A bstract : Background: Genetic variation in the alcohol dehydrogenase (ADH) enzyme is associated with an aversion to alcohol and a lower risk of alcoholism among Asians. There is growing evidence of a functional role of the ADH2*2 allele in alcohol‐drinking patterns among Jews, who have traditionally exhibited low rates of alcoholism and alcohol‐related problems. The mechanism by which this allelic effect is mediated is not yet clearly understood. This study examined the effect of ADH2*2 on alcohol‐elimination rates (AER) under experimental conditions. Methods: Young adult male Jews ( N = 109) received an intravenous alcohol infusion; metabolism was measured by using standard breath alcohol concentration tests. A clamping technique was used to achieve and maintain a target breath alcohol concentration of 50 mg/100 ml for a defined time period. The AER at steady state was calculated. The alcohol disappearance rate was also calculated from the descending limb slope. Polymerase chain reaction was used for allelic determination of the ADH2 and ADH3 loci. Results: The mean AER among ADH2*2 carriers was significantly higher (8.09 ± 1.4 g/hr) than among ADH2*1 homozygotes (7.14 ± 1.5 g/hr; p = 0.003). Significance was retained on adjustment for potential confounding covariates. The ADH2 allele explains 8.5% of the AER variance in this population. Little AER difference was observed across ADH3 genotype groups. The slope of the descending limb increased with increasing copies of the ADH2*2 allele. Conclusions: The rate of alcohol elimination is significantly associated with the ADH2 genotype of Jewish males. Evidence for variation in alcohol metabolism across ADH genotypic groups provides support for the role of physiologic protective factors in alcohol drinking and suggests that reduced drinking among Jews may be genetically as well as environmentally determined. We believe that application of the novel “Indiana clamp” enhances AER measurement accuracy, allowing for detection of hitherto undetectable differences.
Ignorance about Hepatitis-C (HCV) among drug users, treatment staff, and policy makers thwarts treatment uptake and facilitates virus transmission. We assessed knowledge about HCV among methadone patients in Israel, where effective HCV-treatment is provided at low-cost within the national health insurance framework, yet few infected methadone patients are treated. In 2006, 512 patients in two methadone clinics in Israel were interviewed, of whom 53% were HCV-positive. The clinics were purposively selected from the 11 methadone clinics in the country. Respondents exhibited poor knowledge about HCV, particularly about diagnosis and treatment. Lesser-educated respondents were three times more likely to score low on HCV-knowledge compared to those with 12+ years of schooling (AOR = 2.97, 95% CI = 1.5-5.7. HCV-negative patients were also three-times more likely than HCV-positive patients to score low on the HCV-knowledge scale (Adjusted Odds Ratio = 3.0, 95% Confidence Interval = 1.9-4.7). Enhancing HCV-knowledge may help patients avoid becoming infected and infecting others, allay exaggerated fears about hepatitis, and facilitate HCV-treatment initiation among those infected.
Objective: Evidence is provided about the association between “alcohol-use disorders” and the 14-year risk of death in a community sample. Most prior descriptions of this association come from treatment samples. Method: 3,481 adult household residents were recruited into the NIMB Baltimore Epidemiologic Catchment Area survey and interviewed in 1981. The Diagnostic Interview Schedule (DIS) was employed to assess alcohol drinking and other drug-taking behaviors, and to determine fulfillment of DSM-III criteria for “alcohol abuse” and/or “dependence” diagnoses. Participants were followed-up in 1993–1996, by which time 24% of the sample had died. Median age of death was estimated for persons with and without alcohol disorders, and for “heavy” and “nonheavy” drinkers. Cox proportional hazards models adjusted for the influence of age, sex, race, “drug-use disorders,” and tobacco smoking. Results. “Alcohol abuse” and/or “dependence” was associated with a higher risk of death and a younger median age of death (adjusted relative risk =1.3, p =. 016). “Heavy” alcohol consumption was also associated with a significantly elevated risk of death. The DIS diagnosis of “alcohol use disorder” helped predict mortality over and above a prediction based solely upon “heavy drinking” (p <. 01). Conclusions: These findings indicate that the observed increased risk of death associated with “alcohol dependence” is not limited to cases severe enough to have been treated but is also present among cases in the household population.
The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.
Israel hosts nearly 70,000 migrant careworkers. Migrant careworkers work and live with populations extremely vulnerable to the novel Coronavirus, including the elderly and people with pre-existing physical conditions. This rapid assessment aimed to explore psychosocial status and mental wellbeing of migrant careworkers in Israel during the ongoing Covid-19 pandemic and determine risk and protective factors associated with mental distress, anxiety, and depression.This quantitative study was conducted via an online survey. The online survey collected social and demographic data, including country of origin, residence, age, sex, and time in Israel. In addition, questions were asked about knowledge of COVID-19 guidelines, access to supplies, and COVID-related racism. Respondents also completed a psychosocial screening tools, the Hopkins Symptom Checklist-10 (HSCL-10), which was used to screen for depression and anxiety.As of May 3rd, 2020, 307 careworkers responded to the online survey, of whom 120 (39.1%) were found symptomatic using the HSCL-10. Separating the HSCL-10 into subscales, 28.0% were symptomatically anxious, and 38.1% were symptomatic for depression. In multivariate regression, emotional distress was associated with household food insecurity (OR: 5.85; p < 0.001), lack of confidence to care for oneself and employer during the pandemic (OR: 3.85; p < 0.001), poorer general health (OR: 2.98; p < 0.003), non-Philippine country of origin (OR: 2.83; p < 0.01), female sex (OR: 2.34; p < 0.04),, and inversely associated with age (p < 0.03). While 87.6% of careworkers reported having access to hand sanitization materials regularly, only 58.0% had regular access to a medical grade mask, and 21.5% reported household food insecurity. Moreover, 40.0% of careworkers claimed to lack confidence to care for themselves and their employer during the COVID-19 pandemic.Migrant careworkers exhibited high levels of mental distress during the COVID-19 lockdown, associated with lack of confidence or resources to properly care for themselves and their employer. Guidelines and support programs specific to the carework sector, that respect their rights and guard their health, must be developed as part of a coordinated COVID-19 response.
Tenenbaum and colleagues [4] investigated a high risk pediatric population of 100 infants referred to the Hadassah University Hospital’s Medical Adoption Unit for clinical manifestations of FASD2. Four children met FASD criteria: two exhibited fetal alcohol syndrome in the absence of a known history of maternal alcohol exposure, and two exhibited partial FAS3 with confirmed (self-reported) maternal alcohol consumption [5]. Another 11 were classified as “highly likely to receive a FASD diagnosis.” The authors maintain that the prevalence of FASD is likely to be higher as most of these infants had not yet reached one year of age when FASD becomes more apparent. They estimate that 22 to 225 FASD “at-risk” babies are born annually in Israel. Yet, during the 10 year period 1998–2007, only 4 FASD cases were recorded in 17 Israeli hospitals and 6 cases were diagnosed at the primary care level [6]. This discrepancy may be due to insufficient knowledge and awareness among health care professionals, as reported by the heads of all (but one) of the 43 child development centers and genetic counseling clinics in Israel [6], who estimated that there are “tens” of undiagnosed FASD cases, and some put the number at “hundreds.” Regardless of the actual numbers of high risk drinkers and FASD cases, it is clear that physicians and other health professionals, particularly those who serve the adolescent population – those most vulnerable to alcohol-related harms – should be playing a more central role in the prevention, diagnosis, treatment, as well as research, of harmful drinking
Objective: This study provides preliminary evidence on the associations between alcohol consumption patterns and polymorphisms of the alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) enzymes in a Jewish population. Method: Two groups of Jewish men were studied--one group (n = 92) representative of the free-living population of Jerusalem and generally light consumers of ethanol and the other group (n = 53) composed of treatment-enrolled heroin dependent individuals in the same city, most with a history of heavy daily drinking. All participants were interviewed regarding sociodemographic background, present and past alcohol consumption patterns, and familial characteristics including alcohol problems among first-degree relatives. Polymorphisms of the ADH2, ADH3 and ALDH loci were determined for all participants. Results: The less common allele of the ADH2 locus (ADH2*2 allele frequency approximately 20% in Ashkenazic and non-Ashkenazic members of both groups) was related to a reduced mean level of peak weekly alcohol intake in the two groups. In multiple regression models adjusting for family history of alcohol problems and other factors, the ADH2*2 allele accounted for 20% and 30% of the explained alcohol intake variance in these two groups, respectively. Results from a logistic regression indicated that the ADH2*2 allele was also related to infrequent drinking in both groups. Evidence for an independent association between the ADH3 polymorphism and alcohol consumption patterns was not found. The ALDH gene was not polymorphic in this population. Conclusions: This report describes for the first time an association between alcohol consumption patterns and a polymorphism at the ADH2 locus in a Jewish population. The relatively high frequency of the ADH2*2 allele may contribute to the seemingly lower levels of alcohol consumption and heightened sensitivity to alcohol observed among Jews.
