Low-fiber intake as an etiologic factor in cancer of the colon.

A case-control dietary study of 198 patients with cancer of the colon and two matched control groups demonstrated a significantly lower fiber consumption frequency among the cancer patients. This difference was not confined to a few items. Of the 73 items on the fiber list, 61 were eaten less often by the cancer patient than by a neighborhood control, and 57 were consumed less frequently than by a surgical control. These findings support the hypothesis that low-residue foods play an etiologic role in colon carcinogenesis. A mechanism related to the possible potential carcinogenic properties of degraded biliary compounds may be implicated.

Dietary factors and cancer in Israel.

The risk of developing cancer is relatively higher in the European-born Israeli population than in those originating from the Middle Eastern or North African countries. The majority of cancer sites with a higher risk in the European groups involve the gastrointestinal and reproductive systems. Certain leads suggest that at least some of these differences may be attributed to diet. Data based on case-control studies are provided; they indicate a high consomption of starches among gastric cancer patients and a lower fiber consumption in patients with cancer of the colon. The latter observations may be extended to cancer of the breast, ovary, and corpus uteri, assuming an interplay between the concentration of bile degradation products and hormone metabolism. Although a low fiber consumption seems a more likely mechanism, a higher fat consumption is also compatible with this model. However, due to the complexity of human nutrition, it seems unwarranted to incriminate any single dietary factor in carcinogenesis. A better understanding of the metabolic pathways, coupled with consistent observations from distinct populations, should be looked for.

Evaluation of electrocardiogram in emergency room as a decision-making tool.

The contribution of the electrocardiogram to the clinical judgment used by the physician in the emergency room to determine the necessity for hospitalizing patients was evaluated. Thirty-five percent of all 1,578 patients with presumed myocardial infarction referred to the Chaim Sheba Medical Center, Tel Hashomer, Israel, for a one-year period had subsequently diagnosed myocardial infarctions. The ECG in the emergency room detected only 65 percent of these. The physician's clinical judgment was impressive in his decision to admit to the hospital almost all of the remaining 35 percent, while not admitting very many of the patients who did not have subsequently diagnosed myocardial infarctions. When the myocardial infarction was not evident on the ECG and the abnormalities on the tracings were identical for patients with subsequent myocardial infarctions and those without, again the physician made the right choice more often than the wrong. The follow-up ECG also attested to the good judgment of the physician in the emergency room. Of the emergency room ECGs of patients without subsequent myocardial infarctions who were admitted to the hospital, 17 percent showed myocardial infarction by follow-up, while this happened to only 2 percent of those denied admission.

Maternal education as a modifier of the association between low birthweight and infant mortality.

Both low birthweight (LBW) and infant mortality rate (IMR) have been consistently shown to be associated with maternal level of educational attainment. This paper examines the mortality risk attributable to LBW in different levels of maternal education. Comprising the study population were 18,715 singleton live births to Jewish mothers ages 20-39, during the years 1977-1980 in the Negev (the southern part of Israel). Data were obtained from a linked record of birth and death certificates. As expected, proportions of LBW (less than 2500 grams) were inversely related to level of maternal education (12.2% in the lowest educational level, 7.9% and 8.0% in the two intermediate levels, and 7.2% in the highest educational level). The mortality risk attributed to LBW was found to be modified by maternal level of education. Mortality ratios standardized for maternal age and parity were computed, using educational level 3, where the lowest mortality rates were observed, as the standard population. Among LBW infants no significant differences were found across educational levels, except for the lowest educational level where only 69% of the expected number of deaths were observed. The survival advantage of LBW infants in the lowest educational level was observed both in the neonatal and the postneonatal periods. Among normal birthweight (NBW) infants, a statistically significant excess mortality was detected both in the highest and the lowest educational levels. The excess mortality of NBW infants in the highest level of maternal education was due to neonatal mortality (SMR = 2.2), while the excess mortality in this birthweight category in the lowest educational level occur mainly in the postneonatal period (SMR = 2.4).(ABSTRACT TRUNCATED AT 250 WORDS)

A criterion for a standardized definition of low birthweight.

A criterion for the definition of low birthweight (LBW) which is tailored to each population group is presented. The suggested criterion is based on an assumption according to which the distribution of birthweight is actually a mixture of the following two components: the predominant (including about 95% of the newborns and is normally distributed) and the residual (assumed to be mainly composed of newborns under extreme risk for perinatal mortality). The LBW category is defined to include a small but equal (for all groups) percentage of the predominant component. Thus, population groups which differ with respect to their specific predominant birthweight distribution are comparable with respect to the perinatal mortality risk. Application of the suggested definition is demonstrated using data from two ethnic groups in Israel. Results show a smaller percentage of female LBW than males in both population groups when using the suggested criterion. The reverse is observed (i.e. more male than female LBW), using the standard criterion (less than 2500 gm). The suggested criterion is shown to reduce the sex and ethnic differences in perinatal mortality among the respective LBW categories.

Relationship between morbidity and extreme values of body mass index in adolescents.

BACKGROUND: Although the association between overweight and cardiovascular risk factors is well documented in cross-sectional and longitudinal studies, reports of adolescent morbidity associated with underweight in industrialized countries are rare. METHODS: This population-based study includes approximately 110,000 17 year old Israeli Jewish males who underwent routine physical examination at army induction centres. Computerized data tapes include overall health profiles, specification of physical and mental conditions, and height and weight measurements. Medically significant conditions are those with sufficient severity to preclude service in a combat unit. RESULTS: Functional limitation is more prevalent at both extremes of the body mass index (BMI) distribution: 149.5/1000 among severely underweight individuals and 164.3/1000 among severely overweight subjects. Overweight was associated with hypertension (14.9/1000 among the severely overweight), as well as joint conditions of the lower extremities, mainly hip, ankle and knee disorders. Functional disorders associated with underweight are bronchial and lung conditions, including asthma (14.2 and 18.9/1000 in the mildly and severely underweight), scoliosis, intestinal conditions and emotional disorders (mainly neurosis). CONCLUSIONS: Both under- and overweight are associated with morbidity at age 17. Intervention programmes should begin at an early age.

Falls and subjective health rating among the elderly: evidence from two Israeli samples.

Prevention and treatment of falls in the elderly is one of the challenges facing practitioners today. Falls are known to be associated with health status and demographic variables, however relatively little is known about how falls affect the health perceptions of elderly persons. Data from two Israeli samples were analyzed to examine the relationship between reported falls and self-rated health. The first sample was collected in 1978 in home interviews from 96% of residents aged 65 and over of the town of Kiryat Ono (N = 1276). The second sample was collected from a national probability sample of 3494 urban Israelis in 1985, in home interviews. One-year incidence of falls was estimated from both samples at 23-24% for those over 65. Data from both samples showed that recent falls are negatively associated with subjective health rating. In Kiryat Ono, falls interacted with reported chronic conditions, so that the effect of a fall on subjective health status was only apparent in those with few chronic conditions. Among those who reported 4 or more chronic conditions, the occurrence of a fall had no independent effect on subjective health rating. In multivariate analyses of the national data, falls, and particularly those that happened in the home, or that required a visit to the emergency room had a negative effect on subjective health rating, after adjustment for age, sex, education, mobility and visual impairments and use of sleeping pills.

Cause-specific mortality among Israeli adolescents in the 1980s.

PURPOSE: Considerable mortality occurs during adolescence despite it being a relatively healthy period of life. Nationwide analysis of adolescent mortality data helps identify those sub-groups with higher-than-expected death rates, that may be amenable to preventive intervention programs. METHODS: Adolescent mortality in Israel during 1981-1986 is examined by age (10-14, 15-19 years), sex, population group (Jews, non-Jews), and cause of death. Data were abstracted primarily from special publications for 1981-1986. Recently available mortality updates for 1987-1989 were inspected and significant changes in mortality during the latter period have been included. RESULTS: Among an average of approximately 800,000 adolescents aged 10-19 years living in Israel during 1981-1986, the majority (77%) were Jews. Overall mortality was 36.7 per 100,000. Death rates were almost twice as high for males as for females, increased with age for all population subgroups, and were 63% higher for non-Jews compared with Jews. Accidents were the major cause of death among Israeli adolescents (37.7% of total mortality), with male-to-female rate ratio of 3.4. Mortality from all external causes, including accidents, suicide, homicide, and other external causes accounted for 50.6% of all deaths. Neoplasms were the next major cause of death. Israel and U.S. adolescent mortality rates were compared and showed similar trends. CONCLUSIONS: The non-Jewish minority adolescents, and most particularly the males, are at the highest risk of death. Preventive intervention programs should be targeted to the high-risk populations described.

Postpartum depression in an Israeli cohort: demographic, psychosocial and medical risk factors.

Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied prospectively in a community cohort of 288 Israeli women. An Edinburgh Postnatal Depression Scale score of > or = 10 at 6 weeks postpartum was the criterion for PPD. Psychosocial risk factors were found to be the most potent. Lack of social support, marital disharmony, depressive symptoms during pregnancy, history of emotional problems and prolonged infant health problems were most predictive of PPD. The major role of psychosocial factors in PPD was similar to that found in other countries. The results were somewhat different for new Russian immigrants. These findings indicate that early identification of women at risk for PPD is feasible, and that consideration should be taken of subgroups that may be at heightened risk, or for whom risk factors play different roles.

Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors.

This study aimed to assess the prevalence and incidence of postpartum depression (PPD) and to identify risk factors in a community cohort of Israeli-born, as well as new and veteran immigrant women. A random sample of 288 registrants at a community clinic was assessed for depressive symptoms at 26 weeks' pregnancy using the Beck Depression Inventory (BDI) and at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Information regarding risk factors was gathered through interviews and medical record abstracting. The prevalence of PPD was 22.6%. Two-thirds of the women had scored 'depressed' during pregnancy, and one-third (6.9%) were new incident cases. Immigrant status was the only significant demographic predictor of PPD identified by either univariate or multivariate analysis, with Russian new immigrants having over twice the risk for PPD as Israeli-born subjects. The rate of PPD in this Israeli cohort was comparable to that found in other countries. The finding that immigrant status was the most potent demographic predictor may support the role of stressful life events in the etiology of PPD. The use of the EPDS for PPD screening was found acceptable and feasible in the primary health setting.

A survey of sports injuries among a convenience sample of Israeli athletes.

BACKGROUND: Israel lacks a systematic surveillance of sports injuries, and knowledge of risk factors and specific patterns of injury is inadequate. In order to promote prevention of sports-related injuries, the magnitude of the problem must first be identified and the incidence and severity of sports injuries described. OBJECTIVE: To conduct a survey on previous sports injuries among a sample of Israeli athletes. METHODS: A convenience sample of Israeli amateur athletes participating in the 1997 15th Maccabiah Games was randomly selected. The study group answered an anonymous self-administered questionnaire that included sociodemographic data, and information regarding their sports activity and sports-related injuries that had occurred during the previous 2 years. RESULTS: The study group, aged 12-73 years (median age 21), comprised 301 consenting athletes in 28 different sports. Of these athletes 56.1% reported having had at least one injury. Most injuries (75.6%) involved the upper and lower extremities, and 37.8% of the injured sportsmen had received medical attention from a physician. Half of the athletes participated in contact sports--both collision and limited impact. This group had a much greater proportion of reported injuries in all age groups. CONCLUSION: Surveillance of sports injuries should be expanded in order to develop appropriate prevention programs in Israel.

[Interactive health databases on the Internet].

In order to obtain reliable, comprehensive and current data, information systems which enable flexible presentation or analysis are necessary, as opposed to static tables. On-line and interactive numeric health databases on the Internet are increasingly available. Interactive tables can be produced in many fields, e.g., mortality, hospitalizations, cancer incidence, or motor vehicle accidents. The query screens are user-friendly and they can access remote, computerized data. Thus, it is possible to receive immediate responses to specific questions from national or international datasets, which can then be compared with local data--all without leaving one's chair. The aim of this review is to increase awareness of the existence of numeric health databases on the Internet, and their contribution to epidemiological research.

[Depression scale for research in and identification of postpartum depression].

Postpartum depression (PPD) is a relatively frequent and serious condition, with negative consequences for the mother, her infant, and the family. From research and clinical experience in many countries, it has been found that PPD can be identified early, and women at risk for developing PPD can be identified before delivery in the framework of primary health care service. The Edinburgh Postnatal Depression Scale (EPDS) has been found valid for this purpose, both in the original English version, and in translation to numerous languages. The Hebrew translation of the EPDS is presented, and it is recommended that Israeli researchers use the same translation to facilitate accumulation of knowledge regarding the epidemiology of PPD and intervention strategies in various Israeli population groups, and for comparison with data from other countries.

[Mortality among Moslem, Christian and Druze infants].

Infant mortality in 3 heterogeneous non-Jewish religious groups in Israel was examined (1977-80). Risk factors contributing to infant mortality were identified and their effects assessed by logistic regression analysis. Mortality among Moslems and Druze was 26.0/1000, compared to 17.2/1000 among Christians and 12.7/1000 among Jews. These differences between the populations were mostly evident after the first month of life. Unexpected excess mortality rates were observed among female infants, compared to males, in the postneonatal period in all 3 groups. This excess was present mainly in Christian and Druze infants born to fathers with few years of education. The trend persisted after accounting for birth weight, maternal age, birth order and place of birth. The female mortality in the postneonatal period was twice that of males in Christians and 1.5 times higher than that of males in Druze. Congenital malformations and immaturity-related conditions were the main causes of neonatal deaths, while infections were the major cause of postneonatal deaths. Among the Druze the postneonatal death rate due to infections reached 8/1000. In the non-Jewish groups 42% of postneonatal deaths occurred out of hospital, compared to 15% among Jews.

[Road traffic accidents, circumstances, diagnoses and severity of injury--data from the Israeli National Trauma Registry].

The Israeli National Trauma Registry includes data on road traffic accidents from eight trauma centers. The investigation of registry data adds a new dimension to the analysis of road injuries. This dimension includes health information such as the type and severity of injury, treatment provided and outcomes. This article summarizes data on 4,328 patients injured in traffic accidents and included in the National Trauma Registry in 1999. We describe diagnoses and injury severity for road traffic accident casualties and link the injury outcomes to the type of accident. Findings indicate high risk for severe or fatal injuries among pedestrians, particularly among the young and the elderly. Children on bicycles and young car drivers are also at risk. This information will serve as a basis for prevention intervention and education programs.

[Health profile of children without medical insurance].

Lack of medical insurance is a health risk factor. Underutilization or postponement of medical services, as well as lack of planning for long-term care are common among the uninsured, project was implemented within the framework of the Or Yehuda Intervention Program to assess the health status of children from birth to 17 years of age in 72 families without health insurance. Information on medical status and service utilization was summarized for 169 of the 217 children in these families. These families constituted a substantial burden on the health system, both in the form of hospitalization debt (636 hospital-days owed to a nearby hospital) and as uncompensated primary care clinic visits. Half of the visits were made by 12% of the children, while a quarter of the study children had not visited the clinic at all during the preceding year. Among families uninsured for over 2 years, the trend of underutilization was even more pronounced. Significant morbidity and signs of neglect were found among the study children, nearly 60% of whom suffered from health problems and a similar proportion had been hospitalized. The most common diagnoses were infections, congenital anomalies, and musculoskeletal and hematological problems; a third of the children had 2 or more conditions. Over 40% of the study children were referred for specialist consultation or treatment--about half of them to the pediatric subspecialties and the other half to surgical clinics. Signs of medical neglect were noted in 42.6% of study children and among 60.4% of those with 2 or more medical problems.(ABSTRACT TRUNCATED AT 250 WORDS)

[Drowning in Israel--1990-1992].

There are no epidemiological studies of drowning in Israel in the scientific literature, despite prominent reports in the media. We analyzed the extent of mortality from drowning in Israel during 1990-92, attempting to identify and characterize groups at high risk, and to determine trends and differences between Israel and other countries. Computerized death certificate files were provided by the Israel government Central Bureau of Statistics; deaths from drowning were included among external causes codes E-830, 832, E-910, E-954, E-964, E-984. In Israel, as in the United States, mortality from drowning is the fourth cause of death among all unintentional causes, and the second cause in age-groups 1-24, ranking after transport accidents. During 1990-92 there were 1.2 drownings a year/100,000 population. The highest rates were found among young non-Jews 15-24 years old (7.8/100,000) and among elderly Jews (3.5/100,000). Unintentional drowning accounted for 89% of all deaths; while about 10% were defined as suicides. Males had a rate almost 3 times greater than females, and the among Arabs was 2.4 times greater than among Jews. The 1990-92 drowning rate was slightly lower than in previous years. Drowning rates in Israel are lower than in the United States, except in the elderly. Apparently the principal reason for this difference is difference in sites of drowning. In Israel most drownings occur in the sea, so site data are unavailable for international comparisons. Careful consideration of the categories (E-codes) included in the rates, and of local registration procedures, is necessary for international comparisons. Foreign workers, tourists and other nonresidents are not included in national vital statistics. But estimations based on Ministry of Interior sources show that foreign workers (most, recent arrivals) during the last few years are an extremely high risk group. Population-based drowning rates are not an accurate estimation of drowning risk, since universal exposure to the "opportunity to drown" is assumed.

[Traumatic brain injury--the National Trauma Registry].

BACKGROUND: Traumatic Brain Injury (TBI) has been established as a category in reporting systems. Uniform data systems case definition has been suggested for hospital discharge data surveillance systems cases based on ICD-9-CM diagnostic codes. These include fractures and specific mention of intracranial injuries such as contusion, laceration, hemorrhage, and concussion. Inspection of data from the Israel National Trauma Registry suggested that two diagnostic groups of very different severity and outcome were being unjustifiably combined. AIM: To evaluate the validity of categorizing TBI into two discrete groups, using the presence of specific mention of intracranial injury and/or loss of consciousness for more than one hour as the definition of definite TBI. Possible TBI includes skull fractures with no mention of intracranial injury and/or concussion with no loss of consciousness. METHODS: The study population includes all traumatic injuries admitted to hospital, dying in the ER or transferred to other hospitals and recorded in the 1998 Trauma Registry in all 6 level I trauma centers in Israel and two level II centers. RESULTS: The significant difference in severity between groups supports the validity of sub-dividing the TBI classification into definite and possible subcategories. As a result, we obtain two different severity groups without measuring specific severity scores which are limited in the reporting system. CONCLUSION: The groups were significantly different in severity, hospital resource use, immediate outcome, demographic and injury circumstances.