Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries.

BACKGROUND/OBJECTIVES: The Mediterranean diet (MEDDIET) has been shown to be related to longevity. This study aimed to determine the association between adherence to MEDDIET and physical function of older adults in the United-States and Israel. METHODS: Data from the US National Health and Nutrition Survey (NHANES) 1999-2002 and from the Israeli National Health and Nutrition Survey (MABAT ZAHAV) 2005-2006 were used. Participants with nutritional and functional data were included. Adherence to the MEDDIET was assessed by a 9-unit score (MDS). RESULTS: Among 2791 NHANES and 1786 MABAT ZAHAV participants, mean age=71.2 y and 74.9 y, 20% and 27% had low MDS (0-2), 66% and 62% had a medium score (3-5), and 14% and 11% had a high score (6-9), respectively. Higher MDS was associated with higher education and better lifestyle behaviors. Cognitive and physical functions were significantly better in NHANES and MABAT ZAHAV among the highest MDS. In NHANES, MDS (high vs. low) was associated with faster walking speed after adjusting for confounders in a logistic regression model [Odds Ratio (OR)=0.71, P=0.034, Cl 95% 0.511-0.974]. When cognitive function was added, the association was attenuated (OR=0.75, P=0.093, Cl 95% 0.540-1.049). In MABAT ZAHAV, in a logistic regression model adjusted among other to cognitive function, MDS (high vs. low) was associated with fewer disabilities (OR=0.51, P=0.029, Cl 95% 0.276-0.934). CONCLUSIONS: Adherence to the MEDDIET is associated with better health characteristics and better functioning. Further cohort and intervention studies may shed light on temporal and causal relationships between MEDDIET and these parameters.

Giardia lamblia carriage in Israeli Bedouin infants: risk factors and consequences.

Giardiasis is a common protozoan infection, with varying clinical manifestations. We investigated the associations between Giardia lamblia carriage and environmental, family, illness, and growth characteristics. Bedouin infants (n=234) were followed from birth to age 18-23 months. At monthly home visits, stool samples were obtained, history of illness was determined, and an environmental assessment was done. The comparisons presented are between 4 groups defined by length of carriage of G. lamblia. Study children had a mean+/-SD of 4.1+/-2.9 diarrhea episodes. No illness, environmental, or family characteristics were associated with length of carriage. Significant differences were found in weight-for-age and weight-for-height z scores between the never-positive-for-G. lamblia group and all other carriage groups combined. Faltering growth was shown to be subsequent to G. lamblia infection rather than preceding it. Our findings confirm that G. lamblia carriage is not associated with diarrhea. However, the effect on growth deserves further investigation.

Maternal knowledge and environmental factors associated with risk of diarrhea in Israeli Bedouin children.

Diarrhea is still a major cause of morbidity and mortality among children in developing countries. As it is due to multiple causative agents including viruses, bacteria and parasites, biological interventions are not currently available to markedly reduce incidence and severity. We examined maternal knowledge and reported behavior during diarrheal episodes, as well as environmental factors to determine their association with diarrhea. The children and mothers were from a Bedouin township in southern Israel, which has developed preventive and curative health care facilities. The Bedouin population in Israel is in transition from a nomadic to a settled life style. While almost all mothers exhibited good knowledge regarding food storage and prevention of diarrhea episodes in the children, the rate of illness in the children remained relatively high (two episodes per child year of observation). In a multivariate analysis, cessation of breastfeeding during diarrhea, child sleeping with siblings and lack knowledge about risk factors, were the major risk factors for illness with odds ratios (OR): 4.6, p = 0.02, 5.6, p = 0.03 and 1.7, p = 0.06, respectively. These data indicate that even in this population with free access to preventive medical care, greater efforts should be made to educate mothers regarding risk factor for diarrheal disease identification and the benefits of maintaining breastfeeding during diarrhea episodes.

Persistent diarrhea in a cohort of Israeli Bedouin infants: role of enteric pathogens and family and environmental factors.

This study examined the role of enteric pathogens and infant, family, and household characteristics in persistent diarrhea. Bedouin infants from southern Israel were followed from birth to age 18-23 months. During monthly home visits, stool samples were obtained, and feeding practices and history of diarrhea were determined, and at age 3 months, an environmental assessment was done. Diarrhea surveillance was either via a network covering all community health care facilities or via weekly interviews with the mother. None of the enteric pathogens examined, including Cryptosporidium parvum and enteroaggregative Escherichia coli, were associated with persistent diarrhea. In multivariate analyses, age at first diarrheal illness and maternal age and maternal education were independently and significantly associated with the risk of persistent diarrhea. These data suggest that persistent diarrhea is a clinical entity that may be related less to a specific enteric pathogen and more to the health experiences of children and their home environment.

HCV antibodies in saliva and urine.

Infection with hepatitis C virus (HCV) is usually established by detection of serum antibodies (anti-HCV). This study was conducted in order to evaluate whether saliva and urine may substitute serum for anti-HCV detection. Serum, saliva, and urine were obtained simultaneously from 141 patients with a variety of liver diseases and from 52 patients with autoimmune diseases (systemic lupus erythematosus n = 27 and rheumatoid arthritis n = 25). The cell free fraction of saliva and urine samples was tested for anti-HCV using a modification of a serum anti-HCV kit. Western blot analysis was used as a confirmation method. Of the patients with liver diseases, 73 were anti-HCV-seropositive. Salivary and urinary anti-HCV could be detected in 66 (90%) and 36 (49%) of the anti-HCV-seropositive patients, respectively. The presence of anti-HCV in saliva or urine was not related to the severity of liver disease. All the anti-HCV-seronegative liver patients were negative for salivary anti-HCV and 22 (32%) had urinary anti-HCV. The patients with autoimmune diseases were all anti-HCV-seronegative. None had detectable salivary anti-HCV while 33 (63%) were positive for urinary anti-HCV. Western Blot analysis confirmed the presence of anti-HCV in all serum and saliva samples tested but only in 2/12 urine samples. The results suggest that saliva, but not urine, may serve as a substitute for serum for the determination of anti-HCV positivity.

Natural history of Giardia lamblia and Cryptosporidium infections in a cohort of Israeli Bedouin infants: a study of a population in transition.

The natural history of Giardia lamblia and Cryptosporidium infections were determined in a cohort of 164 Bedouin children, from a population not previously studied, which is in transition from nomadism to a settled life style. Stools were sampled monthly from birth to two years of age and at all diarrhea episodes. The risk of infection with G. lamblia and Cryptosporidium infection by age two was 91.5% and 48.8%, respectively. Cryptosporidium prevalence was 3-4% at all ages, whereas G. lamblia prevalence was > 30% after age one. Giardia lamblia and Cryptosporidium asymptomatic detection rates were high, 28.5% and 1.6%, respectively. Detection of G. lamblia was higher in diarrhea episode samples obtained before six months of age, but after that age and overall, the detection was lower than in nondiarrhea samples (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7-0.9, P < 0.05). Detection rates of C. parvum were higher in episode-related samples in all age groups (OR = 2.8, 95% CI = 1.9-4.2, P < 0.05) and infections in boys were more frequently symptomatic than in girls. While G. lamblia does not appear to be a consistent pathogen in this population where it is hyperendemic, Cryptosporidium has been shown to be an important cause of diarrhea in young children in the community.

Maternal anthropometry and infant feeding practices in Israel in relation to growth in infancy: the North African Infant Feeding Study.

Relations between maternal anthropometric status during pregnancy and infant feeding practices and growth from birth through the first 6 mo of life were examined in a cohort of 351 Israeli mother-infant pairs of North African descent. Maternal weight, height, and triceps skinfold thicknesses were determined at 6 and 9 mo of pregnancy, while infants' weights and lengths were measured at birth and at 1, 2, 3, and 6 mo of age with concurrent collection of age-specific maternal-reported infant feeding data. On the basis of multiple-linear-regression analysis that adjusted for potential covariates, mean maternal weight at the first prenatal visit and at 6 and 9 mo of pregnancy were positively associated with birth length (P for trend in all cases < 0.0001) and with linear growth between birth and 1, 3, and 6 mo of age. Maternal skinfold thickness at 9 mo of pregnancy and maternal height were also significantly associated with birth length. Moreover, maternal height, weight, and skinfold thickness at 6 and 9 mo of pregnancy were positively associated with mean birth weight. After adjustment for morbidity in the past month and other covariates, infants breast-fed exclusively had greater attained weight and weight gain in the first 3 mo compared with infants who were bottle-fed exclusively, breast-fed and bottle-fed, or solid-fed exclusively. These findings underscore the need for programs that improve the nutritional status of women before, during, and after pregnancy, and encourage exclusive breast-feeding of infants for at least the first 3 mo of life.

PIP: The associations between maternal anthropometric measures during pregnancy and infant feeding practices and growth in the first 6 months of life were investigated in a cohort of 351 mother-infant pairs of North African (Morocco, Tunisia, Algeria, or Libya) descent but currently residing in Israel's Negev region. Mean maternal weight at the first prenatal visit and at 6 and 9 months of pregnancy was significantly and positively associated with birth length and with linear growth between birth and 1, 3, and 6 months of age. Maternal skinfold thickness at 9 months of pregnancy and maternal height also were significantly associated with birth length, while maternal height, weight, and skinfold thickness at 6 and 9 months of pregnancy were positively associated with mean birth weight. The rate of exclusive breast feeding declined from 34% at 1 month to 18% at 2 months to 6% at 3 months. After adjustment for covariates such as morbidity in the preceding month, maternal anthropometric status, and socioeconomic factors, infants who were exclusively breast-fed had greater attained weight and weight gain in the first 3 months of life than their counterparts who were exclusively bottle-fed, breast- and bottle-fed, or solid-fed. These findings underscore the importance of programs that improve the nutritional status of women before, during, and after pregnancy and promote exclusive breast feeding for at least the first 3 months.

Prevalence of specific IgA and IgM anti-HBc antibodies compared with HBV DNA in the sera of HBsAg chronic carriers.

OBJECTIVE: We evaluated the significance of IgA antibodies directed against the hepatitis B virus core antigen (IgA anti-HBc) as a marker for viral replication. STUDY DESIGN/METHODS: Serum samples of 143 hepatitis B surface antigen (HBsAg) carriers and 189 HBsAg-negative subjects were studied. Hepatitis B virus (HBV) DNA was detected by polymerase chain reaction. IgA anti-HBc was determined by a capture enzyme-linked immunosorbent assay developed in our laboratory. The results were compared with those for IgM anti-HBc, which were determined by a commercially available method. RESULTS: IgA anti-HBc was detected in 57 (40%) and HBV DNA in 38 (27%) of the HBsAg carriers. Among the HBsAg-negative subjects, IgA anti-HBc and HBV DNA were detected simultaneously in four samples. All 42 HBV DNA-positive samples were IgA anti-HBc positive. IgM anti-HBc was detected in 27 (64%) of them. CONCLUSIONS: IgA anti-HBc is a sensitive marker for HBV replication, and its absence may exclude HBV replication. The role of IgA anti-HBc in monitoring response to therapy and predicting clinical course is being evaluated.

HBsAg confirmation: an experimental test.

BACKGROUND: The specificity of HBsAg testing is to be confirmed with antibody blocking to avoid false positive results. OBJECTIVE: To test the experimental HrAb HBsAg-blocking activity and to use this new antibody in the verification of repeatedly reactive HBsAg blood serum samples. STUDY DESIGN: HbsAg screening of three quality control panels was followed by a comparative confirmatory test with commercial HuAb and experimental HrAb. The HrAb was used in subsequent HBsAg confirmation trials. RESULTS: A good agreement in the results obtained using the two antibodies was found, independently of the type of HBsAg neutralization step performed (either preincubation or competitive inhibition). Of the 97 repeatedly reactive HBsAg blood serum samples, 79 were 'confirmed positives'. On repeated confirmations by two antibodies, 13/18 'not confirmed' converted to 'confirmed positives', while the same five samples still remained false positive. CONCLUSION: The results suggest that (1) HrAb is as good as HuAb in HBsAg confirmation and (2) HBsAg confirmatory testing is essential in the laboratory examinations of the HBsAg repeatedly reactive samples.

Maternal recall of infant feeding events is accurate.

STUDY OBJECTIVE: Retrospective infant feeding data are important to the study of child and adult health patterns. The accuracy of maternal recall of past infant feeding events was examined and specifically the infant's age when breast feeding was stopped and formula feeding and solid foods were introduced. DESIGN AND SETTING: The sample consisted of Bedouin Arab women (n = 318) living in the Negev in Israel who were a part of a larger cohort participating in a prospective study of infant health and who were delivered of their infants between July 1 and December 15, 1981. Data from interviews conducted 12 and 18 months postpartum were compared to the standard data collected six months postpartum. MAIN RESULTS: As length of recall increased there was a small increase in the mean difference, and its standard deviation, between the standard and recalled age when breast feeding was stopped and formula feeding and solid foods were started. Recall on formula feeding was less accurate than recall on solid foods and breast feeding. In particular, among those 61% reporting formula use at the six month interview, 51% did not recall introducing formula when interviewed at 18 months. The odds ratio (95% CI) of stunting versus normal length for age for formula fed versus breast fed infants based on recall data (OR = 2.07; 95% CI 0.82-5.22) differed only slightly from those based on the standard data (OR = 2.21; 95% CI 0.77-6.37). The accuracy of a mother's recall varied with her child's nutritional status at the time of the interview, but not with other sociodemographic, infant, or interviewer characteristics. CONCLUSIONS: Retrospective infant feeding data based on maternal recall of events up to 18 months in the past can be used with confidence in epidemiological studies. However, data on formula feeding may not be as accurate as data on breast feeding and solid food feeding, and accuracy may decrease as length of recall increases.

Factors influencing milk insufficiency and its long-term health effects: the Bedouin Infant Feeding Study.

Women who breastfeed have frequently reported milk insufficiency as the reason for introducing the bottle, but no one has addressed its potential long-term health effects. This paper described the factors associated with milk insufficiency versus another reason for introducing the bottle and its potential health effects based on an analysis of a prospective cohort study of 1005 Bedouin Arab women who delivered healthy newborns in 1981 and 1982. By two months postpartum, 72% introduced the infant to the bottle with 72% reporting milk insufficiency as the reason for introducing the bottle. The percentage of milk insufficiency declined with increasing age of the infant. Based on multiple logistic regression analyses, birth season was statistically significantly associated with the odds ratio (OR) of milk insufficiency versus another reason for introducing the bottle during the first two months. Women who delivered in the spring-summer had an increased OR = 1.65 of reported milk insufficiency compared with those who delivered during the rest of the year. Parity was directly related to the OR = 1.04 of milk insufficiency (but just missed significance) during one to two months and was statistically significantly associated with the OR = 1.12 of reported milk insufficiency during 3-18 months. The rates of stunting after the infant was introduced to the bottle and the duration of breastfeeding did not differ by reason for introducing the bottle. Thus the high frequency of reported milk insufficiency was not associated with adverse health effects.

PIP: 1005 Bedouin infants born in 1981-1982 at the Soroka Medical Center Hospital in the Negev, Israel were followed up determine those factors which influence milk insufficiency reporting compared with another reason and the possible effects of the reported reason for introducing the bottle on the rates of stunting and the duration of any breastfeeding. 72% of the mothers had already started bottle feeding their infants by 2 months as did those who claimed to have had insufficient milk. After 2 months, however, the rate of inadequate milk as a reason declined. For example, 50% gave milk insufficiency as a reason at 3-6 months postpartum and 28% at 7-18 months postpartum. Infants born in March-July were at significantly higher risk of being introduced to the bottle with milk insufficiency as the reason in the 1st 2 months of life than those born in other months (odds ratio [OR]=1.65). In early infancy, parity was just slightly related to milk insufficiency (OR=1.04). Yet multiparous women with a 3-18 month index child were more likely to state milk insufficiency as a reason to begin bottle feeding than primiparous mothers (OR=1.12). This was a result of a change from a seminomadic life style to a sedentary life style. Specifically, even though settling in urban areas brought them closer to family and the family visited more often during the traditional 40-day postpartum rest period, assistance during this period fell or was nonexistent. Further, household chores increased. Multiparous mothers needed a rest between breastfeeds and introducing the bottle allowed them this rest. Thus they gave milk insufficiency as justification for this behavior regardless of its occurrence or not. Neither the rates of stunting among infants introduced to the bottle nor duration of breastfeeding differed by reason for introducing the bottle. Thus the high rates of reported milk insufficiency did not adversely affect their health.

The Bedouin Infant Feeding Study: study design and factors influencing the duration of breast feeding.

A longitudinal study of infant feeding practices, growth and morbidity among Bedouin Arab infants residing in the Negev, Israel, was conducted during a 3-year period (1981-1983). Follow-up samples were restricted to healthy newborns. The majority of newborns are breast fed at birth but, by 2 months, 50% are also introduced to a milk supplement. Based on the bivariate analysis using the logrank test to examine the factors associated with exclusive versus partial breast feeding during the first 6 months, those born during the wet cool months are exclusively breast fed longer than those born during the dry season. More traditional women, living in tents rather than houses or huts, exclusively breast feed for at least 6 months. In a multiple logistic regression model, parity, house type and birth season are independently associated with the odds of exclusively breast feeding for the first 6 months of life. Factors influencing the duration of any breast feeding for the first 18 months include: house type, place of residence, birthweight, and whether the infant was stunted at 6 months.

PIP: Researchers followed healthy newborns of 945 Bedouin Arab mothers who delivered either at the hospital in Beer Sheva, Israel or at home during 1981-1982 to examine infant feeding practices. They interviewed the mothers shortly after delivery, at 6 months, and/or at 12 and 18 months. 90% of mothers exclusively breast fed their newborns, but by 2 months only 50% continued to exclusively breast feed. The proportion of infants born between January-May who were exclusively breast fed and those born between July-October was significantly different at around 4 months (29.4% vs. 19%; p.01). This trend was still significant at 6 months (17.7% vs. 7.2%; p.001). Further the log rank test showed a significant trend during the total 6 month period (p.05). In addition, during the total 6 month period, the more traditional Bedouin Arabs were more likely to exclusively breast feed than established women (p.01). Type of housing was the environmental factor which had the greatest influence on breast feeding. For example, at 6 months, 13.9% of mothers who lived in a tent exclusively breast fed compared to 9.1% who lived in a hut and 6.4 % who lived in a house (p.001). In addition, the more children a mother already had the less likely she would exclusively breast feed during the total 6 moth period (p.01). At 6 months, only 7.3% of mothers with 6 children compared to 13.4% with 0 children. The multiple logistic regression model of breast feeding for at least 6 months showed that parity, house type, and birth season were independently associated with exclusively breast feeding. The traditional Bedouin Arab lifestyle (living in tents or huts and in traditional or transitional encampments) contributed strongly to increased duration of breast feeding. Further birth weight and nutritional status at 6 months were independently associated with breast feeding at 18 months.

Perinatal factors influencing infant feeding practices at birth: the Bedouin Infant Feeding Study.

Bedouin Arab women delivering newborns at Soroka Medical Center, Israel, during 1 year were interviewed in hospital to determine the factors influencing infant feeding practices at birth. Eighty-six per cent breastfed, 11% breast and bottlefed, and 3% bottlefed at birth. Based on a multiple logistic regression analysis, the factors that significantly reduced the odds ratio (OR) of exclusive breastfeeding vs. breast and bottle feeding or bottle feeding at birth include: delivering during the high birth season (OR = 0.49); maternal recall of feeling unwell during pregnancy (OR = 0.59); delivering a low birthweight newborn (OR = 0.10); a newborn diagnosed with major malformations (OR = 0.30) or with major illnesses (OR = 0.32); and delivering by Caesarean section (OR = 0.09). In contrast, multiparae experienced an increased odds (OR = 1.67) of breastfeeding. Among primiparae, the factors that significantly reduced the odds of exclusive breastfeeding include: delivering during the high birth season (OR = 0.47); delivering a low birthweight newborn (OR = 0.12); and delivering by Caesarean section (OR = 0.18). Mothers of high-risk neonates and those who deliver by Caesarean section need to be educated about the benefits of exclusive breastfeeding. Young primiparae are a challenge and require qualitative and quantitative research into the reasons precluding exclusive breastfeeding.

Seasonality of births among Bedouin Arabs residing in the Negev Desert of Israel.

From 1 January 1981 to 31 December 1982 information on all births to Bedouin Arab women residing in the Negev Desert of Israel showed a previously unreported seasonal pattern. The peak season, November-February, coincided with the period of cool temperatures and the Bedouin Arab cultural seasons of winter and spring. This pattern is different from those of Jewish and Christian groups in the same region, a difference not attributable to religion alone. Sociodemographic factors associated with the peak season of birth include traditional occupations of fathers, multiparae 2+, and traditional place of residence. This pattern has persisted over the past 15 years although it is less apparent among the more recently sedentarized Bedouin Arabs.

PIP: From 1 January 1981 to 31 December 1982 information on all births to Bedouin Arab women residing in the Negev desert of Israel showed a previously unreported seasonal pattern. The peak season, November- February, coincided with the period of cool temperatures and the Bedouin Arab cultural seasons of winter and spring. This pattern is different from those of Jewish and Christian groups in the same region, a difference not attributable to religion alone. Sociodemographic factors associated with the peak season of birth include traditional occupations of fathers, multiparae 2+, traditional place of residence, timing of breastfeeding and weaning, and dates of marriage. The question of how the transition from a non-seasonal pattern to a seasonal pattern was achieved has yet to be answered. This pattern has persisted over the past 15 years although it is less apparent among the more recently sedentarized Bedouin Arabs.

The forty-day rest period and infant feeding practices among Negev Bedouin Arab women in Israel.

Four hundred and twelve Bedouin Arab women were interviewed within 48 hours of delivering a newborn in 1982 and two months later to examine the effect of social support during the forty-day postpartum rest period on the incidence of exclusive breast feeding at two months. Whereas the distribution of infant feeding practices at two months did not differ among women with and without support during the "forty days," the number of days of help during the "forty days" was significantly associated with type of feeding at two months. The longer the duration of help, the greater were the odds of maintaining exclusive breast feeding after adjustment for covariates by multinomial logistic regression analysis. The association between duration of help and infant feeding practices at two months was modified by the interview month and the feeding practices of the respondents' primary social supports. More respondents with infants who reached two months of age in May and June were exclusively breast feeding than respondents with infants who reached two months in the hot, dry months of July and August. Also, respondents with sisters-in-law who breast fed alone or in combination with the bottle were feeding their infants in the same way after adjustment for covariates. Given the beneficial effects of breast feeding on infant health and development, these findings identify potential avenues of intervention for programs promoting breast feeding.

PIP: In March-June 1982, female Arab students at Ben Gurion University in Beer Sheva, Israel, interviewed 412 mothers within 2 days after they delivered healthy newborns either at the Soroka Medical Center or at home to examine the link between family support during the traditional 40-day rest period and the incidence of exclusive breast feeding during the infant's first 2 months of life. Mothers exclusively breast fed only 86% of the newborns. By 2 months, this percentage fell to just 24%. 22% did not receive any help with chores during the 40-day rest period and only 59% of those who did receive such help had this help for 40 days. These effects were probably a result of the transition from the traditional seminomadic to a sedentary life style. Even though the distribution of infant feeding practices between those who received help with chores during the 40-day rest period and those who did not were not greatly different, the duration of help with cooking did differ between the 2 groups (p = .02). 31% of mothers who had someone help with cooking for =or 40 days exclusively breast fed while only 24% of mothers who had someone help with cooking for 40 days did so. Mothers whose infants were 2 months old in the hot and dry months of July or August were 5 times more likely to switch from breast feeding to breast and bottle feeding than were those whose infants were 2 months old in May or June (p = .006). They were also 4 times more likely to switch from breast feeding to feeding their infants cereal, breast milk and liquids from a bottle (p = .005). Mothers tended to follow the same infant feeding practices as their sisters-in-laws (p = .06 and .01 respectively). The reduction of help with chores during the first 40 days postpartum may adversely affect the health and development of Bedouin mothers and their children.

Undernutrition among Bedouin Arab infants: the Bedouin Infant Feeding Study.

Two hundred seventy-four healthy Bedouin Arab newborns in 1981 were followed for 18 mo to examine the relationship between infant-feeding practices and growth during planned social change. Although wasting was not prevalent, the prevalence rate of stunting (less than or equal to -2 SDs) increased from 12% to 19% to 32% at 6, 12, and 18 mo, respectively. After multiple-logistic-regression adjustment for covariates, the odds ratio (OR) of stunting at 6 mo was reduced among infants breast-fed only or fed with supplement compared with weaned infants. Infant-feeding practices were not associated with stunting in later infancy; however, those stunted at 6 mo had an OR of 13 of stunting at 12 mo and those stunted at 12 mo had an OR of 14 of stunting at 18 mo. In a multiple-linear-regression analysis, seasonality, duration of breast-feeding, hospitalized morbidity, and residual of height at 6 mo were negatively associated with daily average linear growth from 6 to 12 mo; these factors only explained 12% of the variation in daily linear growth.

The prevalence of IgG antibodies to spotted-fever group rickettsiae among urban and rural dwelling children in southern Israel.

The prevalence of IgG antibodies to spotted-fever group rickettsiae was studied in a sample of 1,055 healthy children aged 2-17 years, residents of the desert Negev region of southern Israel. Groups of children from 5 different places of residency were tested: (1) urban children from the city of Beer-Sheva; (2) children from Omer, a suburb of the city; (3) children from rural communes ("kibbutz"); (4) children from small agricultural settlements ("moshav"); and (5) seminomadic bedouin children. Overall 40 sera (3.8%) were positive by the indirect immunofluorescent antibody assay at a titer of 40. The prevalence rate was 3.6% in males and 4.0% in females. Age-specific prevalence rates for the 2-5, 6-9, 10-13 and 14-17 year old groups were 2.0, 5.4, 4.1 and 3.6% respectively. The prevalence rates by place of residency were: urban 3.3%, suburban 3.3%, "kibbutz" 3.8%, "moshav" 5.1% and seminomadic children 3.3%, and did not differ by socio-economic status as measured by degree of crowding. The results indicate that spotted fever is endemic in all human habitats in the Negev region. Our data do not support association to sex or socio-economic status of the children tested. Lack of cumulative prevalence rates with increasing age suggests that antibodies may wane to undetectable levels in the years following the infection.

Natural autoantibodies in the serum of healthy women--a five-year follow-up.

Autoantibodies are often found among healthy individuals. The significance of these findings, regarding the potential development of overt autoimmune disease and the severity of such an eventuality, is as yet unclear. In order to elucidate these issues 506 healthy women were screened and 60 women of child-bearing age were found to posses high titres of various anti-nuclear antibodies. After a 5-year follow-up, 57 of these 60 women were found to have autoantibodies to a variety of autoantigens. Seven of the women had some symptoms that could be associated with the presence of the antibodies (i.e. arthritis, multiple abortions, Raynaud's phenomenon), however, none exhibited overt clinical signs of an autoimmune disease. Our study may point to the fact that in normal subjects (women aged 22-44 years) high titres of natural autoantibodies are not necessarily indicative of a high risk of developing an overt autoimmune condition, at least for a follow-up period of 5 years.

Familial studies on the occurrence of natural autoantibodies.

Natural autoantibodies are often incidentally found in healthy individuals who are not first-degree relatives of known patients with autoimmune diseases. In an attempt to examine whether there exists a familial tendency in the production of such natural autoantibodies, 134 healthy members of 32 families were examined for antibodies against ss-DNA, ds-DNA, poly (I), poly (G), cardiolipin, histones, Sm, RNP, SS-A (Ro) and SS-B (La), using an enzyme-linked immunosorbent assay. Only 16 of the 134 subjects (11.9%) were found to possess autoantibodies in their sera in a titer exceeding the mean by 3 SD, and none of the 'positive' subjects were related. We conclude that in contrast to the familial occurrence of the autoantibodies of first-degree relatives of patients with autoimmune disease, there is no familial tendency in the occurrence of natural autoantibodies.