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Total testosterone (TT) is known to influence health and virility in men. Among men from United States and Europe, numerous sociodemographic and lifestyle factors were reported to be associated with TT. However, associations with TT and Leydig cell function in the Middle East are poorly described. A cross-sectional, population-based sample had a structured interview, physical examinations, and blood tests in two hospitals in Jerusalem, Israel. A subsample (25- to 44-year-old men, n = 286: 124 Israelis, 162 Palestinians) had sex hormone measurements. The primary outcomes were TT and free testosterone/luteinizing hormone (FT/LH) ratio, representing Leydig cell function. Associations with sociodemographic and lifestyle factors, body mass index (BMI), and physical activity (PA) were evaluated using multivariable linear regression. Compared with Palestinians, Israelis had similar TT (4.81 vs. 5.09 ng/mL, p =.405) and higher FT/LH (31.2 vs. 25.8 ng/IU, p =.002). In ln-transformed values, marital status had a stronger association in Palestinians (P for interaction = 0.03). Age, BMI, and PA had a stronger association with TT in Israelis with significant interactions with ethnicity. BMI <25 and a higher PA quartile were associated with a higher TT (p <.001). Among Israelis, age (p =.007), married marital status (p =.007), and BMI <25 were significantly associated with FT/LH. No associations of any factors were identified among Palestinians. Associations with several modifiable factors identified in Western samples were replicated in Israelis and to a lesser degree in Palestinians. Different relationships of several factors with TT and FT/LH could result from ethnically diverse genetic, sociodemographic, and behavioral characteristics that warrant further research. [ABSTRACT FROM AUTHOR]

Purpose: Medical second-trimester abortion in women with prior cesarean section (CS) is becoming an increasingly common phenomenon. However, data about the safety of the procedure are limited. This study addresses this issue. Methods: Retrospective cohort single-center study, done in Hadassah Medical Center in Jerusalem, a tertiary-care university hospital. This study included 779 women who needed pregnancy termination between 13 and 26 gestational weeks. 128 women had at least one previous CS (study group), whereas 651 had no CS (reference group). Protocols used were: (1) misoprostol tablets, 800 mcg vaginally followed by 400 mcg orally every 3 h up to four oral doses, (2) Oxytocin drip. Nearly one-fourth of the women received mifepristone as a preliminary treatment for cervical ripening. The outcomes assessed included the following complications: retained placenta, bleeding with or without requiring blood transfusion, infection, cervical lacerations, uterine adhesions and uterine ruptures. Results: Previous CS does not appear to increase the incidence of complications, excluding clinical bleeding without requiring blood transfusions (p value 0.05), which has a minimal clinical significance. Oxytocin protocol had 3.44 OR for complications, compared to misoprostol (p value 0.03, CI; 1.12- 10.52). No significant correlation was found between Misoprostol dosage and complications (Mann–Whitney U test, p value 0.057). Conclusion: Medical second-trimester abortions for women with prior CS should be considered a safe and effective procedure, with a low complication rate. The most serious complication is uterine rupture, which is uncommon; we recorded one case only. Misoprostol protocol should be preferred. Clinical trial number and date: IRB 0177-17-HMO, 5/2014. [ABSTRACT FROM AUTHOR]

Background Carotid atherosclerosis may be associated with cognitive decline in elderly stroke-free non-demented individuals. However the studies are few, especially amongst adults in midlife. Rarely was socioeconomic status adequately accounted for. Methods In a cross-sectional examination of the population-based Jerusalem Lipid Research Clinic (LRC) cohort, carotid intima-media thickness (IMT), plaque and volumetric flow were determined by ultrasound in 507 cohort members, aged 48–52. At the same visit, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerised test battery. Multivariable linear regression and logistic models were applied. Results In sex-adjusted, but not in multivariable-adjusted linear regression models, IMT and plaque were significantly inversely associated with measures of cognition. However, in binary logistic models adjusted for sex, age, education, childhood and adult SES, and multiple cardiovascular risk factors, IMT was associated with low-ranked (lowest fifth) global cognition (OR per 0.1 mm , 1.25, 95%CI 1.01–1.55, p = 0.044); this association was confirmed in multinomial logistic modelling. The presence of atheromatous plaque was associated with elevated risk for low-ranked global cognitive function in midlife (OR, 1.93, 95%CI, 1.04–3.59, p = 0.037). Common carotid volumetric flow was not associated with cognitive function, and adjustment for volumetric flow did not materially affect the associations of IMT or plaque with global cognition. Conclusion In this population-based cohort in midlife, subclinical carotid atherosclerosis measured as higher IMT and the presence of atherosclerotic plaque was associated with low-ranked global cognitive function. In light of the absence of an independent association of carotid volumetric flow with cognition, and although reverse causation cannot be excluded in this cross-sectional study, we infer that carotid atherosclerosis in midlife may be a marker of intracranial atherosclerosis and possible resulting lower cognitive function. [ABSTRACT FROM AUTHOR]

Although exposure to traffic-related air pollution has been reported to be associated with respiratory morbidity in children, this association has not been examined in Israel. Jerusalem is ranked among the leading Israeli cities in transport-related air pollution. This case–control study examined whether pediatric hospitalization for respiratory diseases in Jerusalem is related to residential exposure to traffic-related air pollution. Cases ( n = 4844) were Jerusalem residents aged 0–14 years hospitalized for respiratory illnesses between 2000 and 2006. These were compared to children admitted electively ( n = 2161) or urgently ( n = 3085) for non-respiratory conditions. Individual measures of exposure included distance from residence to nearest main road, the total length of main roads, traffic volume, and bus load within buffers of 50, 150, and 300 m around each address. Cases were more likely to have any diesel buses passing within 50 m of their home (adjusted odds ratios = 1.16 and 1.10, 95% confidence intervals 1.04–1.30 and 1.01–1.20 for elective and emergency controls, respectively). Our findings indicated that older girls (5–14) and younger boys (0–4) had increased risks of respiratory hospitalization, albeit with generally widened confidence intervals due to small sample sizes. Our results add to the limited body of evidence regarding associations between diesel exhaust particles and respiratory morbidity. The findings also point to possible differential associations between traffic-related air pollution and pediatric hospitalization among boys and girls in different age groups. [ABSTRACT FROM AUTHOR]

The Gihon Spring, Jerusalem, is important for the major monotheistic religions. Its hydrogeology and hydrochemistry is studied here in order to understand urbanization effects on karst groundwater resources, and promote better water management. High-resolution monitoring of the spring discharge, temperature and electrical conductivity, was performed, together with chemical and bacterial analysis. All these demonstrate a rapid response of the spring to rainfall events and human impact. A complex karst system is inferred, including conduit flow, fissure flow and diffuse flow. Electrical conductivity, Na and K values (2.0 mS/cm, 130 and 50 mg/l respectively) are very high compared to other nearby springs located at the town margins (0.6 mS/cm, 15 and <1 mg/l respectively), indicating considerable urban pollution in the Gihon area. The previously cited pulsating nature of the spring was not detected during the present high-resolution monitoring. This phenomenon may have ceased due to additional water sources from urban leakage and irrigation feeding the spring. The urbanization of the recharge catchment thus affects the spring water dramatically, both chemically and hydrologically. Appropriate measures should therefore be undertaken to protect the Gihon Spring and other karst aquifers threatened by rapid urbanization. [ABSTRACT FROM AUTHOR]

The article assesses whether women who experienced stillbirths have an excess risk of long-term mortality. A cohort study was conducted in the setting of the Jerusalem Perinatal Study, a population-based database of all births to West Jerusalem residents. Mortality risk remained significantly increased after adjustments for sociodemographic variables, maternal diseases at pregnancy and placental abruption and preeclampsia.

Objective: The purpose of this study was to examine the association between preeclampsia and cancer incidence. Study Design: The Jerusalem Perinatal Study is a population-based cohort of all births to 41,206 residents of Western Jerusalem from 1964-76. Cancer incidence to 2004 was assessed by linkage of the cohort with the Israel Cancer Registry. Cox''s proportional hazards models were constructed to estimate the hazard ratio for cancer among women who had had preeclampsia. Results: Preeclampsia was associated with a 1.23-fold increased risk of cancer at all sites, a 37% increased risk of breast cancer, and more than a doubling of ovarian cancer risk. Analysis by morphologic condition yielded significantly increased risks for malignancies that were classed as cystic mucinous and serous (relative risk, 1.96; 95% CI, 1.00-3.83) and for ductal, lobular, and medullary carcinomas (relative risk, 1.40; 95% CI, 1.07-1.83). No differential association was observed by sex of offspring. Conclusion: Our study suggests that the previously described protective effect of preeclampsia on cancer is not universal. [Copyright &y& Elsevier]

Objective: To present the set of reasons for and against fertility treatment for a very young patient. Design: An expert opinion based on clinical experience. Setting: An academic-affiliated fertility clinic situated in East Jerusalem. Patient(s): A 16-year-old married teenager with 2 years'' duration of infertility due to polycystic ovarian syndrome was referred to our infertility center after treatment with six cycles of clomiphene citrate and ovarian drilling. Intervention(s): Counseling of the options of fertility treatments, weight reduction, physical exercise, metformin intake, and an additional gonadotropins–intrauterine insemination cycle with IVF backup. Main Outcome Measure(s): Successful pregnancy while avoiding the risk of ovarian hyperstimulation syndrome. Result(s): The patient conceived a single embryo and on the 30th week of gestation suffered premature uterine contractions and gave birth to a 1,330-g preterm male newborn. Conclusion(s): Adolescent contraception and unintended pregnancies are prevalent issues in the Western world, whereas adolescent infertility is unheard of. Early age of marriage and conception imposes tremendous dilemma to the society of reproductive endocrinologists. This important cultural issue ought to be debated regarding the age at marriage, the age at first pregnancy, and the treatment of infertility in married “minors” who need treatment. Such a debate is likely to encourage development of formal guidelines for practitioners, which would clearly be beneficial. [Copyright &y& Elsevier]

Background--Accumulating evidence demonstrates that both maternal prepregnancy body mass index (mppBMI) and gestational weight gain (GWG) are associated with adult offspring adiposity. However, whether these maternal attributes are related to other cardiometabolic risk factors in adulthood has not been comprehensively studied. Methods and Results--We used a birth cohort of 1400 young adults born in Jerusalem who had extensive archival data and clinical information at 32 years of age to prospectively examine the associations of mppBMI and GWG with adiposity and related cardiometabolic outcomes. Greater mppBMI, independently of GWG and confounders, was significantly associated with higher offspring BMI, waist circumference, systolic and diastolic blood pressures, insulin, and triglycerides and with lower high-density lipoprotein cholesterol. For example, the effect sizes were translated to nearly 5 kg/m2 higher mean BMI, 8.4 cm higher waist circumference, 0.13 mmol/L (11.4 mg/dL) higher triglycerides, and 0.10 mmol/L (3.8 mg/dL) lower high-density lipoprotein cholesterol among offspring of mothers within the upper mppBMI quartile (mppBMI >26.4 kg/m2) compared with the lower quartile (mppBMI <21.0 kg/m2). GWG, independently of mppBMI, was positively associated with offspring adiposity; differences of 1.6 kg/m2 in BMI and 2.4 cm in waist were observed when offspring of mothers in the upper (GWG >14 kg) and lower (GWG <9 kg) quartiles of GWG were compared. Further adjustment for offspring adiposity attenuated the observed associations to the null. Conclusions--Maternal size both before and during pregnancy is associated with cardiometabolic risk factors in young adult offspring. The associations appear to be driven mainly by offspring adiposity. Future studies that explore mechanisms underlying the intergenerational cycle of obesity are warranted to identify potentially novel targets for cardiometabolic risk-reduction interventions. [ABSTRACT FROM AUTHOR]

• Almost half of all occupational trauma in the emergency department was hand trauma. • Multiple modifiable risk factors effect rate of hand trauma including distraction by cellular phones. • High compliance was seen in phone or in person interviews held within several days of injury, apparently with little effect of litigation issues. Although prevalent, and variable geographically, there is little information on the incidence and risk factors for occupation hand trauma in our health care system. This pilot study was designed to determine the optimal data collection methods for transient risk factors locally All adult patients with occupational hand trauma treated at an emergency department (ED) during a three-month period were interviewed, either in person or by phone, using a case crossover designed questionnaire, regarding occupation and exposure to potential transient risk factor. Of 206 patients treated with occupational trauma during the study period, 94 had trauma distal to the elbow (46%). Patient compliance was high - 89% of the patients consented to phone interviews and 83% completed in-person ED interviews. In the 75 patients which participated in the study, several risk factors were found to be significant, including machine maintenance and being distracted, including by a cellular phone. We found lack of job experience, limited training on the job site and reports of previous injuries in these workplaces to be prevelent. The risk factors implicated in this study are similar to those reported in previous studies at other locations and are modifiable although this is the first report linking cellular phone use and occupation trauma. This finding should be further examined in a larger group and according to occupational categories. Compliance with the study was high, in person or with phone interviews, making these options viable for further studies. Several minor changes to the questionnaire were suggested although it did conform with the case-crossover study design. According to this study, standard preventive measures may be lacking in Jerusalem and should be implemented more uniformly, including specific workplace safety plans and education and taking into consideration the risk factors documented here. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the association between parity and long-term, all-cause mortality and mortality owing to specific causes in women. Methods: This prospective population-based study included 40,454 mothers who gave birth in Western Jerusalem, Israel, to 125,842 children and were followed for an average of 37 years after the birth of their first child. Cox proportional hazards models were used to evaluate long-term total and specific-cause mortality of women by their parity. Results: We found a U-shaped relationship between the number of offspring and risk of all-cause mortality in mothers. After adjustment for sociodemographic characteristics and maternal health and obstetric conditions, higher mortality rates were observed for mothers of 1 child (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.04–1.4), mothers of 5 to 9 children (HR, 1.21; 95% CI, 1.09–1.33), and mothers of 10 or more children (HR, 1.49; 95% CI, 1.12–1.99) compared with mothers of 2 to 4 children. Mortality risk from specific causes including coronary disease, circulatory disease, and cancer were increased for multiparous women. Conclusions: In this long-term follow-up study, there was an association between number of children and mortality risk for mothers. These findings suggest that maternal pregnancies and postnatal characteristics as reflected by number of children may have consequences for long-term maternal health. [Copyright &y& Elsevier]