Israeli Society Research Articles

Accurate minority Language Representation in the Public Space: the case of Arabic in Israel

ABSTRACT Although Arabic is the native language of a fifth of the Israeli population, its representation in the Israeli linguistic landscape (LL) is problematic. Adopting a sociolinguistic framework that underscores the political nature of language (Ben-Rafael 2009), this study invited Palestinian-Israeli college students to reflect on the linguistic reality in their area through the participatory documentary photography tool ‘PhotoVoice’. The students captured photos of linguistic landscapes, analysed them, and wrote commentaries voicing their reflections. Students ‘PhotoVoices’ shed light on the abundance of mistakes in Arabic words on the signs. Content analysis of the ‘PhotoVoices’ on this issue highlighted students’ cognitive and emotional perceptions and emerging awareness of the explicit and implicit messages delivered through the signage.

Impact of dietary fats on mental health: Omega-3, saturated, and trans fats in a healthy Israeli population

This study investigates the relationship between dietary fat consumption and mental health in a healthy Israeli population, addressing a gap in research regarding the effects of specific fats—Omega-3, saturated fats, and trans fats—on mental well-being. Despite existing studies on general eating patterns and mental health, limited research focuses on these specific dietary fats within this population. A sample of 98 participants was analysed using a correlational design and measures, including nutrition and psychological self-reported questionnaires. Results revealed that higher consumption of trans fats was significantly associated with increased depressive symptoms, with depressive scores significantly higher in those with a high trans-fat intake (M = 16.67, SD = 5.81) compared to those with lower intake (M = 10.25, SD = 4.95). Additionally, the interaction between trans-fat consumption and PUFA/SFA ratio significantly predicted depressive scores (β = 10.86, p < .001 for high PUFA/SFA ratio; β = 3.77, p < .001 for low PUFA/SFA ratio). Similarly, higher trans-fat consumption was linked to increased anxiety symptoms, as indicated by anxiety scores (β = 12.08, p < .001 for high PUFA/SFA ratio; β = 5.22, p < .05 for low PUFA/SFA ratio). Conversely, consumption of saturated fats did not significantly affect mental health, though interactions with PUFA/SFA ratios were noted (β = .14, p < .05 for high PUFA/SFA ratio). The study highlights the complex relationships between different types of fatty acids and mental health, contributing to a deeper understanding of how specific dietary fats impact mental well-being. These findings suggest potential avenues for nutritional interventions to improve mental health, mainly by reducing trans-fat intake.

The Israeli anesthesiology workforce crisis: a reassessment survey

BackgroundAnesthesiologists provide crucial anesthesiology services in the operating room and non-operating room locations. Combined with an aging and growing Israeli population, there is an increasing demand for anesthesiology services. A previous study performed in 2005 showed that most anesthesiologists are immigrant physicians with few Israeli medical school graduates. Since then, physician immigration decreased, many have retired and demand for anesthesia services has increased while insufficient numbers of new anesthesiologists were trained, leading to a shortage, limiting surgeries and other procedures in many hospitals. The present study examined the composition of the Israeli anesthesiology workforce in 2021and compared it to the 2005 workforce.MethodsA cross-sectional survey of demographic and professional information about each Israeli hospital anesthesiologists was solicited from 34 anesthesiology department chairs responsible for 36 Israeli acute care hospitals.ResultsThere are 1313 anesthesiologists in the 36 hospitals, resulting in a ratio of 14.2 anesthesiologists per 100,000 population. 22.6% of anesthesiologists will reach retirement age over the next ten years. The proportion of female anesthesiologists was 28.7%. While Israeli medical school graduates increased to 18.1% from 12.2% in 2005, non-Israeli citizens and non-permanent residents comprised 8.5% of the workforce.ConclusionsDespite growth in the ratio of anesthesiologists per population, a workforce shortage is expected to worsen over the next ten years due to retirements, shortened call hours, and the Yatziv reform which bans graduates of certain overseas medical schools from obtaining Israeli Medical Licenses. The current workforce has compensated for the existing shortage of anesthesiologists by enlisting non-Israeli trainees from overseas. Yet, it is crucial to maintain and enlarge the local Israeli workforce to forestall a worsening shortage.

Contested Victimhood: (Un)Courting Victims of Terrorism in the Israeli-Palestinian Conflict

Despite the growing number of victims of terrorism globally, research is scant about a class of victims who, in theory, epitomize Nils Christie’s concept of the “Ideal Victim,” deemed worthy of public sympathy and social support. The difficult experiences of terrorism victims in Israel, particularly in military court proceedings as documented through interviews, court transcripts, and observations, highlight how the politicization of terrorism exacerbates secondary victimization for terror victims and their families. We postulate that, in addition to the adversarial legal system constraints victims experience in legal proceedings, victim identity in Israel is culturally eschewed in favor of a national(ist) meta-narrative that valorizes strength and self-reliance. A militarized Israeli society asserting its superior might is a symbolic rejection of a helpless victim status, historically forced upon Jews facing persecution and terror. We conclude that terror victims’ treatment mirrors a given society’s image of itself.

Young adults' attitudes towards consanguinity in relation to various sociodemographic factors in the Arab society of Israel

Consanguineous marriages (CMs) have been a longstanding tradition in various communities worldwide, despite their known negative effects on future offspring. Our study aimed to determine the young adults' attitudes towards consanguinity in the Arab society of Israel, pertaining to various sociodemographic factors. The data included in this study were obtained from a national survey. The results showed that 35.4% of adults supported CMs, with a significant gender disparity: 41.2% of males compared to 29.4% of females. A direct correlation between the participants' age and positive attitudes towards CMs was noticeable. A significant portion of married adults (~46%) supported CMs, while majority of the single adults (~42%) held neutral attitudes towards CMs. Additionally, a large majority of adults (~63%) with CMs type had positive attitudes towards consanguinity. Regarding the geographic distribution, and the religious affiliation of adults, notable variations in attitudes were observed. No significant association was found between the adults' education or employment, and their attitudes towards CMs, while an inverse relationship was observed between their income levels and these attitudes. Logistic regression analysis revealed that the parameters which prove to be the significant predictors for the adults' attitudes towards supporting CMs were males, south region, married participants, and CMs type. The findings underscore that majority of the adults' attitudes towards CMs were either neutral or supporting this practice, therefore, effective strategies must be developed to increase the awareness of the young adults in relation to various health implications of CMs, thus improving the well-being of future offspring.

Socio-cultural adaptation of Mental Health First Aid to insular religious communities: the case of ultra-Orthodox society in Israel

ABSTRACT Objective The introduction of Mental Health First Aid (MHFA) in Israel has required a dynamic adaptation of the curriculum to the local social, cultural and religious context. The adaptation to the Jewish ultra-Orthodox community has been particularly rigorous and challenging. This article aims to analyse this process, its principles and steps, as well as the challenges and dilemmas it entails. Method The article employs a qualitative case study design, specifically, the instrumental case study. The adaptation procedure includes five steps: engaging local experts, organising focus groups, collaboration with communities, pilot testing in diverse communities, and iterative feedback loops. The article draws primarily on the perspectives of 45 community members, rabbis and health professionals who participated in four focus groups. Results The adaptation in ultra-Orthodox society addressed stigmatisation, silencing and concealment of mental health issues; gender segregation; educational gaps; and cultural misunderstandings of healthcare approaches. We demonstrate the need to modify the language, scenarios and examples in the curriculum, and engage with religious leaders and educational institutions. This process raises professional and ethical dilemmas, such as how MHFA should approach topics that remain unspoken in ultra-Orthodox communities. Discussion This case demonstrates that cultural adaptation is vital but may be insufficient. Attention should also be paid to social and structural forces, such as social hierarchies and systemic discrimination. A structurally competent approach should be adopted. This is the first case of accommodating MHFA for an insular religious group. It can contribute to adapting MHFA to other insular, encompassing, high-tension religious communities worldwide.

Age-corrected development of preterm children: a population-based study.

The standard practice to account for expected developmental lags in preterm children is calculating their age as if born on their expected delivery date. We aimed to assess the accuracy of standard age correction in a large and diverse population. Routine surveillance data was extracted from a national network of mother-child clinics covering over 70% of the Israeli population. We included children with no developmental delay at age 2 years old, to exclude chronic dysfunctions. For each milestone assessed before age 2 years old we calculated the age of 90% and 95% population-milestone attainment, and compared attainment age between term and preterm children, before and after age correction. The study consisted of n = 656,986 and n = 52,662 term and preterm children respectively. Without age correction extensive gaps were observed in all domains, all degrees of prematurity and persisted throughout the first 2 years of life. With age correction most gaps were resolved among moderate/late preterm children, but not among extreme and very preterm, with residual gaps of at least 2 months for motor and 1 month for language-social development. While standard age correction accounts for maturational delay in late/moderate preterm children, it may underestimate the maturational delay among very/ extremely preterm children. Standard age correction is sufficient for late/moderate preterm children, and underestimates the maturational delay of extreme and very preterm children. Prior evidence on the accuracy of standard age correction across developmental domains and degrees of prematurity was limited to dated, small-scale data. Maturational delays persist throughout the first 2 years of life across all developmental domains and in all levels of prematurity. Developmental assessments without age correction may lead to unnecessary parental anxiety.

“Israel Wilderness School” – Pattern for Discipleship in the Old Testament (God's continual Revelation of Himself to Man, for Pedagogical and Restorative Purposes)

The study explores the concept of discipleship in the Old Testament, highlighting how divine revelation continues to be a pedagogical and therapeutic process. At the centre of this process is the relationship between God and man, beginning with Adam and continuing with the patriarchs, prophets, and the people of Israel, culminating in the Christ disciple’s model. It is emphasised that the whole of revelation provides a complete model for discipleship, to guide humanity towards divine communion. The study also analyses the educational structures in Jewish society, in which the family, the royal court and scribal schools play essential roles. It discusses the biblical terminology specific to discipleship and the relationship between learning and the divine will, concluding that true religious education is about accumulating knowledge and living by God's will so that man can re-enter into a relationship with the supreme Teacher.

The Immigration and Strategic Assimilation of Bene Menashe: A Zomian Jewish Community in Israel

ABSTRACT Based on ethnographic fieldwork conducted among a community of immigrants from the Eastern Indian states of Manipur and Mizoram, Bene Menashe, this article deals with how these immigrants have used ethnic identity to further integrate into mainstream Jewish and Israeli society. Originally known as the Kuki-Chin-Mizo, Bene Menashe claim to be descendants of the lost tribes of Israel, cut off from other Jews for 2,700 years. Several thousand members of the community have emigrated to Israel since the 1990s. Bene Menashe’s background as a singular community of East Asian immigrants in the peripheral town of KA and as recent converts to Judaism, as well as their Zomian (Upland Southeast Asian) background, are central to the community’s negotiation of ethnoreligious identity. Their efforts to integrate into contemporary Israeli society often contrast with the drive of Israeli cultural agents to emphasise the group’s lost tribal heritage, and the community has also both emphasised and sought to discard their previous ethnic identity. Bene Menashe in KA, this article shows, employ several strategies to further their ‘strategic assimilation’ into Israeli society.

Mortality during the SARS-CoV-2 Pandemic: A Comparative Analysis between Lombardy in Italy and Israel.

Background: This retrospective study contrasts the impact of the SARS-CoV-2 pandemic in Lombardy (Italy) and Israel, focusing on mortality, healthcare response, public health measures, and demographics. Methods: We analyzed SARS-CoV-2 data from Lombardy and Israel covering four viral waves. Data included infection rates, hospitalizations, and mortality. In Lombardy, healthcare data were collected from the administrative database of the Lombardy Welfare Directorate; in Israel, they were collected from Clalit Health Services and the Israeli Ministry of Health's COVID-19 database. Statistical analyses compared trends in infection rates, demographics, and mortality rates across the four viral waves by using logistic and linear regression models and adjusting for age, sex, and comorbidities. Results: Lombardy exhibited significantly higher SARS-CoV-2 infections and COVID-19 hospitalization rates during the first wave than Israel, with 71,558 cases over a population sample of ~10 million versus 5741 over a population sample of ~4.7 million in Israel. The majority of cases in Israel were managed at home, with 18 cases only (0.3%) requiring intensive care unit (ICU) hospitalization during the first wave, compared to 4104 (5.7%) cases in Lombardy. Israel's vaccination campaign began earlier, so that by the fourth wave, 439,545 (42.2%) people in Israel were fully vaccinated with three doses, compared to 214,542 (22.9%) in Lombardy. Mortality decreased over time in both sites, dropping from 103 cases (1.8%) to 1550 (0.1%) in Israel and from 13,372 (18.7%) to 4388 (0.3%) in Lombardy. Conclusions: Early public health interventions and vaccination were crucial in managing the SARS-CoV-2 impact.

Association of Acute Incidental Cerebral Microinfarcts With Subsequent Ischemic Stroke in Patients With Cancer: A Population-Based Study.

Incidental diffuse-weighted imaging (DWI)-positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMIs), are a common type of brain ischemia, which can be detected on magnetic resonance DWI for approximately 2 weeks after occurrence. Acute incidental CMI was found to be more common in patients with cancer. Whether acute incidental CMI predicts future ischemic stroke is still unknown. We aimed to examine the association between acute incidental CMI in patients with cancer and subsequent ischemic stroke or transient ischemic attack (TIA). This is a retrospective cohort study. We used Clalit Health Services records, representing over half of the Israeli population, to identify adults with lung, breast, pancreatic, or colon cancer who underwent brain MRI between January 2014 and April 2020. We included patients who underwent scan between 1 year before cancer diagnosis and 1 year after diagnosis. Primary outcome was ischemic stroke or TIA using International Classification of Diseases, Ninth Revision codes. Secondary outcomes were intracranial hemorrhage (ICH) and mortality. Records were followed from first MRI until primary outcome, death, or end of follow-up (January 2023). Cox proportional hazards models were used to calculate hazard ratio (HR) for patients with and without acute incidental CMI, as a time-dependent covariate. The study cohort included 1,618 patients with cancer, among whom, 59 (3.6%) had acute incidental CMI on at least 1 brain MRI. The median (interquartile range) time from acute incidental CMI to stroke or TIA was 26 days (14-84). On multivariable analysis, patients with acute incidental CMI had a higher stroke or TIA risk (HR 2.97, 95% CI 1.08-8.18, p = 0.035) compared with their non-CMI counterparts. Acute incidental CMIs were also associated with mortality after multivariable analysis (HR 2.76, 95% CI 2.06-3.71, p < 0.001); no association with ICH was found. Acute incidental CMI on brain MRI in patients with active cancer is associated with an increased risk of near-future ischemic stroke or TIA and mortality. This finding might suggest that randomly detected acute incidental CMI in patients with cancer may guide primary cerebrovascular risk prevention and etiologic workup.

Parenting Styles and Teachers' Teaching Styles impact on Students' Values Development

This study examines the effect of parenting and teaching styles on students' values development within Arab society in Israel. It aimed to determine: 1) the relationship between parenting style and students’ values development from teachers’ perspectives; 2) how teaching methods using English as a Second Language (ESL) strategies affect students' values development; and 3) demographic differences (sex, role, education, types of schools) among teachers in values development and parenting styles.The sample includes 280 teachers (112 male; 168 female) from Arab high schools' students in northern Israel and 200 parents (104 male; 96 female) who participated in the questionnaire. Findings indicate that authoritative parenting, which balances warmth and control, is most effective in fostering positive values, while authoritarian and permissive styles may lead to poorer outcomes in self-esteem, motivation, and behavior. Discussion-oriented and student-centered teaching approaches promote critical thinking, empathy, and ethical reasoning. No significant differences were found in the impact of teaching and parenting styles on values development based on gender, age, or educational level of teachers, except for differences in direct and delegating teaching styles.The study concludes that parenting and teaching styles are interdependent. Supportive parenting enhances the effectiveness of constructive teaching methods, and teachers' approaches can reinforce values instilled by parents. Recommendations for Arab society include promoting authoritative parenting through educational programs, encouraging discussion-based and student-centered teaching methods via teacher training and curriculum reforms, fostering school and community collaboration, addressing cultural sensitivities, and providing teachers with necessary resources and professional development opportunities.

Food insecurity amongst asylum seekers and people without status in Israel

BackgroundThe COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19.MethodsA multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed.ResultsFour hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05–1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts.ConclusionIn conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.

Gene-Environment Interactions Significantly Alter the Obesity Risk of SH2B1 rs7498665 Carriers.

Src homology 2 B adaptor protein 1 (SH2B1) gene and variants have been found to be associated with common obesity. We aimed to investigate the association between the common missense variant SH2B1 rs7498665 and common obesity risk as well as interactions with lifestyle variables in an Israeli population. An adult cohort (n=3,070; ≥18 years) with the SH2B1 rs7498665 variant and lifestyle, behavior (online questionnaire), and blood glucose data was analyzed. Associations between this variant, obesity risk (body mass index [BMI] ≥25 and ≥30 kg/m2), and interactions with behavioral and lifestyle factors (stress levels, eating habits score [EHS], physical activity [PA], and wine consumption) were investigated. Association and gene-environment interactions were analyzed using binary logistic regressions with interaction. SH2B1 rs7498665 carriers were significantly (P<0.05) more likely to be overweight (BMI ≥25 kg/m2) or obese (BMI ≥30 kg/m2) in recessive (odds ratio [OR], 1.90 and 1.36, respectively), additive (OR, 1.24 and 1.14, respectively), and codominant (OR, 2.00 and 1.41, respectively) genetic models. SH2B1 rs7498665 interacted with lifestyle and behavioral factors as well as glucose levels. PA and moderate wine consumption (1 to 3 drinks/week) reduced obesity risk (OR, 0.35 and 0.71, respectively). Conversely, carriers of two risk alleles who reported high stress levels, had ≥median EHS, and who had a fasting glucose level ≥90 mg/dL had a significantly increased obesity risk (OR, 3.63 and 5.82, respectively). Carrying SH2B1 rs7498665 significantly elevates the risk of obesity. Actionable lifestyle and behavioral factors significantly modulate the rs7498665 genetic predisposition to obesity; PA and moderate wine consumption attenuate the risk, while high stress, EHS, and fasting glucose level increase the obesity risk.

Assessing the Universality of Universal Health Coverage: Israel and the Occupation of Palestine

Abstract Universal health coverage (UHC) is founded on a commitment to health coverage for all. Israel claims to have achieved UHC, while public health services in the Occupied Palestinian Territories (OPT) are left primarily to the Palestinian Authority (PA). In this article, we assess Israel’s responsibility for health in the OPT by examining Israel’s sovereignty over the OPT. We argue that Israel legally and practically remains the sole sovereign entity in the OPT, and then assess the health disparities faced by Palestinians. We conducted a side-by-side comparison of indicators and inputs of the Israeli and PA health systems, including health expenditure and the density of healthcare professionals and facilities, using data from the World Bank, Physicians for Human Rights, the World Health Organization, and the Palestinian Central Bureau of Statistics. On all selected measures, Israel reports better outcomes. Nearly 20% more of the Israeli population has essential service coverage; fewer Israeli citizens report catastrophic health expenditure. Israel reports more than double the proportion of beds and physicians and more than 10 times the health expenditure per capita. Life expectancy is eight years greater for Israelis. We conclude that these disparities amount to systemic exclusion of Palestinians from health services by Israel, undermining Israel’s claim to have achieved UHC. This has important implications for Palestinians, as it reveals Israel’s systematic neglect of the health of Palestinians as a form of structural violence, on top of which it inflicts frequent escalations of violence against Palestinians. It also highlights the importance of looking beyond aggregated indicators to expose the exclusion of marginalized communities.

Identifying potentially undiagnosed individuals with hyper-IgE syndrome using a scoring system

BackgroundHyper-IgE syndrome (HIES) constitutes a group of rare primary immunodeficiency disorders. The diagnosis relies on the National Institutes of Health (NIH) scoring system, incorporating clinical and laboratory data. Scores greater than or equal to 15 raise a strong suspicion of the disease. In an isolated Israeli population, Zinc Finger 341 deficiency, a subtype of HIES, has a carrier incidence of 1:20, but the prevalence of the clinical syndrome within this community remains unknown. ObjectiveTo estimate the prevalence of potentially undiagnosed HIES cases within this population by using the NIH scoring criteria. MethodsThis retrospective cohort study obtained requisite clinical and laboratory data for NIH score computation from the electronic medical records of Clalit Health Services for the isolated village under scrutiny in comparison to a neighboring village. Subsequently, clinical scores were assigned to each subject, enabling comparative analysis of suspected diagnosis rates between the 2 populations. ResultsAmong the 29,390 studied subjects, 12 had a documented diagnosis of HIES. All were in the study village, and none were from the control village (0.08% vs 0%, P < .01). Within the study village, 235 individuals (1.62%) had an NIH score greater than or equal to 15 and were suspected with having HIES almost doubled compared with the control group at 130 individuals (0.87%) (P < .001). ConclusionThis is the first time the NIH clinical score system has been used for population screening. The significant disparity in the prevalence of suspected, undiagnosed cases between the study village and the control village strongly suggests the potential utility of this tool for preliminary screening.

Unveiling factors shaping distress levels over 2.5 years of enduring adversity

In the face of global adversities such as pandemics, military conflicts, and socio-political unrest, the resilience and well-being of populations can be severely tested. This study examines the fluctuating levels of distress within the Israeli population over a period of 2.5 years, encompassing events like the COVID-19 pandemic and various socio-political and security crises. Utilizing a quasi-longitudinal design, data were collected at thirteen time-points, mirroring the demographic makeup of the Israeli Jewish adult population. Measures of psychological distress, societal and individual resilience, hope, morale, and perceived danger were assessed, alongside demographic variables. Statistical analyses included ANOVA and stepwise regression models. Distress levels displayed significant oscillations in response to adverse events. High distress was noted during the latter stages of the study, particularly following a major security incident on October 7, 2023. The regression analyses identified morale and perceived danger as consistent important associations with distress, with individual resilience also inversely related across all time points. The study reveals the dynamic nature of psychological distress in relation to a range of adversities. Morale emerged as a key buffer against distress, whereas perceived danger was a significant stressor, especially during acute- existential threats. These findings have important implications for mental health interventions and policy-making aimed at fostering resilience and mitigating distress in crisis conditions.

Between tradition and modernity: Arab fathers’ experiences of parental guidance in Israel

ABSTRACT The present study examined the experience of parental guidance from the perspective of fathers from the Arab minority population in Israel. The Arab minority in Israel is currently engaged in a transition process – from a traditional and patriarchal society to the modern culture that characterizes the Israeli society. The study implemented a qualitative methodology. The sample included 15 fathers who participated in a parental guidance process. Data were collected through semi-structured interviews. Four themes were gathered: (1) referral to parental training; (2) fathers’ attitudes toward the therapeutic encounter in the context of Arab culture; (3) changes the fathers experienced as a result of the guidance process; (4) significant processes and techniques used in the parental guidance process. The findings highlighted the specific elements of the parental guidance that enables fathers to cooperate without fearing to damage their self-image as an Arab man. In addition, a new concept was proposed – a multi-cultural treatment approach, which describes a situations where both the clients and the social workers are part of a cultural minority and wherein both parties move back and forth along the continuum between the traditional and the modern culture.

The natural history of dihydrolipoamide dehydrogenase deficiency in Israel.

Dihydrolipoamide dehydrogenase (DLD) deficiency is an ultra-rare autosomal-recessive inborn error of metabolism, affecting no less than five mitochondrial multienzyme complexes. With approximately 30 patients reported to date, DLD deficiency was associated with three major clinical presentations: an early-onset encephalopathic phenotype with metabolic acidosis, a predominantly hepatic presentation with liver failure, and a rare myopathic phenotype. To elucidate the demographic, phenotypic, and molecular characteristics of patients with DLD deficiency within the Israeli population, data were collected from metabolic disease specialists in four large tertiary medical centers in the center and south of Israel. Pediatric and adult patients with biallelic variants in DLD were included in the study. A total of 53 patients of 35 families were included in the cohort. Age at presentation ranged between birth and 10 years. Wide phenotypic variability was observed, from asymptomatic individuals in their sixth decade of life, to severe, neonatal-onset disease with devastating neurological sequelae. Six DLD variants were noted, the most common of which was the c.685G>T (p.G229C) variant in homozygous form (24/53 patients, 45.3%; 13/35 families), observed mostly among patients of Ashkenazi-Jewish descent, followed by the homozygous c.1436A>T (p.D479V) variant, found in 20 patients of Bedouin descent (37.7%; 16/35 families). Overall, patients did not necessarily present as one of the previously described distinct clinical phenotypes. DLD deficiency is a panethnic disorder, with significant phenotypic variability, and comprises a continuum, rather than three distinct clinical presentations.

Preference heterogeneity over the aspects of individual well-being: towards the construction of an applied well-being index

Measuring the well-being of individuals is a significant challenge for social scientists, policy makers, and suppliers of social programming, since well-being consists of many dimensions that are difficult to measure, both individually and collectively. Moreover, the relative contribution of each of the various aspects to overall well-being is unknown. We try to answer this challenge using the methodology of Benjamin et al. (Am Econ Rev 104(9):2698–2735, 2014) and using a survey that measures preferences over 27 aspects of individual well-being. We provide estimates of these preferences for a representative sample of the Israeli population. We also document heterogeneity in preferences for respondents with different current levels of well-being and for different demographic groups. For some aspects of well-being, we provide evidence of decreasing marginal utility. For other aspects, we find evidence for what appears to be an increasing marginal utility but we argue that it likely reflects an endogenous determination of the level of well-being. We discuss the policy implications of our findings and how our results could be aggregated to a well-being index that could be used to evaluate and compare the effects of different policy interventions.