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Background: Hair loss is a common, bothersome problem among women. Objective: To evaluate the effect of different brushing frequencies on hair loss in women. Methods: This was a non-randomized crossover study. During a 4-week period, 14 women were asked to brush their hair with different frequencies during each of the 4 weeks. The amount of hairs lost during each week was counted and the average hairs lost during each week was compared with that of a week with a different brushing frequency. Results: In all comparisons analyzed, hair loss was reduced by reducing brushing frequency. A subgroup analysis found strong association (p < 0.05) between brushing frequencies and the magnitude of hair loss. A limitation of the study was that the majority of the subgroup analyses did not find a statistically significant association between brushing frequency and amount of hair lost. Conclusion: Brushing is associated with hair loss. Reducing the brushing frequencies may reduce the amount of hair shed.

The objective of this exploratory retrospective study was to assess the effects of breast cancer diagnosis upon the psychological distress of adult breast cancer patients and their mothers, particularly mothers who experienced past trauma.Four groups of mother-daughter dyads were evaluated using self-reporting measures of psychological distress [Brief Symptom Inventory (BSI)], familial support (PFS), and adjustment to cancer (MAC, IES): breast cancer patients whose mothers were Holocaust survivors (group 1), breast cancer patients with non-traumatized mothers (group 2), healthy daughters of Holocaust survivor mothers (group 3), and a control group of healthy daughters with non-traumatized mothers (group 4).Distress levels of both mothers and daughters in group 1 were significantly higher than distress levels of mothers and daughters in the other three groups. Daughters' distress levels in all four groups were found to be significantly related to mothers' distress levels, with the highest correlation found in both groups of cancer patients. The factors of having a clinically distressed mother and being a second-generation daughter contributed the most to predicting the clinical distress of the daughter.The outcomes imply that the mother's traumatic past intensifies the distressing effect of cancer diagnosis upon both the patient and her mother. The findings concerning the impact of cancer diagnosis upon the patients' non-traumatized mothers were more ambiguous. The results support the idea that in the case of breast cancer patients, a complete psychological evaluation must include not only spouses and children but also the familial background of the patient and the history of the patients' mothers.

Purpose . To evaluate the efficacy of penetration of gentamicin into the cornea of rabbits using iontophoresis with a hydrogel–gentamicin containing probe. Methods . Eight of 10 groups (groups 3–10) of 6 rabbits (one eye per rabbit), underwent corneal iontophoresis using soft stable hydroxyethyl methacrylate hydrogel discs (80% water content) loaded with gentamicin sulphate which were mounted on an iontophoresis probe. The studied current intensities were 0, 0·1, 0·3 and 0·6 mAmp, and the durations of iontophoresis were 10 and 60 sec. Two control groups received 1·4% topical drops of gentamicin every 5 min for 1 hr (group 1) or sub-conjunctival injection of 10 mg gentamicin (group 2). Following sacrifice, aqueous humour was taken, corneas were excised, and gentamicin concentration was determined in aqueous humour and cornea samples. Results . Post-iontophoresis, the concentration of gentamicin in the corneas ranged from high (88·60±38·64 μg ml −1 ) to very low (0·10±0·89 μg ml −1 ). Both the control groups and those rabbits treated with current intensity of 0·1 mAmp or greater obtained therapeutic gentamicin levels in the corneas. Use of iontophoresis for 60 sec or current intensity greater than 0·1 mAmp obtained corneal gentamicin levels not different from sub-conjunctival injection. Application of current intensity of 0·1 mAmp or greater gave corneal gentamicin concentrations comparable to topical application of the drug, except when 0·6 mAmp were used for 60 sec ( p =0·05). Increasing current intensity or duration of iontophoresis significantly increased ( p =0·001 for both) gentamicin penetration into the cornea. Current intensity had more influence (Beta 2 =0·40) than duration (Beta 2 =0·13) on drug penetration. A significant interaction was found between the duration of iontophoresis and the current intensity. Very small or no concentrations of the drug were discovered in the anterior chambers of rabbits. Conclusions . Iontophoresis using hydrogel–gentamicin probe may deliver therapeutic concentrations of gentamicin into the cornea.

Psychological distress and coping styles in women diagnosed with stages I and II breast cancer have attracted substantial clinical and research attention over the last several decades. The contradictory and, at times, controversial findings stimulated the present randomized research whose purpose was to explore the possibility and probability of predicting which variables affect the psychological distress level of women with breast cancer 1 to 5 years after diagnosis (time period 1) and 6 to 8 months after period 1 (time period 2). The study was conducted in two large oncology centers in Graz, Austria, and Jerusalem, Israel, with a sample population comprising 424 patients. The only variables that significantly predicted change in the psychological distress levels (Grand Severity Index, GSI; except for the GSI level during period 1) were Fighting Spirit (Mental Adjustment to Cancer, MAC) in the Graz sample and Perceived Family Support (PFS) in the Jerusalem sample. These results are discussed in relation to other findings. In light of these findings, it is highly important to preliminarily identify women with less adaptive psychological coping mechanisms and to provide them with efficacy tools for behavioral and cognitive changes within their own network of social and health resources.

Objective In this cross-sectional pilot study of couples in whom the man was diagnosed with prostate cancer or the woman with breast cancer, the purpose was to identify and compare the variables that characterize couples where both spouses are in high psychological distress with couples where the psychological distress of both spouses is within the normal range. Methods Psychological distress and perception of family support in 574 individuals (118 consecutive prostate cancer patients and their spouses, and 169 randomly selected breast cancer patients and their spouses) were assessed using the Brief Symptom Inventory (BSI) and the Perceived Family Support (PFS) self-report questionnaires. Results Couples experiencing high psychological distress reported lower levels of perceived family support than couples in whom both spouses reported normal levels of psychological distress. Conclusion The findings support the notion that perceived family support is associated with the psychological distress in both patients and spouses.

Breast cancer is the most common malignant disease among women in developed countries. In Austria and Israel, it accounts for 15% and 18%, respectively, of all cancers and 30% of all cancers in women. The purpose of this study, conducted in Graz, Austria, and Jerusalem, Israel, was to determine whether different geographical and cultural settings differentially affect the psychological distress of women who have survived breast cancer and why. The dependence of psychological distress on psychosocial variables such as quality of life, body image, impact of cancer and coping styles was examined at time 1 in a randomized sample of 424 breast cancer women who were disease-free at the time of the study and were surveyed 1-5 years after diagnosis. The most contributing variables to the level of psychological distress in both populations were: the number of stressful life events during last year, financial problems and feeling uncomfortable with the body. Regarding coping styles, mental adjustment to cancer was the principal contributor to psychological distress level [determined by the Grand Severity Index (GSI) scores] in the Graz group, while intrusion was the principal contributor to the GSI level in the Jerusalem group.

Age-related differences in emotional distress were examined by studying two random samples (N=424) of women diagnosed with early stages of breast cancer in Graz, Austria and Jerusalem, Israel. We found that psychological distress, coping abilities, and different perceptions of illness are attributable to socialization differences of age experience according to young (49 or younger), intermediate (50-64) and old (65 and older) age groups. Patients were interviewed at home to obtain sociodemographic and medical background data. They also completed five standardized instruments (Brief Symptom Inventory, Psychological Adjustment to Illness Scale, Impact of Events Scale, Mental Adjustment to Cancer, and Perceived Family Support). A two-way MANOVA for all the demographic variables yielded significant main group (Graz vs. Jerusalem) effect (P

Cumulative trauma disorder (CTD) refers to a number of conditions arising from overuse of joints or soft tissues. The common risk factors that contribute to the development of these disorders are related to personal and occupational variables. Job analysis of the tasks performed by the dental hygienist have shown that this occupation is particularly at risk. The objectives of this study were to determine the prevalence of CTD symptoms amongst dental hygienists in Israel and to identify which are the factors that are related to CTD. A questionnaire including items concerning demographic data, employment history, professional occupational information, use of instrumentation, and CTD symptomatology was mailed to all 530 registered dental hygienists. Two hundred forty-six hygienists (46%) returned the questionnaire; 63% of the respondents were classified as CTD 'sufferers', Age, year of graduation, hours worked per week, and frequency of changing instruments were found to be significantly related to CTD symptoms. Hygienists at high risk included those aged 50 years or more (Odds ratio, OR = 6), those who graduated before 1986 (OR = 3), those who work more than 34 h per week (OR = 2.5) and those who change two or fewer instruments per patient (OR = 2). The major recommendation resulting from this study is to make dental hygienists aware that they work in a high-risk profession. It is hoped that increased awareness of the risk will spur the hygienist to make appropriate work practice, administrative, and engineering modifications and to seek treatment at the first indication of CTD symptoms.

Objective: In 1977, the Israel Cancer Association held a one-day conference, on the subject of familial breast cancer, for healthy women with at least one first-degree relative diagnosed with breast cancer. The objective of this study was to assess the psychological distress of a sample of the women who attended. Method: Of the 333 healthy women present at the conference, 230 completed three questionnaires: one on sociodemographic data and the medical history of the first-degree relative(s) (mother and/or sister), and two that measure psychological distress: the Brief Symptom Inventory and the Impact of Events Scale. Sample: The subjects were divided into three categorical groups: those whose mother had breast cancer (group A, N = 176), those whose sister had breast cancer (group B, N = 34), and those whose mother and sister both had the disease (group C, N = 20). In addition, subjects were divided into two groups according to the psychological distress level. Results: Analysis of results (using ANOVA and a Chi square test for categorical variables and both univariate and multivariate procedures for psychological distress assessment) showed elevated levels of distress and persistent intrusive thoughts in all groups, and particularly in group C. Conclusion: There is a need to promote genetic diagnostic and appropriate counseling, notwithstanding the potential risks that genetic counseling poses for such women.

The purpose of this study was to evaluate the penetration of gentamicin into the central, midperipheral and peripheral cornea of rabbits following iontophoresis to the central 3 mm of the cornea. Four groups (groups 1-4) of five rabbits (one eye per rabbit) underwent corneal iontophoresis using gentamicin dissolved in agar. Low (1 mg/ml) and high (10 mg/ml) concentrations of gentamicin in agar were used for one or ten minutes. Two control groups (groups 5 and 6) of five eyes each underwent mock iontophoresis with low and high concentrations of agar-gentamicin mixture. Following sacrifice of the rabbits, the central, midperipheral and peripheral parts of each cornea were excised. Gentamicin concentration was determined in each part of every cornea. High concentrations of gentamicin (951.6 +/- 369.4 microg/ml to 26.6 +/- 41.34 microg/ml) were obtained in the central parts of all the iontophoresis-treated corneas. In each group, except group 6, central corneas had higher concentrations of gentamicin compared to midperipheral corneas (p = 0.038 to p = 0.021), and midperipheral corneas had higher levels than peripheral corneas (p = 0.038 to p = 0.021). Following iontophoresis, gentamicin is found in all portions of the corneas; however, the highest concentration of the drug remains in the central cornea.

The aim of the in vitro study was to examine the accumulation of Streptococcus mutans on light-cured composite materials and amalgam. Bacteria cultures were grown in a brain heart infusion medium, and their growth rate was determined through turbidity measurements. The data, so obtained, were evaluated statistically by analysis of variance (ANOVA) followed by Scheffe test. Experiments on amalgam showed better results compared to those on composite materials. There were no statistically significant differences in plaque accumulation on different composite materials after finishing and polishing procedures, compared to plaque accumulation on composite materials against a Mylar strip.

PURPOSE To evaluate the efficacy of topical zinc desferrioxamine in acute corneal alkali injury in rabbits. METHODS Twenty rabbits were anesthetized and a standardized alkali burn (1N NaOH) was performed in the center of the cornea (7.5-mm diameter). The animals were randomly divided into two groups and treated (double-masked) with topical zinc desferrioxamine, 220 microM, (group 1) or its vehicle (group 2). Drops were applied 7 times/day for 28 days. Topical gentamicin, 0.3%, was instilled twice a day. Animals were evaluated twice a week. At each examination (using the slit-lamp), the depth of corneal ulcer was graded as follows: 0, no ulcer; 1, tissue loss less than one third of corneal thickness; 2, one third to two thirds tissue loss; 3, more than two thirds tissue loss; 4, descemetocele; or 5, perforation. Ulceration area, vascularization, and epithelial defects also were measured. RESULTS During the study period, the grading of mean corneal ulcerations in group 1 ranged from 0.2 to 1.00, whereas in group 2, it ranged from 1.4 to 2.7. The mean grade and area of ulceration in group 2 were greater than those in group 1 (p < 0.05). CONCLUSION Topical zinc desferrioxamine may be an adjunctive treatment in protecting the cornea against induced alkali injury.

STUDY OBJECTIVES--To determine the influence of maternal characteristics on the incidence and duration of breast feeding. DESIGN--All the women who delivered in three obstetric wards within a two year period were surveyed. These three wards cover 93% of all births in the Jerusalem district. Women were interviewed on breast feeding of the previous child on the first or second day post partum by a research nurse. PARTICIPANTS--Altogether 8486 women whose previous pregnancy had resulted in a live born singleton who survived for at least one year. MEASUREMENTS AND MAIN RESULTS--Breast feeding information was linked to demographic and health information from hospital records. Using logistic regression analysis, failure to start breast feeding was best predicted (p < 0.001) by caesarean delivery, infant's birth weight, maternal smoking habits, and mother being non-immigrant. Maternal age (< 24 or > 40 years) and father being an ultraorthodox Jew were also positively (p < 0.05) associated with the decision to breast feed. Long term breast feeding (three months or more) was strongly affected (p < 0.001) by maternal education level, with both women with the fewest and the greatest number of years of schooling more likely to breast feed. A similar association was observed in all ethnic groups. Primipara and grandmultipara (parity > 4), new immigrants, ultraorthodox Jews, and non-smokers breast fed their babies for longer. CONCLUSIONS--The importance of maternal characteristics in relation to breast feeding was shown. Caesarean delivery and the infant's birth weight were strongly related to the decision to breast feed as were the demographic characteristics of mother's age and her country of birth. Education was not related to this decision but was strongly associated with the duration of breast feeding, as was parity. The behavioural characteristics of smoking and being ultraorthodox were related to both the decision to start and the duration of breast feeding. Efforts to encourage breast feeding ought to be targeted during the hospital stay and post partum period towards women identified as being at increased risk.

SummaryThe effect of breast feeding on long term maternal weight loss was studied in 9428 women who gave birth in Jersusalem. The postpartum women reported the duration of breast feeding following a previous live singleton birth up to three years earlier. A multiple regression analysis, controlling for the confounding effect of maternal age, education, parity, social class, ethnic origin, smoking, marital status and occupation, was carried out. A statistically significant (P< 0–002) polynomial association was found for duration of breast feeding and reported maternal body mass index, before the last pregnancy. Women who breast fed for only one or two months had a lower body mass, while women who breast fed for three months or more had a body mass similar or even higher than women who did not breast feed. These results suggest that long term breast feeding may lead to weight gain. The study supports the need to reconsider recommended energy intakes for successful lactation accompanied by gradual maternal w...

Psychological distress levels of breast cancer patients whose parents were Holocaust survivors (‘second-generation Holocaust’ patients) were previously shown to be significantly higher than those of a matched group of patients with non-traumatized parents. In this study, we investigated whether this effect reflects only the generally higher distress levels of second-generation Holocaust women or whether breast cancer patients with traumatized parents also present lower adaptation abilities, which result in increased distress to the breast cancer diagnosis. We assessed psychological distress and measures of coping in 193 second-generation Holocaust patients diagnosed with breast cancer, 164 breast cancer patients with non-traumatized parents, 176 healthy second-generation Holocaust women, and 143 healthy women with non-traumatized parents. The main effect of cancer and the main effect of second-generation Holocaust survivor on psychological distress were found to be significant. These two factors (cancer × second generation) had a synergistic effect on the levels of depression and psychoticism. These results support the hypothesis that, at least on some psychological measures, the cumulative distressing effect of having traumatized parents and breast cancer diagnosis is higher than the effect of each factor alone. Copyright © 2005 John Wiley & Sons, Ltd.

In this cross-sectional pilot study of couples in whom the man was diagnosed with prostate cancer or the woman with breast cancer, the purpose was to identify and compare the variables that characterize couples where both spouses are in high psychological distress with couples where the psychological distress of both spouses is within the normal range.Psychological distress and perception of family support in 574 individuals (118 consecutive prostate cancer patients and their spouses, and 169 randomly selected breast cancer patients and their spouses) were assessed using the Brief Symptom Inventory (BSI) and the Perceived Family Support (PFS) self-report questionnaires.Couples experiencing high psychological distress reported lower levels of perceived family support than couples in whom both spouses reported normal levels of psychological distress.The findings support the notion that perceived family support is associated with the psychological distress in both patients and spouses.

We examined the long-term effects of a behavioral intervention on the psychological distress of patients recently diagnosed with localized cancer, who were being treated at Hadassah University Hospital. All 116 patients who met the inclusion criteria (49 men and 67 women) were randomized into an intervention group and a control group on a 3:1 basis. The intervention chosen was Progressive Muscle Relaxation with Guided Imagery, which is intended to decrease psychological distress and increase the patient's sense of internal control. The Brief Symptom Inventory (BSI) and the Impact of Events Scale (IES) were used to assess psychological distress within 1 month of diagnosis, 3 months later (shortly before starting intervention), and 6 months after the end of the intervention. At the final assessment, the effect of the behavioral intervention on psychological distress was positive. The effect was relatively modest but statistically significant when assessed in terms of the Global Severity Index (GSI) (a decrease of 2.3 points in the GSI of the treatment group as compared to an increase of 1.2 points in the GSI of the control group P=.005). Despite these moderately positive findings, we suggest that the results might be more meaningful if cancer patients are first screened for psychological distress to exclude those with a low distress level that does not justify intervention, and only then randomized for participation in the study.

Purpose: To study the visual outcome and factors associated with it in patients with traumatic dehiscence of a cataract surgery wound. Setting: Department of Ophthalmology and the Brown School of Public Health and Community Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel. Methods: A retrospective observational study of 37 eyes of 37 consecutive patients with traumatic wound dehiscence of a cataract surgery wound was conducted. A complete ophthalmic evaluation was performed in all patients. Statistical analysis was done to identify factors associated with the best corrected visual acuity at the end of follow-up. Results: Patients had extracapsular cataract extraction (n = 29), intracapsular cataract extraction (n = 4), or lensectomy (n = 4). No patient had phacoemulsification via a small incision. A univariate analysis showed that factors associated with a worse visual outcome included the presence at presentation of hyphema (P = .05), intraocular lens dislocation or loss (P = .006), vitreous hemorrhage (P = .0002), scleral rupture (P = .001), a long interval from surgery to trauma (P < .0001), and fall as the cause of trauma (P < .0001). In a multivariate model, only a surgery-to-trauma interval longer than 8 weeks was associated with a worse visual outcome (P < .0001). Visual acuity immediately after trauma was a poor predictor of final visual acuity. Conclusions: Visual outcome after traumatic wound dehiscence of a cataract surgery wound was strongly associated with the interval from surgery to trauma. Other factors were less reliable predictors of visual outcome. Traumatic wound dehiscence only moderately affected visual outcome after cataract surgery in most cases.

Purpose To evaluate the effect of using recorded instructions in patients' native language compared with interpreter-assisted instructions on the reliability and duration of the visual field test. Patients and methods Sixty patients referred for visual field testing were included in the study. Thirty-five had limited or no knowledge of the Hebrew language, and 25 control patients were fluent in Hebrew, the native language. None had previous experience with automated perimetry. Patients were randomized to receive recorded instructions on the visual field test in their native language or translator-assisted instructions by the technician before performing the test. For each patient, the time required for instructions and test performance and the reliability indices were documented. Results The method of instruction (recorded or interpreter-assisted) did not affect the time required for patient instructions (66 +/- 24 seconds and 57 +/- 30 seconds, respectively), the time for test performance (7.2 +/- 1.5 minutes and 7.8 +/- 1.8 minutes, respectively), and test reliability as measured by the rate of fixation losses. Regardless of the method of explanation, the time required for instructions and for performing the test were significantly shorter for Hebrew speakers than for non-Hebrew speakers. Conclusion The use of a recorded explanation in the patient's native language before visual field testing is an applicable method for patient instruction. Clinics in areas with multilingual populations may use this method to save technicians time, without adversely affecting the time required for performing the test and its reliability.

Opinions differ about the effects of the Holocaust on the adult offspring of survivors. The authors studied cancer patients who were second-generation Holocaust survivors in an attempt to determine whether they react to their illness with the high distress found to be a characteristic of Holocaust survivors.In a study population of women with breast cancer, 106 second-generation Holocaust survivors were compared to 102 women whose parents were not in the Holocaust. Background information was obtained by interviews. In addition, all patients completed three self-reports: the Mental Attitude to Cancer Scale, the Brief Symptom Inventory, and the Impact of Event Scale.The two groups had identical mean scores on the Mental Attitude to Cancer Scale. The offspring of Holocaust survivors had scores on the Brief Symptom Inventory and the Impact of Event Scale that were substantially and significantly higher and in the range of psychopathology. Within the group, married women and women whose mothers were still alive were even more distressed. Other independent variables shed little light on why the second-generation Holocaust survivors suffered from extreme distress.Second-generation Holocaust survivors are particularly vulnerable to psychological distress and, when faced with a trauma such as breast cancer, react with extreme psychological distress.

• Background: Iontophoresis can enhance penetration of drugs into tissues. We examined the extent of penetration of gentamicin into the cornea of rats during iontophoresis and the effect of varying the concentrations of gentamicin, the duration of iontophoresis and the current densities during iontophoresis. • Methods: Eight groups of rats underwent corneal iontophoresis using gentamicin dissolved in agar. Low and high concentrations of gentamicin were used, as well as low and high current densities and long and short durations of iontophoresis. Control groups received topical or subconjunctival gentamicin, topical saline solution and mock iontophoresis with the agar-gentamicin mixture. The Mann-Whitney test was used for statistical evaluation. • Results: Highly bactericidal concentrations of gentamicin were obtained in all the iontophoresis-treated corneas. The high concentration compared to the low concentration of gentamicin in agar significantly increased the concentration of gentamicin in the corneas, as did the longer duration of iontophoresis. However, higher current intensity did not significantly enhance the drug concentration in the cornea. • Conclusion: lontophoresis with a concentrated gentamicin-agar mixture may provide a rapid increase of levels in the cornea.

Between the end of 1989 and June 1992, 380,152 Russian Jews left the former Soviet Union for Israel, swelling Israel's Jewish population by nearly 10%. Absorbing great waves of immigrants was not new to Israel. Since its establishment in 1948 and the enactment of its Law of Return, large population groups from dozens of different ethnic and cultural backgrounds had immigrated into the country. In 1992 Israel's Jewish population totaled 4,242,500. Of that number, 360,949 had been born in Asian countries, 458,009 in Africa, 1,252,131 in Europe, and 184,317 in America and Oceana.

This study examined whether severe emotional and physical trauma in the past affects the psychological condition of female patients currently afflicted with cancer. Using the Brief Symptom Inventory (BSI), 41 women with cancer, who had sustained extreme trauma during the Nazi Holocaust of the midcentury, were compared with three different groups: a matched group of cancer patients without Holocaust experience, a physically healthy group of female Holocaust survivors, and healthy women without a Holocaust past. Although psychological distress was comparable in the two healthy groups, it was far higher in Holocaust cancer patients than in either their non-Holocaust counterparts or in the group of healthy Holocaust survivors. These results may suggest that the severe trauma of the Holocaust could be responsible for markedly diminished psychological response when such patients are confronted with new stress.

We studied the effect of pressure patching in 27 medical students. Fourteen students had pressure patching in one eye (group 1) and 13 (group 2) had light patching. The fellow eye of each volunteer remained unpatched (group 3). Clinical signs and symptoms were scored and evaluated at the first and the following (after overnight) examinations. Before patching no subject had any of the clinical signs or symptoms. After the patch was removed in groups 1 and 2, all except one volunteer in each group had clinical signs or symptoms, or both, whereas in group 3, none had clinical signs or symptoms. Group 1 had greater scores for clinical signs (P = .019) and for symptoms (P = .038) as compared to group 2. In group 1, two participants did not complete the study period (by removal of the patch) because of severe discomfort and three had temporary irregularities in corneal surface with temporary decrease of vision. We suggest that pressure patching may cause discomfort and changes in visual acuity that are usually attributed to other reasons.

We studied selected coronary heart disease (CHD) risk factors in three consecutive classes of Jerusalem medical students (N = 194). Males had higher cumulative risk scores compared with females because of higher mean systolic and diastolic blood pressures (123/80 vs. 113/74 mmHg), body mass (Quetelet index 23.1 vs. 21.9), more cigarette smoking (2.3 vs. 0.7 cigarettes/day), and despite lower mean cholesterol levels (205 vs. 213 mg/dL). Marital status did not alter total risk for males or for females, but singles smoked more than married persons (2.2 vs. 0.7 cigarettes/day), and married females had higher mean body mass index than singles (22.7 vs. 21.5). The identification of individuals and sub-groups at relatively higher risk for CHD may lead to improvement in risk in highly motivated students.

Effects of testosterone (T) and estradiol-17beta (E-2) on the synthesis of DNA, RNA and protein were studied in explants of the following types of malignant and non-malignant human female breast grown in organ culture: cystic mastitis (7 cases), fibroadenoma (8), carcinoma (17) and uninvolved tissue from cancer-bearing breast (8). In cultures of systic mastitis T uniformly inhibited the incorporation of thymidine-3H into DNA, uridine-3H into RNA and L-amino acids-14C (AA-14C) into protein. E-2 inhibited the incorporation of thymidine-3H, but had a variable effect on the incorporation of uridine-3H and AA-14C. Cultures of fibroadenoma, with no steroid added, were highly proliferative especially at the outer surface, but the incorporation of thymidine-3H, uridine-3H and AA-14C was much lower than in cystic mastitis. Whereas in fibroadenoma T uniformly inhibited the synthesis of DNA, RNA and protein, the effect of E-2 was variable: in most cases it inhibited the synthesis of DNA,but in one it stimulated it appreciably; in the majority of cases E-2 stimulated RNA and protein synthesis. In cultures of cancerous tissue T depressed, in most cases, the incorporation of thymidine-3H, uridine-3H and AA-14C, but it stimulated it in 4 out of 17. E-2 inhibited the synthesis of DNA, RNA and protein in 6 cases (2 of them were inhibited by T), stimulated them in 9 (one stimulated by T) and had no clear effect in 2. The effect of the steroids on the explants of uninvolved tissue was variable and did not always parallel their effect on the cancerous tissue from the respective patients.

This study aims to elucidate if any association exists between the development of arteriosclerotic disease and contamination of the internal human environment with certain organochlorine compounds (OCCs). For this purpose the levels of DDT isomers and their metabolites, and of lindane, dieldrin, heptachlor epoxide, and polychlorinated biphenyls (PCBs) were determined in blood serum of 11 patients suffering from slight to moderate (group A), and 24 patients with moderate to severe (group B), arteriosclerotic lesions. The control group consisted of 27 patients with no obvious manifestations of arteriosclerosis. The main findings of the study in comparison with the control group were: 1. (a) Mean OCC residue levels in blood were slightly higher in group A and markedly so in group B; 2. (b) The variability and the extent of departure from normality of distributions of organochlorine insecticides (OCIs) decreased, whereas those of PCBs increased, in arteriosclerotic patients (more markedly in group B); 3. (c) The degree of correlation between blood serum levels of various OCCs was elevated in group A and low in group B. It remains to be ascertained whether changes in the body burden of OCCs are primary, resulting from increased exposure to and absorption of these compounds which thus contribute to the development of arteriosclerosis, or are of secondary origin, due to inhibition of xenobiotic metabolism caused by interference of the arteriosclerotic process with the functions of drug metabolizing enzymes of liver microsomes.

Serum lactic dehydrogenase (LDH) was evaluated in 51 patients with primary carcinoma of the ovary. An increased activity of this enzyme was found in 69% of the patients. The mean +/- SD activity of LDH correlated significantly with stage of disease: 200 +/- 73 U/l in stages 1 and 2, 295 +/- 107 U/l in stages 3A and 3B, and 362 +/- 91 U/l in stages 3C and 4. Moreover, LDH activity correlated significantly with the histological type of the tumor: 170 +/- 57 U/l in mucinous, 300 +/- 107 U/l in serous, 330 +/- 106 U/l in endometroid, and 352 +/- 98 U/l in undifferentiated carcinoma. Normal activity of LDH was observed in 86% of patients in stages 1 and 2, but in only 21% of patients in stages 3 and 4. Serum LDH activity was not found to be a good predictor of late prognosis of the disease, and it did not correlate with the surgical findings on second-look laparotomy. In addition, LDH activity did not correlate with the surgical debulking effort. However, after completion of cytoreductive surgery and adjuvant therapy, LDH did correlate with the course of the disease. It is concluded that LDH may have a role in the evaluation of a patient with carcinoma of the ovary or with a pelvic mass.

The incidence of pre-eclampsia was studied in 9771 women that were pregnant for the first or second time. The protection offered by a previous pregnancy which ended in abortion was compared to that provided by a first pregnancy that proceeded to term. The rate of pre-eclampsia was 2.9% for primigravid women and was significantly lower (1.5%, p less than 0.001) for women giving birth for the second time. Adjusting by multiple regression for confounding factors (e.g., maternal age, social class, ethnic origin and smoking), the incidence of pre-eclampsia was also significantly lower (p = 0.038) following an induced abortion, but not following a spontaneous abortion.

Organochlorine insecticide (OCI) and chlorinated biphenyl (CB) blood residues were measured in 29 men with oligoastenospermia and in 14 matched control subjects. Although both OCI and CB residue levels were generally low, infertile patients, in comparison with healthy individuals, exhibited significantly higher levels ofp,p′-DDT metabolites in the blood, as well as elevated residues of lindane, tetra- and penta-CBs. These increases were found more frequently in patients with oligospermia (spermatozoa count below 20 million/mL) than in those with astenospermia and normal counts. However, residue levels ofo,p′-DDD and heptachlor epoxide were lower in the study group than in the control group. Correlations between DDT isomers and metabolites and other OCI blood residues were stronger in infertile patients than in the control group, whereas OCI-CB correlations were weaker in the study group. There are several possible mechanisms of Organochlorine compound interference with male fertility functions.

We reviewed 1791 singleton pregnancies of women with a history of previous induced abortion and compared them with 14,857 pregnancies in mothers with no previous induced abortions. Therapeutic termination of pregnancy was associated with a statistically significant increase in the incidence of low birth weight infants and bleeding in the first trimester of pregnancy. When other variables were examined, no significant differences were found between the two groups, except for a significantly higher rate of stillbirths among women who had not had a prior induced abortion. There were no increases in major or minor congenital malformations.

Blood residue levels of some organochlorine pesticides (DDT and its analogues, lindane, dieldrin, heptachlor epoxide) and polychlorinated biphenyls were measured in maternal and cord blood in 20 cases of premature rupture of fetal membranes at term and in 15 matched controls. No evidence of a possible organochlorine compounds role in the pathogenesis of premature rupture of the membrane was found.

Information on the birthweight and gestational age of previous siblings is usually dependent upon maternal recall. This information is of importance in assessing the current risk of perinatal morbidity and mortality. The validity of maternal recall of birthweight and gestational age of 880 children born to 97 multiparas was examined by comparison with hospital records. About 75% of all reported birthweights were accurate to within 100 g and a similar proportion of reported gestational ages was correct to within 1 week. Recall was most accurate for most recent births as well as for earliest births and was not related to maternal age or education. There was a tendency for the smallness of low birthweight infants to be exaggerated by mothers. We conclude that within defined limitations, maternal recall of birthweight and gestational age of previous children is sufficiently accurate for clinical and even for epidemiological use.

Low birthweight and stillbirth rates of 16,647 Jerusalem deliveries were examined by birth-order comparing longitudinal to cross-sectional data. Six hundred fifty-seven complete sibships of 7 or more were assessed, including 95 sibships from the socio-economically homogeneous ultraorthodox Jewish community of Mea Shearim. In both cross-sectional and longitudinal studies grandmultiparas were not at increased risk for low birthweight, but did have a higher frequency of stillbirths.The effect of grand multiparity on low birthweight and stillbirth rates was investigated in 16,647 deliveries in Jerusalem, Israel, comparing longitudinal to cross-sectional data. An advantage of longitudinal studies is that entire sibships are examined, diminishing the confounding effects of social class and ethnic differences. 1069 (6.4%) of infants in the cross-sectional study population of the 16,647 single births delivered by West Jerusalem women in the 26-month study period were low birthweight (2500 gm or less). Primiparas were at a higher risk for low birthweight compared to all other birth orders. In the longitudinal study population of 562 complete sibships of 7 or more births, there were 250 (5.7%) low birthweight infants. Low birthweight rates were highest for 1st born infants and lowest for birth orders 3 and 4. In the Mea Shearim longitudinal subpopulation comprised of ultraorthodox Jews, there was a low birthweight rate of 4.9%, with the highest rate found in birth order 2. The overall stillbirth rate in the cross-sectional study was 7.9/1000 live births. Stillbirth was more frequent in 1st births, less frequent in 2nd and 3rd births, and then rose with increasing birth order to pass at birth order 8-9 the rate in primiparas. The stillbirth rate in the longitudinal study population was 5.0/1000; the lowest such rate was found in birth orders 3 and 4, while the highest rate was recorded in birth order 7. These findings suggest that grand multiparas are not at increased risk for low birthweight, but do have a higher frequency of stillbirths. These conclusions are strengthened in this study because they derive in part from a model population in which parity is not related to socioeconomic status. Because of its long-term socioeconomic homogeneity and stability, the Mea Shearim subgroup is an excellent model for examining perinatal risk and grand multiparity.

This study reviews data on the changes with time of the blood levels of some organochlorine compounds (OCCs) in the general Israeli population. All the studied OCC residues, except for p,p'-DDD, were significantly lower in 1985-1986 than in 1975. A decline in blood residues of organochlorine pesticides was observed mainly in the second half of the 1970s, whereas a fall in the polychlorinated biphenyl residue levels took place in the first half of the 1980s. During the latter period, unexplained increases in p,p'-DDD, dieldrin and heptachlor epoxide residue levels were seen. A significant decrease in the blood levels of OCCs quickly metabolized in the body (p,p'-DDT, tetrachlorobiphenyls) indicated a considerable reduction of environmental exposures. The clear decline in OCC contamination of the environment and, in particular, of the human body during the reviewed period (1975-1986) resulted from the restrictions imposed in Israel on the use of OCCs. Nevertheless this does not mean that this problem has been solved. Some health implications of low-level life-long OCC exposure are discussed, and further environmental and biological monitoring and control measures are recommended.

As part of an epidemiologic teaching exercise, we studied coronary risk factors in two consecutive classes of Jerusalem medical students (n = 124) and calculated a summary coronary risk score for each student. Men were at higher risk than women because of greater body mass, higher blood pressure and more cigarette smoking. Married males were at lower risk than single males because they had lower cholesterol levels and smoked less. Married and single females were at equal risk. Jerusalem students smoked more than most groups of American medical students and less than their European counterparts. There is reason to believe that an exercise of this kind may result in risk-reducing behavior on the part of high-risk students.