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Dankner R.,Gertner Institute for Epidemiology and Health Policy Research | Dankner R.,Tel Aviv University | Dankner R.,Feinstein Institute for Medical Research | Shanik M.H.,Endocrine Associates of Long Island | And 5 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Diabetes is associated with many forms of cancer. Recent evidence has suggested that some treatments for diabetes are associated with an increased cancer risk. Less is known about the association between endogenous insulin in the prediabetes state and cancer risk. RESEARCH DESIGN ANDMETHODS - We investigated cumulative cancer incidence and cancer incidence density over 29 years, according to basal insulin, in a cohort of 1,695 nondiabetic men and women of four ethnic origins, aged 51.8 ± 8.0 years at baseline. Total mortality among the 317 subjects (18.7%) who developed cancer at least 2 years after baseline was assessed. RESULTS - In a Cox proportional hazards model, the all-site hazard ratio of cancer incidence comparing the highest insulin quartile with the other three quartiles was 1.09 (95% CI 0.85-1.40), adjusted for age, sex, and ethnicity. BMI, smoking, and fasting blood glucose were not statistically significant in this model. Basal insulin level was not significantly associated with cancer of specific sites (breast, prostate, colon/rectum, or bladder). Fasting insulin in the upper quartile conferred a 37% increased risk for total mortality among cancer patients, adjusting for age, sex, and ethnic origin (95% CI 0.94-2.00, P = 0.097) compared with that of the lower quartiles. Male sex, older age, and North African origins were associated with a greater risk of mortality during follow-up time. CONCLUSIONS - This long-term cohort study may suggest a role for basal elevated insulin levels, mainly as a negative predictor in cancer prognosis. © 2012 by the American Diabetes Association.

Bercovich E.,Technion - Israel Institute of Technology | Keinan-Boker L.,Haifa University | Keinan-Boker L.,Israel Center for Disease Control | Shasha S.M.,Western Galilee Medical Center
Israel Medical Association Journal | Year: 2014

Background: Previous studies suggest that exposure to starvation and stress between conception and early infancy may have deleterious effects on health later in life; this phenomenon is termed fetal origin of adult disease. Objectives: To determine whether exposure to the Holocaust from preconception to early infancy is a cause of chronic morbidity in adulthood. Methods: This pilot study involved 70 European Jews born in countries under Nazi rule (exposed group) during the period 1940-1945 who were interviewed to determine the presence of chronic diseases. A control group of 230 Israeliborn individuals of the same descent, age, and gender distribution were extracted from the Israel National Health Interview Survey-2 (unexposed group). The prevalence of selected risk factors and chronic diseases was compared between the groups. Results: The prevalence of cardiovascular risk factors and morbidity was significantly higher in the exposed group: body mass index (BMI) (29.06 ± 3.2 vs. 26.97 ± 4.42, P = 0.015), hypertension (62.9% vs. 43%, P = 0.003), dyslipidemia (72.9% vs. 46.1%, P < 0.001), diabetes (32.9% vs. 17.4%, P = 0.006), angina pectoris (18.6% vs. 4.8%, P = 0.001) and congestive heart failure (8.6% vs. 1.7%, P = 0.013). The prevalence of cancer (30.0% vs. 8.7% P; 0.001), peptic ulcer disease (21.4% vs. 7%, P = 0.001), headaches/migraines (24.3% vs. 12.6%, P < 0.001) and anxiety/depression (50.0% vs. 8.3%, P < 0.001) was also higher in the exposed group. Conclusions: These results suggest that exposure to Holocaust conditions in early life may be associated with a higher prevalence of obesity, dyslipidemia, diabetes, hypertension, cardiovascular morbidity, malignancy and peptic diseases in adulthood. These findings set the stage for further research, which might define those exposed as a high risk group for chronic morbidity.

Zbeida M.,Ben - Gurion University of the Negev | Goldsmith R.,Ministry of Health | Shimony T.,Israel Center for Disease Control | Yardi H.,Ben - Gurion University of the Negev | And 2 more authors.
Journal of Nutrition, Health and Aging | Year: 2014

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=71.2y and 74.9y, 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.

Na'amnih W.,Israel Center for Disease Control | Muhsen K.,Israel Center for Disease Control | Muhsen K.,Tel Aviv University | Tarabeia J.,Haifa University | And 3 more authors.
International Journal of Epidemiology | Year: 2010

Objectives: To examine trends in the Arab-Jew life expectancy gap in Israel during 1975-2004 and to determine the contribution of age groups and causes of death to changes in the gap. Methods: Data on life expectancy and mortality rates by cause of death, for Arabs and Jews, were obtained from the Israel Central Bureau of Statistics. Standard life table techniques were used for decomposition analysis to explore the contribution to changes in the life expectancy gap. Results: While life expectancy of Arabs was lower than Jews during 1975-2004, there was a decline in this gap during 1975-98. However, during the following years the gap increased and the difference in 2004 was 3.2 years for men and 4 years for women. During 2000-04, the main causes of death contributing to the gap in life expectancy were chronic diseases, mainly heart disease and diabetes. Heart disease mortality contributed mostly to the overall life expectancy gap for males and females, accounting for 0.89 and 1.17 years, respectively. The age group >65 years contributed most to the gap (1.33 years among males, and 2.42 years among females). Conclusions: Following a period of reduction, the gap in life expectancy at birth between Arabs and Jews in Israel has started to widen. These findings indicate the need for increased attention to primary prevention and disease management in the Arab population. Reducing social and individual risk factors for major causes of death should be a national priority. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2010; all rights reserved.

Mandelboim M.,Sheba Medical Center | Dror P.,Sheba Medical Center | Dror P.,Hebrew University of Jerusalem | Azar R.,Sheba Medical Center | And 3 more authors.
Journal of Clinical Microbiology | Year: 2011

Adenoviruses can cause a broad spectrum of clinical diseases, most of which are self-limited. However, adenovirus infection can occasionally result in severe or lethal infection. Fifty-five adenovirus serotypes are known today, and they are classified into 7 subgroups (subgroups A to G). Here we examined 282 samples derived from hospitalized patients in Israel (September 2006 to August 2008) who were diagnosed as suffering from adenovirus infections. We used a recently described PCR amplification method and subsequent sequencing to identify the adenovirus. In addition, we studied the medical charts of 106 hospitalized patients from Sheba Medical Center in Israel. The most prevalent adenovirus serotypes found were serotypes 1 (22.8%), 2 (19.2%), 7 (18%), and 3 (14%). In addition, we identified several serotypes that have not been identified previously in Israel. Overall, serotypes of subgroup B were found to be approximately 4 times more prevalent among immunocompromised children than among generally healthy children (52.6%; P < 0.007). The realization that the virus subtypes are different among healthy and immunocompromised patients may lead to more efficient treatment of adenovirus infections among immunocompromised children in the future. Copyright © 2011, American Society for Microbiology. All Rights Reserved.

Kesler A.,Neuro ophthalmology Unit | Kesler A.,Tel Aviv University | Stolovic N.,Neuro ophthalmology Unit | Bluednikov Y.,Israel Center for Disease Control | And 2 more authors.
European Journal of Neurology | Year: 2014

Background and purpose: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder related to increased intracranial pressure without clinical, laboratory or radiological evidence of an intracranial space occupying lesion or cerebral sinus vein thrombosis, predominantly affecting obese women of childbearing age. Our aim was to determine the incidence and clinical features of IIH in Israel. Methods: In a cross-sectional study, all medical records of patients discharged from the hospital with a primary diagnosis of IIH during 2005-2007 were reviewed. Results: Four hundred and twenty-eight patients with a new onset of IIH were diagnosed. The average annual incidence rate was 2.02 per 100 000 with an incidence of 3.17 per 100 000 for women and 0.85 per 100 000 for men. The incidence rate in females of childbearing age (18-45) was 5.49 per 100 000. The female to male ratio for >17 years old was 6.1:1 (252 females and 41 males) and 2.1:1 (60 females and 28 males) for ages 11-17. Obesity was documented in 83.4% of patients. Body mass index (BMI) data were available for 159 (37.1%) patients; of these, 59.1% had a BMI ≥ 30. Conclusion: The incidence of IIH in Israel has increased during the last decade. This finding could be related to the increasing rates of obesity. The association of IIH and obesity should be further explored especially with regard to the effect of weight reduction for primary prevention. © 2014 EAN.

Mabjeesh N.J.,Tel Aviv University | Lidawi G.,Tel Aviv University | Chen J.,Tel Aviv University | German L.,Israel Center for Disease Control | Matzkin H.,Tel Aviv University
BJU International | Year: 2012

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Men with persistent suspicion for prostate cancer after previous negative standard transrectal biopsy series are offered saturation biopsy either transrectally or transperineally to increase cancer detection rate. A high-risk group of men with at least two previous negative transrectal biopsies underwent transperineal template-guided saturation biopsy. Prostate cancer was detected in 26%, predominantly in the anterior zones. PSA velocity or doubling time were the most powerful factors to predict cancer. OBJECTIVE To evaluate the detection rate and the regional location of prostate cancer in men undergoing transperineal template-guided saturation biopsy (TTSB). PATIENTS AND METHODS In all, 92 consecutive men with at least two previous negative transrectal biopsy series who underwent a multiple-core prostate TTSB at our centre were included in the study. Univariable and multivariable logistic regression analyses were used to address the relationship between parameters before TTSB and prostate cancer-detection rate. Covariates consisted of age at biopsy, free and total prostate-specific antigen (PSA), prostate volume, digital rectal examination findings, histological findings on previous biopsy, PSA velocity (PSAV), PSA-doubling time (PSADT) and the number of previous negative biopsy sets. RESULTS Prostate cancer was diagnosed in 26% of the men. A median of 30 cores was taken by TTSB. Adenocarcinoma in >2 cores was detected in 58.5% and Gleason score ≥7 was detected in 46% of the diagnosed men. Most of the tumours (83.3%) were found in the anterior zones of the gland, with a significantly higher number of positive cores vs the posterior zones (mean 4.9 vs 1.5, P= 0.015). PSADT and PSAV were the only independent predictors of prostate cancer detection at multivariate analyses with odds ratios of 0.71 (P= 0.014) and 1.58 (P= 0.025), respectively. CONCLUSIONS TTSB has a high prostate cancer-detection rate, especially in the anterior zones. Men after at least two previous negative transrectal biopsy series and persistent suspicion of prostate cancer, as evidenced by rapid PSA dynamics, should be offered TTSB. © 2012 BJU International.

Muhsen K.,Tel Aviv University | Cohen D.,Tel Aviv University | Spungin-Bialik A.,Tel Aviv University | Shohat T.,Tel Aviv University | Shohat T.,Israel Center for Disease Control
Epidemiology and Infection | Year: 2012

We examined the prevalence, correlates and trends of H. pylori infection in Israel using residual sera obtained in 2007-2008 from 1466 Jewish subjects aged 0-77 years and 897 Arabs aged 0-19 years, and in 2000-2001 from 627 Jewish and 575 Arab subjects aged 0-19 years. H. pylori IgG antibodies were measured by ELISA. The age-adjusted H. pylori seroprevalence was 45·2% in Jewish participants. Seropositivity increased with age, reaching 60% at age ≥50 years and ranged from 24·3% in subjects originating from North America/Western Europe/Australia, to 63·2% in those from Asia/Africa/South America. Among Arabs, H. pylori seroprevalence was 42·1% and reached 65% in adolescents. There was no significant change in seroprevalence between 2000-2001 and 2007-2008. High prevalence of H. pylori was found in Arabs, and in Jews originating from countries of high H. pylori endemicity. These findings are characteristic of countries of diverse ethnic structure and recent immigration. © 2012 Cambridge University Press.

Sznitman S.R.,Haifa University | Baron-Epel O.,Haifa University | Boker-Keinan L.,Haifa University | Boker-Keinan L.,Israel Center for Disease Control
Journal of Studies on Alcohol and Drugs | Year: 2013

Objective: Studying drinking patterns in relation to immigration processes is important for reaching a better understanding of changes in drinking habits in host as well as immigrant populations. Research based on assimilation models has previously noted that immigration may affect minority drinking patterns but has failed to acknowledge the possibility that immigration may change the host drinking patterns. The current study applies a bidirectional acculturation model to analyze if, and in what ways, mass emigration from the former Soviet Union (fSU) to Israel may have influenced immigrant drinking habits as well as the drinking patterns of veteran Israelis. Method: A cross-sectional pooled nationally representative stratified simple random sample of the young Israeli Jewish adult population (ages 21-40 years) from 2004 and 2009 was used (n = 1,357; women = 52.7%). Logistic regression examined differences in drinking patterns and differences over time between fSU immigrants and veteran Israelis. Results: There has been a convergence in moderate drinking habits between the two populations, and this convergence is attributed to increases in veteran Israeli moderate drinking over time but not to decreases in fSU immigrant drinking habits. Results also show that heavy drinking is increasing among veteran Israelis but that fSU immigrants continue to drink more heavily and to be more likely to prefer distilled spirits than veteran Israelis. Conclusions: A bidirectional acculturation model may be more appropriate than assimilation models for the study of immigrant drinking patterns because it acknowledges the possibility of changes in immigrant as well as host drinking customs. © 2013 Rutgers University.

Amitay E.L.,Haifa University | Keinan-Boker L.,Haifa University | Keinan-Boker L.,Israel Center for Disease Control
JAMA Pediatrics | Year: 2015

IMPORTANCE: Childhood cancer is a leading cause of mortality among children and adolescents in the developed world and the incidence increases by 0.9% each year. Leukemia accounts for about 30% of all childhood cancer but its etiology is still mostly unknown. OBJECTIVE: To conduct a meta-analysis of available scientific evidence on the association between breastfeeding and childhood leukemia. DATA SOURCES: A thorough search for articles published between January 1960 and December 2014 researching the association between breastfeeding and childhood leukemia was conducted on PubMed, the Cochrane Library, and Scopus (performed in July and December 2014), supplemented by manual searches of reference lists. STUDY SELECTION: To be included in the meta-analyses, studies had to be case control; include breastfeeding as a measured exposure and leukemia as a measured outcome; include data on breastfeeding duration in months; and be published in a peer-reviewed journal with full text available in English. DATA EXTRACTION AND SYNTHESIS: The search identified 25 relevant studies, 18 of which met all inclusion criteria. No publication bias or heterogeneity among these 18 studies were detected. The quality of each study that met the inclusion criteria was assessed using the Newcastle-Ottawa Scale. Multiple meta-analyses were conducted using the random effect model on raw data in the StatsDirect statistical program. MAIN OUTCOMES AND MEASURES: No or short duration of breastfeeding and the incidence of childhood leukemia. RESULTS: The meta-analysis of all 18 studies indicated that compared with no or shorter breastfeeding, any breastfeeding for 6 months or longer was associated with a 19% lower risk for childhood leukemia (odds ratio, 0.81; 95% CI, 0.73-0.89). A separate meta-analysis of 15 studies indicated that ever breastfed compared with never breastfed was associated with an 11% lower risk for childhood leukemia (odds ratio, 0.89; 95% CI, 0.84-0.94), although the definition of never breastfed differed between studies. All meta-analyses of subgroups of the 18 studies showed similar associations. Based on current meta-analyses results, 14% to 19% of all childhood leukemia cases may be prevented by breastfeeding for 6 months or more. CONCLUSIONS AND RELEVANCE: Breastfeeding is a highly accessible, low-cost public health measure. This meta-analysis that included studies not featured in previous meta-analyses on the subject indicates that promoting breastfeeding for 6 months or more may help lower childhood leukemia incidence, in addition to its other health benefits for children and mothers. Copyright 2015 American Medical Association. All rights reserved.

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