Prevention of risk factors for cardiovascular diseases. A community intervention project.

By offering programmes for the prevention of risk factors for cardiovascular diseases through various existing recreational and cultural programmes and personnel, the community centre can add a new dimension to its services by affecting the patterns of behaviour of the public at large, with possible positive implications for health improvement and enhancement.

Episodes of illness in breast-fed and bottle-fed infants in Jerusalem.

In a prospective study on breast-feeding in Jerusalem, 274 middle-class Jewish women were interviewed about their breast-feeding practices, and symptoms and signs of disease, episodes of illness and hospitalization of the infant. Women of a higher education level breast-fed more often and for a longer period than did women with less education. Infants exclusively breast-fed had significantly fewer symptoms of disease than did those not breast-fed or partially breast-fed. The odds ratios for cough, respiratory difficulty, and diarrhea by breast-feeding practice were 3.66, 2.14 and 2.72 (P = 0.04). Significant differences in the number of illness episodes were found between breast-fed and bottle-fed infants at 20 weeks; infants exclusively breast-fed had the least number of illness episodes. A positive association was found between number of illness episodes and duration of breast-feeding. Infants who were breast-fed for 20 weeks had the least number of illness episodes; 52% of them had no episode compared with only 15% who were not breast-fed. Comparison of the numbers of illness episodes among non-breast-fed infants of mothers with low and high education levels indicated that the infants of better educated mothers had a significantly lower percentage of illness episodes (P less than 0.05). Even infants of a middle-class and well-educated population benefit from the breast-feeding practice and its protective effect, more so if they are exclusively breast-fed and for a longer period.

PIP: The frequency of illness episodes in bottlefed, partially breastfed, and exclusively breastfed infants was compared through the 19th postpartum week for 274 infants born at the Hadassah University Hospital between January and July 1979. 402 infants were selected for inclusion in the study from the 1000 consecutive births, which occurred at the hospital during that time period, on the basis of residential proximity to the hospital and single birth status. Mothers of the infants were interviewed after delivery, just prior to discharge, at 6-7 weeks postpartum, and at 20 weeks postpartum. 69% of the mothers were interviewed at all 4 stages, and 274 were interviewed at the 4th stage. At each stage the women were questioned about infant feeding practices and at the 3rd and 4th stage about illness episodes among their infants. 50% of the mothers were Israeli born, 31% were of European or American origin, and the remaining 19% were either from Ais or North Africa. 52% had more than 12 years of schooling, and 48% had less. 89% of the women started breastfeeding in the hospital, 41% still breastfed at 13 weeks, and 27% still breastfed at the 20th week. Prolonged breastfeeding was more common among the more educated mothers than among the less educated mothers. At 20 weeks postpartum the mothers were asked whether their infants experienced any of 10 symptoms during the previous week. Infants exclusively breastfed at 20 weeks had significantly fewer symptoms than partially breastfed and bottlefed infants. For example the proportion of infants who had more than 1 symptom was 8% for the exclusively breastfed, 43% for the partially breastfed, and 43% for the bottlefed infants. Odds ratios for the bottlefed infants compared to the breastfed infants for respiratory difficulties, cough, diarrhea, and vomiting were respectively 3.66, 2.14, 2.72, and 2.14. When educational level was controlled, the corresponding values were 3.33, 1.96, 2.27, and 1.49. An analysis of the number of illness episodes which occurred between the 6th and 20th postpartum weeks revealed that excusivley breastfed infants had significantly fewer episodes than the other 2 groups of infants. For example, the proportion of infants who had 3 or more illness episodes was 16% for bottlfed infants, 4% for partially breastfed infants, and 0% for exclusively breastfed infants; and the proportion reporting no episodes of illness was 62% for the exclusively breastfed, 47% for the partially breastfed, and 29% for the bottlefed. The pattern held for all educational groups and was strongest for infants whose mothers had the least education. Furthermore, 11% of the bottlefed, 8.1% of the partially breastfed, and 2.7% of the exclusively breastfed infants required hospitalization at some point between the 1st and 20th postpartum week. These findings demonstrate that even in predominantly middle class populations, breastfeeding provides health advantages for infants.

Advice from the obstetrician and other sources: do they affect women's breast feeding practices? A study among different Jewish groups in Jerusalem.

Breast feeding practices and the sources of advice that influenced them were studied in a sample of 276 women from North East Jerusalem. They were followed-up for 4 1/2 months and interviewed on 4 occasions during that period. It was found that 89.7% started breast feeding after parturition, 62.4% were breast feeding by 6 weeks, 40.3% were breast feeding after 3 months and 27.3% were still breast feeding by 4 1/2 months postpartum. Obstetrician's advice given at the 6 weeks postpartum examination was significantly associated with duration of breast feeding (P = 0.001). Other sources of guidance were not significantly related to duration of breast feeding when controlling for social class. Analysis of variance indicated that women of higher social classes breast fed more and for a longer period of time. There was no difference in the pattern of attendance at the obstetrician's examination by social class, although a very small proportion of women belonging to the lower social classes reported getting advice on breast feeding during that visit. There was a strong relation between advice of the obstetrician and percentage of women breast feeding 4 1/2 months postpartum. Country of origin of the women also affected breast feeding practices. Women of Western origin breast fed more and longer than women of Asian or North African origin. This might be explained by social movements that attempt a return to more natural life styles which are prominent in Western societies. The differential relationship between advice of obstetrician and women belonging to different social classes is discussed and key elements in the relation between obstetrician's advice and women's breast feeding practices are considered.

Relationship of breast feeding versus bottle feeding with emergency room visits and hospitalization for infectious diseases.

Breast-feeding habits of 480 Jewish infants visiting a pediatric emergency room (ER) with infectious diseases were compared to those of 502 healthy infants visiting maternal-child health centers (MCH). (These centers are attended by almost 100% of the Jewish infant population.) Among infants under 5 months of age with acute gastroenteritis and upper respiratory infections, breast feeding was significantly less prevalent than among age-matched infants in the MCH group (22.6%, 18.5% and 53.4% respectively, P less than 0.0001). Infants with acute otitis media and lower respiratory tract infections showed the same trend although the numbers were small. A very short breast-feeding period of 2 weeks or less was more prevalent among the ER group and was associated with increased hospitalization rate. These data emphasize the importance of breast milk in reduction of ER visiting and hospitalization rate.

PIP: Breastfeeding habits of 480 Jewish infants visiting a pediatric emergency room (ER) with infectious diseases were compared to those of 502 healthy infants visiting maternal-child health centers (MCH; these centers are attended by almost 100% of the Jewish infant population). Among infants under 5 months of age with acute gastroenteritis and upper respiratory infections, breastfeeding was significantly less prevalent than among age-matched infants in the MCH group (22.6%, 18.5%, and 53.4% respectively, P0.0001). Infants with acute otitis media and lower respiratory tract infections showed the same trend although the numbers were small. A very short breastfeeding period of 2 weeks or less was more prevalent among the ER group and was associated with increased rates of hospitalization. These data emphasize the importance of breastmilk in reduction of ER visitation and hospitalization rates.

Clustering of Hodgkin's disease in Israel: a case-control study.

The geographical distribution of Jewish patients in Israel with HD diagnosed between 1960 and 1972 differed significantly from that of individually-matched population controls. Significant clustering occurred in 3 regions of the country. The odds ratio expressing the greater tendency of patients to have lived in one of these regions 5-9 years before the diagnosis, as compared with that of their paired controls, was 2.4. The association with residence in a higher-risk region was not significantly modified by sex, age, period of immigration, region of birth, father's region of birth, or date of diagnosis. The association was weaker for cases with nodular sclerosis than for those with other subtypes of HD. The clustering could not be explained by available data on the characteristics and prior experience of the cases and controls. There was a significant correlation between the risk of HD in a region and the proportion of native Israelis in its Jewish population, but there were no significant correlations with a variety of other demographic, natural and socioeconomic features of the regions. There was no significant time-space interaction. The findings suggest that susceptible people living in certain parts of the country during the 1950's and 1960's had a somewhat enhanced risk of HD because of exposure to unidentified environmental factors active in those regions at that time.

A case-control study of Hodgkin's disease in Israel.

Jewish residents of Israel in 1960-72 with Hodgkin's disease (HD) were compared with controls drawn from the general population. The controls were individually matched by sex, age, origin, and date of immigration. The comparison showed a significant association between HD and parental consanguinity and pointed to the possible etiologic role of recessive inheritance. Females with HD tended to have a lower parity than did their controls. Associations between HD and a high educational level and the presence of a flush toilet in the childhood home were significant and gave limited support to the hypothesis that a high standard of living in childhood increases the risk of subsequent HD. Tonsillectomy and a history of work with wood or trees were significantly associated with mixed cellularity but not with other histologic subtypes. Differences between patients with HD and controls with respect to cigarette smoking, exposure to animals, marital status, previous blood transfusions or jaundice, contact with asbestos, residual or occupational mobility, or other characteristics were not significant.