Dental utilization disparities in a Jewish context: reasons and potential solutions.

UNLABELLED: Demographic discrepancies in dental healthcare utilization and access to care have historically been studied and attributed to such factors as socioeconomic status, race, and ethnicity. Such potential discrepancies and contributing factors amongst the Jewish population have been little explore. OBJECTIVE: To examine the frequency of dental visits among Jewish subgroups and explored possible explanatory factors for differences in dental healthcare utilization, such as financial constraints, dental anxiety, religious perspectives on health, lack of perceived need, poor accessibility, and scheduling conflicts. BASIC RESEARCH DESIGN: Cross-sectional study. PARTICIPANTS: A religiously diverse non-clinical sample of 169 Jews completed measures on demographics, dental visit frequency, dental anxiety, and general religiousness. RESULTS: On average, Orthodox Jews visit the dentist less often than non-Orthodox Jews (OR = 0.43) and Ultra-Orthodox Jews markedly less (OR = 0.23). Moreover, differences between these groups in dental visits were largely mediated by differences in dental anxiety, poor accessibility, lack of perceived need and scheduling conflicts. CONCLUSION: These results identify a population that is at risk for poor oral health and suggests possible preventive and corrective interventions.

Modelo causal del prejuicio religioso / Causal Model of religious prejudice

El objetivo de este trabajo es avanzar en la investigación que analiza la asociación entre religión y prejuicio. Este estudio se ha realizado con varias muestras cristianas dentro y fuera del ámbito universitario: 211 y 155 participantes respectivamente. Se utilizan varios instrumentos para evaluar la orientación religiosa, prejuicio religioso, autoritarismo de derechas, fundamentalismo, frecuencia de oración, literalismo, creencias, emociones, favorabilidad y racismo moderno. Se ha creado una Escala del Prejuicio Religioso con cuatro factores (homofobia, sexismo, intolerancia religiosa y distancia social) que muestra ser un instrumento útil para conocer la compleja relación entre religión y prejuicio. Los resultados señalan que las variables autoritarismo de derechas y el fundamentalismo son los mejores predictores del prejuicio y además, la muestra no universitaria (grupos religiosos y parroquias) presenta un mayor prejuicio religioso (AU)

The aim of the present paper is to extend previous research that examines the relationship between religion and prejudice. This study was conducted with samples inside and outside the university context: 211 and 155 participants respectively. Various instruments are used to measure the religious orientation, religious prejudice, rightwing authoritarianism, fundamentalism, frequency of prayer, literalism, beliefs, emotions, favorability and modern racism. A Religious Prejudice Scale has been created with four factors (homophobia, sexism, religious intolerance and social distance) and is shown as a useful tool to understand the complex relationship between religion and prejudice. The results show that the variables right-wing authoritarianism and fundamentalism are the best predictors of prejudice and also that the non university sample (religious groups and churches) manifests a greater religious prejudice (AU)

The genome-wide structure of the Jewish people.

Contemporary Jews comprise an aggregate of ethno-religious communities whose worldwide members identify with each other through various shared religious, historical and cultural traditions. Historical evidence suggests common origins in the Middle East, followed by migrations leading to the establishment of communities of Jews in Europe, Africa and Asia, in what is termed the Jewish Diaspora. This complex demographic history imposes special challenges in attempting to address the genetic structure of the Jewish people. Although many genetic studies have shed light on Jewish origins and on diseases prevalent among Jewish communities, including studies focusing on uniparentally and biparentally inherited markers, genome-wide patterns of variation across the vast geographic span of Jewish Diaspora communities and their respective neighbours have yet to be addressed. Here we use high-density bead arrays to genotype individuals from 14 Jewish Diaspora communities and compare these patterns of genome-wide diversity with those from 69 Old World non-Jewish populations, of which 25 have not previously been reported. These samples were carefully chosen to provide comprehensive comparisons between Jewish and non-Jewish populations in the Diaspora, as well as with non-Jewish populations from the Middle East and north Africa. Principal component and structure-like analyses identify previously unrecognized genetic substructure within the Middle East. Most Jewish samples form a remarkably tight subcluster that overlies Druze and Cypriot samples but not samples from other Levantine populations or paired Diaspora host populations. In contrast, Ethiopian Jews (Beta Israel) and Indian Jews (Bene Israel and Cochini) cluster with neighbouring autochthonous populations in Ethiopia and western India, respectively, despite a clear paternal link between the Bene Israel and the Levant. These results cast light on the variegated genetic architecture of the Middle East, and trace the origins of most Jewish Diaspora communities to the Levant.

HLA class II genetic diversity in Arabs and Jews of Iran.

BACKGROUND: Anthropological studies based on highly polymorphic HLA genes provide useful information for bone marrow donor registry, forensic medicine, disease association studies, as well as designing peptide vaccines against tumors, and infectious or autoimmune diseases. OBJECTIVE: This study was designed to investigate the genetic relationship of Iranian Arabs and Jews using HLA-class II genetic diversity. METHODS: HLA-DRB1, DQA1, and DQB1 allele frequencies and haplotypes were determined in 134 Iranian Arabs from two different communities and 91 Iranian Jews using PCR/RFLP and PCR/SSP methods. RESULTS: Neighbor-joining analyses showed a closer genetic relationship between Iranian Arabs and Iranian Jews than between either Iranian Arabs and Middle Eastern Arabs or Iranian Jews and other Jews. The results of AMOVA test also revealed no significant difference between these populations and other Iranians. CONCLUSION: It seems that, Iranian Arabs are originally from the Iranian gene pool and speak Arabic due to their encounter with Arabs. Iranian gene flow to immigrant Jews followed by their expansion in this country may also explain the close genetic relationship among different Iranian ethnic groups.

Target organ damage in hypertensive patients of different ethnic groups.

BACKGROUND: Hypertension is associated with involvement of target organs which varies among the different ethnic groups. The multiplicity of the population in Israel offers an opportunity for evaluating target organ damage in hypertensive patients of different ethnic origins. METHODS AND RESULTS: Data were collected from the computerized medical files of hypertensive patients in primary care clinics. The analysis was done on 576 hypertensive patients: 138 Bedouins (Arab residents), 141 Sephardic Jews (immigrants from North Africa and the Middle East), 152 Asian-Indian Jews (immigrants from India) and 145 Ashkenazi Jews (immigrants from Europe and North and South America). In multivariable logistic regressions adjusted for known risk factors and ethnicity, the prevalence of cerebrovascular disease was the highest among the Asian-Indian Jews (OR=3.09, p value=0.009). Renal damage was highest among the Bedouins (OR=4.54, p value<0.0001) and Asian-Indian Jews (OR=2.88, p value=0.005). The differences in the prevalence of renal damage among the various ethnic groups were even more pronounced among patients without diabetes (OR=8.31, p value<0.0001 in Bedouins and OR=7.46, p value=0.001 in Asian-Indian Jews). The prevalence of ischemic heart disease did not differ significantly among the four ethnic groups. CONCLUSIONS: The prevalence of cerebrovascular and renal diseases are both significantly associated with ethnic origin of Asian-Indian Jews and Bedouins. However, the multivariate analysis shows that the prevalence of ischemic heart disease is not associated with ethnicity.

Ashkenazi Jews and breast cancer: the consequences of linking ethnic identity to genetic disease.

We explored the advantages and disadvantages of using ethnic categories in genetic research. With the discovery that certain breast cancer gene mutations appeared to be more prevalent in Ashkenazi Jews, breast cancer researchers moved their focus from high-risk families to ethnicity. The concept of Ashkenazi Jews as genetically unique, a legacy of Tay-Sachs disease research and a particular reading of history, shaped this new approach even as methodological imprecision and new genetic and historical research challenged it. Our findings cast doubt on the accuracy and desirability of linking ethnic groups to genetic disease. Such linkages exaggerate genetic differences among ethnic groups and lead to unequal access to testing and therapy.

Mitochondrial DNA sequence variation in Jewish populations.

Sequence analysis of HVRI and HVRII mitochondrial DNA was carried out on 107 Jewish samples from Ashkenazi, Oriental, North African, and Sephardic origins. Control region sequences were assigned to a haplogroup by means of the analysis of the RFLP motif -7025 AluI or by using sequence motifs. A total of 88 different haplotypes were observed with a lower incidence of unique haplotypes (68.2%) than in other populations. Four individuals with one position of sequence heteroplasmy at nucleotides 16093, 16134, 16169, and 235, respectively, were detected. The mean pairwise difference in the Jewish population was 9.7 nucleotides. The gene diversity was 0.996, and the random match probability was 1.3%. When the data were compared with the autosomal and Y-chromosome markers previously studied in these populations, sex-specific differences could be observed in the Jewish populations. This fact must be taken into account for choosing suitable databases to correctly weigh the value of the evidence of a mtDNA and/or Y profile match.

The matrilineal ancestry of Ashkenazi Jewry: portrait of a recent founder event.

Both the extent and location of the maternal ancestral deme from which the Ashkenazi Jewry arose remain obscure. Here, using complete sequences of the maternally inherited mitochondrial DNA (mtDNA), we show that close to one-half of Ashkenazi Jews, estimated at 8,000,000 people, can be traced back to only 4 women carrying distinct mtDNAs that are virtually absent in other populations, with the important exception of low frequencies among non-Ashkenazi Jews. We conclude that four founding mtDNAs, likely of Near Eastern ancestry, underwent major expansion(s) in Europe within the past millennium.

Sensorineural hearing loss in Jewish children born in Jerusalem.

OBJECTIVE: Many factors, hereditary and environmental, may cause deafness. The aim of the present study was to analyze data on the etiology of bilateral sensorineural hearing impairment in children born in the Jerusalem area during 1978-1991, and to compare the results to those of a previous survey (1968-1977) in the same area. METHODS: The study included 150 Jewish children (139 families) with hearing loss, born during 1978-1991. Information was obtained on prenatal, perinatal and postnatal events, history of hearing loss in the family, the parents' communities and consanguinity. Children with a sensorineural hearing impairment of 56 dB HL or greater in the better ear, within the frequency range of 0.5-4 kHz were included in the study. The hearing loss was classified as moderate-severe (56-70 dB HL), severe (71-90 dB HL) and profound (91 dB HL or more) in the better ear. Mutations in the coding sequence of the connexin 26 (C x 26) and the connexin 30 genes were examined in some of the families. RESULTS: The hearing impairment was hereditary in 66 (44%) of the children, environmental in 31 (21%) and four children (3%) had multiple malformations. The cause was unknown in 49 (33%) children. Sixty-two families were of European origin (Ashkenazim) and 62 of Afro-Asian origin (Sephardim). Consanguinity was in 7% of the families. Mutations in connexin 26 and the deletion in connexin 30 were diagnosed in 9/18 families tested. The incidence of hearing loss decreased from 1.28 per thousand during 1968-1977 to 1.06 per thousand during 1978-1991. The rate of environmental causes decreased over the years together with an increase in the rate of unknown causes. The rate of hearing loss among Sephardim decreased significantly and increased among Ashkenazim. CONCLUSIONS: The rate of hearing impairment in Israel is as that found in other countries, as was the distribution of the causes of deafness. The decrease in the rates of hearing impairment among the Sephardim may be due to a continuing decrease in consanguineous marriages among Sephardim. It is expected that the group of unknown causes will become smaller in future with the availability of more molecular genetic tests.

Consanguinity, intracommunity and intercommunity marriages in a population sample of Israeli Jews.

BACKGROUND: Changes in the marriage patterns of Israeli Jews have been associated with the mass immigration of Jews from many countries over a relatively short period of time. AIM: This study seeks to document consanguineous, intracommunity and intercommunity marriage patterns, and to observe the changes that have occurred over time, and in relation to the level of education and religiousness. SUBJECT AND METHODS: During 1990-1992, 4388 Jewish women were interviewed after delivery in maternity wards throughout Israel. Demographic information was received, with special emphasis on country of origin, community and consanguinity of the couples and their parents. RESULTS: The consanguinity rate among the couples was 2.3%, including 0.8% first cousin marriages, with the highest consanguinity rate among Eastern Jews (7.1%). The rate of intracommunity marriages was 64% (25% Ashkenazim, 22% Sephardim and 17% Eastern Jews). The rate of intercommunity marriages was lowest among Ashkenazim. It rose with the level of education and inversely to the degree of religiousness. CONCLUSION: Over the past decades there has been a decline in consanguineous and intracommunity marriage rates and an increase in intercommunity marriages. Immigrant and ultraorthodox women tended to marry within the community as opposed to Israeli-born women and those with higher educational level who tended to intermarry with other communities as well.

Class structure in a deeply divided society: class and ethnic inequality in Israel, 1974-1991.

Despite the fact that in many societies ethnicity plays an important role in stratification processes, a common view held by students of stratification argues that the role of ascriptive criteria in stratification processes is diminishing, and that the main axis of the modern stratification system is rooted in the division of labour in the marketplace. Despite this, most Israeli sociologists have taken the ethnic and national cleavages to be the main axes of stratification in Israel. This paper utilizes the 1974 and 1991 mobility surveys in Israel to examine changes over time in the association between ethnicity/nationality (i.e., Ashkenazi-Jews, Sephardi-Jews and Israeli-Arabs) and class position in the Israeli stratification structure. It also examines the extent to which inequality of opportunity within the Israeli class structure is affected by ethnicity/nationality. Here it is found that the ethnic/national cleavage in Israel appears to have played a less important role over time in the allocation of Israeli men to class positions. It is shown that class crystallization processes that result from the differentiation of employment contracts in the marketplace produce a relatively common level of inequality of opportunity in Israel, across sub-populations and over time. Any difference in the level of inequality of opportunity between the various sub-populations would appear to result, in part, from different historical process of, and government policy towards, the three sub-populations.

The I1307K APC polymorphism: prevalence in non-Ashkenazi Jews and evidence for a founder effect.

A missense mutation within the APC gene, I1307K, was described in Ashkenazi individuals at risk for colorectal cancer (CRC) and in the general population. The anecdotal reporting of the occurrence of this mutation in some non-Ashkenazi individuals led us to hypothesize that within the Jewish people, the I1307K polymorphism may reflect a founder mutation, and that the mutation is not restricted to ethnic Ashkenazis. To test that notion, and to establish the occurrence rate of the I1307K polymorphism in non-Ashkenazi Jewish populations, we screened Iraqi and Moroccan Jews and consecutive Jewish CRC patients and performed haplotype analysis with APC-linked markers in two I1307K carrier families. We analyzed Jewish individuals: 210 Moroccans, 160 Iraqis, 148 Ashkenazi, and 349 CRC patients (227 Ashkenazi and 122 non-Ashkenazi). The mutation detection scheme included PCR followed by denaturing gradient gel electrophoresis (DGGE) or modified restriction analysis (MRA). Haplotypes were assessed using three intragenic and three flanking markers. The I1307K polymorphism was detected in 29/227 Ashkenazi (12.8%), 2/122 (1.6%) non-Ashkenazi CRC patients, and in 2 individuals each (approximately 1%) within the Moroccan and Iraqi populations. Allelic pattern analysis in all our I1307K carriers, revealed a common haplotype for the three intragenic markers tested, in all mutation carriers, regardless of ethnic origin. The I1307K polymorphism, therefore, exists in all ethnic Jewish populations: Ashkenazi and non-Ashkenazi, with or without colon cancer. Jewish I1307K mutation carriers share a common allelic pattern with APC-linked markers. This strongly supports the notion of a founder mutation for I1307K.

Rapid detection of the two common mutations in Ashkenazi Jewish patients with mucolipidosis type IV.

Among Ashkenazi Jewish individuals with mucolipidosis IV (ML IV), two mutations in the ML IV gene, IVS3-1A --> G and delEX1-EX7, account for more than 95% of disease alleles. The reported method of genotyping for the delEX1-EX7 mutation involves a cumbersome multistep procedure. In the present study, a new simplified one-step procedure is described that detects this mutation in both patients and carriers. An improved procedure is also described for detection of the IVS3-1A --> G mutation. Using these improved procedures, we have characterized the ML IV mutant alleles in 27 patients and 95 of their relatives from 22 families, and in 123 unrelated and unaffected Ashkenazi Jewish controls. Of the 27 ML IV patients, 16 patients (59.3%) were found to be homozygous for the IVS3-1A --> G mutation and 1 patient (3.7%) homozygous for the delEX1-EX7 mutation. Additionally, 9 patients (33.3%) were compound heterozygotes for IVS3-1A --> G/delEX1-EX7. Among the 123 Ashkenazi Jewish controls, two individuals were identified as heteroallelic with one IVS3-1A --> G mutation (carrier frequency: approximately 1 in 61); none showed the delEX1-EX7 mutation. The modifications described here provide a more facile means of genotyping patients and carriers and expand the possibilities for screening at-risk populations.

Incidence of BRCA1 and BRCA2 mutations in Ashkenazi colorectal cancer patients: preliminary study.

BACKGROUND: Mutations in BRCA genes are associated with an elevated incidence of colorectal cancer (CRC). While 20% of CRC patients have a familial history of colonic malignancies, in only 5% is the genetic setting understood. Thus, a majority of these patients lack any known genetic marker. Our aim was to explore the relevance of BRCA mutations to serve as such markers in the genetic screening and counseling of CRC patients. PATIENTS AND METHODS: 136 consecutive Israeli Jewish patients with sporadic CRC were screened for BRCA "Ashkenazi mutations": 185delAG, 5382insC and 6174delT. Carrier status was evaluated employing PCR, restriction analysis, SSCP and a Pronto BRCA kit. RESULTS: We found one 185delAG and two 6174delT carriers, altogether three Ashkenazi carriers out of 87 Ashkenazi patients tested, 3.5%. No carriers were found among the Arabs and non-Ashkenazi Jews surveyed. CONCLUSIONS: Our preliminary results show elevated rates of BRCA "Ashkenazi mutations" in Ashkenazi CRC patients, suggesting their involvement in CRC carcinogenesis. An implementation of a wider study will establish the role of these mutations as genetic markers for CRC.

Lack of association between smoking and Crohn's disease but the usual association with ulcerative colitis in Jewish patients in Israel: a multicenter study.

OBJECTIVE: The association between smoking and inflammatory bowel disease (IBD) is well established, but data in Jewish patients in Israel were discrepant. The aim of this study was to examine the smoking habits of Jewish IBD patients in Israel in a large scale, multicenter study. METHODS: Patients with established IBD aged 18-70 yr were interviewed in relation to smoking and other habits. Two controls (one clinic and one neighborhood control matched by age, sex, community group, and education) were sought for each subject. RESULTS: A total of 534 patients (273 ulcerative colitis [UC], and 261 Crohn's disease [CD]), along with 478 clinic controls and 430 neighborhood controls, were interviewed. There was no significant difference in the smoking habits between CD patients and their controls. Of patients with CD, 24.5% were current smokers, as compared to 19.9% of clinic controls and 25.2% of neighborhood controls (NS). The odds ratio for CD in current smokers was 1.30 (95% confidence interval 0.85-1.99) versus clinic controls, and 0.96 (0.63-1.46) versus neighborhood controls. There were also no significant differences in the proportion of ex-smokers between the groups. Only 12.9% of UC patients were current smokers versus 21.9. % Clinic controls, and 26.4% community controls (p<0.005). The proportions of ex-smokers were higher in UC patients 29.7% versus 25.9%, and 19.5% in their respective controls (p<0.001 vs. community controls). No significant differences were found in the proportions of never-smokers between IBD patients and controls. All the above trends were similar in four different parts of the country. The proportion of current smokers in UC decreased with the extent of disease (19.7% in proctitis, 13.6% in left-sided, and 4.5% in total colitis) (p<0.05). Patients with UC were more likely to be light smokers(1-10 cigarettes/day), whereas patients with CD were more likely to be moderate smokers (11-20 cigarettes/day) in comparison to their controls. CONCLUSIONS: The lack of association between smoking and CD has now been established in Jewish patients in Israel. The association was found in UC. The stronger genetic tendency in CD may contribute to this discrepancy.

HLA-A, -B, -C polymorphism in a UK Ashkenazi Jewish potential bone marrow donor population.

To further our knowledge of HLA polymorphism in different ethnic populations and to increase the number of full HLA class I typed potential bone marrow donors on the Anthony Nolan Bone Marrow Trust register, HLA-A, -B and -C polymorphism was characterised in 412 Ashkenazi Jewish potential donors. Serological typings and limited molecular analysis was performed for HLA-A and -B, and molecular typings were performed for HLA-C. Gene and haplotype frequencies were calculated using the maximum likelihood method and compared with UK Caucasoid and other Jewish populations. While the specificities identified were in general overlapping with the UK Caucasoid data, a difference in the frequencies of individual specificities was observed. For example, HLA-B62, a common serotype found in the UK Caucasoid population, is almost absent in the Ashkenazim. HLA-A, -C, -B haplotype frequencies also differ between the two populations with A26-Cw*1203-B38 and A24-Cw*04-B35 significant in the Ashkenazim, whilst A1-Cw*07-B8, a common Caucasoid haplotype, was found to be less frequent. Overall the results for the UK Ashkenazi population were most similar to previous reports on Polish/Russian Jews.

Haredi women, haredi men, stress and distress.

This report examines data from interviews with 179 strictly-orthodox Jews living in London. The impetus was a debate in this journal on the question whether men or women in the strictly-orthodox (haredi) community are more stressed. Many of the observations made in this journal on the quality of life among haredi men and women in Israel were borne out among the strictly-orthodox London Jews interviewed. Quantitatively, severe stress and clinical levels of depression and anxiety were similar among the men and women studied, but women had overall more eventful lives than men, and were more likely to suffer from borderline depression and anxiety--though these differences were only marginally significant. It is suggested that the London sample studied were probably similar to haredim in Israel, and that the findings might therefore be applicable.