast-feeding habits among Jewish and Arab mothers in Hadera County, Israel.

A survey of breast-feeding habits of Jewish and Arab mothers was carried out in Hadera county in Israel. Jewish mothers breast-fed their babies approximately 3 months, while Arab mothers did so for 5 months. The rate of breast-feeding among Jewish and Arab mothers was 84% and 94.4%, respectively. The results indicated that education, previous experience, enjoyment, husband's encouragement, previous information about the importance of breast-feeding, belief that breast-feeding strengthens the mother-child relationship, and the convenience of breast- over bottle-feeding were all factors that had an impact on breast-feeding habits among Jewish but not Arab mothers. Breast-feeding as a means of birth control, religion, and impairment of the breast's shape were factors that had no effect on either Arab or Jewish mothers. Complications during pregnancy and cesarean delivery decrease the probability of breast-feeding in Arab and Jewish mothers. Jewish mothers stopped breast-feeding because of insufficient milk, fatigue, work obligations, and physician's recommendation. Among Arab mothers the main reasons were insufficient milk, physician's recommendation, baby's refusal, and nipple problems. Jewish mothers who decided not to breast-feed stated that the reasons were previous experience with insufficient milk, nipple problems, and unpleasant feelings. The few Arab mothers who did not breast-feed cited medical or nipple problems.

Breast Feeding↗

Psychometric properties of the Arabic version of Quality of Life Index.

AIM: This paper reports a study to translate the English language version of the Quality of Life Index into Arabic and estimate its reliability and content validity. BACKGROUND: Quality of life has become an important concern in health care and social policy. It is a difficult construct to define and measure, as it is determined by cultural, ethical, personal and religious values. The generic Ferrans and Powers Quality of Life Index was developed to measure quality of life of healthy individuals. Specific versions of the index were developed for particular diseases, such as diabetes, cancer and end-stage kidney disease. The instruments were initially developed for English-speaking clients and were later translated into several languages and used within a variety of cultures. However, there were no Arabic versions of the tool available to measure the quality of life of general populations or of people with particular diseases. METHOD: The Quality of Life Index was translated into Arabic using two of the techniques suggested in the literature for translation - back translation and bilingual technique. The same process was followed in the translation of the original scale and various disease-specific versions of the instrument. The work took place between 1995 and 2004. FINDINGS: The translated Arabic Quality of Life Index demonstrated a high degree of accuracy of translation and estimates of content validity. Subsequent to the translation of the original scale into Arabic, 13 disease-related versions of the instrument were translated and are ready for use with clients who speak Arabic. Four of the versions have been used to collect data from clients. The results revealed high estimates of reliability for the generic, diabetes, cancer and dialysis versions. CONCLUSION: The Arabic version of the Quality of Life Index is highly reliable and has sufficient content validity for measuring quality of life of Arabic-speaking clients.

Communication Barriers↗

HLA polymorphisms in Saudi Arabs.

The HLA-A, -B, -C, -DR, Bf and GLO phenotypes of 109 unrelated Saudi Arab males have been determined. HLA-A and -B antigen frequencies were compared with data reported for European Caucasoids and various Arab populations. Most similarities in antigen frequencies were seen between Saudi Arab and Iraqi populations. A high frequency of Bw50 was observed in Saudi Arabs. The frequencies of HLA-DR antigens in Saudi Arabs were compared to European Caucasoids. HLA-DR7 was at high frequency in Saudi Arabs. Linkage disequilibria between alleles of HLA loci was examined. Many instances of previously reported antigen associations were seen in Saudi Arabs, together with a number of associations which have not been described elsewhere. HLA-Cw6-Bw50-DR7-BfS0.7 is suggested as being a common haplotype in Saudi Arabs.

Complement Factor B↗

Speech perception test for Arabic-speaking children.

The high incidence of hearing impairment in the Arabic-speaking population in Israel, as well as the use of advanced aural rehabilitation devices, motivated the development of Arabic speech assessment tests for this population. The purpose of this paper is twofold. The first goal is to describe features that are unique to the Arabic language and that need to be considered when developing such speech tests. These include Arabic diglossia (i.e., the sharp dichotomy between Literary and Colloquial Arabic), emphatization, and a simple vowel system. The second goal is to describe a new analytic speech test that assesses the perception of significant phonological contrasts in the Colloquial Arabic variety used in Israel. The perception of voicing, place, and manner of articulation, in both initial and final word positions, was tested at four sensation levels in 10 normally-hearing subjects using a binary forced-choice paradigm. Results show a relationship between percent correct and presentation level that is in keeping with articulation curves obtained with Saudi Arabic and English monosyllabic words. Furthermore, different contrasts yielded different articulation curves: emphatization was the easiest to perceive whereas place of articulation was the most difficult. The results can be explained by the specific acoustical features of Arabic.

Adolescent↗

[Hemoglobin O Arab in Ivory Coast and western Africa].

The authors report 44 cases of hemoglobin O Arab share out in 3 phenotypes (A O Arab, C O Arab and S O Arab). The study of this abnormal hemoglobin has allowed the following conclusions: The Hb O Arab is a rare mutant of hemoglobin. The heterozygote form A O Arab and the association Hb C--Hb O Arab do not present any clinical and hematological manifestations. The associations Hb S--Hb O Arab brings about a serious hemoglobinopathy which has clinical and hematological features like the sickle-cell disease (SSFA2).

Adolescent↗

Bibliometric aspects of medical information in Arab countries.

This paper discusses the current state and development of health and biomedical literature in Arab countries. The study concentrates on the Arabic sources of medical articles, and surveys and analyzes the size of the literature and its development in the past 100 years. Two aspects of these sources are covered: the Arab medical information sources published within the Arab region, and those published outside the region. This includes the quantity of material available within and outside the Arab region. The size of the Arab medical literature indicates that it is worthy of collection. Treatment of the Arab medical literature, a pressing and urgent issue, is needed to assist in the research and development of an Arab medical infrastructure.

Bibliometrics↗

Identification and semi-quantitative determination of gum Arabic in wines by GC-MS and size exclusion chromatography.

A method for the identification and the semi-quantitative determination of the food additive gum Arabic in wines is described. Tests carried out on solutions spiked with known amounts of wine and gum Arabic polysaccharides allowed to define the suitable conditions for their quantitative precipitation and size exclusion analysis. CG-MS analyses of the different recovered fractions allowed to discriminate between gum Arabic and wine polysaccharides through the identification of glucose and mannose present only in wine polysaccharides. The proposed method was based on the wine polysaccharides free peak area obtained by size exclusion chromatography. The same cut-off time was always used both in the preparation of the calibration plot and in the analysis of the real samples. Gum Arabic was determined in a ratio of 1/10 w/w with wine polysaccharides with a detection limit of 0.074 mg ml(-1) which is lower than the lowest gum Arabic amount usually added into wines. Owing to the moderately low natural variability of the gum Arabic standards the described procedure is suitable for a semi-quantitative analysis even if its accuracy allowed a quite reliable determination of the gum Arabic amount usually added to wine.

Chromatography, Gel↗

Comparative study of eating-related attitudes and psychological traits between Israeli-Arab and -Jewish schoolgirls.

OBJECTIVE: The aims of the study were to examine weight concerns, dieting and eating behaviours in a group of Israeli-Arab schoolgirls as compared with Israeli-Jewish schoolgirls, as well as to investigate the reliability of the Arabic (Palestinian) version of the eating disorder inventory-2 (EDI-2). METHOD: The sample consisted of 2548 Israeli schoolgirls, including 1885 Jewish and 663 Arab adolescents ranging in age from 12 to 18. The study was conducted in 1998-2003 from urban and rural residential settings in the northern part of Israel. The (EDI-2) was the assessment tool used, yielding scores on 11 sub-scales. RESULTS: The Israeli-Arab schoolgirls scored significantly higher than the Israeli-Jewish schoolgirls in most EDI-2 sub-scales. In addition, the sub-scale inter-item consistency of the translated Arabic (Palestinian version) of the EDI-2 was found to be reliable. DISCUSSION: The drive to be thin found among Israeli Arab schoolgirls is not reflected in their small number of ED clinic referrals. These discrepancies are discussed in light of the socio-cultural changes currently taking place in the Israeli Arab population due to the influence of Western-oriented life in Israel.

Adolescent↗

The Jewish-Arab divide in life expectancy in Israel.

Life expectancy at birth in Israel in 2001 was 77.7 years for males and 81.6 years for females among Jews, and 74.5 and 77.8 years for males and females, respectively, among Israeli Arabs. In spite of vast improvements in health conditions of the two populations since Israel's statehood in 1948, persistent disparities in life expectancy between the two groups have challenged the Israeli socialized health care system. These disparities are influenced primarily by differences between the two population groups in infant and child mortality rates. This early study suggests that the distribution of life expectancy across localities in Israel reflects the distribution of those localities' socio-economic condition index (not including health and medical care), and the distribution of medical services. The positive association between life expectancy and the index is pronounced, however, only within the Jewish population but not among Arabs. While there may be no significant difference in life expectancy among Jews and Arabs living in poorer communities, there are fewer Arabs living in relatively affluent communities. Thus, persistent higher concentration of poverty among Arabs than among Jews has sufficed to maintain the gap in life expectancy between them. In addition, however, there are population-specific effects: wealth and education are more protective among Jews than among Arabs, while medical services are more protective among Arabs.

Adolescent↗

Arab immigrants: a new case for ethnicity and health?

Community-based studies of Arab Americans point to significant health problems among the immigrants, a finding that runs contrary to theories of immigrant selectivity. This study is the first to use nationally representative data to test this question. Using new questions that identify region of birth in the 2000 and 2001 National Health Interview Surveys, we compare the self-rated health and activity limitation of Arab immigrants to US-born white Americans and test the extent to which social, demographic, and immigrant characteristics account for observed disparities. The results find that Arab immigrants do not significantly differ from US-born whites in their self-rated health and are less likely to report limitations in activity. Length of time in the US has no composite effect on health; however, US citizenship does. Compared to the most recent immigrant arrivals, Arab immigrants who are citizens report worse health while their peers who are not officially American (non-citizens) do not, regardless of their duration of US residency. Contrary to prior studies on Arab health, we find that Arab immigrants are not uniformly disadvantaged in their health outcomes and that their health profile is more diverse than currently documented. The results also suggest that controlling for years of US residency may be insufficient for capturing the cumulative effects of acculturation on immigrant health. We conclude by suggesting avenues of future research for capturing heterogeneity among emergent ethnic populations such as Arab Americans.

Adolescent↗

Jewish-Arab violence: perspectives of a dominant majority and a subordinate minority.

In 2 studies, the authors investigated intergroup violence as perceived by Israeli Jews and Israeli Arabs. University and junior high school students judged Jewish-Arab clashes, which ended in shots fired at a crowd of either Jewish or Arab demonstrators. The authors hypothesized that judgments of these shootings would be contingent on 3 variables: the origin of the respondent, the origin of the shooter, and the level of danger to the shooter. The results tended to support those hypotheses: (a) Both Jewish and Arab respondents justified shootings by members of their own group more readily than those by members of the other group. (b) Jewish judgments of violence were associated more closely than Arab judgments with the danger that the demonstrators posed to the shooter. (c) The Jewish respondents referred to self-defense more often than did the Arab respondents to justify their judgments, whereas the Arab respondents referred more often to intergroup considerations. Those differences may reflect the disagreement between the majority and the minority on the issue that each group should take into consideration in cases of international violence.

Adult↗

Specifications for gum arabic (Acacia senegal); analytical data for samples collected between 1904 and 1989.

The regulatory specifications for gum arabic (Acacia senegal) are superficial and inadequate to ensure that it is not adulterated with non-permitted gums from other botanical sources. Moreover, the existing specifications do not give the consumer the essential assurance, fundamental to food safety evaluation principles, that the nature and quality of gum arabic used in foodstuffs always conforms to that of the Test Article selected for the toxicological studies which justified the current status ('ADI not specified') of gum arabic as a permitted food additive. The availability of well-preserved gum arabic samples, collected between 1904 and 1939, has enabled invaluable data to be added to those derived from samples from the most recent crops. The resulting analytical data substantiate and greatly extend the quantitative information available previously for the chemical characterization of gum arabic for regulatory and trade purposes. The data confirm that good-quality commercial gum arabic was used previously as the Test Article. There is no evidence that the specific rotation of gum arabic has become significantly less negative in recent years.

Amino Acids↗