Multiple sclerosis: genetic versus environmental aetiology: epidemiology in Israel updated

The incidence and prevalence of multiple sclerosis (MS) were compared, controlling for age, in native-born Israelis of different origins and in immigrants to Israel. This comparison was carried out in two populations, countrywide and in Jerusalem. In the countrywide population, ascertainment was based mainly on hospitalizations; it included 252 patients who were native-born and 150 who had immigrated from Africa-Asia (AA immigrants). The 89 MS patients of Jerusalem also included patients diagnosed in outpatient clinics. In native-born Israelis whose father was born in Europe-America (I-EA), the incidence and prevalence of MS were found to be as high as or even higher than that found previously in immigrants from Europe-America. Among native-born Israelis whose father was born in Africa or Asia (I-AA), the yearly age-adjusted incidence and prevalence rates were found to be 1.4- to 1.8-fold higher than among AA immigrants, pointing to environmental factors. The incidence and prevalence rates in the I-EA were 1.2- to 1.6-fold higher than in the I-AA, pointing to genetic factors. These results seem to point to both environmental and genetic factors in the aetiology of MS. Further research is needed, however, to disentangle the genetic factors from possible environmental differences in the two ethnic groups.     

Epidemiology of multiple sclerosis in Arabs in Kuwait: A comparative study between Kuwaitis and Palestinians

On December 31, 1988 there were 201 registered multiple sclerosis patients in Kuwait, an overall prevalence rate (PR) of 10.2 per 100000; among them were 186 Arabs, of whom 72 were Palestinians and 51 Kuwaitis. Comparison of these two subgroups, who had a similar age distribution revealed that the disease was2 1/2 times more frequent among Palestinians (PR 23.8/100 000) than among Kuwaitis (PR 9.5/100 000). Palestinians also showed significant differences from Kuwaitis in eye color, blood group distribution and HLA-DR and HLA-DQW epitopes frequency. This suggests that genetic rather than environmental factors might be the underlying cause for the high susceptibility to develop MS among Arabs originating from the Eastern Mediterranean basin.     

Aseptic meningitis: Frequency among Israeli ethnic groups

The relative frequency of aseptic meningoencephalitis (AME) was compared in populations of diverse origin, A countrywide search of Israel during 1969-1970 disclosed 1350 cases who fit strict diagnostic criteria. The average annual incidence was 21.6 per 100000 population. The total incidence was similar in Afro-Asian, Euro-American and Israeli Jewish groups but among Israeli Arabs, the incidence was apparently lower. Age-specific incidence showed a peak in infants under one year of age among Arabs and Afro-Asian Jews whereas Euro-Americans and Israeli Jews had a peak incidence at 5-9 years. Larger family size among Arabs and Afro-Asian Jews might account for the higher incidence in infants. Age-specific incidence may be a better index than total incidence of important differences in AME among various ethnic groups.     

Daily stresses and uplifts during times of political tension: Jews and Arabs in Israel

This study examined similarities and differences between Jews and Arabs in Israel in terms of their daily stressful and uplifting experiences and assessed the relation between these experiences and family and life satisfaction. Data were collected from representative samples of 697 Jews and 303 Arabs by using a computerized-assisted telephone interviewing system. Contrary to expectation, Jews reported more sources of hassles than did Arabs, whereas Arabs reported more uplifts. A structural equation modeling multigroup analysis indicated a similar factor suucture for hassles and uplifts in both groups. Family satisfaction was positively related to uplifts but not to hassles. For Arabs, uplifts had a positive effect only on family satisfaction, whereas for Jews they had a positive effect on both family and general life satisfaction.     

A community study on emotional distress among Arab and Jewish Israelis over the age of 60

BACKGROUND: The elderly constitute a vulnerable group for psychopathology, yet research on their mental health among both Arab and Jews in Israel remains limited. The same is the case in Arab countries. This paper reports on the contrasting distribution of the mean emotional distress (ED) scores and rates of suspected clinical cases, and their related risk factors, among community residents over the age of 60. METHODS: Several national agencies conducted a survey on 5,055 elderly individuals to investigate their health status, including ED. The interview included socio-demographic and behavioral health items, as well as a modified 12 item-GHQ as a measure of ED. Total ED scores and prevalence rates for suspected psychopathology were calculated. Their respective risk factors were examined using univariate and multivariate methods. RESULTS: The ED scores were highest among Muslim Arabs (4.9), followed by Christian Arabs (4.2), Jews (3.1) and Druzes (2.8). Their estimated prevalence rates were 43.4%, 37.0%, 21.4%, and 17.0%, respectively. The gradient of these results remained unchanged in the multivariate analysis for ED scores adjusting for confounding variables. In contrast, logistic regression analysis controlling for confounding variables did not find a differential risk for suspected psychopathology between Arabs and Jews. CONCLUSION: Conceivably, the higher demoralization scores among elderly Arabs are associated with their minority status affiliation, as well as with the rapid social changes that have taken place in their midst. A cultural response style may be entertained as a possible explanation. However, these factors do not impact the risk for suspected psychopathology where no differential risk was noted after adjustments for confounders.     

Environmental risk factors for subacute sclerosing panencephalitis (SSPE)

In Israel, SSPE has been shown to be much more frequent among Sephardic Jews and Arabs than among Ashkenazic Jews. In the present study, we tried to explore environmental factors that may be of etiological importance and explain these differences in prevalence. The study is a case-control one, which includes 95 patients and 2 groups of controls, with 95 people in each. The general population controls were group-matched to the case group by sex, age, and ethnic origin. The family controls consisted of the sibling closest in age to each patient. A statistically significant positive correlation was found between risk of SSPE and early measles infection, large family, overcrowding in the home, older age of the mother, higher birth order, fewer years of schooling of the parents, fewer cultural activities, and rural place of birth. All these factors are interpreted as contributing to a higher risk of early measles infections, which thus may well be the main risk factor for SSPE.     

Suicide in Israel: crossnational comparisons

A comparison of rates of completed suicide is made among different national and religious groups in Israel. Rates are higher for Jews than for Arabs. Psychological and sociocultural hypotheses are used to attempt to explain these findings.     

Differences in age of first hospitalization for schizophrenia among immigrants and nonimmigrants in a national case registry

While previous studies have found an increased incidence of schizophrenia in some immigrant groups, differences in age of onset in these groups has not been examined. The purpose of this study was to compare age of first hospitalization of (1) native-born people versus immigrants, (2) immigrants from different countries of origin, and (3) first generation immigrants versus second generation immigrants; and to reexamine gender differences in age of first hospitalization. Data were extracted on all first hospital admissions nationally for the years 1978-1992 (n = 10,902) from the National Psychiatric Hospitalization Case Registry of the State of Israel Ministry of Health. Immigrants were older at time of first hospitalization than nonimmigrants, with considerable variations between different countries of origin. Second generation immigrants (i.e., born in Israel to immigrant parents) had ages of first hospitalization similar to people with native-born parents. Males had earlier ages at first hospitalization than females. The results suggest that immigration may have a delaying effect on age of first admission and support previous findings regarding gender difference in age of onset.     

Do children cope better than adults with potentially traumatic stress? A 40-year follow-up of Holocaust survivors

Anecdotal reports suggest that child survivors of the Nazi persecution are functioning well as adults. Ratings of their parents by a randomly selected community sample of young adult Ashkenazi Jews on a scale that measured Schizoid, Paranoid, Depressive/Masochistic and Type A/Normal Aggressive symptoms permitted verification of these reports. Among the parents were groups who were children, adolescents, or young adults in 1945, at the end of World War II. Child-survivor parents did not differ from native-born parents on these measures 40 years later, whereas, consistent with the empirical findings of others, survivors who were adolescents or young adults at the end of the war manifested more paranoid and depressive/masochistic symptoms than native-born parents. To explain this possible greater long-term resilience among those who were child survivors, reference is made to later caretakers, endowment, cognitive and social development, and psychodynamics.     

The risk of motor neurone disease and multiple sclerosis is different in Estonians and Russians. Data from South Estonia

Epidemiological studies were performed in South Estonia to establish the prevalence rate of multiple sclerosis (MS) and motor neurone disease (MND). The case finding method included information from the hospital records of the central hospital in the region-the University Hospital (for MS from 1942 to 1989), from all neurologists in the region, from the Estonian MS Society and Association of Muscular Disorders, and from nursing homes in the region. The prevalence day was 31 December 1989. MND incidence was established for the period of 1986-1995. The results demonstrated high prevalence rates of MS among native Estonians (55.3 per 100 000), somewhat lower prevalence among native-born representatives of other nationalities (43.6 per 100 000) and the lowest prevalence rate of MS among non-Estonian immigrants (26.6 per 100 000). The differences were not statistically significant. The results for MND demonstrated the opposite pattern. The mean annual incidence rate of MND for 10 years was statistically significantly higher among people of other nationalities (2.5 per 100 000) and Russians (2.6 per 100 000), and lower in native-born Estonians (1.1 per 100 000). No differences in health care or clinical picture were established. The reasons for the demonstrated differences in MND incidence remain unclear.     

Distribution of treated mental illness in the neighborhoods of Jerusalem

The authors compared the rates of treated mental illness among ethnically advantaged Ashkenazic Jews and ethnically disadvantaged Sephardic Jews in four areas of Jerusalem defined by socioeconomic status. They found that the rates of illness were higher in areas of lower socioeconomic status, that the Ashkenazim had higher rates of illness than the Sephardim in the areas of lower status, and that there was a comparatively high rate of illness among the Ashkenazim in the very religious Jewish neighborhoods. They interpret these findings on the basis of the theories of social causation and social selection, including genetic transmission.     

Photosensitive Epilepsies and Photoconvulsive Responses in Arabs

The occurrence of photosensitivity (PS) was examined in 327 Arabs greater than or equal to 15 years of age with epilepsy by intermittent photic stimulation (IPS). A control group of 192 nonepileptic Arabs greater than or equal to 15 years of age were also examined by IPS. Of the epileptic patients, 24 (7.3%) were photosensitive, an incidence comparable to that in whites in contradistinction to the reported rarity among African blacks. This finding indicates that environmental factors, particularly excessive sunshine, does not appear to influence the occurrence of PS among epileptic patients. The occurrence of PS among epileptic patients may depend more strongly on the presence of an epileptic syndrome known to have association with PS.     

An estimate of the prevalence of dementia among residents of long-term care geriatric institutions in the Jerusalem area

BACKGROUND: To determine the prevalence of dementia among the residents of geriatric institutions in the greater Jerusalem area. METHODS: A population-based, cross-sectional survey of a representative sample, weighted according to the level of care, of 11 of the 88 long-term care (LTC) wards in 34 LTC institutions providing care for the elderly residents in the greater Jerusalem area in 1999. A single physician interviewed 311 residents. The presence of dementia was determined from medical records and by performance on the Modified Mini-mental State Examination (3MS) instrument (with a score less than 78/100 indicating significant cognitive impairment or suspected dementia), and professional care providers were interviewed for their opinion regarding the presence of dementia in each subject. RESULTS: The mean age of the patients was 83.9 years and 75% were women. Overall, 180 residents, representing 49.9% of the weighted sample in Jerusalem LTC facilities, were determined to have dementia according to medical records, ranging from 22.9% in independent and frail care units to 97.7% in skilled nursing care wards. However, based on their performance on the 3MS, the prevalence of cognitive impairment with suspected dementia among the subjects was substantially greater, with the staff being unaware of this diagnosis in about one-quarter of the subjects. CONCLUSIONS: There is a high prevalence of dementia in geriatric institutions in the Jerusalem area, particularly in those providing greater care. Moreover, significant cognitive impairment is probably under-reported in the medical records.     

Problem Severity Profiles of Substance Abusing Women in Therapeutic Treatment Facilities

This article aims to examine specific substance use profiles among former Soviet Union (FSU) immigrant and native-born women in Israeli therapeutic treatment facilities. Individuals were sampled at drug treatment facilities and assessed using the Addiction Severity Index. ASI scores suggest differences between the two groups. Among the findings are native born females have been using heroin and amphetamines longer than FSU immigrants; however, immigrant women have more years of alcohol use. FSU women are more inclined to be injection drug users, prefer shorter forms of treatment, and to use alcohol when receiving treatment for heroin addiction. FSU women have higher levels of chronic medical problems, HCV, and HIV/AIDS. The study results tend to support the position that treatment of special populations may be enhanced if their particular needs associated with personal attributes and background characteristcs are considered and met in a treatment environment.     

Epidemiology of Guillain-Barré syndrome

From 1969 through 1972, a nationwide search for cases of Guillain-Barré syndrome (GBS) is Israel revealed 89 patients. The average annual age-adjusted incidence was 0.75 per 10(5) persons. Overall incidence of the syndrome was similar in Jewish groups of diverse ethnic backgrounds. Arabs had a lower overall incidence than Jews (0.46 per 10(5) persons), perhaps attributable to fewer Arabs at risk in older age groups. Peaks of incidence occurred among individuals over 60 and under 4 years of age when all cases were combined. No clear seasonal or geographic clustering of GBS was evident in Israel during the 4 years of this study. The incidence of GBS in the present study agrees with previous population-based estimates.     

Association between patients' gender, age and immigrant background and use of restraint--a 2-year retrospective study at a department of emergency psychiatry

The study aimed to determine rates and types of patient restraint, and their relationship to age, gender and immigrant background. The study retrospectively examined routinely collected data and data from restraint protocols in a department of acute psychiatry over a 2-year period. Each patient is only counted once in this period, controlling for readmission. Of 960 admitted patients, 14% were exposed to the use of restraints. The rate was significantly higher among patients with immigrant background, especially in the younger age groups. Most commonly used were mechanical restraint alone for native-born patients and a combination of mechanical and pharmacological restraints for patients with immigrant background. The use of restraints decreased when patients reached 60 years. Both patients' age and immigrant background seem to have an impact on the use of restraint.     

Torsion dystonia in israel

A country-wide search for idiopathic torsion dystonia (ITD) in Israel between 1969 and 1975 revealed 42 patients (41 Jewish and 1 Druze Arab). Prevalence of ITD per million population, age-adjusted to the United States population in 1970, was 10.8 in the total Jewish population (22.0 among Jews of European extraction contrasted with 1.5 among Jews with Afro-Asian forebears). Among Europeans, the highest prevalence was among Jews from Eastern Europe. The average age-adjusted annual incidence rates per million population were 0.43 in the total Jewish population, 0.98 in the Europeans, and 0.11 in the Afro-Asians. Among the 40 patients for whom familial data were available, the majority of cases (26) were sporadic. The other 14 belonged to four unrelated European families, all of Russian-Polish origin. The pattern of inheritance in these four families fits an autosomal dominant model with incomplete penetrance.     

Epidemiology of suicide in Israel: a nationwide population study

BACKGROUND: In Israel, some population characteristics and lifestyle patterns make epidemiological research on suicide of particular interest. The Israeli population is characterized by ethnic diversity, with a multi-religious, multi-national mosaic of Jews and Arabs. These subgroups also vary in their suicidal behavior. The aims of the present study were to examine the trends in suicide incidence rates in Israel from 1984 to 1994, to identify sub-populations at high risk for suicide and to identify suicide methods associated with increased risk. METHODS: Suicide rate trends in Israel over the period from 1984 to 1994 were examined for four subgroups: Jewish men and women, and Arab men and women. Cases of undetermined external cause (UEC) of death were also considered. Mortality data were obtained from the computerized data files of the Israeli Central Bureau of Statistics, which includes cause of death and sociodemographic variables. Suicide was classified according to the ICD-9 codes. RESULTS: Suicide rates were higher for Jews than for Arabs, and higher for men than for women. The rates among both population and sex groups increased directly with age. A significant increase over the years studied was found for Jewish men, particularly in the 18- to 21-year-old age group. An increase in the use of firearms was noted, mainly in the groups in which total suicide rates increased. CONCLUSIONS: The findings of this study highlight the need for further studies to identify both sub-populations at high risk for suicide, and societal trends such as lifestyles, immigration, military service, and media exposure to violence, as first steps toward planning of intervention programs to reduce suicide rates.     

First admission rates for schizophrenia in immigrants to the Netherlands

Data from the Dutch national register were examined in order to determine first admission rates for schizophrenia in the four largest immigrant groups to the Netherlands (from the countries of Surinam, the Netherlands Antilles, Turkey and Morocco). Rates for immigrants from Surinam and the Netherlands Antilles exceeded by far those of the antive-born population. Differences in proportions of compulsory first admissions between young male immigrants from these countries and their native-born counterparts were small and statistically not significant. Rates of first admissions for young male immigrants from Morocco were also much higher than those for the native-born population, but rates for female immigrants from Morocco and for immigrants from Turkey were not increased. These results support British studies reporting an increased incidence of schizophrenia in Caribbean immigrants to the United Kingdom.Published in part by the Nederlands Tijdschrift voor Geneeskunde (in Dutch): 1994, 138: 345–350