Shai Linn

No association between coffee consumption and adverse outcomes of pregnancy.

We analyzed interview and medical-record data of 12,205 non-diabetic, non-asthmatic women to evaluate the relation between coffee consumption and adverse outcomes of pregnancy. Low birth weight and short gestation occurred more often among offspring of women who drank four or more cups of coffee a day and more often among the offspring of smokers. After controlling for smoking, other habits, demographic characteristics, and medical history by standardization and logistic regression, we found no relation between low birth weight or short gestation and heavy coffee consumption. Furthermore, there was no excess of malformations among coffee drinkers. These negative results suggest that coffee consumption has a minimal effect, if any, on the outcome of pregnancy.

The association of marijuana use with outcome of pregnancy.

We analyzed interview and medical record data of 12,424 women to evaluate the relationship between marijuana usage and adverse outcomes of pregnancy. Low birthweight, short gestation, and major malformations occurred more often among offspring of marijuana users. When we used logistic regression to control for demographic characteristics, habits, and medical history data, these relationships were not statistically significant. The odds ratio for the occurrence of major malformations among marijuana users was 1.36, higher than odds ratios for other exogenous variables, and the 95 per cent confidence interval was 0.97-1.91. More data are needed to establish firmly or rule out an association between marijuana usage and major malformations. Until more information is available, women should be advised not to use marijuana during pregnancy.

The association of alcohol consumption with outcome of pregnancy

Patterns of alcohol consumption were assessed in 12,440 pregnant women interviewed at the time of delivery. Only 92 women (0.7 per cent) reported drinking 14 or more drinks per week, with most consuming fewer than 21 drinks per week. In the crude data, alcohol intake of 14 or more drinks per week was associated with a variety of adverse pregnancy outcomes, including low birthweight, gestational age under 37 weeks, stillbirth, and placenta abruptio. After use of logistic regression to control for confounding by demographic characteristics, smoking, parity and obstetric history, only the association of placenta abruptio with alcohol consumption of 14 or more drinks per week remained statistically significant. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks per week was not associated with and increased risk of any adverse outcome. No association was seen with congenital malformations at any level of alcohol intake.

Work and Pregnancy

Pregnancy outcomes of 7,155 women who worked between one and nine months of pregnancy were compared with outcomes of 4,018 women who were not employed. There were no differences in rates of prematurity, Apgar score, birthweight, perinatal death rate, or malformation prevalence. Working women were divided into those who left employment during the first eight months and those who worked all nine months. The latter had a lower rate of adverse outcome than the other working group and the nonworking group. This indicates that working to term in the absence of contraindications does not impose an added risk on mother or infant. After control of confounding by parity and other relevant factors, an increased risk of prolonged gestational age was seen among primiparous working women. There was an increased risk of fetal distress among those women leaving work prior to nine months who were having their third or subsequent child. A small decrease in birth weight was seen among women who left work prior to term but not among those who worked all nine months. Overall the results are reassuring that working during pregnancy is not in itself a risk factor for adverse outcome.

Familial clustering of classic kaposi sarcoma

It is widely accepted that there is a causal association between Kaposi sarcoma-associated herpesvirus (KSHV) and Kaposi sarcoma (KS). However, the majority of individuals infected with KSHV never develop KS. Here, we present a unique familial case of classic KS, in which the disease occurs in 4 siblings who have no recognized underlying immunodeficiency. We examine risk factors that could play a role in this condition, including KSHV infection, KSHV DNA load, genetic variants of KSHV, infection with additional viruses, interleukin-6-promoter polymorphism, and HLA genotype. We hypothesize that a genetic susceptibility to KS, in combination with KSHV infection, may play an important role in the presented familial case.

The relationship between induced abortion and outcome of subsequent pregnancies

Abstract We analyzed interview and record review data from 9,823 deliveries to evaluate the relationship between prior history of induced abortion and subsequent late pregnancy outcomes. Complications such as bleeding in the first and third trimesters, abnormal presentations and premature rupture of the membranes, abruptio placentae, fetal distress, low birth weight, short gestation, and major malformations occurred more often among women with a history of two or more induced abortions. A logistic regression analysis to control for multiple confounding factors showed that a history of one induced abortion was statistically significantly associated with first-trimester bleeding but with no other untoward pregnancy events, and a history of two or more induced abortions was statistically associated with first-trimester bleeding, abnormal presentations, and premature rupture of the membranes. While these relationships merit further research, the results of this study are largely reassuring. A history of one or more prior induced abortions does not appear to increase substantially the risk of adverse late outcomes of subsequent pregnancies.

Spatial analysis of air pollution and cancer incidence rates in Haifa Bay, Israel

The Israel National Cancer Registry reported in 2001 that cancer incidence rates in the Haifa area are roughly 20% above the national average. Since Haifa has been the major industrial center in Israel since 1930, concern has been raised that the elevated cancer rates may be associated with historically high air pollution levels. This work tests whether persistent spatial patterns of metrics of chronic exposure to air pollutants are associated with the observed patterns of cancer incidence rates. Risk metrics of chronic exposure to PM(10), emitted both by industry and traffic, and to SO(2), a marker of industrial emissions, was developed. Ward-based maps of standardized incidence rates of three prevalent cancers: Non-Hodgkins lymphoma, lung cancer and bladder cancer were also produced. Global clustering tests were employed to filter out those cancers that show sufficiently random spatial distribution to have a nil probability of being related to the spatial non-random risk maps. A Bayesian method was employed to assess possible associations between the morbidity and risk patterns, accounting for the ward-based socioeconomic status ranking. Lung cancer in males and bladder cancer in both genders showed non-random spatial patterns. No significant associations between the SO(2)-based risk maps and any of the cancers were found. Lung cancer in males was found to be associated with PM(10), with the relative risk associated with an increase of 1 microg/m(3) of PM(10) being 12%. Special consideration of wards with expected rates <1 improved the results by decreasing the variance of the spatially correlated residual log-relative risk.

Cancer incidence and survival among children and adolescents in Israel during the years 1998 to 2007.

Our goal was to describe childhood cancer incidence and survival in Israel and to identify demographic and epidemiologic variations among children and adolescents with cancer. We used data from the Israel National Cancer Registry to examine the incidence and survival of pediatric cancer in Israeli children aged 0 to 19 years, diagnosed during the years 1998 to 2007. Cases were analyzed according to sex, age, ethnicity, and geographic region. Among the 4255 cases of childhood cancer, there was a total age-adjusted incidence rate of 172.4 per million for children aged 0 to 19 years and 153.4 per million for children aged 0 to 14 years. The incidence rate for boys was higher than for girls (192.5 and 153.3, respectively) and higher for Jewish children than for Arab children (177.6 and 156.8, respectively). The largest groups were leukemias (22%), lymphomas (20.2%), and central nervous system tumors (17.4%). The number of new cases increased each year, but the incidence rate remained steady. The survival probability updated to December 2008 was estimated and the 5-year survival was calculated for the new cases until the end of 2003. The overall survival at 5 years was 80.8%, with 72.8% for the Arabic population and 83.2% for the Jewish population, and depended on the diagnosis. Incidence and survival in childhood cancer in Israel is at the same medium level compared with other parts of the world. This study may set the basis for investigating the genetic and environmental factors that cause pediatric cancer in Israel, delineating the genetic basis for ethnic origin disparities in survival.

Increased 6-sulfatoxymelatonin excretion in women with polycystic ovary syndrome.

OBJECTIVE To determine melatonin production in hyperandrogenic women. DESIGN Controlled prospective study. SETTING Outpatients in an academic medical center. PATIENT(S) Twenty-two women with polycystic ovary syndrome (PCOS), 20 women with idiopathic hirsutism, and 15 age-matched individuals who had similar body mass indexes as controls. INTERVENTION(S) Fasting blood samples and 24-hour urinary samples were obtained from all participants. MAIN OUTCOME MEASURE(S) All participants provided serum samples for the measurement of LH, FSH, testosterone, E(2), DHEAS, 17 alpha-hydroxyprogesterone (17-OHP), and insulin levels, as well as urinary 6-sulfatoxymelatonin (aMT6s). RESULT(S) Women with PCOS had higher aMT6s, testosterone, LH/FSH ratio, and insulin values than either women with idiopathic hirsutism or control women. Testosterone inversely correlated with aMT6s in PCOS. Regression analysis revealed that only testosterone was an important determinant of aMT6s in PCOS. CONCLUSION(S) Women with PCOS have increased melatonin production.

Use of a Refined Drug Tracer Algorithm to Estimate Prevalence and Incidence of Parkinson's Disease in a Large Israeli Population

Estimating rates of Parkinsons disease (PD) is essential for health services planning and studies of disease determinants. However, few PD registries exist. We aimed to estimate annual prevalence and incidence of PD in a large Israeli population over the past decade using computerized drug purchase data. Based on profiles of anti-parkinsonian drugs, age at first purchase, purchase density, and follow-up time, we developed a refined algorithm for PD assessment (definite, probable or possible) and validated it against clinical diagnoses. We used the prescription database of the second largest Health Maintenance Organization in Israel (covers ~25% of population), for the years 1998-2008. PD rates by age, gender and year were calculated and compared using Poisson models. The algorithm was found to be highly sensitive (96%) for detecting PD cases. We identified 7,134 prevalent cases (67% definite/probable), and 5,288 incident cases (65% definite/probable), with mean age at first purchase 69 ± 13 years. Over the years 2000-2007, PD incidence rate of 33/100,000 was stable, and the prevalence rate increased from 170/100,000 to 256/100,000. For ages 50+, 60+, 70+, median prevalence rates were 1%, 2%, 3%, respectively. Incidence rates also increased with age (RR = 1.76, 95%CI 1.75-1.77, ages 50+, 5-year interval). For ages 50+, rates were higher among men for both prevalence (RR = 1.38, 95%CI 1.37-1.39) and incidence (RR = 1.45, 95%CI 1.42-1.48). In conclusion, our refined algorithm for PD assessment, based on computerized drug purchases data, may be a reliable tool for population-based studies. The findings indicate a burden of PD in Israel higher than previously assumed.