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PubMed2005

Birth weight standards in the live-born population in Israel.

BACKGROUND: Lacking curves of "intrauterine" growth, most birthing centers in Israel use United States or Canadian based curves as standards. OBJECTIVE: To establish population-based standards of birth weight of live-born infants in Israel. METHODS: Data on birth weight and gestational age were obtained from the registries of the Israel Ministry of Health and Ministry of the Interior, During the 9 year study period there were 1,074,122 infants delivered in Israel; 787,710 (73%) were included in this analysis. RESULTS: In this study we provide data of birth weight by gestational age of live infants born in Israel between 1993 and 2001. Ranges of birth weight by gestational age are also depicted for singleton and multiple pregnancies. Fetuses in multiple pregnancies grow in a similar manner to singletons until 30 weeks of gestation, after which their growth slows down. CONCLUSIONS: Use of these data as a standard for "intrauterine" growth better represents the Israeli neonatal population than the North American standards. In addition, curves of multiple pregnancies are significantly different from those of singleton pregnancies and might be more appropriate in these pregnancies.

Birth Weight↗
PubMed2005

The epidemiology of primary biliary cirrhosis in southern Israel.

BACKGROUND: The epidemiology of primary biliary cirrhosis has changed significantly over the last decade, with a trend towards increasing prevalence in many places around the world. OBJECTIVES: To determine the overall prevalence of PBC in southern Israel and the specific rates for different immigrant groups between January 1993 and October 2004. METHODS: Multiple case-finding methods were used to identify all cases of PBC in the study region. Age-adjusted prevalence rates were compared among the different immigrant groups. RESULTS: A total of 47 cases of PBC were identified with an overall prevalence of 55 cases per million. All patients were women, and all except for a Bedouin Arab were Jewish. Foreign-born patients comprised 70% of our PBC cohort even though they represent only 45.4% of the regional population. This predominance of immigrants did not change when the rates were adjusted for age (P < 0.001). The prevalence rates were 40, 177, and 58 cases per million for those born in Israel, North Africa or Asia, and Eastern Europe, respectively. The age-specific prevalence rate for women older than 40 years varied from 135 cases per million among those born in Israel to 450 among immigrants from Eastern Europe and the former USSR to 700 cases per million among immigrants from North Africa and Asia. CONCLUSIONS: The prevalence of PBC in southern Israel is similar to that reported from some European countries. The rate is much higher among Jews than Arabs and among immigrants to Israel compared to native Israelis.

Adult↗
PubMed1991

Methadone maintenance and clonidine detoxification in the treatment of opiate addicts in Israel: suggesting evidence for cultural differences in the effectiveness of treatment modalities for opiate addiction.

A 13-month longitudinal study examined two treatment programs in Israel: Methadone Maintenance (MM) with adjunct psychotherapy, and Clonidine Detoxification (CD) with adjunct psychotherapy and antidepressants. A lower 3-month drop-out rate was found in the CD clinic in comparison to the MM clinic. After 13 months of treatment, approximately 50% of the patients in the treatment groups relapsed to heroin and the rest were either drug-free (in the CD clinic) or mainly maintained on methadone (in the MM clinic). No significant differences were observed in employment status, patient attitudes toward their therapists, and patient and therapist attitudes toward their respective treatment modalities. The effectiveness of these two treatment modalities was further compared to results obtained in the United States and other western countries. The results indicate that MM is less effective in Israel than in the United States. No clear-cut conclusion concerning the relative efficacy of CD treatment in Israel in comparison to other western countries can be inferred. The pattern of heroin use among heroin addicts, the popularity of methadone as an illegal drug in Israel, and the application of MM treatment modality in Israel may explain these results.

Antidepressive Agents↗
PubMed1991

The efficacy of pediculicides in Israel.

Fourteen pediculicides currently available in Israel were evaluated for their killing effect on the eggs, nymphs and adults from a laboratory-grown colony of body lice (Pediculus humanus humanus). The efficacy of all pediculicides was determined after a single treatment. The exposure time of the lice to the preparations was according to the manufacturers' instructions. The shampoo formulations Hafif (Abic, Israel), Pyracide (Fischer, Israel), A-200 Pyrinate (Norcliff Thayer, USA) and T-Pal (Fischer, Israel) killed 27-78% of the lice and 7-26% of the eggs. Prioderm (Rafa, Israel) shampoo 100% mortality of lice and 13% mortality of eggs. The gel formulation (A-200 Pyrinate) resulted in 100% mortality of lice and 42% mortality of eggs. The liquid formulation (Pyrinyl, Barre, USA) gave poor results with only 65% killing of lice and 26% of the eggs. The spray formulations (Kin-X and Kin-Soff, Milchan, France; and Ricide, Fischer) killed all the lice and 77-95% of the eggs. Lotion and solution formulations (Hafif; Monocide, Fischer; and Nouryl, Chefaro, Holland) caused 100% mortality of lice and 36-85% mortality of eggs. Mortality with control solutions varied between 4 and 16% for both lice and eggs.

Aerosols↗
PubMed1990

Israel's expenditure on health services.

In 1986, the State of Israel utilized 7.6% of its gross national product (GNP) for health care. At first glance this seems to be a reasonable level of expenditure when compared with the percentage of GNP devoted to health care in eight selected industrialized non-communist nations. However, Israel devoted fewer dollars per citizen on health care than any of the eight other nations. We investigate the role of three factors that contributed to this relatively low expenditure level: a) health personnel and bed supply levels, b) operations and procedure rates, and c) relative wage costs of health personnel. If Israel had the same level of per capita GNP as the USA, its annual health service per capita expenditure would increase from $472 to $1,328. If, in addition, its health personnel received the same wage differentials (in relation to the average wage levels) as those received by health personnel in the USA, it is estimated that Israel would spend around $1,842 annually per capita on health care (representing 10.7% of its GNP). This figure is only $98 less than what the USA spends, and creates a vastly different impression concerning the efficiency of the health system than does the original unadjusted expenditure of only $472 per head, which is $1,468 less than that spent by the USA. The Israeli health system can be said to be characterized by adequate manpower inputs, high bed occupancy rates, low surgery rates relative to the USA (not necessarily a negative phenomenon), and low relative wage inputs. The relatively limited available output indicators lead us to believe that productivity per person employed in the health services could be raised. The low absolute levels of health expenditures in Israel are mainly due to a combination of a low GNP per head and relatively low wage differentials between health service staff and other income earners.

Bed Occupancy↗
PubMed1990

Estimates of illegal abortions in Israel, 1980-83.

Since the legalization of abortion in Israel in the late 1970s, only aggregate information on legal abortions has been available. A brief history of the public debate and relevant legislation concerning induced abortions in Israel is presented in the first part of this report. The second part presents estimates of the extent of illegal abortions in Israel during the years 1980-83. These estimates were obtained through standardization based on data for selected countries where the abortion law is similar to or more liberal than that in Israel, the system of abortion registration is more reliable and detailed, and the prevailing contraceptive habits and attitudes of women are known. Estimates indicate that: a) the total number of abortions in Israel is about half that quoted by the media from nonscientific sources, and b) the annual number of illegal abortions constitutes between 25 and 30% of the estimated total number of abortions.

Abortion, Illegal↗
PubMed1988

AIDS in Israel, 1987.

Between mid-1982 and 1 January 1988, 35 cases of AIDS among permanent residents of Israel were reported to the Israel Ministry of Health. In contrast to the experience in the United States and Europe, the semiannual incidence rates of AIDS are low and have increased slowly over the past 6 years (0.6 to 1.1 cases/million). Risk factors for AIDS were identified in 34 patients: homosexuality in 18, hemophilia in 14 and blood transfusions in 2. Seventeen of the 18 homosexuals were most likely infected abroad, and all hemophilia patients had received imported commercial clotting factors. The two patients associated with blood transfusion received blood donated in Israel. The spectrum of clinical presentations and opportunistic pathogens is similar to that reported in the Western world, except for one case of disseminated Mycobacterium simiae infection. Sexual relations abroad of local homosexuals and receipt of imported clotting factors by Israeli hemophiliacs are currently the most important risk factors for AIDS in Israel. However, the prevalence of HIV infection among Israeli homosexuals is still low and is probably indicative of the more conservative life-style, the later introduction of the virus, and the earlier application of safe sex, in comparison with other Western countries. Furthermore, since spread of the virus seems to be increasing among Israeli i.v. drug abusers, attention should be focused on this group as well, so as to prevent a major outbreak of AIDS in Israel.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Prevalence of antibodies to cytomegalovirus in a parturient population in Israel.

The aim of our study was to assess the serologic immunity to cytomegalovirus (CMV) in a population of pregnant women in Israel. We measured the titers of both IgG and IgM to CMV in 6,126 pregnant women by enzyme immunoassay. Of these, 84.3% were found to be positive for anti-CMV IgG and 15.7% were seronegative, and thus susceptible to primary infection. The total number of women positive for anti-CMV IgM, and hence suspected of being infected with the virus during or shortly before their pregnancy, was 43 (0.7%). An acute infection was therefore diagnosed in 4.35% of IgG seronegative women. A significantly higher CMV seropositivity rate was found in the parturient population as compared to surveys conducted in Israel in the 1970's. The seropositivity rates found in Israel are similar to those reported in Asia and Africa. The rate of serosusceptibility and the risk of primary CMV infection in pregnancy are lower in Israel than in Europe and North America. According to the observed incidence of primary CMV infection in pregnant women, it can be estimated that approximately 280 cases of fetal infection occur in Israel every year, potentially resulting in 56 symptomatic newborns.

Adult↗
PubMed1998

Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children?

Accurate diagnosis of infective endocarditis may be difficult. The Beth Israel criteria and the newer Duke criteria assign probability to the diagnosis of infective endocarditis on the basis of the presence of common features and manifestations. We reviewed 111 cases of pediatric infective endocarditis diagnosed and treated over 19 years. Each case was classified by the two criteria, and the results were compared. Of 111 cases, 73 (66%) and 18 (16%) were classified as definite by the Duke criteria and the Beth Israel criteria, respectively. No cases were rejected by the Duke criteria, while 21 (19%) of 111 were rejected by the Beth Israel criteria. In 18 pathologically proven cases, reanalysis without pathological data showed that the Duke criteria had significantly greater sensitivity (83%) than the Beth Israel criteria (67%) (P < .03). Echocardiographic evidence was required in 22 cases for definite classification by the Duke criteria; none were rejected, however, when echocardiographic findings were ignored. Our results suggest that the Duke criteria are superior to the Beth Israel criteria for the diagnosis of pediatric infective endocarditis.

Adolescent↗
PubMed1995

Evaluation of the Duke criteria versus the Beth Israel criteria for the diagnosis of infective endocarditis.

New diagnostic criteria for infective endocarditis (IE) have been proposed by the Duke University Endocarditis Service (Durham, NC) to update the widely used Beth Israel (Boston) criteria. We compared the Duke criteria with the Beth Israel criteria in a series of 115 consecutive patients with suspected IE who were hospitalized in a referral center. The diagnosis of IE was histologically and/or bacteriologically confirmed for 27 operated patients. If surgery had not been performed on these 27 patients, 22 vs. 12 would have been classified as having ¿clinically definite¿ and ¿probable¿ IE by the Duke vs. the Beth Israel criteria, respectively, whereas 0 vs. 5 would have been ¿rejected¿ by the Duke vs. the Beth Israel criteria, respectively. The improvement in sensitivity of the criteria from 44% (Beth Israel) to 82% (Duke) was statistically significant (P < .01). We confirm that the Duke criteria improve the sensitivity of diagnosis of IE. The specificity of these criteria should be further evaluated.

Adult↗
PubMed2003

Effect of ethnicity on mortality of very low birthweight infants in Israel.

BACKGROUND: Multiple demographic, genetic, and environmental factors differ between Muslim and Jewish infants in Israel. OBJECTIVE: To evaluate whether, after adjustment for perinatal factors associated with mortality, excess mortality occurs in very low birthweight (VLBW) Muslim compared with Jewish infants. DESIGN: The Israel National VLBW infant database includes data on 99% of all VLBW births in Israel. The study population comprised 5015 Jewish and 1549 Muslim VLBW infants of more than 23 weeks gestation, born between 1995 and 1999. The Mantel-Haenszel test was used for stratified analysis and logistic regression analysis to assess the effect of ethnic origin on mortality. RESULTS: The death rate was significantly higher among Muslim infants (22.7% v 17.2%; crude odds ratio 1.42; 95% confidence interval 1.24 to 1.63). Excess mortality in Muslims occurred mainly in the 32-33 week (8.0% v 2.8%) and >33 week (14.7% v 4.7%) gestational age groups, and in birthweight groups of 1000-1249 g (17.6% v 9.3%) and 1250-1500 g (9.1% v 3.6%). In VLBW infants without congenital malformations, there was a significantly higher risk of mortality among Muslim infants (odds ratio 1.28; 95% confidence interval 1.04 to 1.57) compared with Jewish infants, after adjustment for gestational age, birth weight, small for gestational age, prenatal care, prenatal steroid treatment, plurality, mode of delivery, and Apgar score. CONCLUSIONS: Excess mortality was present among Muslim VLBW infants without congenital malformations. Perinatal factors associated with increased risk of mortality were more prevalent in the Muslim VLBW population. The pattern of disparities suggests inadequate access to, or utilisation of, effective perinatal technology in the Muslim population in Israel.

Databases, Factual↗
PubMed2003

A prospective national survey of management and clinical outcome of acute myocardial infarction in Israel, 2000.

BACKGROUND: Little information is available on the clinical practice and implementation of guidelines for treating acute myocardial infarction patients in Israel. OBJECTIVE: To assess patient characteristics, hospital course, management, and 30 day clinical outcome of all AMI patients hospitalized in Israel during a 2 month period in 2000. METHOD: We conducted a prospective 2 month survey of consecutive AMI patients admitted to 82 of 96 internal medicine departments and all 26 cardiac departments operating in Israel in 2000. Data were collected uniformly by means of a hospital and 30 day follow-up form. RESULTS: During the survey 1,683 consecutive patients with a discharge diagnosis of AMI were included. Their mean age was 66 years; 73% were male. The electrocardiographic pattern on admission revealed ST elevation, non-ST elevation and an undetermined ECG in 63%, 34% and 4% of patients respectively. Aspirin and heparin were given to 95% of patients. Beta-blockers and angiotensin-converting enzyme inhibitors were given to 76% and 65% of patients respectively. Among hospital survivors, 45% received lipid-lowering drugs. Thrombolytic therapy was administered in 28% of patients, coronary angiography was used in 45%, and 7% of patients underwent primary percutaneous coronary intervention. The 7 and 30 day mortality rates were 7% and 11% respectively. CONCLUSIONS: This nationwide survey shows that one-third of the AMI patients in Israel are elderly (> or = 75 years). The survey suggests that clinical guidelines for the management of patients with AMI are partially implemented in the community. Data from large surveys representing the "real world" practice are of utmost importance for the evaluation of clinical guidelines, research and educational purposes.

Aged↗
PubMed1998

Molecular epidemiology of adenovirus type 7 in Israel: identification of two new genome types, Ad7k and Ad7d2.

The molecular epidemiology of Adenovirus type 7 in Israel was investigated. Fifty-seven adenovirus isolates identified as serotypes 7 or 7a which were recovered from patients in Israel between 1968 and 1995 were analyzed by restriction enzymes digestion using BamHI for primary discrimination and identification of genome types and by six additional enzymes: BstEII, HpaI, BglI, BglII, BclI, and XbaI for confirmation and determination of genomic subtypes. Four digestion patterns were identified with BamHI; one of them was new. Using BstEII, two patterns were obtained, one of them new. Digestion with the other five enzymes yielded known patterns. The analysis revealed four different genomic types and subtypes, which circulated in Israel in different years: subtype 7a1; type 7b, a type with a new BamHI pattern which was designated type 7K, and a subtype with a new BstEII pattern which differed from type 7d by one restriction site and was designated type 7d2. Twenty-two isolates from 1968 through 1975 and from 1984 were Ad7a1. Three isolates from 1973-1974 were Ad7b. Five isolates from 1968 through 1973 were Ad7K and 27 isolates from 1992 through 1995 were Ad7d2. This demonstrates the temporal change in the circulating genome types with up to three genome types cocirculating in 1 year (1973). The two new types, Ad7k and Ad7d2 could have evolved in Israel or could have been imported by travellers and immigrants from neighboring or distant countries.

Adenovirus Infections, Human↗
PubMed2007

Disordered eating related behaviors among Arab schoolgirls in Israel: an epidemiological study.

OBJECTIVE: To examine the prevalence of disordered eating attitudes and behaviors among three religious subgroups of Arab schoolgirls in Israel (Moslems, Druze, and Christians). METHOD: The sample consisted of 1,131 Arab schoolgirls in Israel, including 922 (81.5%) Moslem, 125 (11.1%) Christian, and 84 (7.4%) Druze adolescents, in the 7-12th grades. The sample was drawn from urban and rural residential settings from all parts of Israel using a clusters sampling method. RESULTS: The Christian subgroup had a significantly lower total eating disorder inventory-2 (EDI-2) score than the Druze and Moslem subgroups, which had similar total EDI-2 scores. Significant differences were found between the three religious subgroups in all subscales, except in drive for thinness (DT), bulimia, body dissatisfaction, and asceticism. A total of 154 (13%) Arab schoolgirls scored higher than the cut-off point of >>14 on the EDI-DT subscale. CONCLUSION: The results are discussed in light of the differences between the Christian, Druze, and Moslem subgroups and in terms of various aspects of Arab culture in Israel.

Adolescent↗
PubMedDate not supplied

Private medical services in acute-care hospitals in Israel.

The objective of this study was to assess the proposed introduction of out-of-pocket funded inpatient and outpatient services (abbreviated as PMS) into government acute-care hospitals in Israel. This issue of public-private mix in not-for-profit hospitals is discussed in terms of the experience with PMS gained in selected advanced market economies. Then, the major contours of the Israeli system of health care, and the gradual evolving of patient-financed medical services within government acute-care hospitals in Israel, is described. The experience gained in the few public hospitals in Jerusalem that have been operating PMS is assessed critically. The concluding part reviews the advantages and disadvantages of these developments in public and government acute-care hospitals in Israel. It is concluded that PMS in public hospitals in Israel represents a policy aimed primarily at benefiting a select group of senior physicians in those hospitals.

Financing, Personal↗
PubMed1995

An epidemiological study of posterior uveal melanoma in Israel, 1961-1989.

Trends in the incidence rate of uveal melanoma in Israel during the period 1961-1989 among Jews of various geographical origins and among non-Jews were examined, and found to be stable over time. Based on data of the Israel Cancer Registry, 515 cases were included in the final study population after an independent case-finding ascertainment survey. The average annual incidence rate per million for all Jews was 5.7 for both males and females; the rates for non-Jews were: males 1.6, females 1.3. Incidence rates within the Jewish sub-populations show significant differences. The highest rates by sub-population were for Jews born in Europe or America (7.5 for males and for females), followed by Jews born in Israel (males 6.8, females 6.7); and lowest in Jews born in Africa (males 2.1, females 2.3) and Asia (males 1.6, females 2.8). Jews born in Israel had rates lower than Jews born in Europe and America during the 1960s, but in the 1980s the situation was reversed. Results suggest that rate differences between population groups and over time stem from constitutional factors or from the direct or indirect effect of sunlight radiation, whether early in life or from cumulative exposure.

Adult↗
PubMed1991

Prevalence of HBsAg carriers in native and immigrant pregnant female populations in Israel and passive/active vaccination against HBV of newborns at risk.

Israel has no official prevention policy at present against perinatal and horizontal transmission of hepatitis B virus (HBV) infection in newborns and children at risk. The present study was designed to assess the prevalence of HBV carrier state in a population of 11,123 pregnant women at term. Among this population (mean age 29.7 +/- 5.9), 98 women (0.88%) were found to be asymptomatic HBsAg+ carriers, and 97% of these carriers were anti-HBe+. Evidence for HBV replication, as determined by serum HBV-DNA, was established in 6.6% of the HBsAg+/anti-HBe+ population. The HBsAg carrier rate was strongly influenced by religion, continent, and country of birth of the carrier mothers. The highest relative carrier rate was found among women of Moslem origin (4.3%), as compared to Jewish women (0.67%). Most carrier women were born in Israel (56.1%) to mothers who had emigrated from regions with intermediate or high endemicity of HBV, such as North Africa or the Middle East. In these groups, the HBsAg carrier rate ranged between 1.2 and 3.0%. Ninety-three percent of newborns receiving passive/active vaccination against HBV developed protective levels of anti-HBs. Finally, evidence for horizontal transmission of HBV was found in 19.3% of 83 non-vaccinated children in families of HBsAg carriers. The present study therefore establishes HBsAg prevalence rates in specific risk groups of women at term and confirms the need for an official policy on immunization against HBV in Israel. Since over 50% of women at term belong to the defined risk groups, universal active vaccination of the entire newborn population each year is suggested as the most rational and needed policy in Israel.

Adolescent↗
PubMed2004

A prevalence estimate of pervasive developmental disorder among immigrants to Israel and Israeli natives- a file review study.

BACKGROUND: The prevalence rates of pervasive developmental disorder (PDD) have risen in the West over the last 10 years. There is argument over the etiology of this change in rates. Social and cultural processes including migration have been hypothesized. Israel, as a country of ongoing immigration with a national registry of children diagnosed with PDD, offers an opportunity to compare rates of PDD among immigrants from developing countries and native Israelis. METHOD: A Social Security national registry of 1004 children diagnosed with PDD was reviewed and rates were calculated using data extracted from the Israel National Bureau of Statistics. Of all Jewish children that were born in the years 1983-1997 and who are currently living in Israel, we defined four groups: (1). native Israelis of non-Ethiopian extraction (N = 1198, 300), (2). native Israelis of Ethiopian extraction (N = 15600), (3). immigrants of non-Ethiopian extraction (N = 110300) and (4). children born in Ethiopia (N = 11800). A further breakdown of groups 1 and 3 by well-characterized ethnic or geographical origins was not possible. RESULTS: The rate of PDD was significantly elevated in native Israelis as compared to all immigrant children. Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction. CONCLUSIONS: Birth in Israel, an industrialized country, is a marker for an environmental risk factor for PDD. This may indicate that gestation, birth or infancy in industrialized countries exposes children to environmental insults that increase the risk for contracting PDD.

Adolescent↗