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Using records from the National Insurance Institute of Israel, we recognized all children with autism spectrum disorders (ASD, N = 8072) or hearing loss (HL, N = 2231) born in Israel between 2005 and 2010. Typical developed children were taken from a random 20% sample of children born during the same years (N = 227,492). Analyses were adjusted for year of birth, population group, parental ages, parental education, child birth order and peripherality. Working women, who gave birth to children with either ASD or HL, were at increased risk of not maintaining their working status over the 5 years after birth. There is a decreased ratio between household wage after and before birth, in families with children with either ASD or HL.

Autism spectrum disorder (ASD) is a developmental disorder with increasing prevalence worldwide, yet has unclear etiology. We explored the association between maternal exposure to particulate matter (PM) air pollution and odds of ASD in her child. We conducted a nested case-control study of participants in the Nurses' Health Study II (NHS II), a prospective cohort of 116,430 U.S. female nurses recruited in 1989, followed by biennial mailed questionnaires. Subjects were NHS II participants' children born 1990-2002 with ASD (n = 245), and children without ASD (n = 1,522) randomly selected using frequency matching for birth years. Diagnosis of ASD was based on maternal report, which was validated against the Autism Diagnostic Interview-Revised in a subset. Monthly averages of PM with diameters ≤ 2.5 μm (PM2.5) and 2.5-10 μm (PM10-2.5) were predicted from a spatiotemporal model for the continental United States and linked to residential addresses. PM2.5 exposure during pregnancy was associated with increased odds of ASD, with an adjusted odds ratio (OR) for ASD per interquartile range (IQR) higher PM2.5 (4.42 μg/m3) of 1.57 (95% CI: 1.22, 2.03) among women with the same address before and after pregnancy (160 cases, 986 controls). Associations with PM2.5 exposure 9 months before or after the pregnancy were weaker in independent models and null when all three time periods were included, whereas the association with the 9 months of pregnancy remained (OR = 1.63; 95% CI: 1.08, 2.47). The association between ASD and PM2.5 was stronger for exposure during the third trimester (OR = 1.42 per IQR increase in PM2.5; 95% CI: 1.09, 1.86) than during the first two trimesters (ORs = 1.06 and 1.00) when mutually adjusted. There was little association between PM10-2.5 and ASD. Higher maternal exposure to PM2.5 during pregnancy, particularly the third trimester, was associated with greater odds of a child having ASD.

We analyzed data from the Israeli National Insurance Institute (NII). Autism Spectrum Disorder (ASD) incidence was calculated for all children born in Israel 1992–2009, and by population groups. Overall, 9,109 ASD cases among 2,431,649 children were identified. ASD cumulative incidence by age 8 years increased 10-fold during 2000–2011, from 0.49 % to 0.49 %, while other child disabilities in NII increased only 1.65-fold. There was a consistent increase in ASD incidence with advancing birth cohorts born 1992–2004, stabilizing among those born 2005–2009. ASD rates among Israeli Arabs were substantially lower, and increased about 10 years later than the general population. The findings suggest a role for ASD awareness, accessing of the government benefit, or the way the concept of ASD is perceived.

Background The increase in ambient temperatures (Ta) and emissions of greenhouse gases over the last century has focused attention on the effects of ambient temperatures on health outcomes. We aimed to investigate the association between Ta and the clinical measures of term low birth weight (tLBW) and small for gestational age (SGA) in singleton term infants using a decade of regional hospital data in southern Israel. Methods We linked all births in Soroka University Medical Center in the southern district of Israel insured by Clalit Health Services with pregnancy Ta estimated by our novel hybrid spatio-temporally resolved prediction model. Logistic regression generalized additive models and general linear models were used, with either tLBW or SGA as the dependent variable, modeling entire pregnancy and trimester-specific Ta adjusting for seasonality, time trend, particulate matter, maternal age, gravidity, parity, ethnicity, sex, poverty index and population density. Results The study population included 56,141 singleton term newborns, with 1716 (3.1%) cases of tLBW and 8634 (15.4%) cases of SGA . The average and the median Ta across the entire pregnancy were 19.9 (SD: 1.77, range: 14.6–24.9) degrees centigrade. The lowest Ta quartile (Ta = < 18.5) was associated with higher risk of tLBW (odds ratio = 1.33, 95%CI 1.11–1.58) while the highest Ta quartile (Ta > =21.3) was not significantly associated with tLBW (odds ratio = 1.17, 95%CI 0.99–1.38), in comparison to the two intermediate quartiles. When analyzing SGA as the dependent variable, the lowest Ta quartile was associated with significantly higher risk of SGA (odds ratio = 1.18, 95%CI 1.09–1.29) while the highest quartile was associated with significantly lower risk of SGA (odds ratio = 0.91, 95%CI 0.84–0.99) in comparison to the two intermediate quartiles. Conclusions Our findings suggest that lower pregnancy Ta may increase the risk of tLBW and SGA, and higher pregnancy Ta may decrease the risk of SGA in singleton term infants in southern Israel.

Background Environmental management in the Israeli health system is driven primarily by safety regulations. Such regulations aim to reduce hazardous exposures to employees, patients, and visitors, as well as some specific aspects of broader environmental toxicity to humans and nature. Most environmental precautions in the system target traditional exposures and do not specifically consider the health system’s own impact on climate change. This article aims to justify incorporating climate change mitigation actions into short- and long-term plans in Israeli health organizations and present a schematic strategic roadmap to do so. Main body Climate change poses many threats to global health, including risks from severe weather events, changes in vector-borne diseases, increased hazardous air pollutants, food and water shortages, and adverse effects on reproductive health. The most effective effort in climate change mitigation is reducing greenhouse gas emissions to the atmosphere. Ignoring the health sector’s emissions contradicts the ancient medical principle: first, do no harm ( primum non-nocere ). Furthermore, many climate mitigation methods introduce additional health co-benefits. Special attention and medical considerations are needed to safely reduce emissions from the health sector. This article reviews healthcare’s most common emission sources, including energy consumption, transportation, food, waste, supplies, and the supply chain. An organizational carbon management strategy should include recognizing the problem and committing to action, estimating the organizational carbon footprint, developing and prioritizing alternative interventions, and developing a carbon management plan with measurable short- and intermediate-term goals. Conclusion Climate mitigation in the health sector is encompassed by the moral obligation of the Israeli healthcare system to do no harm. Performance measures to support GHG emission reductions should be adopted into the existing, successful Israeli programs of quality measures in medicine, both in the community and hospitals. In addition, Israel academic institutions for health and medical education should incorporate sustainable health into their curricula for students of health professions and as part of continuous medical education. Such policy actions will contribute to a healthy health system that supports climate change mitigation while providing health co-benefits to the Israeli population.

Exposure to airborne particles is a risk factor of many short- and long-term health effects. Most epidemiological studies include estimates of exposure to ambient particles, however, people living in developed countries spend most of their time indoors. This work presents an analysis of a field campaign of simultaneous measurements of indoor-to-outdoor particle number concentrations (PNCs) in Israel. Fine and coarse PNCs were continuously measured using Dylos DC1700 devices from October 2016 to October 2017. The median outdoor PNC was always higher than the indoor PNC in all the five sampling locations. Outdoor fine PNCs peak during the night and experience a trough in the afternoon. The median of the fine indoor-to-outdoor PNC ratio (IOR) was 0.83, with an inter quartile range (IQR) of 0.59. The median of the coarse IOR was 0.70, with an IQR of 0.77. Lower IORs were experienced at night than during the day, with a daily peak (IOR > 1) around noon. Information about the IOR in different regions and seasons may help epidemiologists and policy makers understand the true health effects of particulate air pollution, and correct their exposure estimations such that they account for indoor exposure as well.

Dendritic cells are potent antigen-presenting cells, common in inflammatory processes. We sought to investigate dendritic cell expression in papillary thyroid carcinoma and the relationship of dendritic cell density with the extent of thyroiditis and prognosis. Specimens from 69 consecutive patients with papillary thyroid carcinoma were immunohistochemically stained for the S100 protein, and the number of positive dendritic cells was counted. Cells were sparse in normal thyroid tissue and common in areas of thyroiditis and papillary carcinoma. Dendritic cell density in papillary carcinoma correlated with the thyroiditis grade and dendritic cell density in surrounding areas of thyroiditis. High-grade thyroiditis (42% of patients) was inversely associated with 3-year recurrence. Dendritic cell density was not associated with disease-free survival. The lack of prognostic value of dendritic cell density is not compliant with the only other relevant study in the literature, and further research is required.

Haifa Bay Area (HBA) contains Israel’s principal industrial area, and there are substantial public concerns about health effects from its emissions. We aimed to examine associations between exposure to air pollution from HBA industrial area with prevalent asthma and other atopic diseases at age 17. This is a cross-sectional study. The study population included all adolescents born in Israel and whose medical status was evaluated for mandatory military recruitment by the Israeli medical corps during 1967–2017. We analyzed prevalent asthma, allergic rhinitis, atopic dermatitis, and rhinoconjunctivitis. We estimated exposure to industrial air pollution by a kriging interpolation of historical SO2 observations and adjusted the associations to the year of birth, SES, school orientation, and traffic pollution. The study population included n = 2,523,745 adolescents, among which 5.9% had prevalent asthma and 4.6% had allergic rhinitis. Residency in HBA was associated with a higher adjusted risk of asthma, compared with non-HBA residency. Still, this association was limited to the three lowest exposure categories, while the highest exposure group had the lowest adjusted risk. Sensitivity analyses and other atopic diseases presented similar results. These results do not provide support for causal relationships between HBA industry-related emissions and prevalent atopic diseases.

[...]criteria pollutants may be only a proxy for the actual agents that promote pathological brain processes. [...]the developmental window for the involvement of the pollutant in the pathological processes is not known. [...]mutual adjustment for exposures during several time points would strengthen the causal interpretation.31 Finally, animal studies provide relevant findings for possible mechanisms,32 but they can bridge only part of the gap because ASD is not a condition seen in animals. [...]despite many positive associations, the relationship with ASD is still not considered in policy discussions of air pollution.

To investigate whether treatment initiated with an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) for patients with ischemic heart disease, hypertension, or diabetes causes a reduction in hemoglobin (Hb) levels. This was a retrospective cohort analysis using the computerized database of a large health maintenance organization. Included were all adults with a first purchase of an ACE-I, an ARB, or a calcium channel blocker (CCB) between January 1, 2004, and December 31, 2009, defined as the index date. Measures of Hb levels before and 1 year after the index date were reviewed, and the change was calculated. All the analyses were stratified by pharmaceutical class. The main exposure variables were the proportion of days covered (PDC) by these drugs and the mean enalapril dosage (for enalapril users only). Levels of Hb before and after treatment were available for 14,754 patients taking ACE-Is, 751 taking ARBs, and 3087 taking CCBs. A high PDC was significantly associated with greater yearly reductions in Hb levels compared with a low PDC for CCB use, but was more pronounced for ACE-I and ARB use. A high PDC was also associated with a higher odds of developing anemia in ACE-I users (odds ratio [OR], 1.59; P<.001) and ARB users (OR, 2.21; P=.05). In nonanemic enalapril users, every 10-mg increment in daily dose was associated with an OR of 1.45 for the development of anemia (P<.001). The association remained after excluding nonadherent patients. Levels of Hb are reduced during the first year of use of ACE-Is and to a lesser extent with use of ARBs. This association is dose dependent and is not explained by patient adherence.