Therapeutic potential of deep brain stimulation of the nucleus accumbens in morbid obesity.

OBJECTIVE Morbid obesity is a growing problem worldwide. The current treatment options have limitations regarding effectiveness and complication rates. New treatment modalities are therefore warranted. One of the options is deep brain stimulation (DBS) of the nucleus accumbens (NAC). This review aims to summarize the current knowledge on NAC-DBS for the treatment of morbid obesity. METHODS Studies were obtained from multiple electronic bibliographic databases, supplemented with searches of reference lists. All animal and human studies reporting on the effects of NAC-DBS on body weight in morbidly obese patients were included. Articles found during the search were screened by 2 reviewers, and when deemed applicable, the relevant data were extracted. RESULTS Five relevant animal experimental papers were identified, pointing toward a beneficial effect of high-frequency stimulation of the lateral shell of the NAC. Three human case reports show a beneficial effect of NAC-DBS on body weight in morbidly obese patients. CONCLUSIONS The available literature supports NAC-DBS to treat morbid obesity. The number of well-conducted animal studies, however, is very limited. Also, the optimal anatomical position of the DBS electrode within the NAC, as well as the optimal stimulation parameters, has not yet been established. These matters need to be addressed before this strategy can be considered for human clinical trials.

Modeling long-term effects attributed to nitrogen dioxide (NO2) and sulfur dioxide (SO2) exposure on asthma morbidity in a nationwide cohort in Israel.

Studies have provided extensive documentation that acutely elevated environmental exposures contribute to chronic health problems. However, only attention has been paid to the effects of modificate of exposure assessment methods in environmental health investigations, leading to uncertainty and gaps in our understanding of exposure- and dose-response relationships. The goal of the present study was to evaluate whether average or peak concentration exerts a greater influence on asthma outcome, and which of the exposure models may better explain various physiological responses generated by nitrogen dioxide (NO2) or sulfur dioxide (SO2) air pollutants. The effects of annual NO2 and SO2 exposures on asthma prevalence were determined in 137,040 17-year-old males in Israel, who underwent standard health examinations before induction to military service during 1999-2008. Three alternative models of cumulative exposure were used: arithmetic mean level (AM), average peak concentration (APC), and total number of air pollution exposure episodes (NEP). Air pollution data for NO2 and SO2 levels were linked to the residence of each subject and asthma prevalence was predicted using bivariate logistic regression. There was significant increased risk for asthma occurrence attributed to NO2 exposure in all models with the highest correlations demonstrated using the APC model. Data suggested that exposure-response is better correlated with NO2 peak concentration than with average exposure concentration in subjects with asthma. For SO2, there was a weaker but still significant exposure response association in all models. These differences may be related to differences in physiological responses including effects on different regions of the airways following exposure to these pollutants. NO2, which is poorly soluble in water, penetrates deep into the bronchial tree, producing asthmatic manifestations such as inflammation and increased mucus production as a result of high gaseous concentrations in the lung parenchyma. In contrast, SO2, which is highly water soluble, exerts its effects rapidly in the upper airways, leading to similar limited correlations at all levels of exposure with fewer asthmatic manifestations observed. These data indicate that differing exposure assessment methods may be needed to capture specific disease consequences associated with these air pollutants.

Varicocoele among 1 300 000 Israeli adolescent males: time trends and association with body mass index.

Scarce data are available on epidemiology of varicocoele, the most common surgically correctable cause of male infertility. The objectives of this study were to evaluate the association between body mass index (BMI) and varicocoele and to assess trends in prevalence over time. We conducted a nationwide population-based long-term (1967-2010) study among 1 323 061 Israeli adolescent males using data from mandatory medical examination. BMI was grouped into underweight, normal weight, overweight and obese categories by percentiles adjusted for age in months and by further classification to five categories within normal weight. Univariable and multivariable logistic regression models were constructed, adjusting for possible confounders. Varicocoele prevalence (N = 47 398) increased during the study period from 1.6% for the 1950-1954 birth cohort to 4.6% for the 1990-1993 birth cohort, with the steepest rise in the normal weight group. Varicocoele unadjusted rates were highest (4.1%) among underweight and lowest (1.6%) among obese. In a multivariable model, adjusted for birth cohort, height, age and socio-demographic factors, we found a decreased risk for varicocoele in the overweight group [odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.49, 0.54] and the obese group (OR = 0.34, 95% CI: 0.32, 0.37), compared with the normal weight group. Within the normal weight group, a monotonic inverse association between BMI percentile and varicocoele was observed, most notable among 75-84.9 percentile compared to 25-49.9 percentile (OR = 0.65, 95% CI: 0.63, 0.68). In conclusion, varicocoele is common among adolescents in Israel, and its prevalence had increased in recent decades, providing clues to direct further andrological research on the role of modern lifestyle and environment in the aetiology of varicocoele. BMI, across percentiles, was found to be monotonically inversely associated with varicocoele, thus directing research and clinical efforts.

Efficacy and costs of nutritional rehabilitation in muscle-wasted patients with chronic obstructive pulmonary disease in a community-based setting: a prespecified subgroup analysis of the INTERCOM trial.

RATIONALE: Limited data are available on effectiveness and costs of nutritional rehabilitation for patients with COPD in community care. METHODS: In a 2-year RCT, 199 COPD patients (FEV(1)%pred. 60% [SD 16%]) and impaired exercise capacity were randomized to the interdisciplinary community-based COPD management program (INTERCOM) or usual care (UC). A prescheduled subgroup analysis was performed on 39 of 199 patients who were muscle wasted and received UC or nutritional therapy in combination with exercise training. Body composition, muscle strength, and exercise capacity were assessed at baseline and 4, 12, and 24 months. RESULTS: Between group differences after 4 months in favor of the intervention group: fat free mass index (FFMI 0.9 kg/m(2) [SE = 0.2, P < .001]), body mass index (BMI 1.0 kg/m(2) [SE = 0.4, P = .009]), maximum inspiratory mouth pressure (Pimax 1.4 kPa [SE = 0.5, P = .011]), quadriceps average power (QAP 13.1 Watt [SE=5.8, P = .036]), 6-minute walking distance (6MWD 27 m, [SE = 11.5, P = .028]), cycle endurance time (CET 525 seconds [SE=195, P = .013]), and peak exercise capacity (Wmax 12 Watt [SE = 5, P = .036]). Between group difference over 24 months in favor of the intervention group: Pimax 1.7 kPa (SE = 0.53, P = .004), QAP 19 Watt (SE = 6, P = .005), 6MWD 57 (SE = 19, P = .006), and CET 485 seconds (SE = 159, P = .006). After 4 months total costs were Euro 1501 higher in the intervention group than in the UC group (P < .05), but not significantly different after 24 months. Hospital admission costs were significantly lower in the intervention group -euro 4724 (95% CI -7704, -1734). CONCLUSION: This study in muscle-wasted COPD patients with moderate airflow obstruction shows a prolonged positive response to nutritional support integrated in a community-based rehabilitation program.

Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility.

OBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evaluating the effect of an INTERdisciplinary COMmunity-based management program (INTERCOM) for patients with chronic obstructive pulmonary disease (COPD). The program was offered by physiotherapists, dieticians and respiratory nurses. During the 2-year period, patients reported all resource use in a cost booklet. In addition, data on hospital admissions and outpatient visits, visits to the physiotherapist, dietician or respiratory nurse, diet nutrition, and outpatient medication were obtained from administrative records. The cost per quality-adjusted life-year (QALY) was calculated in two ways, using data from the cost booklet or registrations. RESULTS: In total, 175 patients were included in the study. Agreement between self-report and registrations was almost perfect for hospitalizations (rho = 0.93) and physiotherapist visits (rho = 0.86), but above 0.55, moderate, for all other types of care. The total cost difference between the registrations and the cost booklet was 464 euros with the highest difference for hospitalizations 386 euro. Based on the cost booklet the cost difference between the treatment group and usual care was 2,444 euros (95 percent confidence interval [CI], -819 to 5,950), which resulted in a cost-utility of 29,100 euro/QALY. For the registrations, the results were 2,498 euros (95 percent CI, -88 to 6,084) and 29,390 euro/QALY, respectively. CONCLUSIONS: This study showed that the use of self-reported data or data from registrations effected within-group costs, but not between-group costs or the cost utility.

Systemic impairment in relation to disease burden in patients with moderate COPD eligible for a lifestyle program. Findings from the INTERCOM trial.

INTRODUCTION: In contrast with the frequency distribution of chronic obstructive pulmonary disease (COPD) stages in the population, in which the majority of the patients is classified as GOLD 2, much less information is available on the prevalence and implications of systemic manifestations in less severe patients relative to GOLD 3 and 4. AIM: To characterize local and systemic impairment in relation to disease burden in a group of GOLD 2 COPD patients (n = 127, forced expiratory volume in one second (SD): 67 (11)% pred) that were eligible for the Interdisciplinary Community-based COPD management (INTERCOM) trial. METHODS: Patients were included for this lifestyle program based on a peak exercise capacity (Wmax) < 70% of predicted. Metabolic and ventilatory response to incremental cycle ergometry, 6 minute walking distance (6MWD), constant work rate test (CWR), lung function, maximal inspiratory pressure (Pimax), quadriceps force (QF), quadriceps average power (QP) (isokinetic dynamometry), handgrip force (HGF) and body composition were measured. Quality of life (QoL) was assessed by the St. George's Respiratory Questionnaire (SGRQ) and dyspnea by the modified Medical Research Council (MRC) dyspnea scale. Exacerbations and COPD-associated hospital admissions in 12 months prior to the start of the study were recorded. Burden of disease was defined in terms of exercise capacity, QoL, hospitalization, and exacerbation frequency. GOLD 2 patients were compared with reference values and with GOLD 3 patients who were also included in the trial. RESULTS: HGF (77.7 (18.8) % pred) and Pimax (67.1 (22.5)% pred) were impaired in GOLD 2, while QF (93.5 (22.5)% pred) was only modestly decreased. Depletion of FFM was present in 15% of weight stable GOLD 2 patients while only 2% had experienced recent involuntary weight loss. In contrast to Wmax, submaximal exercise capacity, muscle function, and body composition were not significantly different between GOLD 2 and 3 subgroups. Body mass index and fat-free mass index were significantly lower in smokers compared to ex-smokers. In multivariate analysis, QF and diffusing capacity (DLco) were independently associated with Wmax and 6 MWD in GOLD 2 while only 6 MWD was identified as an independent determinant of health-related QoL. HGF was an independent predictor of hospitalization. CONCLUSIONS: This study shows that also in patients with moderate COPD, eligible for a lifestyle program based on a decreased exercise capacity, systemic impairment is an important determinant of disease burden and that smoking affects body composition.

Characteristics of injuries presenting to a rural health centre in western Kenya.

OBJECTIVES: To describe characteristics of injuries among patients presenting to a rural health centre in western Kenya, and identify the associated risk factors. DESIGN: A retrospective descriptive study. SETTING: A primary care Ministry of Health Rural Health Centre in western Kenya. RESULTS: Of the 315 injured patients, 62% were males and 38% females. Young adults aged 15-44 years were the most affected, comprising 63.5%. The five most common causes of injury were struck by object (36.6%), assault (34.4%), falls (11.6%), burns (6.2%) and road traffic accidents (4.7%). Quarrels and fights were the leading reasons for assaults among males (69.5%) and females (44.4%). Most injuries occurred at work (36.2%), when subjects were engaged in vital activities (19.5%) or during play/leisure time (19.2%). A third of injured adults aged 15 years and above had consumed alcohol prior to the injury event. Alcohol use was significantly associated with assaults (51.3%) than all other causes of injury (OR=4.51, p<0.0001). CONCLUSION: The pattern and certain risk factors for non-fatal injuries among patients attending a rural health centre, such as place of occurrence, activity and alcohol use, can be identified through a facility-based electronic injury surveillance system. The information can be used to develop context-specific injury prevention interventions in the community.

[The role of occupational exposures in the etiology of bladder cancer].

In a case-control study in southern Israel, 150 male subjects with histologically proven transitional cell cancer (TCC) of the bladder were matched with 150 controls. Both groups were interviewed regarding past occupational exposures, lifestyle habits, and co-morbidities. Significant associations were demonstrated between certain occupational exposures and the risk to develop TCC. These exposures were (a) organic solvents (OR 3.5, 95% CI = 1.4-8.4), (b) aromatic amines and\or paints (OR = 2.7, 95% CI = 1.1-6.3) and (c) PAHs (OR = 1.9, 95% CI = 1.2-4.3). Similarly, significant associations were found between certain occupations (jobs) and the risk of future TCC, such as metal workers and welders. In conclusion, certain types of occupational exposures and industrial jobs bear extra risk for the future development of TCC (in addition to the well established risk of smoking). Thus, better identification and control of these occupational risk factors (chemicals and work processes) is required in order to reduce the risk for this relatively common cancer and improve protection for the relevant groups of workers.

The relationship between occupational psychological stress and female fertility.

OBJECTIVE: To investigate the association between occupational psychological stress and female fertility. METHODS: This was a case-control study including consecutive working female patients attending fertility and in vitro fertilization clinics in the Soroka University Medical Center. We compared occupational stress between 64 working patients who had attended the clinics due to female infertility (case group) and 106 working patients who had attended the clinics due to their partner's reproductive impairment (control group). RESULTS: Patients from the female infertility group were older (31.9 +/- 6.2 versus 30.2 +/- 4.6, P = 0.047) and tended to participate more in sporting activity [23.4 versus 10.4%, odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.05-6.73, P = 0.022] as compared with patients from the male infertility group. Patients from the case group tended to work more weekly hours as compared with the controls (33.6 +/- 16.8 versus 26.9 +/- 17.4, P = 0.028). High reliability was found, as demonstrated by Cronbach's alpha of 0.81-0.90 for the four burnout parameters. Patients from the female infertility group had significantly lower listlessness scores as compared with the control group, using the Mann-Whitney test (2.6 +/- 1.1 versus 3.1 +/- 1.2, P = 0.013). CONCLUSIONS: Patients admitted due to female infertility tended to have lower listlessness scores as compared with patients admitted due to their partner's infertility problem. No significant association was found between other burnout, job strain and job satisfaction scores and women's fertility status.

Regional occupational health service - an assessment.

AIM: To present, partially in quantitative terms, the basic characteristics of a regional occupational health service in southern Israel. METHOD: Records of the annual activities of the regional occupational health service were analyzed over a period of about 10 years. RESULTS: Overall there were about 25,000 contacts per year, such that about 15,000-16,000 different individuals were examined each year (out of a population of about 150,000 workers). About 45% of the examinations performed were surveillance (statutory), 38% fitness-to-work, and 15% pre-employment examinations. These proportions were quite stable over the whole study period, even though services are provided to hundreds of work-sites of markedly different sizes, exposures, and technological development. As expected, the type and rate of abnormal findings differ significantly among the 3 categories: 7% for pre-employment examinations, 18% for surveillance, and 53% for fitness-to- work examinations. CONCLUSION: In order to provide adequate occupational health services to a large, non-uniform population of workers, a clear understanding of the "occupational map" of the region is needed. A good insight into the characteristics, aims, and scope of the 3 main categories of examinations used in occupational health could assist in forecasting, planning, and providing adequate regional occupational health service.

Assessment of work-related risks factors for carpal tunnel syndrome.

BACKGROUND: The association of carpal tunnel syndrome with occupational risk factors is well established. However, in clinical practice these factors are only rarely considered and evaluated. Managing these risk factors could prevent the occurrence of future cases and alleviate treatment of the afflicted individuals. OBJECTIVES: To estimate the role of occupational risk factors in a large group of patients diagnosed by electrophysiological studies as suffering from CTS. METHODS: A group of 396 subjects (204 women, 165 men) who were tested in one laboratory by electrophysiological studies were further evaluated (by questionnaire) to determine the possible role of occupational and other risk factors in the etiology of their syndrome. RESULTS: Persons employed in high force--low repetitive or low force--high repetitive jobs, harbor an extra risk for developing CTS as compared with controls, OR = 3.21 (95% C1 = 1.5-6.9) and OR = 4.72 (95% C1 = 1.8-12.5), respectively. These jobs include typists/secretaries, nursing personnel, production workers and housewives. CONCLUSION: Evaluation of a general group of examinees referred for electrophysiological studies on sympathology compatible with CTS may show that occupational risk factors play a substantial role in the development of symptoms. By increasing the awareness of clinicians and the public to these risk factors, appropriate preventive measures can be introduced and the burden of the disease reduced.

Comparison of industrial hygienists' exposure evaluations for an epidemiologic study.

OBJECTIVES: A study was conducted to determine what level of information is required by industrial hygienists before they can develop exposure estimates comparable with those developed from a more in-depth evaluation. METHODS: Three industrial hygienists evaluated formaldehyde exposures of 300 jobs selected from an earlier epidemiologic study. The jobs were evaluated over the following 6 cycles: (i) job title and industry; (ii) job title, industry, dates; (iii) job and department title and industry; (iv) cycle 3 information with dates; (v) cycle 3 information with a plant report; and (vi) job and department title, industry, dates, and the report. Each hygienist assigned jobs to 1 of 4 exposure categories, which were compared with the categories in the original epidemiologic study. RESULTS: Overall, the mean differences between the hygienists' evaluations and the standard, although small, changed little over the cycles. The kappa statistic was poor to moderate for all the cycles, but the agreement was greater than expected due to chance. There was moderate improvement in overall agreement over the cycles using the weighted kappa statistic, but little improvement in the intraclass correlation coefficients of the hygienists' evaluations, which ranged from 0.4 to 0.5. Department information improved the agreement with the standard by 5--10%, but dates did not the improve agreement. There were some differences by type of plant, job function, exposure level, and date of the estimate. Using a hypothetical exposure-response scenario, this level of misclassification would have resulted in missing an association. CONCLUSIONS: Although there was slight improvement with increasing levels of information, these findings suggest that the subjective categorical assessment of exposures by industrial hygienists will not produce exposure estimates comparable to more in-depth evaluations of exposure.

Case-referent study on occupational risk factors for bladder cancer in southern Israel.

OBJECTIVE: To evaluate the possible association between occupational exposures (risk factors) and male bladder cancer in the Negev region (southern Israel) to enable preventive strategies to be applied. METHODS: A total of 92 male bladder cancer patients, diagnosed at a regional medical center between 1989 and 1993, were studied by interview and compared with 92 males without oncological disease after matching by age and country of origin. A special questionnaire was developed to gather information on demography, life-time occupational history, smoking habits, coffee consumption, and health status. Statistical analysis of the case-referent data was done using the SPSS-5 package for performance of the chi-square test, conditional logistic regression, and multiple classification analysis. RESULTS: Significant associations were found between bladder cancer occurrence and (1) three different groups of occupational exposures [a - solvents (P = 0.002, OR not computed due to the lack of exposed persons among referents), b - dusts (P = 0. 02; OR = 4.67), and c - exposure to multiple chemicals (P < 0.001, OR = 6.25); (2) nephrolithiasis (P = 0.02, OR = 11.00); and (3) cigarette smoking (P = 0.01, OR = 1.87). CONCLUSIONS: Certain types of occupational exposure, different from that to aromatic amines and dyes, may be considered as contributing factors in the epidemiology of bladder cancer. Better identification of these chemicals and the work processes where they are used may help in abating such exposures, thus leading to a reduction in the risk for this relatively common cancer.

[Evaluation of clinical findings in occupational health examinations].

Findings in occupational health examinations of a regional service are analyzed. The service provides pre-employment, surveillance and work-capacity evaluations for about 150,000 workers from many types of work-sites and occupations. The average number of pre-employment examinations (during 1993-97) was 4,800/year, and there were relevant pathological findings in about 6.6%. Most findings involved the respiratory (11%) and cardiovascular systems (10%) or eyes (10%). The average annual number of surveillance system examinations was 10,750. There were relevant findings in about 16%, mainly of the respiratory system (17%) and noise-induced hearing damage (about 80%). Work-capacity examinations constituted about 35% of the work-load (9,250 examinees/year). In 53% a significant health problem affecting an individual's job performance was identified. Pathological findings were found in the musculoskeletal (21%), cardiovascular (7.5%), respiratory (3%), and neurological systems (2%). Occupational health examinations can identify areas in which prevention and intervention or cooperation with other medical specialties are indicated, as well as specific topics requiring further training of occupational physicians.

Periodical multiphasic screening and lung cancer prevention.

The purpose of this work is to evaluate the utilization of information gathered by multiphasic screening with respect to lung cancer detection and smoking cessation techniques. A cohort (follow-up) study is reported in which cancer incidence and factors affecting its occurrence are evaluated in a group of about 20,000 presumably healthy adults along a period of approximately 10 years following comprehensive multiphasic health examinations. Lung cancer occurrence is primarily related to smoking. The risk is higher in smokers and is dose-dependent; OR = 0.21, (CI = 0.08, .53) in never smokers, OR = 1.53 (CI = 0.8, 3.2) in past and current moderate smokers, OR = 4.92 (CI = 2.18, 11.11) in current heavy smokers. Moreover, smokers with compromised pulmonary function (FEVI/FVC < 75%) are at an even higher risk of developing lung cancer OR = 4.22 (CI = 2.2, 8.2) for past and current moderate smokers; and OR = 10.7 (CI-2.5, 38.6) in current heavy smokers. Information gathered in periodical multiphasic health examinations could be utilized by health professionals to encourage smoking cessation and smoking prevention in the appropriate screenees. Various elements of the multiphasic test results could contribute to such prevention efforts. While every smoker should receive appropriate evaluation and consultation regarding nicotine dependence, smokers with reduced pulmonary function represent an extra high risk group to which special attention should be given.

Prevalence of cholelithiasis in non-diabetic haemodialysis and continuous ambulatory peritoneal dialysis patients.

Haemodialyzed (HD) patients have been found to have an increased bile cholesterol level and an increased saturation index in bile. These changes were markedly enhanced in the presence of a low-protein diet. To evaluate whether such changes influence the prevalence of cholelithiasis in patients with end-stage renal failure, real-time sonography was performed to detect the presence of gallstones (GS) in 54 HD (28 males, 26 females, mean age 52.4 +/- 15.4 years) and 39 continuous ambulatory peritoneal dialysis (CAPD; 22 males, 17 females, mean age 59.1 +/- 14.9 years) patients. No patient had diabetes. The patients' charts were reviewed for the following data: age, sex, primary renal disease, obesity (20% above ideal weight), history suggestive of gallbladder disease or previous cholecystectomy, duration of dialysis, and serum cholesterol levels. Overall, cholelithiasis was documented in 12 of 93 (12.9%) patients, 7 HD and 5 CAPD. When comparing the factors outlined above, no significant difference was found between HD and CAPD patient groups, either with or without cholelithiasis. Gallbladder disease was asymptomatic in all except 1 patient who required cholecystectomy. Using a healthy control group consisting of local age- and sex-matched inhabitants, GS were found in 8 of 134 (6%) of them (p > 0.05). We conclude that the prevalence rate of GS in our dialysis population (HD and CAPD) is similar to that of a local general population following a western-style diet, irrespective of dialysis mode.

Herbicide (Roundup) pneumonitis.

A case of acute intoxication presented as toxic pneumonitis after exposure to Roundup (glyphosate) (Solaris Group, Monsanto; San Ramon, CA) herbicide in an agriculture worker. The correct etiologic factor causing this specific clinical picture was identified only 2 weeks later, after a thorough occupational history was taken and meticulous delineation of the working conditions and exposures of the involved worker were made. As a rule, occupational related diseases are not readily elucidated by nonoccupational physicians. However, most acute intoxication events are first encountered by such physicians. In these situations, rapid and comprehensive evaluation is necessary in order to clearly identify the causative agent(s) and to initiate the appropriate treatment. Consulting occupational physicians at this early stage may facilitate early and accurate diagnosis.

The association between smoking and inflammatory bowel disease among israeli jewish patients.

: Our objective was to assess the association between smoking status before the onset of disease and inflammatory bowel disease (IBD) in Israeli Jewish patients through a case-control study conducted at the Hadassah University Hospital in Jerusalem, Israel, and a periodic health examination center. The cases included 71 patients with ulcerative colitis (UC) and 91 with Crohn's disease. Patients younger than 18 years at onset of disease were excluded. The controls included 162 healthy, asymptomatic individuals, matched with the patients with IBD by age at onset of disease and gender. Fewer patients with UC were current smokers (9.8%) than were controls (25.0%; p < 0.05). More patients with UC were former smokers (21.0%) than were controls (14.0%; p < 0.05). The odds ratio for UC in smokers compared with ex-smokers was 0.26 (95% CI, 0.13-0.53), and for smokers compared with never-smokers was 0.34 (95% CI, 0.21-0.54). No significant associations were found between smoking status and Crohn's disease. The results for UC are consistent with most reports and probably reflect a true association between smoking status and disease. The lack of association between smoking and Crohn's disease is in agreement with a previous Israeli study but differs from other reports. This may reflect a genetic predisposition among Jews that obscures the effects of smoking.