The
frequency
of
30 marriages have crossed hamulah lines, and inter-village marriages are few (14%). "The effective rate of malformations must be even higher than we calculated because fatal fetal major anomalies that do not survive to term were not included in the study", said Dr Mordechai : Shohat, director of the Institute of Medical Genetics at Beilinson, who collaborated on the research. It is also possible that the higher infant mortality of Israeli Muslims than Israeli Jews (14 vs 7-4 deaths per: 1000 births, respectively) can be attributed in part to inbreeding load, despite almost double the fecundity (37 vs 18.7 births per 1000 population of reproductive age). : : is a serious health Inbreeding public : than half the More of Israeli problem. Arab population lives in villages of 10 000 to 20 000 in rural areas. Although many of: these villages are only a few kilometres from each other, there is virtually no inter-village communication, and thus these populations are at high risk for the genetic founder effect. Despite its medical sequelae and genetic implications, hamulah marriages con- : tinue. "A drastic and unique approach geared towards this population is : to prevent the high rate of suggests Jaber, "including special educa- : tional programmes to increase the awareness of the population and its leaders to the genetic consequences of marriages within the village and the hamulah, and extensive genetic counselling with availability of prenatal diagnosis". : As the villages slowly modernise and
riages. Only
Consequences of consanguinity consanguineous
mar-
among Israeli Arabs hovers over 50% because half of these marriages are
riages
between first-cousins, often double firstcousins. This was determined following a survey of 8521 families of Israeli Arab children in grade 2 (8 years) in 158 schools in 70 villages, towns, and cities (Arch Pediatr ; Adolesc Med 1994; 148: 412-12). This has resulted in a frequency of major congenital malformations (central nervous system,
cardiovascular, urogenital, skeletal, ophthalmic) of up to about 16% in the proge- : ny of first-cousin
Request for papers to be withdrawn Asscher, principal of St George’s Hospital Medical School, London, UK, has requested the withdrawal of two papers that were published in the British Journal of Obstetrics and Gynaecology earlier this year.I,2 This move follows an internal inquiry into the validity of the Sir William
articles. Mr J M Pearce, first author of both papers and deputy editor of the journal, has been suspended from his post as honorary senior lecturer at the school. He faces possible disciplinary action by St George’s Healthcare Trust. Sir William’s statement, released on Nov 29, also said that Prof Geoffrey Chamberlain, editor of the journal and head of St George’s obstetrics and gynaecology department "showed an error of judgement in allowing his name to go forward as a co-author of one of the papers, but, nevertheless, it is recommended that no further action be taken by the School". Similarly, no formal actions will be taken against the second authors of the two
marriages. This is a five-fold increase over the background population, said Dr Lutfi Jaber, director of the Bridge to Peace Pediatric Center, a well-baby clinic in Taibe and satellite of the Schneider Pediatric Center of the Beilinson Medical Center-Tel Aviv University, speaking to the Israel-France Binational Symposium on Hereditary Diseases, : Molecular Diagnosis, and Gene recently held in Jerusalem. : According to local tradition and historirequired papers. cal accounts, Taibe, one of the largest and malformation", Separate action has been taken by the most developed Arab villages in Israel, Royal College of Obstetrics and Gynaewas founded about 250 years ago by cology, for whom the journal is published. about 10 Muslim families (hamulahs) After a meeting on Nov 26, the council of who came from the Saudi desert and via the college set up an independent inquiry the mountain villages of the West Bank. into the ways in which articles submitted Some fewer Egyptian progenitors were for publication in the journal are settled in the village about 160 years ago, reviewed. and fewer still settled during the 1948 : Sarah Ramsay Israeli War of Independence. Today each more young people go to university, the of Taibe’s hamulahs, which are extended "villagers are tending to judge each other 1 Pearce JM, Mayonda IT, Chamberlain GVP. families with the same last name, number by their attributed rather than ascribed Term delivery after intrauterine relocation of between 1000 to 4000 descendents, makcharacteristics" and are "increasingly rean ectopic pregnancy. Br J Obstet Gynaecol : ceptive to health education", such as that ing a total of about 24 000 residents. 1994; 101: 716-17. Of 610 randomly sampled Taibe fami2 Pearce JM, Halid R. Randomised controlled proposed by Jaber, says Prof Yitzhak Reittrial of the use of human chorionic lies, 524 are intra-village marriages, 40% er, director of the Arab-Jewish Institute. : are known consanguineous marriages, and gonadotrophin in recurrent miscarriage associated with polycystic ovaries. Br J about half of these are first-cousin mar- Rachelle H B Fishman Obstet Gynaecol 1994; 101: 685-88.
i
;
Therapy,
greater
UK
occupational
asthma
1
awareness A nationwide campaign to raise awareness of the causes of occupational asthma has been instigated by the UK Health and Safety Executive and the National Asthma
1
: Campaign. The impetus for the scheme came from results of a five-year study headed by Prof1 Anthony Newman-Taylor and colleagues of the Royal Brompton Hospital, London. They looked at 401 subjects who had been working for more than a month in an
1
where acid anhydrides were extensively used. They also studied 400 subjects working with laboratory animals. The results confirmed a direct relation between the amount of workplace exposure to respiratory sensitisers, such as acid anhydrides found in spray paints and rat area
1566
urine protein found in laboratory workplaces. The studies also showed that, although the intensity of exposure was the main factor in determining whether a person
developed
occupational
asthma, .
smokers and those predisposed to developing allergies had a higher risk. The current rate of occupational asthma cases is 1500-2000 cases a year. Murray Devine, a senior HSE health official said, "We now know that the risk of someone developing the illness is related to the extent of exposure to the sensitiser. It is not an idiosyncratic response in certain individuals. Therefore there is a real need to reduce this toll of ill ; health by preventing exposure to respiratory sensitisers or, where this is not possible, by putting in place effective control measures". :
;
directly
Clare
Thompson
News in brief NHS fiddlers Primary health services are the part of the NHS at greatest risk of fraud according to a report published by the Audit Commission of England and Wales this week (Ensuring Probity in the NHS). The Commission wants the family health service authorities, which oversee primary care, to refer all suspected fraud to the police, rather than dealing with it
internally. Daddy’s DNA Despite difficulties in interpreting DNA tests (see p 1563), the controversial UK Child Support Agency, which aims to secure regular child-mainpayments from absent parents, introduce DNA testing to resolve
tenance
is
to
disputed year.
paternity
cases
early
next