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Mira Y Friedman,1,2 Maya Leventer-Roberts,3 Joseph Rosenblum,4 Nir Zigman,4 Iris Goren,4 Vered Mourad,4 Natan Lederman,5 Nurit Cohen,5 Eran Matz,6 Doron Z Dushnitzky,6 Nirit Borovsky,6 Moshe B Hoshen,3 Gili Focht,1 Malka Avitzour,1 Yael Shachar,1 Yehuda Chowers,7 Rami Eliakim,8 Shomron Ben-Horin,8 Shmuel Odes,9 Doron Schwartz,9 Iris Dotan,10 Eran Israeli,11 Zohar Levi,10 Eric I Benchimol,12–14 Ran D Balicer,3 Dan Turner1 On behalf of the Israeli IBD Research Nucleus (IIRN) 1The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel; 2Braun School of Public and Community Medicine, The Hebrew University – Hadassah Medical Center, Jerusalem, Israel; 3Clalit Research Institute, Chief’s Office, Clalit Health Services, Tel Aviv, Israel; 4Maccabi Healthcare Services, Tel Aviv, Israel; 5Meuhedet Health Services, Tel Aviv, Israel; 6Leumit Health Services, Tel Aviv, Israel; 7Department of Gastroenterology, Rambam Health Care Campus, Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel; 8Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 9Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel; 10Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; 11Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center, Hebrew University, Jerusalem, Israel; 12CHEO Inflammatory Bowel Disease Centre, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada; 13Department of Pediatrics and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada; 14Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada Background: Before embarking on administrative research, validated case ascertainment algorithms must be developed. We aimed at developing algorithms for identifying inflammatory bowel disease (IBD) patients, date of disease onset, and IBD type (Crohn’s disease [CD] vs ulcerative colitis [UC]) in the databases of the four Israeli Health Maintenance Organizations (HMOs) covering 98% of the population. Methods: Algorithms were developed on 5,131 IBD patients and 2,072 controls, following independent chart review (60% CD and 39% UC). We reviewed 942 different combinations of clinical parameters aided by mathematical modeling. The algorithms were validated on an independent cohort of 160,000 random subjects. Results: The combination of the following variables achieved the highest diagnostic accuracy: IBD-related codes, alone if more than five to six codes or combined with purchases of IBD-related medications (at least three purchases or ≥3 months from the first to last purchase) (sensitivity 89%, specificity 99%, positive predictive value [PPV] 92%, negative predictive value [NPV] 99%). A look-back period of 2–5 years (depending on the HMO) without IBD-related codes or medications best determined the date of diagnosis (sensitivity 83%, specificity 68%, PPV 82%, NPV 70%). IBD type was determined by the majority of CD/UC codes of the three recent contacts or the most recent when less than three contacts were recorded (sensitivity 92%, specificity 97%, PPV 97%, NPV 92%). Applying these algorithms, a total of 38,291 IBD patients were residing in Israel, corresponding to a prevalence rate of 459/100,000 (0.46%). Conclusion: The application of the validated algorithms to Israel’s administrative databases will now create a large and accurate ongoing population-based cohort of IBD patients for future administrative studies. Keywords: inflammatory bowel diseases, Crohn’s disease, ulcerative colitis, search algorithms, validation, case ascertainment, Israel, administrative database research

The growth pattern of infants from birth to 2 years of age was studied in a homogenous Moslem semirural community near Jerusalem. The weight of the study population was compared with that of children from a western neighbourhood in Jerusalem and the National Centre of Health Statistics standard. The Abu Ghosh children are lighter than the Jerusalem and the National Centre of Health Statistics populations at birth and subsequently at 1, 6, 12, and 24 months of age. The percentage of weight gain between any two measurements at the various ages is slightly lower than that of the Jerusalem population. There is no decline in percentage of weight gain after weaning. Birthweight has accounted for a high percentage of explained variance of weight at 6 months (14.4%), but explained only 1.2% of variance at 24 months. The percentage of girls below the 10th centile was less than that of boys. The genetic and environmental effects on growth as well as the effect of the mother and child health services on the child rearing patterns of the populations are discussed. [ABSTRACT FROM PUBLISHER]

Introduction: Inflammatory bowel diseases (IBD) are becoming a significant cause for chronic long term complex morbidity, particularly among adolescents and young adults. IBD patients require multidisciplinary management and considerable health resources. Recent advances and developments in the diagnostics and therapeutic options require identification and tight monitoring of these patients at both hospital and community level for better management and care., Aims: To establish at Maccabi Healthcare Services (MHS) a dedicated registry for inflammatory bowel disease patients for long term monitoring in order to optimize care, better use of health resources and to promote high quality research., Methods: A national project, initiated and headed by a team from Shaare Zedek Medical Center aimed to resolve the complexity in identifying IBD patients at the community setting. The project included data from all Israeli HMOs and major hospitals, that was incorporated into various algorithms to determine prevalence and incidence and to distinguish between Crohn's disease and ulcerative colitis diagnoses. Eventually, an algorithm that includes the number of diagnoses, number of purchases and duration of IBD-related medications showed the best results for separating those that suffer from IBD and those that do not. This algorithm was further validated by chart review., Results: According to the established registry criteria there were 14488 IBD patients in MHS, 13000 active. Additionally we have established an ongoing platform for ongoing monitoring of clinical, therapeutic, laboratory and imaging information., Discussion: Establishing an IBD registry in MHS was enabled by a national project that combined deep professional knowledge of the disease by leading academic centers together with advanced informatics and community large data. We now move on to operate the registry in real life, together with live monitoring of various parameters in order to promote excellent care, communication with patients, management and control and to enable prospective high quality research.

CTG repeat expansion in DMPK, the cause of myotonic dystrophy type 1 (DM1), frequently results in hypermethylation and reduced SIX5 expression. The contribution of hypermethylation to disease pathogenesis and the precise mechanism by which SIX5 expression is reduced are unknown. Using 14 different DM1-affected human embryonic stem cell (hESC) lines, we characterized a differentially methylated region (DMR) near the CTGs. This DMR undergoes hypermethylation as a function of expansion size in a way that is specific to undifferentiated cells and is associated with reduced SIX5 expression. Using functional assays, we provide evidence for regulatory activity of the DMR, which is lost by hypermethylation and may contribute to DM1 pathogenesis by causing SIX5 haplo-insufficiency. This study highlights the power of hESCs in disease modeling and describes a DMR that functions both as an exon coding sequence and as a regulatory element whose activity is epigenetically hampered by a heritable mutation., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Fragile X syndrome (FXS) is the most common heritable form of cognitive impairment. It results from epigenetic silencing of the X-linked FMR1 gene by a CGG expansion in its 5'-untranslated region. Taking advantage of a large set of FXS-affected human embryonic stem cell (HESC) lines and isogenic subclones derived from them, we show that FMR1 hypermethylation commonly occurs in the undifferentiated state (six of nine lines, ranging from 24% to 65%). In addition, we demonstrate that hypermethylation is tightly linked with FMR1 transcriptional inactivation in undifferentiated cells, coincides with loss of H3K4me2 and gain of H3K9me3, and is unrelated to CTCF binding. Taken together, these results demonstrate that FMR1 epigenetic gene silencing takes place in FXS HESCs and clearly highlights the importance of examining multiple cell lines when investigating FXS and most likely other epigenetically regulated diseases.

Background: Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms., Objectives: To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures., Methods: Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year., Results: Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up., Conclusions: The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

To examine the prevalence of traditional and Internet bullying and the personal, family, and school environment characteristics of perpetrators and victims. Students (12-14 years old) in 35 junior high schools were randomly selected from the Jerusalem Hebrew (secular and religious) and Arab educational system (n = 2,610). Students answered an anonymous questionnaire, addressing personal, family, and school characteristics. Traditional bullying and Internet bullying for perpetrators and victims were categorized as either occurring at least sometimes during the school year or not occurring. Twenty-eight percent and 8.9 % of students were perpetrators of traditional and Internet bullying, respectively. The respective proportions of victims were 44.9 and 14.4 %. Traditional bullies presented higher Odds Ratios (ORs) for boys, for students with poor social skills (those who had difficulty in making friends, were influenced by peers in their behavior, or were bored), and for those who had poor communication with their parents. Boys and girls were equally likely to be Internet bullies and to use the Internet for communication and making friends. The OR for Internet bullying victims to be Internet bullying perpetrators was 3.70 (95 % confidence interval 2.47-5.55). Victims of traditional bullying felt helpless, and victims of traditional and Internet bullying find school to be a frightening place. There was a higher OR of Internet victimization with reports of loneliness. Traditional bully perpetrators present distinctive characteristics, while Internet perpetrators do not. Victims of traditional and Internet bullying feel fear in school. Tailored interventions are needed to address both types of bullying.

Objectives: Preimplantation genetic diagnosis (PGD) enables the identification of affected embryos prior to implantation. We present for the first time three families in which either the oocytes or embryos obtained from female carriers of mutations in the iduronate-2-sulfatase (IDS) gene underwent PGD for mucopolysaccharidosis type II (Hunter syndrome). Furthermore, we report the first ever derivation of a Hunter's syndrome (46, XX) human stem cell line from embryos (HESC) carrying the IDS and oculocutaneus albinism type 2 mutations., Methods: Combined polar body (PB) 1 and 2 or a single cell of a six- to eight-cell embryo (blastomere) was used for genetic analysis by multiplex polymerase chain reaction assay using six microsatellite polymorphic markers flanking the gene and mutation., Results: One couple underwent four PB-PGD cycles, with birth of a healthy girl; the second couple with one PB-PGD cycle had healthy twins; the third couple underwent seven cycles of double PGD for Hunter and Albinism syndrome with birth of healthy twins. One novel Hunter 46, XX HESC line was established displaying typical characteristics of HESC cells., Conclusions: PGD is a reliable method to prevent pregnancy of children affected with Hunter syndrome. In addition, derived HESC can be further utilized for drug testing and better understanding of the pathogenesis of this syndrome., (Copyright © 2011 John Wiley & Sons, Ltd.)

Maccabi Healthcare Services (MHS), the second largest HMO in Israel, has chosen to implement a multi-annual strategy to promote equality and equity in healthcare. Within the strategy's framework, MHS will maintain an ongoing process of studying the variability of its members characteristics for the purpose of adjusting service provision and improving health outcomes. MHS has recently published its first Equality Report, dedicated to defining the observed associations between its members demographic and socioeconomic characteristics and their health measures. The report identifies those sub-groups belonging to Israel's geographic and social peripheries that require focused interventions. Based on the report's recommendations, MHS has decided to designate promotion of equality as its strategic objective, a filter through which every policy decision will be reviewed. In addition it was decided to: 1. develop an organizational methodology to produce an index to assess reductions in disparities over time; 2. adjust MHS services to member's ethnic and cultural needs; 3. strengthen perceptions of community orientation based in primary care; 4. target resources to "social peripheries", beginning in 2010; 5. improve service accessibility and availability in geographically peripheral areas; 6. reduce economic barriers to healthcare. This article details the disparities as analyzed in the report in addition to the specific policy decisions made in their wake.

Background: Recurrent emergency room referrals and re-hospitalisation of terror victims (external cause of injury E990-E998 and selected cases from E970-E978) [International Classification of Diseases, 9th revision. Clinical modification, 5th ed. (ICD-9-CM). Los Angeles, CA: Practice Management Information Corporation; 1998] have not as yet been examined in the literature. Our objective was to evaluate the extent of hospital services' usage following a terror event and to characterise the casualties who return for hospitalisation and rehabilitation following their discharge., Methods: A retrospective longitudinal study including all terror victims who were hospitalised at our level I trauma centre between October 2000 and March 2004. Data on the first hospitalisation of these victims (n=497 cases) were retrieved from the hospital's trauma registry. Data on recurrent emergency room referrals and re-hospitalisation of the 464 cases who survived were taken from the hospital's administrative computerised database., Results: Four hundred and ninety-seven terror victims were hospitalised, of which 464 survived their first hospitalisation. Two hundred and nineteen (47%) were subsequently re-referred to the hospital. The total number of recurrent hospital referral days amounted to 77% of the total first hospitalisation days for all casualties. A strong association was found with regard to severity of injury, length of stay in the intensive care unit (ICU) and total length of stay. Logistic regression analysis found total length of stay of initial hospitalisation as the only significant variable., Conclusions: The recurrent hospitalisation of terror victims places a heavy burden on the health system. Further studies should be conducted to determine the reasons for these recurrent referrals and to explore whether the number of recurrent referrals can be reduced or at least planned for.

Background: Trauma management includes the care provided both in hospital and by emergency medical systems in the community. In many cases it is the parents who decide where to take an injured child for care, depending on the circumstances and severity of the injury, the personal characteristics of the injured or the carer and the availability and accessibility of services., Objectives: To examine the use of pre-hospitalization services and reasons for their use by children and adolescents according to the injury and personal characteristics., Methods: The study group comprised 924 Israeli citizens aged 0-17 years hospitalized for injuries in six hospitals across Israel. Carers were interviewed in the hospital regarding the circumstances of the injury event, the use of pre-hospitalization services, and sociodemographic characteristics. Data on the cause and nature of the injury were obtained from the hospital records., Results: The proportion of severe injuries (Injury Severity Score 16+) was higher in Arab children than Jewish children (15% and 9% respectively). Sixty-three percent of the Arab children and 39% of the Jewish children used community services prior to hospitalization. The odds ratio of proceeding directly to the hospital was 0.44, 95% confidence interval 0.29-0.69, for the Arab compared to the Jewish children, controlling for severity, cause and nature of the injury, sociodemographic characteristics, and the reported availability of ambulance services., Conclusions: More Arab than Jewish carers tended to seek care in the community for an injured child, but the effect of personal characteristics on seeking care was similar in both population groups. Issues of availability and accessibility of services may explain the differences.

Background: Head injuries, especially in young children, are frequent and may cause long-lasting impairments., Objectives: To investigate the outcome of head and other injuries caused by diverse mechanisms and of varied severity., Methods: The study population consisted of Jews and Arabs (n=792), aged 0-17 years old, hospitalized for injuries in six hospitals in Israel. Caregivers were interviewed during hospitalization regarding circumstances of the injury and sociodemographic variables. Information on injury mechanism, profile and severity, and length of hospitalization was gathered from the medical files. Five months post-injury the caregivers were interviewed by phone regarding physical limitations and stress symptoms., Results: Head injuries occurred in 60% of the children, and of these, 22.2% suffered traumatic brain injury with loss of consciousness (type 1). Among the rest, 22% of Jewish children and 28% of Arab children remained with at least one activity limitation, and no statistically significant differences were found among those with head or other injuries. The odds ratio for at least two stress symptoms was higher for children involved in transport-related injuries (OR 2.70, 95% confidence interval 1.38-5.28) than for other mechanisms, controlling for injury profile. No association was found between stress symptoms and injury severity., Conclusions: Most children had recovered by 5 months after the injury. Residual activity limitations were no different between those with head or with other injuries. Stress symptoms were related to transport-related injuries, but not to the presence of TBI or injury severity.

The p38 mitogen-activated protein kinases are activated in response to various extracellular signals in eukaryotic cells and play a critical role in the cellular responses to these signals. The four mammalian isoforms (p38alpha, p38beta, p38gamma, and p38delta) are coexpressed and coactivated in the same cells. The exact role of each p38 isoform has not been entirely identified, in part due to the inability to activate each member individually. This could be resolved by the use of intrinsically active mutants. Based on previous studies on yeast p38/Hog1 [Bell M, Capone R, Pashtan I, Levitzki A & Engelberg D (2001) J Biol Chem276, 25351-2538] and human p38alpha[Diskin R, Askari N, Capone R, Engelberg D & Livnah O (2004) J Biol Chem279, 47040-47049] we have generated intrinsically active p38beta, p38gamma and p38delta mutants. In addition, we have identified a new activating mutation site in p38alpha. Most of the activating mutations are located in the L16 loop, in which conformational changes were shown to induce activation. We show that these changes impose substantial autophosphorylation activity, providing a mechanistic explanation for the intrinsic activity of the mutants. The new active variants maintain specificity towards substrates and inhibitors similar to that of the parental wild-type proteins, and are phosphorylated by mitogen-activated protein kinase kinase 6, their upstream activator. Thus, we have completed the development of a series of intrinsically active mutants of all p38 isoforms. These active variants could now become powerful tools for the elucidating the activation mechanism and specific biological roles of each p38 isoform.

The p38 family of kinases is a subgroup of the mitogen-activated protein kinase family. It is composed of four isoforms and is involved in critical biological processes as well as in inflammatory diseases. The exact unique role of each p38 isoform in these processes is not understood well. To approach this question we have been developing intrinsically active variants of p38s. Recently we described a series of mutants of the human p38alpha, which were spontaneously active as recombinant proteins purified from Escherichia coli cells. We show here that some of these mutants are spontaneously active in several mammalian cells in culture. The spontaneous activity of some mutants is higher than the activity of the fully activated wild type counterpart. We further produced mutants of the other p38 isoforms and found that p38beta(D176A), p38gamma(D179A), p38delta(D176A), and p38delta(F324S) are spontaneously active in vivo. The active mutants are also spontaneously phosphorylated. To test whether the mutants actually fulfill downstream duties of p38 proteins, we tested their effect on activating protein 1(AP-1)-mediated transcription. Active mutants of p38alpha induced AP-1-driven reporter genes, as well as the c-jun and c-fos promoters. An active variant of p38gamma suppressed AP-1-mediated transcription. When active variants of p38alpha and p38gamma were co-expressed, AP-1 activity was not induced, showing that p38gamma is dominant over p38alpha with respect to AP-1 activation. Thus, intrinsically active variants that are spontaneously active in vivo have been obtained for all p38 isoforms. These variants have disclosed different effects of each isoform on AP-1 activity.

Background: Trauma systems were created in order to provide optimal care for trauma patients. Hence, patients transferred to level I trauma centers are assumed to be transferred due to medical reasons as a result of complex injuries., Objectives: To explore the reasons for transfer of patients from regional to level I trauma centers in Israel as a basis for establishing a national policy regarding transfers., Methods: The data on patients transferred to five level I trauma centers during a 6 month period were collected using a structured form., Results: The study population comprised 929 patients transferred from regional hospitals. Most transfers were due to the need for a specialty unavailable at the first hospital (65%) or for special diagnostic equipment (3% in Jews, 23% in Arabs). Only 3.6% of the transferred patients were transferred because of multi-system injury. Some casualties were transferred following their own request, 26% Jews and 3% Arabs., Conclusions: Most patient transfers concur with the recommendations of the Ministry of Health, namely, the absence of a certain specialty or equipment. The fact that many of the transfers reflect a lack of available resources at the first evacuation destination suggests that increasing the availability of these resources can help reduce secondary triage. It is recommended that a cost-benefit analysis be conducted.

Constitutively active mutants that acquired intrinsic activity and escaped regulation, serve as powerful tools for revealing the biochemical, biological and pathological functions of proteins. Such mutants are not available for mitogen-activated protein kinases (MAPKs). It is not known how to mimic the unusual mode of MAPK activation and to enforce, by mutations, their active conformation. In this review we describe the strategies employed in attempts to overcome this obstacle. We focus on a recent breakthrough with the p38 family that suggests that active variants of all MAPKs will soon be available.

Background: To determine whether there are inequalities in the incidence of fatal and non-fatal unintentional injuries among Jewish and Arab children in Israel., Methods: A nationwide random sample of injured children aged 0-17 attending emergency rooms (ER) during one year was selected (n = 11 058). The number of cases was weighted to 365 days and rates and odds ratios (OR) were calculated. Logistic regression was performed to study the OR of hospitalization in the total population and among Jews and Arabs controlling for independent variables., Results: The incidence of ER admissions among the Jews was 752.6/10 000 (95% CI: 738.1-767.1), 1.5 times higher than among the Arabs (492.8/10 000, 95% CI: 472.8-512.8). However, the rate of hospitalization was 1.1 times higher among Arabs than among Jews and the mortality rate was 3.2 times higher among Arabs than among Jews., Conclusions: The differences in injury rates for fatal and non-fatal injuries may be due to differences in the severity of injuries or in the use of services by the two populations. A study is underway to elucidate this point.

Background: Trauma is viewed by many as a global problem. The phenomenon of similar outcomes within differing healthcare delivery systems can illuminate the strengths and weaknesses of various trauma systems as well as the effects of these characteristics on patient outcome., Objectives: To compare and contrast demographic and injury characteristics as well as patient outcomes of two urban/suburban trauma centers, one in Israel and the other in the United States., Methods: Study data were obtained from the trauma registries of two trauma centers. Demographic variables, injury characteristics and outcomes were compared statistically between registries., Results: Significant differences between the registries were found in demographic variables (age), injury characteristics (Injury Severity Score and mechanism of injury), and outcome (mortality and length of stay). Age and Injury Severity Score were found to be significant predictors of outcome in both registries. The Glasgow Coma Score was found to contribute to patient outcomes more than the ISS. Differences were found in the relative impact of injury and demographic factors on outcomes between the registries. After including the influence of these factors on patient outcomes, significant differences still remained between the outcomes of the trauma centers., Conclusions: Despite possible explanations for these differences, true comparisons between centers are problematic.

The Israeli National Trauma Registry includes data on road traffic accidents from eight trauma centers. The investigation of registry data adds a new dimension to the analysis of road injuries. This dimension includes health information such as the type and severity of injury, treatment provided and outcomes. This article summarizes data on 4,328 patients injured in traffic accidents and included in the National Trauma Registry in 1999. We describe diagnoses and injury severity for road traffic accident casualties and link the injury outcomes to the type of accident. Findings indicate high risk for severe or fatal injuries among pedestrians, particularly among the young and the elderly. Children on bicycles and young car drivers are also at risk. This information will serve as a basis for prevention intervention and education programs.

Unlabelled: Vascular trauma from accidental or iatrogenic causes is becoming more common in children. In early infancy, the most common arterial injuries are caused by diagnostic or interventional cardiac catheterizations. Doppler arterial pressure measurements and the computed ankle-brachial pressure index (ABI) are the most helpful diagnostic modalities in the assessment and follow-up of the ischemic extremity. Because normative ABI data in small children are not available, an ABI of 0.9 or less (based on data obtained from an adult population), is used to indicate limb ischemia in young infants. The purpose of this study was to define the normal values of ABI in newborns and infants., Materials and Methods: Three hundred and fifty patients were divided into two groups: group 1 (n = 200; male-to-female ratio, 1:1) were full-term (gestational age 40 +/- 1.3 weeks, surface area 0.22 +/- 0.02 m2) healthy newborns following uneventful pregnancy and delivery. Group 2 (n = 150) were healthy patients aged 2 weeks to 2.5 years admitted for elective hernia repair. All the patients underwent a complete physical examination, which excluded any cardiovascular pathology. The systolic blood pressure (BP) was measured bilaterally over the brachial, tibialis posterior, and dorsalis pedis arteries. All BP data were obtained in the supine position, using an ultrasonic Doppler flow detector, an appropriately-sized pneumatic cuff and a sphygmomanometer. The chosen cuff size was long enough to completely encircle the circumference and wide enough to cover 75% of the length of the upper arm. The same cuff was applied around the ankle above the malleoli. BP values were expressed as mean +/- SD in mm Hg. If there was a difference between the BP in the two arms, the higher pressure was used for calculation of the ABI., Results: The BP measurements in newborns (group 1) were left brachial, 98 +/- 11; right brachial, 90 +/- 10 (P < .001), left and right tibialis posterior and left and right dorsalis pedis were 83, 81, 84, and 82 mm Hg, respectively. The mean computed ABI was 0.88 +/- 0.11. Fifty eight percent of the newborns had an ABI less than 0.9 (lower limit of normal in adults). The ABI values in patients belonging to group 2 increased with age and surface area. The mean ABI was 1.0, 1.1, and more than 1.1 in patients aged, 1, 1.5, and 2 years with surface areas of 0.4, 0.5 and 0.6 m2, respectively (P < .001 compared with group 1)., Conclusion: The normative ABI in newborns and infants is significantly lower than in older children and reaches normal (adult) values during the second year of life. These data may be used as a reference when assessing lower extremity ischemia caused by trauma in young patients.

In a study of the evacuation process of injured people from motor vehicle accidents, 2,206 injured evacuees were interviewed in five emergency rooms in Israel. Of these, only 53% were evacuated professionally (by ambulance or helicopter), and only 75% arrived directly to an emergency room. In a logistic regression analysis, differences were found in relation to regions, type of road (urban vs. interurban), education, and severity of the injury. Higher education was associated with lower percentage of professional evacuation. Of those injured who arrived directly at emergency rooms, 67% did so within an hour (the "golden hour"). We found that professional evacuation was more rapid than nonprofessional evacuation.

Mortality from malignant lymphomas among the Jewish population of Israel rose during the period 1950-71. Above the age of 50 years the annual increment exceeded that in most other countries for which data are available. The rise occurred among older adults in all population groups and among children and young adults born in Africa. It was greater among native-born than among foreign-born adults. The mortality rates among foreign-born persons varied with the continent of birth. No clear-cut relationships were found with age at immigration or period since immigration. The trends for non-Hodgkin's lymphomas parallelled those for lymphomas as a whole, but those for Hodgkin's disease varied in different population groups. The findings suggest an increase in the incidence of lymphomas, more marked among native-born than among foreign-born adults, which can be speculatively attributed to environmental factors.

Jewish residents of Israel in 1960-72 with Hodgkin's disease (HD) were compared with controls drawn from the general population. The controls were individually matched by sex, age, origin, and date of immigration. The comparison showed a significant association between HD and parental consanguinity and pointed to the possible etiologic role of recessive inheritance. Females with HD tended to have a lower parity than did their controls. Associations between HD and a high educational level and the presence of a flush toilet in the childhood home were significant and gave limited support to the hypothesis that a high standard of living in childhood increases the risk of subsequent HD. Tonsillectomy and a history of work with wood or trees were significantly associated with mixed cellularity but not with other histologic subtypes. Differences between patients with HD and controls with respect to cigarette smoking, exposure to animals, marital status, previous blood transfusions or jaundice, contact with asbestos, residual or occupational mobility, or other characteristics were not significant.