Objective. The aim of this study was to assess the extent of nondisclosure of type 1 diabetes in adolescents and investigate its association with several psychosocial parameters and clinical outcomes. Research design and methods. This was a cross-sectional study based on data collected from 69 adolescents with type 1 diabetes who were 12–18 years of age and followed at our diabetes clinic. The degree of disclosure, demographics, diabetes management, and psychosocial issues were assessed via questionnaires. Clinical parameters were derived from medical records. Associations between nondisclosure status and clinical and psychosocial study variables were assessed. Results. Fifty-three participants (77%) reported some extent of nondisclosure. Nondisclosure was associated with low self-esteem, reduced friend support, and increased diabetes-related worries. Nondisclosure was also found to be associated with diminished self-care behaviors related to insulin administration and with elevated A1C. Conclusion. Our results demonstrate that nondisclosure of type 1 diabetes in adolescents may be more common than initially recognized and is likely associated with unfavorable psychological outcomes and reduced self-care and diabetes management. Our results emphasize the importance of social interactions and disclosure in adolescents and may serve as a potential stepping stone to address other social barriers hindering diabetes management.

Studies of the association between maternal nutrition and birth outcomes have investigated differing nutrients, maternal socioeconomic conditions, and timing within the reproductive cycle; and have produced inconsistent results. We evaluated the association of preconceptional maternal dietary intake with birth outcomes among low socioeconomic status ethnic minority women in a high-income country. In this prospective cohort study, habitual preconceptional dietary intake was assessed among pregnant Bedouin Arab women in Israel (n = 384), using a short culturally specific, targeted food frequency questionnaire. Multiple nutrients (protein, lysine, calcium, iron, zinc, folate, omega-3 fatty acids) were evaluated simultaneously via a diet quality score derived from principal component analysis. Multivariable logistic regression was used to test associations between the diet quality score and a composite adverse birth outcomes variable, including preterm birth, low birth weight and small for gestational age. Sixty-nine women (18%) had adverse birth outcomes. Women with low preconceptional diet quality scores had low intakes of nutrient-rich plant foods, bioavailable micronutrients, and complete proteins. In multivariable analysis, a woman at the 10th percentile of the diet quality score had a 2.97 higher odds (95% CI 1.28–6.86) of an adverse birth outcome than a woman at the 90th percentile. Low diet quality during the preconceptional period was associated with adverse birth outcomes among low socioeconomic status minority women in a high-income country. The results have implications for the development of appropriate intervention strategies to prevent adverse birth outcomes, and the promotion of adequate nutrition throughout the child-bearing years.

Early social and economic deprivation, associated with poor nutrition and physical inactivity, may lead to adverse health trajectories. A cluster-randomized controlled-trial examining the effect of a school-based comprehensive intervention on nutrition knowledge, eating habits, and behaviors among low socioeconomic status (LSES) school-aged children was performed. LSES school-aged children (4–7 years) and their mothers were recruited from 11 schools, located in one town. The intervention was implemented on three levels: children, mothers, and teachers. The intervention (IArm) included nutrition classes for children, mothers, and teachers and physical activity (PA) classes for children; the control (CArm) received PA only. Interventions were conducted by professional personnel, who were trained during in a two-day session to deliver the specific program in schools. Family data were obtained by parental interviews. Food knowledge observations, packed lunch records, and anthropometric measurements were obtained in school at baseline, six months, and at the end of the school year. Of 258 children enrolled, 220 (87.6%) completed the six-month program. Only children in the IArm improved their nutrition knowledge and eating-habits and increased food variety and fruit and vegetable consumption, quality score of packed lunches (p < 0.001 for all), habitual water drinking increased (p = 0.02), and decreased sweet-drink consumption (p = 0.05). A school-based comprehensive nutrition intervention targeting LSES population improved eating habits, nutritional knowledge, and healthier packed lunches.

OBJECTIVES:Carbapenem-resistant Gram-negative bacteria (CRGNB) pose a clinical challenge. We attempted to estimate the mortality burden of CRGNB among haematological cancer patients.METHODS:This was a retrospective cohort study. We included adult patients hospitalized in the haemato-oncological/bone marrow transplantation departments for chemotherapy, between 2008 and 2014, with Gram-negative aerobic bacteraemia. We compared patients with CRGNB and carbapenem-susceptible Gram-negative bacteraemia (CSGNB). The primary outcome was 14 day all-cause mortality. In addition, we assessed 1 year survival. Multivariable logistics regression analysis and adjusted Cox regression analysis were conducted. Analyses were adjusted to the propensity for CRGNB bacteraemia.RESULTS:The cohort included mostly young patients (mean age 50.1 years) with acute leukaemia (264/423, 62.4%) and the median absolute neutrophil count at bacteraemia onset was 0 × 10(9)/L. The unadjusted 14 day mortality rate was higher for patients with CRGNB compared with CSGNB [45.6% (47/103) versus 15% (48/320), respectively (P < 0.001)]. Adjusting to baseline prognostic factors, infection characteristics and the propensity score retained a significant association between CRGNB and 14 day mortality (OR 5.14, 95% CI 2.32-11.38). Including only the first bacteraemic episode per patient, 1 year mortality was 74.7% (68/91) for patients with CRGNB versus 49.8% (119/239) for patients with CSGNB (P < 0.001). Adjusting for risk factors associated with 1 year mortality, the HR for mortality with CRGNB was 1.48 (95% CI 1-2.2). CRGNB bacteraemia was associated with several risk factors for mortality, including inappropriate empirical antibiotic treatment and less effective definitive antibiotics.CONCLUSIONS:This study demonstrated a significant adjusted association between CRGNB and mortality up to 1 year among haemato-oncological patients receiving chemotherapy.

Influenza vaccination is recommended for cancer patients; however, adherence is low. We aimed to identify predictive factors for vaccination among cancer patients. We conducted a case-control analysis of a patient cohort in the 2010-2011 influenza season. We included adult cancer patients with solid malignancies undergoing chemotherapy, and haematological patients with active disease. Patients who died between October and November 2010 (N = 43) were excluded from analysis. Cases received the 2011 seasonal influenza vaccine, and controls did not. Data were obtained from patients' records, and validated through personal interviews. We collected socio-demographic information, and data on the malignancy and co-morbidities and triggers for vaccination and non-vaccination. We performed bivariate and multivariable analyses, in which vaccination status was the dependent variable. Of 806 patients included in analysis, 387 (48%) were vaccinated. Variables associated with vaccination on bivariate analysis were older age, higher socio-economic status, lower crowding index, marital status (widowed > married > single), malignancy type (haematological > solid tumours) and time from diagnosis, low-risk malignancy, diabetes, past vaccination, country of birth (non-Russian origin), and physicians' recommendations. Predictive factors found to be independently associated with vaccination on multivariable analysis were past vaccinations, low-risk malignancy, and country of birth. In the analysis conducted among interviewees (N = 561), recommendations from the oncologist (OR 10.7, 95% CI 5.4-21.2) and from the primary-care physician (OR 3.35, 95% CI 2.05-5.49) were strong predictors for vaccination. We conclude that 'habitual vaccinees' continue influenza vaccinations when ill with cancer. Physicians' recommendations, especially the oncologist's, have a major influence on patients' compliance with influenza vaccination.

BACKGROUND:A high prevalence of iron deficiency anemia persists in Bedouin Arab and Jewish pediatric populations in southern Israel.OBJECTIVES:To compare the effect of daily use of the micronutrient supplementation (MMS), "Sprinkles," a powdered formulation of iron, vitamins A and C, folic acid and zinc, with liquid iron and vitamins A and D on iron deficiency at 12 months of age.METHODS:The 621 eligible Bedouin and Jewish infants in the study were assigned to the MMS and control arms and received supplementations from age 6 to 12 months. We examined the change in hemoglobin, hematocrit, mean cell volume, red blood cell distribution, serum ferritin and transferrin saturation. In addition, we used the high Iron Deficiency Index (IDI) if two or more of the above six parameters showed abnormal levels.RESULTS:Rates of anemia decreased significantly over the 6 month period, from 58.8% to 40.6% among Bedouin infants (P = 0.037) and from 40.6 to 15.8% among Jewish infants (P = 0.017). In Bedouin infants the prevalence of high IDI decreased significantly from 79.2% to 67.4% (P = 0.010) in the MMS group, but there was no change in the controls. Among Jewish infants, the high IDI prevalence decreased from 67% to 55.6% with no statistically significant difference in the two study arms. In the multivariate analysis in Bedouin infants MMS use was associated with a reduced risk of 67% in high IDI at age 12 months as compared to controls (P = 0.001). Fewer side effects in the intervention groups in both ethnic populations were reported.CONCLUSIONS:MMS fortification of home food can be recommended as an effective and safe method for preventing iron deficiency anemia at 12 months of age.

OBJECTIVE:To examine the relationship between acculturation and obesity among low socioeconomic status (LSES) children.DESIGN:Cross-sectional study.SETTING:Children from 12 preschools in LSES neighborhoods were recruited.PARTICIPANTS:Anthropometric measurements were obtained from 238 children (aged 4-7 years) and 224 mothers. Sociodemographic characteristics and perceptions of child's weight were collected from mothers. We compared native Israelis and immigrants for risk factors for obesity, using a 9-year cut-off to define new and acculturated immigrants.RESULTS:The combined prevalence of overweight and obesity (OWOB) among children was 29.8% (71/238) using the World Health Organization (WHO) growth standard. Mean age, sleeping hours, sex distribution and poverty level were similar between immigrants and natives. Prevalence of OWOB and current parental smoking were significantly lower among children of new immigrants (P = .02). More than 82% of mothers underestimated their child's weight status, 74.2% of OWOB children were perceived as normal-weight (NW) and 8% as thin. In a multivariable logistic-regression analysis comparing NW to OWOB children, maternal underestimation of the child's weight status (OR = 7.5; 95%CI: 3.4-16.5, P < .0001) and being born to acculturated immigrants (OR = 2.3 95% CI: 1.1-4.7, P = .03) were associated with OWOB. Ethiopian children were at lower risk for obesity. Paternal smoking increased the risk for obesity by 2-fold in non-Ethiopian, and 5-fold in Ethiopian children (OR = 2.0 and 5.0, respectively; P for interaction = .026).CONCLUSIONS:Acculturation, perception of child's weight status and parental smoking are associated with childhood OWOB. Immigration status should be considered when programs to prevent childhood obesity are implemented in mixed populations.

[1] Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991;22:983–8. [2] Bungard TJ, GhaliWA, Teo KK, et al. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 2000;160:41–6. [3] Wann LS, Curtis AB, January CT, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;123:104–23. [4] Mant J, Hobbs FD, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007;370:493–503. [5] The ACTIVE Writing Group on behalf of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006;367:1903–12. [6] Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effect of aspirin. N Engl J Med 2001;345:1809–17.

Background The prevalence and manifestation of posttraumatic stress symptoms in young children may differ from that observed in adults. This study examined sociodemographic, familial, and psychosomatic correlates of posttraumatic stress disorder (PTSD) among preschool children and their mothers who had been exposed to ongoing missile attacks in the Gaza war. Methods One hundred and sixty-seven mothers of preschoolers (aged 4.06.5 years) were interviewed regarding PTSD and psychosomatic symptomatology of their children, as well as their own reactions to trauma. Results Fourteen mothers (8.4%) and 35 children (21.0%) screened positive for PTSD. Sociodemographic characteristics were not associated with PTSD among mothers or children. Among children, the only significant risk factor was having a mother with PTSD (OR = 12.22, 95% CI 2.7554.28). Compared to children who did not screen positive for PTSD, those who did screen positive displayed significantly higher rates of psychosomatic reactions to trauma, most notably constipation or diarrhea (OR = 4.36, 95% CI 1.6411.60) and headaches (OR = 2.91, 95% CI 1.077.94). Conclusions Results of this study add to the burgeoning literature on child PTSD, emphasizing the important role of maternal anxiety and the psychosomatic reactions associated with exposure to ongoing traumatic experiences in young children.

Background: The ability to determine the relationship between diet and health outcomes in children requires reproducible and validated long-term dietary assessment tools such as food frequency questionnaire (FFQ).Objective: To test the reproducibility and relative validity of a FFQ for young children using 24-hour food recalls (24HRs), anthropometric measurements, and a comprehensive feeding practices questionnaire (CFPQ).Methods: Children (aged 5-6) and their mothers were recruited during one school-year (2008) from preschools. Children's anthropometric measurements were obtained. Mothers provided during a personal interview on three occasions a 110-item semiquantitative FFQ, 24HRs and CFPQ. Pearson-correlation coefficients were calculated between the results of the FFQ and 3*24HR. Validity coefficients between the FFQ and the different measurements were calculated. Scores of the 12 factors of the CFPQ were calculated and related to dietary intake.Results: Sixty-six healthy children (47% boys) were recruited. Pearson's correlations between the average of the FFQs and 3*24HRs ranged from 0.3-0.6 (P<0.05). The highest correlation coefficients were 0.59 for total fat intake and 0.56 for energy. Dietary intake of energy and carbohydrates differed significantly (P=0.05, 0.001 respectively) across the three BMI z-score levels (normal-weight, overweight, obese) and the three waist circumference tertiles (0.019, 0.006 respectively). Obesogenic factors from the CFPQ correlated with consumption of empty calories like sweets, snacks, junk foods and sweet drinks.Conclusions: The modified FFQ is a relatively valid instrument to estimate mean energy intake in preschool children. The questionnaire performs reasonably well to rank children with respect to macronutrients intake as well as obesogenic food groups.

Bedouin Arabs in southern Israel are a traditionally semi-nomadic population undergoing the nutrition transition in a context of urbanisation. The effect of these changes on the nutritional status of pregnant women is unknown. The Dietary Exposures and Pregnancy Outcomes in a Society In Transition (DEPOSIT) study evaluated the adequacy of pregnant Bedouin women's usual dietary intake and their nutritional status. Dietary intake was assessed in a cross-sectional study design using repeat 24 h recall (24HR) questionnaires. The National Cancer Institute method was used to estimate the usual intake of selected nutrients. The Estimated Average Requirement (EAR) was used to evaluate nutrient intake adequacy. Measured weight and height data were used to calculate the participants' BMI. A total of 1109 24HR were obtained from 683 participants, of which 8 % contained no animal-source protein and an additional 43 % contained no haeme-Fe. Animal-source protein intake reached less than half of the EAR for most participants (71 %). Over 90 % had inadequate intakes of Ca, Fe, animal-source Zn, vitamin A and folate. The probability of consuming haeme-source Fe was higher among urban than rural participants (OR 1·68, 95 % CI 1·17, 2·41), and among those with employed v. unemployed husbands (OR 1·81, 95 % CI 1·27, 2·58). Only 14 % reported consuming home-produced animal products. According to pre-pregnancy BMI, 42 % were overweight or obese. The DEPOSIT study findings suggest that Bedouin Arab women are in need of interventions that address the co-existing problems of inadequate nutrient intakes and increased risk of obesity.

BACKGROUND:Distinct weight loss dietary strategies are associated with changes in specific food groups. OBJECTIVE:To address the effect of changes in specific weight of food groups on weight loss in a 2-year low-fat, Mediterranean, low-carbohydrate intervention trial (DIRECT). METHODS:We assessed changes in the intake of 12 food groups among 322 participants (body mass index [BMI] = 31 kg/m(2); age = 52 years; 86% men), using a validated electronic food frequency questionnaire. RESULTS:The weight of the 3592.9 ± 1558 (g/d ± SD) of baseline food consumed consisted mainly of liquids, excluding water (32.6% of total weight of food); vegetables (18.8%), fruits (17.7%), dairy (9.0%), meat (7.7%), and bread/cereal/pasta/potatoes (7.1%). Participants significantly reduced food intake by 283.73 ± 1342 (g/d ± SD) at 6 months and by 963.36 ± 1869 (g/d ± SD) at 24 months (p < 0.05 as compared with baseline). Food weight changes were similar across diet groups (p = 0.366), whereas 6-month body weight loss was -4.6 ± 4.4 kg, -4.7 ± 4.9 kg, and -6.4 ± 6.6 kg for low-fat, Mediterranean, and low-carbohydrate groups, respectively; p < 0.026). In multivariate regression models, adjusted for age, sex, baseline body weight, and changes in weight intake of 12 food groups (g/d), independent dietary predictors (standardized-β) at 6 months (rapid weight loss phase) were as follows: decreased consumption of sweets and cakes (β = 0.493; p = 0.008) in the low-fat group, tendency toward increased crude legumes (β = -0.196; p = 0.061) in the Mediterranean group, and increased vegetable intake (β = -0.249; p = 0.018) in the low-carbohydrate diet group. In the entire group, in models further adjusted for diet type, leading predictors for rapid weight loss phase were as follows: increased vegetables by ~140 g/d (β = -0.116; p = 0.045) and decreased intake of sweets and cakes by ~30 g/d (β = 0.162; p = 0.010). Universal predictors for 2-year successful weight loss in the entire group were as follows: increased intake of vegetables (β = -0.192; p = 0.007) and meat (β = -0.146; p = 0.026) and decreased intake of eggs (β = 0.187; p = 0.003), processed legumes (β = 0.195; p = 0.002), and beverages (β = 0.135; p = 0.032). CONCLUSIONS:Two-year weight loss is associated with a decrease of ~1 kg of total food consumed and may be achieved by a variety of changes in specific food groups within different diet strategies. Universal predictors of successful weight loss in the rapid weight loss phase across all diet strategies are increasing the weight of intake of vegetables and decreasing the weight of intake of sweets and cakes.

Introduction Iron deficiency anaemia still affects a quarter of the world's population increasing risk of infectious disease morbidity, impaired growth and mental development. According to current policy children undergo screening for iron deficiency anaemia at age 9–12M. Methods Prospective Study The study population included Moslem Bedouin 2.5–3-Y-old children that followed from 6M in Well Baby Clinic. All parents of participants were interviewed during enrolment and monthly meetings. The blood samples were taken from children at enrolment and during last follow-up visit. Anaemia (Hb<11 g/dl) and Iron Deficiency Index (at least 2 of 6 abnormal indicators, including Haemoglobin, Haematocrit, Mean Corpuscular Volume, Red blood cell distribution Width, serum ferritin, and transferin saturation) were defined. Results The study population included 180 infants. The mother's young age was found as a risk factor for mild anaemia. Male sex was associated with a higher rate of moderate anaemia compared with female sex (76.2% and 52.8%, respectively, p=0.043). Children with anaemia had lower average of dietary iron consumption than children with normal levels of Hb (p=0.009). Iron deficiency anaemia at age 6M was a significant and independent risk factor for toddlers' anaemia (OR=3.47, p<0.001) controlling for the mother's age, child gender and consumption of dietary iron. Conclusion The most significant factor for anaemia among this population is iron deficiency anaemia at the age of 6M. Prevention, early detection (at age 6M) and appropriate treatment of anaemia in the first year of life are critical to prevent anaemia and its consequences later life.

OBJECTIVE:To develop a targeted FFQ (TFFQ) and evaluate its effectiveness for ranking minority women by their intake of multiple nutrients important to a healthy pregnancy.DESIGN:In Stage 1, food groups derived from 24 h recall dietary data were entered into a stepwise multiple regression model to identify 'discriminating' foods for the TFFQ; in Stage 2, the TFFQ and a 24 h recall were administered to pregnant women. The TFFQ data were used to create a Habitual Multi-Nutrient Intake Scale (H-MNIS) for ranking the women. The effectiveness of the ranking was tested against women's reported nutrient intakes on the 24 h recall.SETTING:Southern Israel.SUBJECTS:In Stage 1, 519 Bedouin Arab adults; in Stage 2, 404 pregnant Bedouin women.RESULTS:Of the ninety-three food groups included in the regression analysis, twenty-eight explained >80 % of the between-person variability in the intake of the target nutrients. Whole-wheat bread was a main discriminator for protein, Fe, Zn, Ca and folate. Fish, poultry and canned tuna explained ≥88 % of the between-person variation in DHA and EPA intakes. The mean daily intakes of pregnant Bedouin women from the 24 h recall data differed significantly across H-MNIS quartiles (P < 0·01) for all but three target nutrients (folate, EPA, DHA); and the P for trend was significant (P < 0·02) for all but EPA.CONCLUSIONS:The TFFQ and H-MNIS represent rapid assessment tools for studying maternal nutrition on a multi-nutrient basis, and effectively ranked pregnant Bedouin women into exposure groups by their intake of the target nutrients.

To identify modifiable risk factors for obesity among low socioeconomic status (LSES) children. Cross-sectional data were obtained from 238 4–7-year-old children and 224 mothers from LSES preschools. Anthropometric measurements were obtained; mothers were interviewed about sociodemographic characteristics, health behaviors, perceptions and beliefs. The combined prevalence of overweight and obesity (OWOB) among children was 29.8% based on the new World Health Organization (WHO) growth standard. Prevalence of OWOB (body mass index ⩾25) among mothers was 51.8%. Mean age, sleeping hours, gender distribution and poverty level were similar between normal and OWOB children. Over 82% of mothers underestimated their child's weight status. Of the 62 OWOB children, 74.2% were perceived by their mothers as having ‘normal weight’ (NW) and 8% were perceived as ‘thin’. Mothers perceived 67 out of 158 NW children (42.4%) as ‘thin’ (P<0.001). Mediation analysis indicated that 10% of the effect of maternal underestimation on child's OWOB may be mediated through child's daily sedentary hours (P=0.06). In a multivariable logistic-regression analysis controlling for maternal obesity, knowledge regarding breakfast's importance and child's daily sedentary hours, maternal underestimation of the child's weight status (odds ratio=7.33; 95% confidence interval (CI):2.41–22.37; P<0.0001) and parental smoking (odds ratio=3.25; 95% CI: 1.26–8.40; P=0.015) were the only significant factors associated with OWOB in LSES children. Maternal perception of child's weight status and parental smoking are associated with childhood OWOB among LSES children. These parameters can help identify children at risk for obesity. Maternal perception may be amenable to intervention.

STUDY OBJECTIVES:To evaluate the effects of pediatric epilepsy on sleep in parents of epileptic children. METHODS:Cohort design in which the sleep quality of parents of epileptic children (POEC) and parents of nonepileptic children (PONEC) in the month preceding recruitment were compared using the self-administered Pittsburgh Sleep Quality Index (PSQI). RESULTS:Mothers of epileptic children had a 7-fold occurrence of sleep disturbances when compared to mothers of non-epileptic children (OR = 6.66 CI 95% 1.10-70.08). The sleep characteristics that showed statistically significant differences were: sleep duration, sleep continuity, and self-evaluation of sleep quality (p < 0.05 for all parameters). No significant difference in sleep quality was found between fathers of epileptic children and fathers of nonepileptic children. CONCLUSIONS:Sleep disturbances are more common in mothers of epileptic children. The sleep quality of mothers to epileptic children should be considered in their comprehensive management, and if necessary, the sleep disturbance should be addressed.

Background: The existence of causal associations between levels of industrial air pollutants, morbidity and mortality is well established. This study evaluated the feasibility of establishing and maintaining an ongoing integrated computerized information system (ICIS) to estimate and monitor association between mortality rates among Jewish and Bedouin adult population of the Negev, and environmental air pollution by about 100 chemicals, from air monitoring stations of the industrial complex Ramat Hovav (RH). Methods: We intend to develop the ICIS system for monitoring chronic diseases morbidity and all-causes and cause-specific mortality in the Negev region, for adult Jews and Bedouins in the Negev based on the linkage of several data sources in an ongoing manner. These are; a) Beer-Sheva regional office of Ministry of Health (MOH) computerized mortality database (mortality causes, socio-demographic details, place of residence since 2004 and occupation from personal interview); b) A sample of the Health maintenance Organization's Negev population; c) Soroka Hospital hospitalizations records; d) Data of air pollutants emissions from RH by date. Results: The current analysis was based on data for sample of 100,000 health insured Jewish and Bedouin patients (the settlements served as a statistical unit), mortality data from MOH and air pollutant concentrations, as recorded by monitoring stations of RH for 2007-2010. The overall and cause-specific mortality rates were calculated, continuous air pollution values were cut off by national "Almog" and international Texas reference. Data was linked to measurements of air pollutants from the air dispersion AERMOD models using GIS. Conclusions: Low rates of excess pollutant levels were shown. Since the long-term exposure to low doses environmental hazards have important impact on human health we intend to use the air pollutants concentration in their original continuous scale in future work and meteorological data will also be taken into account.