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Zini A, Sgan-Cohen H D, Marcenes W. Is religiosity related to periodontal health among the adult Jewish population in Jerusalem? J Periodont Res 2012; 47: 418-425. © 2011 John Wiley & Sons A/S Background and Objective: Religiosity may be a relevant protective factor for periodontitis, as it is for other chronic systemic diseases. The objective of the present study was to assess the relationship between periodontitis and religiosity, and whether oral health-related behaviours, spirituality and social support are included in the potential pathways that explain the association between religiosity and periodontitis. Material and Methods: Cross-sectional data were part of a retrospective study. The stratified random-sampling technique was limited to the Jerusalem Jewish population. Conceptual hierarchical data analysis modelling was adopted, assuming that socio-economic position was the most distal determinant, age and gender were confounders, and social support, spirituality and oral health behaviours were mediators in the relationship between religiosity and periodontitis. Results: Kappa intra-examiner values (0.89) were satisfactory. Response rate was 88.0%. The final sample included 123 men and 125 women. The mean age was 38.6 years (SD 3.25 years), with 33.9% declared to be 'orthodox', 33.1%'religious' and 33.1%'secular'. Higher levels of religiosity ( p = 0.01), support of internal life through spirituality ( p = 0.03), higher family social support ( p = 0.02) and low levels of plaque ( p = 0.05) were related to lower levels of periodontitis. Religiosity led to higher family social support and support of internal life through spirituality, which was related to plaque level and periodontitis. Conclusion: Religiosity had a protective effect against periodontitis through extrinsic and intrinsic pathways. This should be considered as part of aetiology and prognosis, in potential prevention and care of periodontitis. [ABSTRACT FROM AUTHOR]

AbstractAims: The objectives were to determine periodontal treatment needs using the CPITN index, of Israeli permanent force military personnel. Methods: The study population consisted of 1300 military personnel aged 25–44 years (mean age 33.8±5.4), who attended obligatory routine medical and dental examinations. Clinical examinations were conducted by 3 calibrated examiners, employing flat dental mirrors, the specially designed WHO periodontal probes (FDI probes) and following CPITN criteria. The frequency distributions were studied with regard to age groups, gender and education, as well as differences in the severity of the disease. Also, the mean number of sextants affected per person by age was assessed. Results: Only 1.19% of the subjects demonstrated healthy periodontal tissue. Shallow pockets were similarly found among all age groups, and the number of persons with deep pockets increased with age. Deep pockets were found almost 3 × more among males (18.66%) in comparison with females (6.19%). Persons with higher education (>12 years), had less deep pockets and bleeding than individuals with less than 12 years of education (p<0.05). Conclusions: Compared with data from other countries reported by the WHO, this periodontal status indicates a relatively high level of treatment needs. This survey provides a substantial contribution to the national oral health data bank concerning the adult working population in Israel. [ABSTRACT FROM AUTHOR]

This study evaluated the epidemiological and clinical characteristics of human metapneumovirus (hMPV) infection among hospitalized patients with acute respiratory infections during 2015-2021 and assessed the impact of the coronavirus disease 2019 pandemic on hMPV infection. A single-center, retrospective cohort study was performed, including pediatric and adult patients with laboratory-confirmed hMPV. Of a total of 990 patients, 253 (25.6%), 105 (10.6%), 121 (12.2%), and 511 (51.6%) belonged to age groups 0-2, 3-17, 18-59, and ≥60 years, respectively. The highest percentage (23.0%) of patients were hospitalized during 2019 and the lowest (4.7%) during 2020. Patients < 18 years experienced high rates of comorbidities (immunodeficiencies: 14.4% and malignancies: 29.9%). Here, 37/39 (94.9%) of all bronchiolitis cases were diagnosed in patients < 2 years, whereas more patients in older age groups were diagnosed with pneumonia. A greater proportion of hMPV patients diagnosed with viral coinfection (mostly respiratory syncytial virus and adenovirus) were <18 years. The highest percentages of intensive care unit admissions were recorded among patients < 18 years. Our findings demonstrate that hMPV is an important cause of morbidity in young children and a possibly underestimated cause of morbidity among older adults., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Objectives: To compare infection rates and circulating subtypes of human metapneumovirus (hMPV) before (2019-2020) and after the emergence of coronavirus disease 2019 (COVID-19) (2021) in Israel., Methods: In total, 12,718 respiratory samples were collected from hospitalized patients of all ages during the years 2019 to 2021 at the Sheba Medical Center in Israel and subjected to reverse transcription-polymerase chain reaction analysis. In addition, whole-genome sequencing was performed to characterize the subtypes of hMPV circulating in Israel between 2019 and 2021., Results: A total of 481 samples were found positive for hMPV. Before the emergence of COVID-19, hMPV peaked in winter months and declined thereafter. In sharp contrast, during the COVID-19 pandemic, we observed a delayed peak in hMPV infection cases and higher infection of young children. Viral sequencing showed a shift in the most prevalent circulating hMPV strain from A2b to B1 during the years 2019, 2020, and 2021., Conclusion: Compared with the years before the COVID-19 pandemic, in 2021, hMPV mostly affected young children, and the most prevalent circulating subtype shifted from A2b in 2019 to B1., Competing Interests: Conflict of interest The authors declare no conflict of interests., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To describe the planning stage and the first year of "Smiles," an innovative, inclusive oral health promotion program among preschool children, ages 3 to 5, encompassing the enhancement of daily toothbrushing skills, engagement of teaching staff and parents, and integration of a supportive environment of supervised toothbrushing in kindergartens., Method and Materials: The major components of the first year of the program included workshops with the teaching staff, working sessions with the preschool children, and workshops with the parents. Program participation, program cooperation, program satisfaction, and kindergarten teachers, kindergarten parents, and dental hygienists' attitudes towards this component of the program were recorded and evaluated. Minor components of the first year of the program included assimilation and integration of daily supervised toothbrushing in some of the kindergartens. Program participation, kindergarten teachers, kindergarten teachers' assistants, and kindergarten parents' attitudes towards this component of the program were recorded and evaluated., Results: In total, 180 kindergartens, in nine locations across Israel, including 5,311 preschool children, their parents, and teaching staff, took part in the first year of the program. High levels of participation (80% and above), cooperation (9.55 to 9.78) and satisfaction (9.62 to 9.81) were recorded in the first year of the program. Kindergarten teachers, parents, and dental hygienists expressed high levels of support for continuing the program beyond its first year (9.86 to 10.00). Regarding the daily supervised toothbrushing model in the kindergartens, high levels of satisfaction (9.50 to 9.75) and willingness to continue the program (9.50-10.00) were recorded among kindergarten teachers, assistants, and parents., Conclusion: The "Smiles" program serves as an example of successful collaboration between many partners and stakeholders from different organizations, sectors, and government ministries, local authorities, kindergarten management and staff, parents, and the most important partners, the preschool children. Its adherence to the basic principles of health promotion, and its professional adjustment to early childhood with positive atmosphere of happiness, joy, and shared warmth, contributed to the success of the program.

Introduction: Quality measurement programs exist in Israel and around the world and their role is, among other things, to monitor and proceed according to quality indicators in order to improve the quality of medical care. In Israel and England, there are programs for measuring quality in hospitals., Objectives: The purpose of this work is to compare the program for measuring quality in hospitals in Israel with the corresponding program in England in terms of the process of determining indicators, methods of collecting data and ways of reporting and publishing the data. This article reviews the similarities and differences between quality measurement programs in hospitals operating in the two countries and examines the performance rates of similar indicators in the two countries., Methods: A comprehensive literature review was conducted to learn about the quality measurement programs in hospitals in both countries, and then designated websites for programs from which more information about the programs was derived., Results: We found that in Israel there is an inclusive body, a quality department in the Ministry of Health, which is responsible for the process of determining the indicators in consultation with officials in the Medical Association, while in England there is also a body responsible for the program, the National Health Service (NHS), but it cooperates with other bodies who share some responsibilities. It was also found that in both countries the programs include indicators on common topics such as: acute myocardial infarction, cerebrovascular accident, fractures in the femoral neck and more and in each subject there are identical indices and different indicators. Beyond that there are also different measured issues in the two programs. We also found that in quality measurement programs in hospitals in Israel and England there are 4 identical indicators in all of which the results of hospitals in Israel are better than the results of hospitals in England, even though in England there is a reward for the indicators and in Israel there isn't such a reward. The reason for this is probably because the program in Israel sets targets for the indicators, while England does not., Conclusions: The two countries can learn from each other in order to improve the quality of health services that are provided.

Maternal docosahexaenoic acid (DHA) is required during pregnancy to supply for normal fetal growth and development. This pilot study aimed to assess the unknown fatty acid (FA) composition in a cohort of non-pregnant and pregnant Israeli women at term and their offspring on a normal diet without n-3 FA supplementation. The fatty acid profile, analyzed using gas chromatography, showed significantly higher plasma monounsaturated (MUFA) and lower n-6 FA percent distribution with similar n-3 index, in pregnant compared to non-pregnant women. RBC exhibited significantly higher MUFA with similar n-3 index, in pregnant compared to non-pregnant women. N-3 FA significantly correlated between neonates' plasma, with higher n-3 index, and pregnant women's DHA. Conclusion: DHA levels in non-pregnant and pregnant Israeli women at term were comparable and the DHA in pregnant women's plasma positively correlated with their neonate's level, suggesting an efficient mother-fetus FA transfer and/or fetal fatty acid metabolism to longer FA products., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The aim of the present research is to examine the relationship between participation in the Enlightened Youth project for youths at risk and integration in employment at the end of the process, type of employment, dropout from school, and enlistment in the army. A database was prepared containing information on all the youths (499 in number) who were admitted to a multidisciplinary day Centre for Youths at Risk in Israel, of whom 86 participated in the project. To match a comparison group to the youths participating in the project, the propensity score matching method was operated. The research findings show a significant correlation between participation in the project and all the parameters examined, with implications regarding employment as a contributing factor among youths at risk, in terms of their personal lives, as well as financial and social well-being.

Introduction: Despite the impressive decline in mortality from atherosclerotic cardiovascular diseases (ASCVD), these diseases still account for a large proportion of the overall morbidity and mortality worldwide. A vast amount of research has demonstrated the key role played by circulating lipoproteins, and especially low-density lipoprotein (LDL), in the etiology of atherosclerosis, and numerous studies have proven the efficacy of interventions that lower the atherogenic lipoproteins in reducing morbidity and mortality from ASCVD. While previous guidelines placed an emphasis on the use HMG-CoA reductase inhibitors (statins) for the treatment of dyslipidemia, recent studies have shown that other LDL cholesterol lowering drugs, including ezetimibe and the PCSK9 inhibitors, can provide additional benefit when used in combination with (and in certain cases instead of) statins. These studies have also shown that blood LDL cholesterol levels lower than previously recommended targets provide additional benefit, without evidence of a threshold beyond which the benefit ceases and without excess adverse effects. The updated guidelines were formulated by a committee that consisted of representatives from the Israeli Society for the Research, Prevention and Treatment of Atherosclerosis, the Israel Society of Internal Medicine, the Israeli Heart Association, the Israeli Neurology Association and the Israel Association of Family Medicine. They provide recommendations for revised risk stratification of patients, novel target goals, and the use of evidence-based treatment and follow-up strategies with reference to specific patient sub-groups.

Introduction: Intense military operations during deployment or training are associated with elevations in inflammatory cytokine markers. However, the influence of an inflammatory response on military-specific skills is unclear. This study examined the association between brain-derived neurotrophic factor (BDNF), glial fibrillar acidic protein, markers of inflammation, marksmanship and cognitive function following a week of intense military field training., Methods: Twenty male soldiers (20.1±0.6 years; 1.78±0.05m; 74.1±7.9kg) from the same elite combat unit of the Israel Defense Forces volunteered to participate in this study. Soldiers completed a five-day period of intense field training including navigation of 27.8km/day with load carriages of ~50% of their body mass. Soldiers slept approximately fivehours per day and were provided with military field rations. Following the final navigational exercise, soldiers returned to their base and provided a blood sample. In addition, cognitive function assessment and both dynamic and static shooting (15 shots each) were performed following a 200 m gauntlet, in which soldiers had to use hand-to-hand combat skills to reach the shooting range., Results: Results revealed that tumour necrosis factor-α (TNF-α) concentrations were inversely correlated with dynamic shooting (r=-0.646, p=0.005). In addition, a trend (r=0.415, p=0.098) was noted between TNF-α concentrations and target engagement speed (ie, time to complete the shooting protocol). BDNF concentrations were significantly correlated with the Serial Sevens Test performance (r=0.672, p=0.012)., Conclusion: The results of this investigation indicate that elevated TNF-α concentrations and lower BDNF concentrations in soldiers following intense military training were associated with decreases in marksmanship and cognitive function, respectively., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

A traditional and ethical principle recognizes a country's primary general welfare responsibility to the young and the old. However, the middle, adult, age group cannot and should not be disregarded. The current dental component of the National Health Insurance Law (NHIL), in Israel, only includes children and the elderly. The present commentary focuses on the large group of adults, age 19-74, which are currently excluded.The cumulative incidence of disease increases over the lifetime of a person. We believe that a NHIL commitment with a major age gap in coverage is unacceptable. The recent manuscript, published by Natapov et al., in this journal, has documented the overall dental health of the older Israeli population, with emphasis on nutritional aspects. This contribution to the literature is commendable. However, we aim to follow in the steps of the Alma Ata Declaration and Ottawa Charter of the World Health Organization (WHO) and to clarify that the government's responsibility should cover all residents regardless of their age. In addition, a dental health epidemiological data base, currently nonexistent for adults, is called for.

Backgroud: The need for dental treatments, especially those related to dental caries, may be associated with and influenced by a wide range of demographic variables. The aim of this study was to describe caries related treatment needs among young Israeli adults and the association with several socio-demographic factors, including socio-economic cluster (SEC), intellectual capabilities, ethnicity and other variables., Methods: Data were collected from dental records of army recruits between 2012 and 2013. We cross-examined data regarding dental treatment needs with socio-demographic variables: age, gender, SEC, intellectual capability score (ICS), birth place of participant and parents, education and immigration., Results: Data received regarding 13,398 combat recruits during their first four months of military training. Most subjects were males (92.4%), with a mean age of 18.9 years. 10.8% were immigrants, with 12.2 years living in Israel before their recruitment. Only 17.7% had no dental treatment needs. Mean number of teeth needing treatment was: for restorations 1.96 ± 2.59, for root canal therapies 0.07 ± 0.44 and for extractions 0.05 ± 0.28. Low ICS scores and low SEC group were significantly associated with higher treatment needs (P < 0.001). Statistically significant higher treatment needs were observed among participants who originated from immigrant families. In a multivariate analysis (Generalized Linear Model), gender, age, ICS score, SEC group and country of birth were found as independent predictors for number of restorations needed., Conclusion: Socio-demographic variables significantly influence dental treatment needs and should be taken into account when preparing intervention programs in this population.

Objectives: The aim of the present study was to investigate the distribution of oral cariogenic bacteria among 12-year-old Palestinian children attending schools in East Jerusalem., Materials and Methods: Salivary levels of mutans streptococci (MS) and Lactobacilli (LB) were examined by semi-quantitative commercial kits and then correlated to social-demographic parameters., Results: Overall, 52.1 % of the examined children presented the highest possible ranking score categories for MS bacteria, with only 5.4 % in the lowest category. Only 12.6 % of the school children presented the highest LB score, while 25 % had the lowest ranking score. Salivary MS levels in children attending private schools were lower than those of children in government schools and United Nations Relief and Works Agency (UNRWA) schools. Conversely, levels of LB were lowest in children attending UNRWA schools compared to government and private schools. Girls had significantly higher amounts of MS and LB than boys (p = 0.001). Lower MS levels were significantly related to the following socioeconomic variables: higher father's education level (p = 0.037), higher mother's education level (p = 0.063), mother's employment status (p = 0.012), and lower home density (p = 0.001). For LB, the only significant socioeconomic variable was higher father's employment level, which was related to lower LB level (p = 0.025)., Conclusions: Levels of MS and LB were found to be strongly related with socioeconomic status among Palestinian children in East Jerusalem. The relatively high prevalence of cariogenic bacteria suggests that oral care prevention and treatment demands special attention from the health care institutions and authorities.

The concentration of the toxic elements Ag, As, Cd, Co, Mn, Mo, Pb, Se, and U and the elements Al, Mg, Cu, Fe, and Zn in human hair samples of population living in the north of the Negev Desert in Israel was determined. The study population consisted of three subgroups: Jewish urban population, Bedouin urban population, and Bedouins living in unrecognized villages (the "dispersion"). The main focus is on the differences between these subgroups in an attempt to explore factors responsible for the variation in trace metal contents in hair samples. The results show that the level of several elements, particularly Ag, Mn, and Pb, in the female Bedouin group significantly differed from the other groups in the study. Exploring the reasons for these differences, we concluded that the lifestyle of those women is the main cause. The female Bedouin subgroup is exposed to heavy metals from kitchen utensils, jewelry, and makeup. Therefore, differences in the heavy metal concentration in the hair samples of this group were attributed to the traditional unique lifestyle and social behavior of the females in the Bedouin society.

Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three-year experience developing a new Computed Tomography (CT)-based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT-based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students' experience with the new CT-based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT-based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors., (Copyright © 2013 American Association of Anatomists.)

The immigration absorption of the Ethiopian community poses a great Zionist challenge to the State of Israel. The Department of Community Dentistry established a long and ongoing relationship with this unique population on a variety of levels. We revealed an alarming deterioration of their oral health status since their arrival to Israel. Concurrently, we explored the association between oral health and psychosocial variables among these immigrants. Accordingly, we implemented a holistic community oral health care program (prevention, treatment, dental, medical, social, psychological), with the participation of a multidisciplinary team of Ethiopian born professionals. In addition, as part of the integration process in the Israeli society and workplace, our department educated and trained individuals of this community as dental assistants and dental hygienists in courses held at the Hadassah Medical Organization. We strongly believe that this model of relationship and support should be implemented on a national level.

Objectives: To describe the distribution and trends of oral and pharyngeal lymphoma cases in Israel., Methods: Incidence rates were derived from the Israel National Cancer Registry and included all registered data from 1970 to 2006. Oral lymphoma included the tongue, mouth, salivary glands, tonsils, and pharynx. Morphological description was according to WHO classification of lymphoid neoplasms., Results: A total of 670 cases were diagnosed, mean age 59.5 years, half were over 65 years old. Tonsils were the most prevalent site of involvement (36.0%), followed by the pharyngeal region and salivary glands. Over the years, the prevalence of lymphoma in salivary glands increased by 49%, whereas in tonsils lymphoma decreased by 28.6%. The overall 5-year survival rate was 57% with best rates among young people., Conclusion: The correlation of survival, type of lymphoma and age, was similar to extra-oral lymphoma. A trend of increased cases in the parotid region, dissimilar to other oral sites, raises a question of possible external factors or an increase in autoimmune diseases. Head and neck clinicians should be aware of different sites, types, and prognoses for the different age groups., (© 2012 John Wiley & Sons A/S.)

Fundamental changes have occurred in dental services for children in Israel that are likely to affect workforce needs for dental hygienists. The aim of this study was to describe the employment situation and job satisfaction of a sample of dental hygienists in Israel, to estimate associated variables, and to discuss corresponding possible implications for training programs after these changes. An e-mailed questionnaire sent to all dental hygienists in the Israeli Dental Hygienists Association list included questions about respondents' demographic background, years of experience, working hours, desire to work in an alternative occupation, and sense that they were valued within the dental community. The response rate was 20.7 percent. The responses showed that dental hygienists worked, on average, in 2.11 different working venues, 23.64 hours/week, and 12.34 hours in the private sector. Almost 63 percent of the respondents were willing to add working hours as a dental hygienist, preferably in the private sector. Also, 38.2 percent of the respondents worked in an extra non-dental hygienist job (mean=7.05 hours/week). These dental hygienists reported a high level of job satisfaction. After regression analysis, a high number of working venues, years of experience, and hypothetically choosing again to be a dental hygienist were found to be significant indicators of job satisfaction (R(2)=0.491). It is important that dental hygienists be satisfied and willing to expand their activities. Legislative changes may require reorientation and refocusing of dental hygiene education programs.

The aim of this study was to assess the relationship between religiosity and dental caries, and whether oral health-related behaviours, spirituality and social support are included in the potential pathways which explain the association between religiosity and dental caries. The present cross-sectional study employed a stratified sample, according to religiosity level (33.1% secular, 33.1% religious and 33.9% orthodox), of 254 Jewish adults in Jerusalem. The objective was to examine the pathway between religiosity, spirituality and social support and its effect on oral health outcomes by DMFT, controlling for socio-economic position and health behaviour determinants. Religiosity was determined and validated by self-definition. Social support was assessed by the Multidimensional Scale of Perceived Social Support. Spirituality was estimated by the Hebrew version of the SpREUK Questionnaire for Religiosity, Spirituality and Health. The mean caries experience (DMFT) was 10.75. Secular people revealed significantly higher DMFT than their religious and orthodox counterparts (78.0 vs. 43.9 and 39.3%, respectively, p < 0.01). A conceptual logistic regression model revealed a possible pathway, wherein a higher level of religiosity was distally associated with superior dental health outcomes, mediated by high spirituality, strong social support and positive oral health behaviours. The present study identified a strong statistical association between caries experience and religiosity. The direction of the association suggested that being religious had a protective effect on caries experience. Our conceptual hierarchical approach suggests a pathway to explain the association between the level of religiosity and dental caries experience. In this study this association was mediated by extrinsic (i.e. social support) and intrinsic (i.e. spirituality) pathways., (Copyright © 2012 S. Karger AG, Basel.)

Faced with stressful experiences, such as uncertainty or novelty, the adrenal glands secrete glucocorticoid hormones to help us cope with stress. Since many decision-making situations are stressful, there is reason to believe that voting is a stressful event. In this study, we asked voters in Israel's national election (N=113) to report on their general affective state immediately before entering the polling place using the Positive Affect Negative Affect Schedule (PANAS) and to provide us with a saliva sample through which we could evaluate their cortisol levels. Compared to a second sample of voters who reported their affective state on election night (N=70), we found that voters at the ballot box had higher positive and negative affect. Moreover, our voters at the polling place exhibited cortisol levels that were significantly higher than their own normal levels obtained on a similar day, and significantly higher than those of a second control group sampled the day after the elections (N=6). Our data demonstrate that elections are exciting, yet stressful events, and it is this stress, among other factors, that elevates the cortisol levels of voters. Since elevated cortisol has been found to affect memory consolidation, impair memory retrieval and lead to risk-seeking behavior, we discuss how these outcomes of elevated cortisol levels may affect voting in general and the field of electoral studies in particular., (Copyright © 2011 Elsevier B.V. and ECNP. All rights reserved.)

Objectives: The purpose of the current study was to evaluate sexual dysfunction among female fibromyalgia syndrome (FMS) patients., Methods: Fifty female subjects were recruited and were asked to complete a questionnaire regarding sexual functioning. The control group included fifty-five healthy age-matched volunteers. The participants underwent a physical examination and tender point assessment was performed using manual palpation. All participants filled out the Arizona Sexual Experience Scale, which evaluates five areas of sexual functioning: sexual drive, sexual arousal, vaginal wetting, orgasm and sexual satisfaction., Results: FMS patients had significantly lower scores on all five aspects of sexual function assessed. A positive correlation was observed between the sexual drive score, signifying a decrease in sexual drive, and the number of tender points documented on examination. Similarly, a positive correlation was observed between the sexual satisfaction scale (indicating decreasing levels of sexual satisfaction) and the number of tender points documented. A positive correlation was demonstrated between the sexual arousal and orgasmatic scales and between the tender point counts, indicating a decrease in sexual arousal and in orgasmatic function in correlation with an increasing number of tender points., Conclusions: The results of the current study indicate a multi-factorial sexual dysfunction among female FMS patients. All stages of sexual functioning, evaluated were significantly disturbed in comparison with the healthy controls. Physicians treating FMS patients should be aware of, and actively inquire about, sexual dysfunction as part of a multi-disciplinary evaluation of such patients.

Objectives: To investigate whether Fibromyalgia (FM) patients differ from their first-degree relatives with and without FM regarding the four personality traits, based on Cloninger's TPQ questionnaire (1)., Methods: The study population was obtained from a genetic study from 2003-2007 and included 129 female FM patients, 27 female relatives with undiagnosed FM and 30 female relatives without FM. All participants completed a socio-demographic questionnaire and the Tridimensional Personality Questionnaire (TPQ) (1) that refers to four personality dimensions: 'novelty seeking', 'harm avoidance', 'reward dependence' and 'persistence'. Non-articular tenderness was evaluated by tender point count and by dolorimetry., Results: FM patients and their relatives with FM had higher scores on 'harm avoidance' than relatives without FM (p<0.001, p=0.017 respectively). Furthermore, the mean point counts of FM patients were significantly higher and their tenderness thresholds were significantly lower than that of their relatives in the other two groups (p<0.001; p<0.001, respectively)., Conclusions: The findings suggest that relatives with FM display personality resemblance to FM patients especially in the personality trait harm avoidance. It appears that there are factors in this personality trait that are hereditary and that may contribute to the development of FM. However, the results could not differentiate between factors from a genetic or a non-genetic origin, due to the study design. In addition, FM's place as an independent component among genetic disorders such as pain, depression and anxiety is still unclear.

Objectives: To assess the frequency of fibromyalgia among a population of Holocaust survivors in Israel as well as the occurrence of post-traumatic stress disorder (PTSD) and concurrent psychiatric symptoms, including depression and anxiety among survivors., Methods: Eighty-three survivors of the Nazi Holocaust and 65 age-matched individuals not exposed to Nazi occupation were recruited. Physical examination and manual tender point assessment was performed for the establishment of the diagnosis of fibromyalgia and information was collected regarding quality of life (SF-36), physical function and health (FIQ), psychiatric symptoms (SCL-90) and PTSD symptoms (CAPS)., Results: Significantly increased rates of fibromyalgia were identified among Holocaust survivors compared with controls (23.81% vs. 10.94, p<0.05). Significantly increased rates of posttraumatic symptoms and measures of mental distress were also identified among survivors., Conclusions: The results indicate a significantly increased prevalence of fibromyalgia among Holocaust survivors six decades after the end of the Second World War. This finding furthers our knowledge regarding the long-term effect of stress on the development of fibromyalgia.

Unlabelled: Although both acute and chronic stress leads to pain, the precise characteristics of this association have not been well defined. Sderot is an Israeli town exposed to repeated missile attacks. Ofakim, a town of similar demographic and socioeconomic characteristics, had not been targeted, as of the period of our study. We examined the occurrence and characteristics of pain and related somatic symptoms in Sderot and Ofakim., Methods: One thousand and twenty-four individuals in Sderot and 1006 in Ofakim were interviewed regarding pain, somatic symptoms, mood, trauma-exposure, and general health status., Results: Significantly higher levels of trauma-related symptoms and somatic symptoms were noted in Sderot compared with Ofakim (p<0.001). Chronic widespread pain (CWP) was more common in Sderot (11.1%) than Ofakim (8.3%; OR 1.37, p=0.038). Women were more likely (13.9% vs. 9.3%; OR 1.45, p=0.06) than men (8.9% vs. 7.3%, OR 1.24, p=0.37) to experience CWP in Sderot vs. Ofakim. Amongst males, chronic regional pain (CRP) was more common in Sderot (19.2%) than in Ofakim (14.2%; p=0.036). Pain severity in Sderot was significantly higher than in Ofakim (p<0.001)., Conclusions: Similar to previous studies that have suggested that chronic stress is associated with chronic pain, this study demonstrates significantly increased rates of somatic complaints, including pain, fatigue and IBS-like symptoms, among individuals in Sderot compared with Ofakim, as well as significantly higher rates of trauma-related symptoms. Thus, a fibromyalgia-like symptoms cluster was more likely to be found in Sderot compared with Ofakim. Widespread pain was reported as being significantly more frequent by inhabitants of Sderot compared with Ofakim. These results have relevance to both the general population and for populations enduring chronic stress.

Objective: To determine the incidence and clinical consequences of asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia (ALL)., Methods: Sixty-five newly diagnosed children and adolescents aged 0.4-21 years with ALL or lymphoblastic lymphoma were retrospectively evaluated for lipid abnormalities. They were treated according to the ALLIC-BFM 2002 protocol between 2002 and 2005. Fasting cholesterol levels were measured in all patients and triglycerides (TG) in 42/65 patients., Results: Prior to treatment, mean cholesterol level was 149 +/- 50 mg/dl, and increased to maximal level 274 +/- 124 mg/dl during treatment. Mean TG level during treatment was 459 +/- 526 mg/dl (range 54-3,009). Twelve patients (28%) had TG levels <200 mg/dl, 18 (43%) had 200-400 mg/dl, 3 (7%) had 400-600 mg/dl, 4 (10%) between 600 and 1,000 mg/dl, and 5 (12%) patients had >1,000 mg/dl. No association was found between TG levels and age or gender. One of the 12 patients with TG >400 mg/dl developed left saggital sinus thrombosis and left frontal lobe infarct. TG level at the time of the event was 2,640 mg/dl. None of the five patients with TG levels >1,000 mg/dl developed pancreatitis. Children with TG levels between 400 and 600 mg/dl were treated by fasting. Fibrates and heparin were added to those with levels >600 mg/dl. Lipid abnormalities normalized in all children upon completion of asparaginase treatment., Conclusions: Abnormalities of lipid profile in children with ALL during asparaginase therapy are relatively common. We recommend measuring TG before and during asparaginase treatment. Initiation of conservative treatment could prevent further increase of TG and decrease the risk of potential complications.

Background: High levels of lip cancer have been reported among Israelis over the last four decades. Epidemiological descriptions and analyses for this region have not previously been presented., Objectives: To establish the incidence, trends and histology of lip cancer and associated demographic variables in Israel over time., Methods: Data for 1970-2006 were derived from the Israel National Cancer Registry. Incidence and trends over time and analyses by lip site, sex, age, origin, histology and 5-year survival were studied., Results: Of 4337 new cases, most were found among men (61.4%), people aged over 53 years (75.5%), and those with lighter skin (62.6%). Lip cancer cases were 40 times more prevalent in the external than in the inner lip. The dominant tumour type was squamous cell carcinoma at the external lower lip and intraoral lip mucosa (predominantly in men) and basal cell carcinoma (originating from skin) at the external upper lip (predominantly in women). Minor salivary gland tumours, melanoma and metastases were also reported. Slight increases in the trend of upper lip cancer and decreases for lower lip cancer were reported., Conclusions: Men, fair-skinned individuals and those over 53 years of age were at higher risk for lip cancer. A higher incidence of external lip cancer, compared with internal, may indicate a major role for sun exposure rather than smoking. The effect of public awareness campaigns as well as occupational changes, both related to sun exposure, should be studied carefully as potential factors in the changing incidence of lip tumours.

Objectives: To evaluate the prevalence of fibromyalgia in survivors of a major train crash in southern Israel, three years after the event., Methods: Survivors were contacted by mail and telephone. Individuals consenting to participate in the study underwent physical examination, including a tender point count and dolorimetry, as well as extensive evaluation of parameters relating to quality of life, presence of widespread pain, fatigue, physical and social function, posttraumatic symptoms and symptoms related to anxiety, dissociation, depression, somatisation, etc., Results: Fifteen percent of survivors participating in the study met ACR criteria for the classification of fibromyalgia. Significantly lower rates of physical and emotional functioning were found among survivors with fibromyalgia compared with those not meeting the classification criteria. Survivors with fibromyalgia rated significantly higher on scales of somatisation, obsessive-compulsive ideation, interpersonal sensitivity, depression, anger and hostility, phobic and general anxiety, paranoid ideation and psychoticism. Survivors with fibromyalgia also rated significantly higher on scales of posttraumatic symptoms including intrusion, avoidance and arousal. These individuals also rated significantly higher on the Peritraumatic Dissociative Experiences Questionnaire (PDE-Q) and the Dissociative Experiences Scale (Hebrew version) (DES-H)., Conclusion: Fibromyalgia was found to be highly prevalent, three years after a major train crash, among individuals exposed to the combination of physical injury and extreme stress. This finding is in accordance with previous data regarding the association of fibromyalgia with both physical and emotional trauma and calls attention to studying the underlying susceptibility factors which may partake in this association.

Objective: To study caries levels and related variables among first grade and fourth grade schoolchildren in one Jerusalem geographic region in 2005, and possible changes in caries levels over three decades: the 1980s, 1990s and finally in 2005., Methods: Dental caries was examined, within schools, employing the DMFS and defs indices, for permanent and deciduous teeth respectively., Results: Data indicate a consistent decline in disease: a reduction from 1.64 to 0.32 to 0.16 for DMFS, and 13.95 to 8.09 to 5.07 for defs (1983, 1992, 2005, respectively), among first grade children; and from 3.50 to 2.50 to 1.07 for DMFS, and 13.88 to 7.26 to 4.16 for defs, (1983, 1992, 2005, respectively), among fourth grade children., Conclusions: A consistent decrease in caries has been detected over three decades. Specific causal factors were not ascertained.

Objective: We evaluated the accuracy of diagnosis of fibromyalgia (FM) by family physicians., Methods: We performed a retrospective cohort analysis of 646 consecutive patients newly referred to the outpatient rheumatology clinic of Soroka University Medical Center from January 1, 2005, until December 31, 2007. The kappa statistic was used to measure agreement between family-physician and rheumatologist diagnoses for FM in the total patient cohort as well as in groups stratified by ethnicity. Sensitivity and specificity of family-physician diagnosis of FM were calculated using rheumatologist diagnosis as the gold standard. There were no exclusion criteria., Results: During the time period of the study, 646 new patients were seen in the rheumatology clinic. Of 196 patients referred with an initial diagnosis of FM, the consultant rheumatologist confirmed this diagnosis in 71% of cases. The overall kappa for FM diagnosis between family physicians and rheumatologists was 0.70 (p<0.001), indicating a good level of agreement. Agreement was substantially lower among Bedouin patients (kappa=0.35, p=0.003). All other patients in our study were Jewish Israelis. Using rheumatologist diagnosis as the gold standard, overall sensitivity and specificity of FM diagnosis by family physicians were 87.4% and 88.3%, respectively., Conclusion: Family physicians in our region are able to accurately diagnose FM. Future studies might focus on evaluating the factors and biases accounting for differences in level of diagnostic accuracy for FM among various ethnic groups.

Background: The prevalence of obesity among children and adolescents in the western world has increased dramatically., Objectives: To assess the efficacy of routine childhood obesity screening by primary physicians in the pediatric population in Israel and the utilization of health services by overweight children., Methods: The electronic medical records of children aged 60-83 months registered in 39 pediatric primary care centers between January 2001 and October 2004 (n=21,799) were reviewed. Those in whom height and weight were documented during a clinic visit (index visit) were classified as overweight, at risk of overweight, or normal weight according to body mass index percentiles. The number of visits to the pediatrician, laboratory tests and health care costs 12 months after the index visit were calculated., Results: Anthropomorphic measurements were performed in 1556 of the 15,364 children (10.1%) who visited the clinic during the study period. Of these, 398 (25.6%) were overweight, 185 (11.9%) were at risk of overweight, and 973 (62.5%) were normal weight. Children in the first two groups visited the clinic slightly more often than the third group, but the differences were not statistically significant (P = 0.12), and they had significantly more laboratory tests than the rest of the children visiting the clinics (P = 0.053). Health care costs were 6.6% higher for the overweight than the normal-weight children., Conclusions: Electronic medical records are a useful tool for population-based health care assessments. Current screening for obesity in children during routine care in Israel is insufficient and additional education of community pediatricians in diagnosis and intervention is urgently needed.

Fibromyalgia syndrome (FMS) is a chronic pain syndrome of unknown aetiology characterized by diffuse pain over more than 3 months and tenderness in specific sites named tender points. The aim of this study was to assess the prevalence and severity of FMS among patients suffering from episodic migraine. Ninety-two consecutive patients (20 male, 72 female) fulfilling the International Headache Society criteria for migraine with and without aura from a tertiary headache clinic were evaluated. A headache and generalized pain history was recorded, tender points were evaluated by thumb palpation. The diagnosis of FMS was made based on the 1990 American College of Rheumatology classification criteria for FMS. Sixteen (22.2%) of the female patients and none of the male patients were diagnosed as suffering from FMS. Migraine severity and characteristics were similar to other female migraine patients. Patients suffering from migraine-FMS had lower quality of life scores and higher levels of mental distress. A high incidence of FMS was found among female migraine patients but not in males. The coexistence of FMS should be considered when choosing a prophylactic migraine therapy.

Background: The inhabitants of 3 different types of population centers in Israel were assessed as to stress-related symptomatology during 2003 and 2004. These centers have been exposed to 2 distinct forms of violence-sporadic, large-scale terror attacks in the metropolitan areas in the heart of Israel and daily "war-zone" conditions in the settlements beyond the 1967 borders of Israel., Method: A semistructured interview and questionnaire survey of a random sample of 314 inhabitants of a suburb of Tel-Aviv, a settlement in the West Bank (Kiryat-Arba), and the Gush-Katif settlement cluster in the Gaza Strip was performed. Symptoms of acute stress and chronic (posttraumatic) stress as well as symptoms of general psychopathology and distress were assessed., Results: The inhabitants of Gush-Katif, in spite of firsthand daily exposure to violent attacks, reported the fewest and least severe symptoms of stress-related complaints, the least sense of personal threat, and the highest level of functioning of all 3 samples. The most severely symptomatic and functionally compromised were the inhabitants of the Tel-Aviv suburb, who were the least frequently and least directly affected by exposure to violent attacks. Because the Gush-Katif population is exclusively religious, the data were reassessed according to religiousness. The religious inhabitants of Kiryat-Arba had almost the same symptom profile as the Gush-Katif population, whereas secular inhabitants of Kiryat-Arba reported faring worse than did either population in the Tel-Aviv suburb., Conclusion: Deeply held belief systems affecting life-views may impart significant resilience to developing stress-related problems, even under extreme conditions. Religiousness combined with common ideological convictions and social cohesion was associated with substantial resilience as compared to a secular metropolitan urban population.

Background: The planned mandatory geographical relocation of the population inhabiting the Gush Katif settlements, planned to take place in July 2005, stands at the focus of public debate and has aroused virulent disagreements an ideological, political, national and security issues., Aims: In order to prepare for professional assistance in coping with possible emotional problems arising from the forced relocation and in order to create support systems for professional interventions on the personal and family levels, the national health administration is seeking to design an adequate inclusive program, based at least partly on lessons learned from the relocation of populations from Sinai peninsula (Yamit and Rafiah areas) in April of 1982. However, little has been reported in the literature which can aid in designing a suitable intervention, tailored for an event such as this. Based on an analysis of the differences between combat- and terror-related trauma, and the forthcoming forced relocation of the civilian population of an entire geographical area, we propose a specifically adapted approach to professional intervention in the possible emotional consequences of the events., The Proposed Model: The proposed principles are a mirror image of the accepted principles for combat reaction: distance from the arena as opposed to proximity, delayed intervention (after the acute phase) instead of immediacy, and expectation for actions related to adapting to a new existential reality rather than the expectation for speedy return to the arena. These principles seem to us far more suited to the demands of the complex situation ahead, in order to provide relief and assist in adaptation, and to prevent later complications of possible emotional sequelae.

Serotonergic (5-hydroxytryptamine; 5-HT) mechanisms have been implicated in a number of physiological and pathophysiological processes including mood, anxiety, and cognitive functioning. Among the many 5-HT receptor subtypes, the 5-HT2A receptors (5-HT2A-R) seem to be of particular importance in mediating these effects, and they are prime targets for a variety of psychoactive substances-from hallucinogenic drugs, through atypical antipsychotics, to anxiolytics and antidepressants. Various selective 5-HT2A-R ligands induce different behavioral responses. To determine whether receptor downregulation is an essential part of anxiolytic action, levels of 5-HT2A receptors were manipulated in rats using a nonpharmacological approach-by the administration of an antisense oligodeoxynucleotide (ASODN) to 5-HT2A-R. Each ASODN was injected icv between two and five times at 24-hr intervals. Control rats received injections of either a scrambled oligodeoxynucleotide (ScrODN) or the vehicle only. On Day 6, anxiety-related behavior was assessed in the elevated plus maze paradigm and performance of memory tasks in the Morris water maze. Gene transcripts were measured by quantitative reverse transcription polymerase chain reaction (PCR). The results show that compared to vehicle and ScrODN control animals, icv 5-HT2A-R-ASODN administrations for 4 consecutive days (but not less) significantly decreased anxietylike behavior and improved memory retention performance. The reduction in anxiety-related behavior in 5-HT2A-R-ASODN rats was accompanied by a decrease in 5-HT2A-R-mRNA expression in the frontal cortex and in the hippocampus. Receptor downregulation has been proposed as one of the central mechanisms for anxiolytic drug actions. Antisense-mediated downmanipulation of receptors in this study, especially of 5-HT2A, supports this theory.

Aim: The audit of dental satisfaction and its association with the reported outcome of a dental health care programme for elderly patients., Design: A telephone survey of 162 patients in a Jerusalem municipal dental clinic for geriatric patients, who had completed a treatment course in oral rehabilitation., Results: The average age of the respondents was 73.2 +/- 8.45 years, over 80% of who were very satisfied or satisfied with the treatment given by the dental clinic staff. Only 1.8% were not satisfied (the remaining 17.9% were unable to answer the question). Among those who responded, 91.6% were currently using their full dentures, 80.4% reported an improvement in chewing ability, and 82.3% an improvement in appearance. Respondents who reported daily use of dentures and improved chewing and appearance, also reported higher levels of satisfaction with the clinic., Conclusions: These results indicate a potentially important role of satisfaction with dental staff in optimal compliance and success of a geriatric oral health care programme.

Introduction: In Israel there are approximately 9,000 "sheltered" children who are lodged in several boarding schools. These children have been removed from their parents' guardianship, some with their parents permission and some by court order, usually due to neglect or abuse. This article describes these children and the efforts implemented regarding oral health: dental care insurance, a preventive program which has been conducted for approximately 10 years among 80 boarding schools and family care shelters, evaluation of these services and caries levels among the children., Methods: A sample of 123 children was examined in four Israeli boarding schools. The DMF(T) index was employed according to WHO guidelines, by one examiner, using a torch, plane dental mirror and probe when required., Results: An average DMF(T) level of 4.62 was detected among 12 year olds. Among all the children from ages 1-18 years, only 30% were caries free. The rate of caries-free children decreased with age., Conclusions: Caries prevalence among this population was higher than levels reported in Israel and abroad. There is a clear need for oral health promotion among this community.

Relapse rates of 30 opiate-addicted social service clients who were given a 9-month course of naltrexone after being rapidly detoxified using naltrexone + clonidine under anesthesia were compared to 33 similar clients detoxified in a 30-day intensive inpatient detoxification but not given naltrexone. Both groups had the same counseling aftercare. Telephone follow-up of 26 of the intensive inpatient detoxification clients and 24 of the rapidly detoxified clients found no significant differences (p = .62) in relapse rates, with 34% of respondents returning to regular opiate use 13.4 (+/- 3.8) months after detoxification. Naltrexone maintenance and counseling following rapid detoxification may be as effective as intensive inpatient detoxification and counseling.

Objectives: The primary aim of this study was to assess the frequency of post-traumatic stress disorder (PTSD) in patients with the fibromyalgia syndrome (FMS). The influence of gender on measures of PTSD in fibromyalgia (FM) patients also was examined., Methods: Seventy-seven consecutive patients (40 women and 37 men) who fulfilled the criteria for FM were asked to complete questionnaires measuring the prevalence and severity of symptoms of PTSD, anxiety, and depression. The subjects were divided in 2 groups based on the presence or absence of PTSD symptoms., Results: In this study, 57% of the FM sample had clinically significant levels of PTSD symptoms. The FM patients with PTSD reported significantly greater levels of avoidance, hyperarousal, reexperiencing, anxiety, and depression than did the patients without clinically significant levels of PTSD symptoms. The prevalence of PTSD among the FM patients in this study was significantly higher than in the general population. Women with FM and PTSD reported a greater number of past traumatic events than did their male counterparts., Conclusions: The results represent the first comprehensive study applying structured clinical assessment of trauma exposure and PTSD to a group of FM patients. This study shows a significant overlap between FM and PTSD, according to the currently accepted diagnostic criteria for each., (Copyright 2002, Elsevier Science (USA). All rights reserved.)

Water fluoridation in Israel was initially introduced on a municipal level in 1981. Legislation in favor of national water fluoridation was approved in 1998. Over the last year an increasing campaign against the fluoridation project has become more and more evident. The material published by the opponents to fluoridation, distributed in pamphlets, daily journals and mass media resources, illustrate as in the USA, an endless and unrestrained "duel" between opponents and supporters of fluoridation. In Israel, in contrast to the USA, referenda are unprecedented, therefore, the political "battle field" is transferred to the municipal authorities and the Knesset. The pivotal component of the Israeli opponents to fluoridation regards the public's health and safety. Unscientific publications appear regularly in the daily journals and electronic mass media with no reference of supporting studies ever mentioned. The inevitable question addressed in this article is what are the best ways of action to be taken by the supporters of fluoridation is Israel. The main and most important mode of action against this campaign is, undoubtedly, continuous persuasion. Nevertheless, the continuous daily struggle of the supporters must be in a world-wide frame and be adjusted to the different target groups of the public. An effective confrontation should include nation-wide available publications (internet, daily papers and multimedia) with special emphasis on the important subjects (e.g. evidence based care, significance of toxic doses and the value of social justice), in a format comprehensible to the public and its leaders. The American experience helps us to understand that the opposition to water fluoridation will not diminished but, on the contrary, is expected to strengthen. We must look forward with no illusions and establish ways of action and cooperation by learning from past experience and from that of our collaborators. This will serve as the basis for the ongoing frank and persuasive efforts, derived from a deep and honest belief in the justice of our way.

Background: The hands of health care workers are a major source of nosocomial infection. Studies conducted mainly in intensive-care units and emergency departments have shown low compliance with hand hygiene recommendation., Objective: To study hand hygiene practices in outpatient dermatology clinics in Israel., Methods: The fingers of 13 dermatologist physicians were sampled for bacterial cultures and their hand hygiene practices were monitored by two observers. In addition, 51 dermatologists attending a professional conference completed a questionnaire on hand hygiene practice., Results: All the physicians' hands were found to be contaminated. Staphylococcus aureus was isolated in 9 cases (69.2%), a methicillin-resistant S. aureus in 1 (7.7%). Monitoring revealed 555 opportunities for handwashing; the average compliance was 31.4%. In the questionnaire, the main reasons given for poor hand hygiene were excessive work schedule (58%), lack of awareness (35.3%), reaction to disinfectants (17.7%) and lack of readily available facilities (15.7%)., Conclusion: The hands of dermatologists are frequently colonized with microbial pathogens, but compliance with hand hygiene practice recommendations is low, despite a fairly high awareness of the importance. An active educational infection control program should be introduced in dermatology clinics., (Copyright 2002 S. Karger AG, Basel)

Leprosy is rare and non-endemic in Israel. Cases of leprosy are invariably imported by immigrants or foreign workers arriving from endemic areas. In view of the relative rarity of the disease, clinicians and pathologists are not always alert to the possibility of the disease or recognize potential symptoms. A case history is presented of a 31-year-old immigrant presenting symptoms of skin lesions and nodules on the hands and facial region, especially the ear lobe. Confirmation of the infection was provided by histopathology of suspected lesions stained for acid-fast bacilli (modified Fite-Faraco staining).

The reported data on the association of kidney and urinary tract malformations with supernumerary nipples are contradictory. We examined 200 children, ages 1 month-16 years, who were being followed because of recurrent urinary tract infection for supernumerary nipples. The patients were divided into two groups: those who were found to have urinary tract malformations on radiographic studies (n=92) and those who were not (n=108). All children were examined for any abnormal pigmentation along the milk line, and the entire body was examined for ectopic supernumerary nipples. Two of the children with proved urinary tract pathology and two of the children with no urinary tract pathology had supernumerary nipples. The odds ratio for having supernumerary nipples among the first group was 1.18 (95% CI: 0.084-16.53, p=0.627). Our results indicate no association between kidney and urinary tract malformations and supernumerary nipples. We believe the message to the practicing physician is that there is no need for radiographic or ultrasonographic investigation of the urinary tract in asymptomatic children found to have supernumerary nipples on routine physical examination.

Objectives: This study sought to measure the effect of a community health education program on reported infants' bottle-feeding practices and infants' toothbrushing behavior, with or without distribution of toothpaste and toothbrushes., Methods: In this quasi-experimental comparison group design study conducted in mother and child health centers in Jerusalem, parents of 727 children were surveyed by telephone at baseline and six months later. The cohort of infants was aged 6-12 months at baseline. The program group received structured health education. The control group received no organized educational intervention. Within the program and control groups, half of the centers were randomly given toothpaste and toothbrushes., Results: Parents' reports revealed a secular 32.5 percent increase in toothbrushing for infants with no intervention, 45.1 percent for infants only receiving toothpaste and toothbrushes, 43.7 percent for infants only receiving the health education program, and a 60.4 percent increase for infants receiving health education together with toothpaste and toothbrushes (chi-square, P = .0002). Modification of bottle-drinking practices, in this program, was unsuccessful., Conclusion: The free distribution of toothpaste and toothbrushes, together with an oral health education program, is recommended as a potentially practical and effective method of promoting early oral hygiene practices.

Attention deficit hyperactivity disorder (ADHD) is a developmental syndrome expressed along three domains: inattention, hyperactive-impulsive, and combined type. Both environmental and genetic factors contribute to the etiology of this complex disease. We previously reported an association in 48 ADHD triads (both parents and proband) between the catechol-O-methyl- transferase (COMT) polymorphism (especially the high enzyme activity val allele) and the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) combined category (excluding inattention) of ADHD (however, see erratum, Am. J. Med. Genet. [Neuropsychiatr. Genet.] 96:893). In the current report, we attempted to replicate this finding in an independently recruited group of 70 nuclear families using the haplotype relative risk design. In the current investigation, no evidence for association of the COMT polymorphism and ADHD (or any of the DSM IV subtypes) was observed in either the current cohort or the expanded cohort of 118 Israeli triads. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:858-860, 2000., (Copyright 2000 Wiley-Liss, Inc.)

Background: The goal of this study was to find a possible link between blood glucose levels and periodontal disease., Methods: In a prospective study the dental health of 10,590 military service men and women was examined. The relationships of periodontal condition, expressed as CPITN index, and blood glucose levels were tested. The effect of gender, body mass index (BMI), and smoking was also evaluated., Results: Blood glucose levels were significantly and positively associated with severe periodontal disease, men, and higher BMI. Smoking did not affect blood glucose levels., Conclusions: Blood glucose levels might be associated with severe periodontal disease.

This study was conducted among a representative sample of 7,139 21-year-old Israeli adults, upon release from compulsory military service. Data were collected between 1994 and 1997. The average DMFT level found was 8.49+/-4.95. Untreated caries (according to the D component of DMFT) was 2.25+/-2.90 and significantly higher among males. Untreated caries was also significantly associated with geographic origin: higher among subjects of African or former USSR descent; and with family size: higher among subjects with four or more siblings; with education: caries was higher among subjects with less than 12 years of schooling; and with smoking: caries was more extensive among those who smoked (P<0.0001 for all the associations). Caries severity (DMFT) was found to be significantly associated with father's country of origin and number of siblings (highest among subjects of Asian and African descent and those who had four or more siblings). This is the largest and most representative Israeli survey of young adults to date. Data were compared with available data from studies conducted in 1956, 1966, 1973, and 1985. DMFT scores had previously increased from the 1950s until the 1980s. Treatment levels had increased since the 1980s. The present data, together with results of studies conducted among Israeli children, indicate a recent national decrease in caries experience. This study indicates a further increase in caries treatment level, but a persisting inequity according to social variables.

To evaluate the perimeter trapping strategy as a control method, field tests were conducted in three different host species of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann), in Israel. Dry traps baited with a three component food-based synthetic attractant that were hung in the peripheral rows of a plum, a pear, and a persimmon orchard, caught female C. capitata (up to 20.1, 1.4, and 4.1 female C. capitata per trap per day, respectively). Fruit damage, estimated at harvest, indicated a negligible percentage for the plum orchard (< 1%), 3% for the persimmon orchard (compared with 9% at an untreated neighboring plot), and no damaged fruit in the pear orchard. Finally, dissections of female C. capitata caught in dry traps on different host plant species indicate that a high percentage (range, 84-100%) contained mature eggs. The attraction of mature females to the dry traps might explain the successful results. Future research, to determine precisely how many traps should be placed and how frequently they should be serviced, is necessary before applying this strategy on a commercial basis.

A representative random sample of 597 Arab school-teachers in northern Israel, was surveyed regarding sources and levels of knowledge and attitudes about dental caries prevention. Data were measured according to a self-administered questionnaire from a 91.4 per cent response rate. When ranking the effectiveness of different caries preventive measures teachers on average listed optimal water fluoridation as a lower priority compared to toothbrushing, dental visits, fluoride mouthrinses and eating fewer sweet products. Placing of fissure sealants was ranked as the second least effective caries preventive measure, with 39.6 per cent not knowing the effectiveness. Only 68.5 per cent of the school-teachers were aware of the anti-bacterial role of fluoride, and only a small minority knew of fluoride's potential in healing incipient caries. Teachers seemed less motivated to being involved in dental health school programmes which involved dedicating school time and their active involvement, such as fissure sealant programmes at school, supervision of brushing and flossing, and school mouthrinsing programmes. They revealed positive attitudes towards: informing parents about the importance of oral hygiene and teaching children about preventive dentistry. Teachers' main reported source of knowledge was the dental office. It is the responsibility of the dental profession to ensure that updated knowledge is correctly conveyed to schoolteachers, who are an important and potentially influential sector of dental health consumers and health education agents.

A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education.