Ethnic disparities in colorectal cancer outcomes: a population study from Israel.

Objectives: Colorectal cancer (CRC) is an important cause of morbidity and mortality worldwide. Clear ethnic disparities in the incidence of CRC and its outcomes have been observed globally, but only few research efforts have been invested so far in the unique ethnic scene of Israeli population. This study aims to compare the clinico-pathologic features, tumor's characteristics and prognosis between Arab and Jewish CRC patients as well as among Jewish subgroups living within the same central coastal region in Israel.Methods: In this retrospective, single center study, a total of 401 patients with pathologically confirmed CRCs diagnosed during the years 2008-2015 were included. These were divided into Jewish (n = 334) and Arab (n = 67) groups. Data collected included demographics, country of birth, clinical presentation and family history. Tumor stage, location, histologic grade and mortality rate were compared retrospectively between both groups and within Jewish sub-populations.Results: Arabs were significantly younger at diagnosis (62.7 ± 12.9 vs. 69.3 ± 13.01; P < 0.01), presented more frequently with rectal bleeding, and were less likely to be diagnosed due to positive fecal occult blood test (9% vs. 22.6%; P = 0.012). Tumor distribution through the colon was comparable between both groups and characterized by a distal predominance. Arabs had a significantly higher rate of advanced stage at diagnosis (58% vs. 50.5%, OR = 2.454, 95%CI = 1.201-5.013; P = 0.02) when compared to Jews. Mortality rates were comparable between both groups. In the Jewish subpopulation analysis, we found that immigrants, especially those born in the former USSR, presented with significantly advanced tumor stages when compared to native Israelis (55% vs. 37.5%; P = 0.02).Conclusion: CRC in two major ethnic populations in Israel, Arabs and Jews, varied in terms of age at diagnosis, clinical presentation and stage at diagnosis. Similar findings were documented within a non-native Jewish subpopulation, raising the possibility of a low utilization of screening programs in these groups.

Self-stigma formation process among younger and older Israeli Arabs diagnosed with depression.

OBJECTIVES: Self-stigma is common among persons with depression. Still, studies that examined the process of self-stigma concentrated mostly on younger adults (ages 18-65) with mental illness in general, with a limited number of studies examining older adults with depression. This study was aimed to examine and compare the self-stigma formation process and its relation to self-esteem among younger (ages 18-64) and older Israeli Arabs (age 65+) diagnosed with depression. The study was based on a self-stigma model which defines the self-stigma formation process as composed of three stages: stereotypes awareness, stereotype agreement, and self-concurrence. METHOD: A total of 160 younger and older Israeli Arabs with depression completed measures of self-stigma formation process, self-esteem, and socio-demographic and health characteristics. RESULTS: The self-stigma formation process was found as a multi-level and progressive model for both younger and older adults, despite that older adults reported significantly higher levels of self-stigma in all stages of the process. Low self-esteem was significantly associated with higher levels of stereotype agreement and self-concurrence in both age groups. CONCLUSION: The self-stigma formation process provides an adequate model for understanding depression self-stigma in both younger and older adults. Appropriate intervention programs aiming to reduce self-stigma should be developed, focusing on reducing the three stages of self-stigma.

The yield of full BRCA1/2 genotyping in Israeli Arab high-risk breast/ovarian cancer patients.

PURPOSE: While the spectrum of germline mutations in BRCA1/2 genes in the Israeli Jewish population has been extensively studied, there is a paucity of data pertaining to Israeli Arab high-risk cases. METHODS: Consecutive Israeli Arab breast and/or ovarian cancer patients were recruited using an ethically approved protocol from January 2012 to February 2019. All ovarian cancer cases were referred for BRCA genotyping. Breast cancer patients were offered BRCA sequencing and deletion/duplication analysis after genetic counseling, if the calculated risk for carrying a BRCA mutation by risk prediction algorithms was ≥10%. RESULTS: Overall, 188 patients participated; 150 breast cancer cases (median age at diagnosis: 40 years, range 22-67) and 38 had ovarian cancer (median age at diagnosis: 52.5 years, range 26-79). Of genotyped cases, 18 (10%) carried one of 12 pathogenic or likely-pathogenic variants, 12 in BRCA1, 6 in BRCA2. Only one was a rearrangement. Three variants recurred in more than one case; one was detected in five seemingly unrelated families. The detection rate for all breast cancer cases was 4%, 5% in bilateral breast cancer cases and 3% if breast cancer was diagnosed < 40 years. Of patients with ovarian cancer, 12/38 (32%) were carriers; the detection rate reached 75% (3/4) among patients diagnosed with both breast and ovarian cancer. CONCLUSIONS: The overall yield of comprehensive BRCA1/2 testing in high-risk Israeli Arab individuals is low in breast cancer patients, and much higher in ovarian cancer patients. These results may guide optimal cancer susceptibility testing strategy in the Arab-Israeli population.

Microevolution and Patterns of Transmission of Shigella sonnei within Cyclic Outbreaks Shigellosis, Israel.

Whole-genome sequencing unveiled host and environment-related insights to Shigella sonnei transmission within cyclic epidemics during 2000-2012 in Israel. The Israeli reservoir contains isolates belonging to S. sonnei lineage III but of different origin, shows loss of tetracycline resistance genes, and little genetic variation within the O antigen: highly relevant for Shigella vaccine development.

Trends in the incidence of type 1 diabetes among Jews and Arabs in Israel.

OBJECTIVE: To assess the trends in the incidence of type 1 diabetes between 1997 and 2010 among 0-17-yr-old Israeli Jews and Arabs compared with global trends. METHODS: Data on children with newly diagnosed type 1 diabetes reported by pediatric endocrinologists from 19 medical centers to the Israel Center for Disease Control, as part of the National Diabetes Register. RESULTS: During 1997-2010, 2857 Jews and 757 Arabs were diagnosed with type 1 diabetes. The average age-adjusted incidence among Jews was higher than Arabs [12.2 per 100 000, 95% confidence interval (CI) 10.5-14.2 and 8.9 per 100 000, 95% CI 7.5-10.7, p = 0.0001, respectively], however, the annual percent change was higher for Arabs compared with Jews (4.0 vs. 3.6%, p = 0.005, respectively). The mean age at diagnosis was similar for Jews and Arabs (9.6 ± 4.4 vs. 9.9 ± 4.4 yr, p = 0.08), and it remained stable during 1997-2010 in both ethnic groups (p = 0.6). In both Jews and Arabs the highest annual percent change was observed in younger children. It was 4.9% for children aged 5-9 yr and 10.7% for children aged 0-4 yr, respectively. There were no differences in the frequency of diabetic ketoacidosis (DKA) between Jews (39.9%) and Arabs (41.3%), (p = 0.5). CONCLUSION: Type 1 diabetes incidence of Jews and Arabs in Israel is increasing. The incidence is higher in Jews than in Arabs; however, the annual percent change is higher in Arabs than in Jews. In both Ethnic groups the incidence of type 1 diabetes is increasing especially among young children.

High-Quality Contact With Fellow Majority Group Students Is Associated With Better Academic Performance of Minority Group Students.

We examined the association between intergroup contact and academic performance at university among minority students in a context with a segregated pre-university school system. Study 1 tested whether participation in a group dynamics course, which involves intimate interpersonal contact between Israeli Arab (n = 125) and Jewish students, was associated with better grade point average (GPA). As expected, Arab students who participated in the course had a higher GPA than those who did not, even when controlling for pre-university achievements. The corresponding difference among Jews was substantially smaller. Study 2 (N = 90), a longitudinal study, revealed that the quality of contact with Jewish students at university was associated with Arab students' subsequent higher GPA, even when controlling for pre-university contact, proxies of academic achievements, and perceptions of intergroup relations. The quality of contact with Jewish students was also associated with Arab students' sense of academic belonging. Theoretical and practical implications are discussed.

Cognitive illness representations among Israeli Arabs diagnosed with depression and their relationship with health-related quality of life.

BACKGROUND: The number of studies that have assessed cognitive illness representations among people diagnosed with depression, and their relationship to health outcomes, has clearly grown. Nevertheless, the relationship between cognitive illness representations and health-related quality of life (HRQoL) has received very little research attention. AIMS: This study examined cognitive illness representations, based on the self-regulation model (SRM), and the contribution of each dimension of these cognitive illness representations to health-related quality of life (HRQoL) among Israeli Arabs diagnosed with depression. METHODS: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive illness representations (identity, timeline, consequences, personal control, treatment control, and coherence), HRQoL, and sociodemographic and health characteristics. RESULTS: Participants reported high levels of negative perceptions in the identity, timeline, and consequences dimensions, and moderate levels in the dimensions of personal control, treatment control, and coherence. Also, participants reported low levels of HRQoL. Identity, consequences, and coherence were found to be the main determinants of HRQoL. CONCLUSION: This study underlines the crucial role of the identity, consequences, and coherence dimensions in the HRQoL of individuals diagnosed with depression. The findings indicate that clinical interventions targeting cognitive illness representations of individuals with depression, and in particular identity, consequences, and coherence, might be helpful in improving the HRQoL of this population.

Health-related quality of life among Israeli Arabs diagnosed with depression: the role of illness representations, self-stigma, self-esteem, and age.

BACKGROUND: Studies that examined health-related quality of life (HRQoL) and related factors among people diagnosed with depression, have only focused on sociodemographic and clinical factors. This study examined the contribution of illness representations (IRs), self-stigma, self-esteem, and age group (younger adults aged 18 to 64 and older adults aged 65+) to HRQoL among Israeli Arabs diagnosed with depression. METHODS: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive and emotional IRs, self-stigma, self-esteem, HRQoL, and sociodemographic and health characteristics. RESULTS: Participants reported low levels of HRQoL, with the older adults reporting significantly lower levels of HRQoL in comparison to those reported by the younger adults. Low levels of HRQoL were significantly associated with negative cognitive and emotional IRs, high levels of self-stigma, and low levels of self-esteem. Cognitive IRs, self-stigma, self-esteem, and age group were found to be the main determinants of HRQoL. LIMITATIONS: Limitations of the study include use of a cross-sectional design among culturally homogeneous sample. This limits the generalizability of our results and conclusions, and prevented us from determining causal relationships. CONCLUSIONS: This study emphasizes the role of cognitive IRs, self-stigma, and self-esteem, as well as age, in the HRQoL of individuals diagnosed with depression. Intervention programs should be mindful of these determinants in order to improve the HRQoL of individuals diagnosed with depression.

Impact of a Culturally Adapted Version of Illness Management and Recovery on Israeli Arabs With Serious Mental Illness.

OBJECTIVE: In recent years, there has been growing awareness of the need for cultural adaptation of evidence-based practices, which is essential for successful implementation in diverse cultural contexts. This study investigated the impact of a culturally adapted version of Illness Management and Recovery (IMR), an evidence-based practice developed in the United States, on Israeli Arabs with serious mental illness. METHODS: Using a quasi-experimental design, we compared the outcomes of 86 people who completed the culturally adapted IMR version with outcomes from a matched control group (N=64) who received treatment as usual. RESULTS: Mixed repeated-measures analyses of variance demonstrated significant improvements in the domains of recovery, hope, self-efficacy, and quality of life among those who completed culturally adapted IMR. CONCLUSIONS: The culturally adapted Arabic version of IMR for Israeli Arabs was found to generate significant positive improvement. The findings are discussed with emphasis on the importance of cultural adaptation.

Children's Attitudes to Parental Mediation in a Traditional Society.

Since the 1980s there have been many reports on parental mediation of children's behavior, from TV watching to Internet surfing, but most of the data come from Western societies. Israeli Arab society is a traditional patriarchy, which is in a constant change. The use of handheld devices, mainly smartphones which enable Internet access, has become a status symbol, leading to challenges with parental control issues. This study examines the overlap between parents' and children's perceptions of parental mediation in the Arab population, specifically if parental education and the child's age influence parental mediation. Data were collected from 1,871 Israeli Arab parents living in northern Israel and their children (N = 1,199) in grades 5-10 using an online parental mediation questionnaire. Parental mediation was perceived differently by parents and their children, although the perceptions of fathers and mothers were similar as were the perceptions of boys and girls. The perceptions of academic fathers and academic mothers also differed. The results also indicated that children's perceptions of parental mediation are affected by age. The findings and their implications are discussed.

Between modern and traditional values: Informal mental health help-seeking attitudes according to Israeli Arab women, primary care patients and their providers.

BACKGROUND: Israeli Arab women under-utilize mental health services. OBJECTIVES: The present study evaluated the use of alternative services for dealing with depression and anxiety among Israeli Arab women and primary care providers. MATERIAL: Four focus groups with primary care patients and two focus groups with primary care providers were conducted. Constant comparisons were employed in order to identify major themes related to informal help-seeking behaviors. DISCUSSION: Three informal help-seeking behaviors were identified: (a) social support, divided into extended family and neighbors versus nuclear family and close friends; (b) religiosity, divided into inner, direct practices and beliefs versus externally mediated ones; and (c) self-help techniques, such as engagement in activities and distancing oneself from the situation. Both social support and religiosity were viewed with ambivalence by primary care patients and providers. CONCLUSION: The findings suggest that the Arab population in Israel might be lacking informal sources of support at times of mental health needs.