Lital Keinan-Boker

BACKGROUND: During the last few decades much effort has been invested into lowering smoking rates due to its heavy burden on the population's health and on costs for the health care services. OBJECTIVES: To compare trends in smoking rates between adult Arab men and Jewish men and women during 2000-2008. METHODS: Six random telephone surveys were conducted by the Israel Center for Disease Control in 2000-2008 to investigate smoking rates. The number of respondents was 24,976 Jewish men and women and 2564 Arab men. The percent of respondents reporting being current smokers was calculated for each population group (Jews and Arabs) by age, gender and education, and were studied in relation to time. RESULTS: Among Jewish men aged 21-64 smoking declined during 2000-2008 by about 3.5%. In the 21-44 age group this decline occurred only among respondents with an academic education. Among Jewish women this decline also occurred at ages 21-64, and in the 45-64 age group this decline was due only to a decline in smoking among those with an academic education. Among Arab men aged 21-64 an increase in smoking rates of about 6.5% was observed among both educated and less educated respondents. CONCLUSIONS: Smoking prevalence is declining in Israel among Jews, but not among Arab men. The larger decrease in smoking rates among academics will, in the future, add to the inequalities in health between the lower and higher socioeconomic status groups and between Arabs and Jews. This calls for tailored interventions among the less educated Jews and all Arab men.

Endothelium-dependent vasodilator function may be regarded as an index of inflammation. Endothelial dysfunction has been observed in stroke patients and has been related to stroke physiopathology, stroke subtypes, clinical severity, and outcome. Our aim was to measure systemic vascular function directly (using forearm flow mediated dilatation) in patients with acute ischemic stroke and to clarify whether recent acute ischemic stroke is associated with impaired vascular function. Patients who were not eligible for thrombolytic therapy because of delayed arrival were randomly recruited to the study after signing a consent form. All 43 patients were conscious and had an acute ischemic stroke. Brain CT was performed on admission, and clinical evaluation was carried out by a neurologist on admission and four days later. Vascular responsiveness was evaluated by ABI and by endothelial function measurements on admission. Levels of P-selectin were measured during the first 24 hrs and on day 4. Forty-three patients (28 men and 15 women) and 23 healthy men (control) were enrolled in the study. Patients were older (62.4±12.5 y vs 44.2±11.6 y, p=0.001), had worse endothelial dysfunction (-4.4±7.4% vs 16.6±7.6%, p=0.001), and had a higher BMI (28±6 vs 24±5, p=0.001). No gender effect was found in endothelial function (-5.1±7.8% vs -2.5±6.6%, p=0.25) and ABI (1.0±0.26 vs 1.0±0.5, p=0.29). However, men had lower BMIs compared to women (26.8±5.8 vs 31.4±5.5, p=0.01). The neurological scale decreased from 4.9±3.4 to 3.2±3.0 on day 4 (p=0.001). In men, it was 4.8±3.8 on admission, and decreased to 3.2±3.4 on day 4 (p=0.001). In women, it was 5.0±2.7, and decreased to 3.3±2.3 on day 4 (p=0.001). P-selectin levels were high on admission (68.0±55.5 pg/ml) and increased 4 days later (102.3±72.0 pg/ml) (p=0.01). Men had higher levels on admission (79.1± 66.7 pg/ml vs 48.9± 15.4 pg/ml, p=0.02) and rose on day 4 to 113.6±82.6 pg/ml (p=0.05); in women P-selectin increased from 48.9± 15.4 pg/ml to 83.5±46.4 pg/ml (p=0.01), without gender effect on day 4 (113.6±82.6 pg/ml [men] vs 83.5±46.4 pg/ml [women] (p=0.08)). None of the univariate models seemed statistically significant---gender (p=0.448), age (p=0.100), BMI (p=0.607), ABI (p=0.103), FMD% (p=0.456), and P-selectin (p=0.195). Patients with acute stroke had severe endothelial dysfunction during the first 24 hrs with high P-selectin levels that further increased over the first week. Vascular instability and procoagulant activity are still in progress in the first days following acute stroke and patients are at risk to develop more vascular events at that time.