Epidemiology of youth suicide in Israel.

OBJECTIVE: This study examined sociodemographic correlates and temporal trends in suicide among young Jews, Moslem Arabs, Druzes, and Christian Arabs in Israel. METHOD: The average yearly rates (1975 through 1989) for suicide and undertermined causes of death were calculated for children, adolescents, and subjects of army age. Rates were examined by gender, national/religious affiliation, and place of residence for all groups and, in addition, by ethnic origin among the jews. Logistic regression was used to ascertain the statistical differences. Temporal changes were examined by plotting the rates over the 15-year period and fitting a regression line. RESULTS: Among the young, differences by gender, national/religious, and ethnic origin did not consistently follow the pattern found in adults. Male Jews and Druzes of army age, facing a period of enhanced stress and availability of weapons, showed increased risk for suicide. Temporal trends for suicide differed from the worldwide pattern of increasing risk; these changes, however, were not homogeneous across all groups. CONCLUSIONS: The suicide rates among the youth in Israel, as in adults, are among the lowest in the world. Army service may be a period of enhanced risk, justifying preventive action. The almost worldwide trend of increasing suicide among the young is only partially present.

Decision-making in the critically ill neonate: cultural background v individual life experiences.

OBJECTIVES: In treating critically ill neonates, situations occasionally arise in which aggressive medical treatment prolongs the inevitable death rather than prolonging life. Decisions as to limitation of neonatal medical intervention remain controversial and the primary responsibility of the generally unprepared family. This research was designed to study response patterns of expectant mothers towards treatment of critically ill and/or malformed infants. DESIGN/SETTING: Attitudes were studied via comprehensive questionnaires divided into three sections: 1-Sociodemographic data and prior personal experience with perinatal problems; 2-Theoretical philosophical principles used in making medical ethical decisions; and 3-Hypothetical case scenarios with choices of treatment options. SUBJECTS AND RESULTS: Six hundred and fifty pregnant women were studied. Maternal birthplace (p = 0.005) and level of religious observance (p = 0.02) were strongly associated with the desire for maximally aggressive medical intervention in the hypothetical case scenario. Specific personal experiences such as infertility problems, previous children with serious mental or physical problems were not correlated with the selection of different treatment choices. Of the theoretical principles studied, only the desire to preserve life at all costs was significantly associated with the choice for maximal medical treatment (p = 0.003). CONCLUSIONS: Maternal ethnocultural background and philosophical principles more profoundly influenced medical ethical decision-making than did specific personal life experiences.

Data linkage methods used in maternally-linked birth and infant death surveillance data sets from the United States (Georgia, Missouri, Utah and Washington State), Israel, Norway, Scotland and Western Australia.

In this paper we describe the methods used to link birth and infant mortality and morbidity surveillance data sets into sibships using deterministic or multistage probabilistic linkage methods. We describe nine linked data sets: four in the United States (Georgia, Missouri, Utah and Washington State), and four elsewhere (Scotland, Norway, Israel and Western Australia). Norway and Israel use deterministic methods to link births and deaths into sibships. The deterministic linkage is usually dependent on the availability of national identification numbers. In both countries they assign these numbers at birth. Deterministic linkage is usually highly successful, and the major problem is the validation of linkages. In the United States, Western Australia and UK linkage is multistage and probabilistic. This approach is usually dependent on the calculation linkage weights from sociodemographic variables. The success rates of probabilistic methods are above 80%. Maternally-linked perinatal data open new vistas for epidemiological research. Recurrence of poor perinatal outcomes is more appropriately studied using longitudinally-linked data sets. In addition, the emergence of risk factors and the recurrence of risk factors can be studied.

The Israeli Maternal Perinatal Database: methods and preliminary evaluation.

The Israel Maternal Perinatal Database (IMPD) includes the 1980-92 birth cohorts and was created using deterministic linkage, based on a unique identity number. This number is assigned at birth for Israeli-born infants and upon acquiring permanent or temporary residential status for immigrants and is used widely. The IMPD includes approximately 1.3 million births and about 400,000 mothers with more than one birth, 40,000 mothers with more than three births and 20,000 grand multipara mothers with four births or more. The pretest-based estimates of incorrectly matched births are 2%. The expected percentage of underlinkage is 5-10% for births occurring before 1985. Since 1985, incorrect maternal underlinkages result only when a birth occurs out of Israel to an Israeli resident. One of the advantages of the IMPD is the ability to estimate linkage reliability, validity and censoring effects by comparison with an external data sources, the National Population Register, which groups each mother with all her living children under the age of 18 years. One of the potential analysis pitfalls is the effect of censoring at entry as a result of influx of immigrants from the former Soviet Union and Ethiopia.

Accelerated weight gain by infants with pulmonic stenosis.

Retrospectively we compared the weight gain of infants who had significant valvular pulmonic stenosis with the growth of infants who had mild pulmonic stenosis and small ventricular septal defects. Our results indicate that the infants with significant pulmonic stenosis gained weight exceptionally well in comparison with others.

Relationship between suicide and myocardial infarction with regard to changing physical environmental conditions.

In recent years, the possible association of changes in mortality from cardiovascular disease and myocardial infarction (MI) and deaths related to violence and the suicide rate has been repeatedly discussed. This study examined the relationship between cosmic physical changes (solar, geomagnetic and other space activity parameters) and changes in the total number of in-hospital and MI-related deaths and deaths from suicide to determine if a relationship exists between the distribution of total and MI-related deaths with suicide over time; some differences in the serotonergic mechanisms involved in the pathogenesis of MI and suicide were also taken into account. All suicides (n = 2359) registered in the State of Israel from 1981 to 1989 (108 months) were analysed and compared with the total number of deaths (n = 15601) and deaths from MI (n = 1573) in a large university hospital over 180 months (1974-1989). The following were the main features of the Results. (1) Monthly suicide rate was correlated with space proton flux (r = 0.42, P = 0.0001) and with geomagnetic activity (r = -0.22, P = 0.03). (2) Total hospital and MI-related deaths were correlated with solar activity parameters (r = 0.35, P < 0.001) and radiowave propagation (r = 0.52-0.44, P < 0.001), an with proton flux (r = -0.3 to -0.26, P < 0.01). (3) Monthly suicide distribution over 108 months was correlated with MI (r = -0.33, P = 0.0005) and total hospital mortality (r = -0.22, P = 0.024). (4) Gender differences were prominent.(ABSTRACT TRUNCATED AT 250 WORDS)

Asphyxia-related infant mortality rates.

We present an epidemiological study of asphyxia-related infant mortality. Via linkage of birth and death certificates, infant mortality data were analyzed for all infants born in Israel from 1985 through 1988. During this period, there were 397,083 live births in Israel, and 4392 infants subsequently died within the first year of life (total infant death rate of 11.1/1000 live births). Of the deaths, 176 (4.0%) were associated with a diagnosis of perinatal asphyxia, resulting in an overall asphyxia-related infant mortality rate of 0.44/1000 live births. The percent of deaths attributable to asphyxia was calculated by birthweight, maternal age, and birth order and was compared with overall infant mortality rates analyzed for the same variables. Interesting results include the following: (1) Asphyxia-related mortality within the low birthweight group was proportional to overall birthweight-specific mortality for that group; (2) birthweight more than 4.5 kg disproportionately increased the risk of asphyxia-related mortality; and (3) perinatal asphyxia did not add to the risk of mortality subsequent to teenage pregnancy.

[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.

Childhood mortality from accidents in Israel, 1980-84.

There were on average 1.5 million children aged 0-17 in Israel during the period 1980-84, with an average accidental mortality rate of 10.9/100,000. Although 77% of the children were Jewish and 23% non-Jewish, 45% of the accidental deaths occurred in the non-Jewish population. The accidental mortality rate among non-Jewish children was 20.9/100,000, which was 2.6-fold greater than that among Jewish children (7.9/100,000). Among both population groups, the male death rates were considerably higher than the female rates (10.5 vs. 5.1 among Jewish males and females, respectively, and 25.1 vs. 16.5 among non-Jewish children). The non-Jewish death rates were highest among infants less than 1 year of age, with females outnumbering males. Inspection of the male to female rate ratios showed a greater disparity between the sexes in both population groups as age increased. The proportion of motor vehicle accident (MVA) deaths was 52.7% among Jews and 40.4% among non-Jews. Drowning was the second ranking cause of accidental death (approximately 15%) in Israeli children, followed by falls (approximately 8%). The age distribution of MVA mortality was strikingly different in the two Israeli population groups. Among the Jews the rates peaked in the 15-17 age group in both sexes; however, among the non-Jews the rates peaked in the 1-4 age-group, with most of these deaths probably representing pedestrian deaths. On the average, the MVA serious injury rates were about ten times greater than the MVA mortality rates. Variations of mortality from accidents in different age, sex and population groups clearly indicate that preventive intervention programs must be targeted specifically to each age-sex-population group.