Feature of the Month – Israel

The Gertner Institute for Epidemiology and Health Policy Research

The Gertner Institute is located on the grounds of the largest hospital in central Israel- the Sheba Medical Center, Tel Hashomer. The institute is affiliated to Tel Aviv University Medical School and comprises 6 scientific units, a central biostatistics unit and a computer center.

The Cancer and Radiation Epidemiology Unit conducts research in cancer epidemiology, genetic epidemiology and ionizing and non-ionizing radiation effects. Our Unit has embraced the perception of epidemiology as a major tool for decision making and health policy planning, and has become a fundamental part in this process, by advising the relevant ministries (Health, Science & Technology, Environmental Protection and Education) on the basis of updated data and knowledge acquired in these fields.

The unit includes professionals who come from diverse backgrounds including medicine, epidemiology, genetics, nursing, statistics, and computer science. In addition, there are Master and Ph.D. students who are currently conducting their theses in the Unit. The unit also employs experienced clerical and technical aid personnel for managing data. The staff has long-standing experience in community-wide epidemiological studies.

ISRAEL

Capital: Jerusalem

Largest city: Jerusalem

Official languages: Hebrew, Arabic

Total population: 8,268,400

MOBI-Kids population: 1,800,000

Popular foods: Falafel, Hummus, Shawarma, Jachnun, Shakshuka

National PI – Prof. Siegal Sadetzki (MD, MPH)

Academic – graduated from the Technion Medical School in Israel, where she received her B.Sc and MD degrees (1989). In 1994 she completed her MPH at the Hebrew University School of Public Health.

Board certified in Epidemiology and Public Health. Associate professor in the Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, published more than 100 peer reviewed articles and 5 chapters in books.

Professional Positions and Activities – Director of the Cancer and Radiation Epidemiology Unit since 2000. Serves as the National Principal Investigator of the «Tinea Capitis» studies in Israel. These studies focus on late radiation effects of ionizing radiation, with particular emphasis on implementation of results through legislation and public health activities. Since January 2013, she serves as the Director of the Israeli National Information Center for Non-Ionizing Radiation.

Serves as an advisor to the Minister of Health and the Director General of the Ministry of Health in subjects that relate to health policy and decision making in her fields of expertise. She is involved in several national and international committees (e.g. the National Oncology Advisory Board, the National Council for Imaging, the National Council of Health, the Israeli Ministry of Health representative in the International Advisory Committee of the WHO International EMF Project)

Fieldwork coordinator – Revital Bar-Sade Bruchim (PhD)

Academic – graduated from the Technion Medical School in Israel, where she received her B.Sc. Following, she studied Human genetics at Sackler School of medicine in Tel-Aviv University (Israel), where she received her M.Sc and PhD. In 2006 she received Postdoctoral degree form McGill University, Montreal, Canada. Dr. Bruchim Has a broad background in Genetics and Epidemiology, with specific training and expertise in key research areas of the Mobi-Kids project.

Professional Positions and Activities – Since 2007 she is working as a senior researcher at the Gertner Institute, supervising and monitoring international and nationwide studies mainly in the field of genetic impact on health and late effects of ionizing and non-ionizing radiation. Dr. Bruchim has participated in the conduction of several brain tumor studies among which is the Mobi-kids, where she was involved in the preparation of the study tools including questionnaires and the protocols.

Brief Background of the study

Recruitment of brain tumor patients and matched controls has begun in Israel in August 2010. Cases are identified from all 7 neurosurgery departments across the country whereas controls are identified from 11 hospitals, in order to have representative geographical coverage.

Until now, 110 eligible brain tumour cases and 292 eligible controls were identified in Israel and 237 participants (84 cases and 153 controls) have been interviewed

Funding sources

The European Union (EU)

Collaborating hospitals

How did your center become involved in MOBI-Kids?

The Israeli center was, and still is, an active partner in the international investigation of the possible health effects of mobile phone use, beginning with a pilot study performed in 1998 and followed by the Interphone study (2000-2007). Therefore, it was only natural for us to participate in the Mobi-Kids study.

Are you involved with more than fieldwork?

The Israeli center is responsible for Work Package 2 which has an important role in the finalization of the study instruments including the study protocols, questionnaires and procedures for implementing the study.

What are your research interests (beyond MOBI-Kids)?

The Cancer & Radiation Epidemiology Unit is investigating health effects of both ionizing and non-ionizing radiation. One of our main studies is a long term follow-up of health effects of childhood exposure to ionizing radiation (the Israeli Tinea Capitis [TC] study). This research is based on a large cohort of 29,475 individuals who were exposed to radiation in the 1950s, for the treatment of Tinea Capitis (ringworm) and evaluates risk of developing cancer and other health outcomes among irradiated subjects. These studies also explore the hypothesis of genetic susceptibly to radiation aiming to identify genes involved in the formation of radiation induced tumors. The results of the Israeli TC studies have been implemented in legislation and in the formulation of the appropriate medical guidelines for irradiated subjects.

In the field of brain tumors, the unit is involved in several studies among which are 2 international studies, administrated in Baylor college of medicine (BMC), Huston Texas, USA, focusing on the investigation of the genetic background of familial and sporadic glioma (Gliogene and GICC studies): The Gliogene website: www.gliogene.org

Do you have any recent publications/links/resources to share that you think are relevant and important (either at the international or national level)?

A paper, led by our center, entitled: «The MOBI-Kids Study Protocol: Challenges in Assessing Childhood and Adolescent Exposure to Electromagnetic Fields from Wireless Telecommunication Technologies and Possible Association with Brain Tumor Risk» was recently accepted for publication in the journal «Frontiers in Public Health«. The manuscript describes the considerations needed to cope with the challenges of investigating the possible association between mobile phone use and the development of brain tumors among children, adolescents and young adults. http://www.ncbi.nlm.nih.gov/pubmed/25295243
Another paper publishes by prof. Sadetzki and Prof. Cardis in 2011 entitled: «Indications of possible brain-tumor risk in mobile-phone studies: should we be concerned?» (Occup Environ Med. 2011 Mar;68(3):169-71), discusses the main issues in the interpretation of the findings reported in published studies of brain tumors in relation to mobile-phone use, particularly the largest of these, Interphone, and their potential public-health implications. The authors concluded that while more studies are needed to confirm or refute these results, indications of an increased risk in high- and long-term users from Interphone and other studies are of concern. Since more than 4 billion people, including children, using mobile phones even a small risk at the individual level could eventually result in a considerable number of tumors and become an important public-health issue. The authors suggested that until definitive scientific answers are available, simple and low-cost measures, such as the use of text messages, hands-free kits and/or the loud-speaker mode of the phone should be used to reduce exposure to the brain from mobile phones.

Are you involved in other studies on EMF? Or other environmental exposures and risk of brain tumours?

Technological advances in telecommunications, have led to increasing exposure to non-ionizing radiation (NIR), raising concern regarding its potential health effects. Consequently, the Israeli government resolved to establish a National Information Center on NIR.

Established in 2013, The TNUDA Center, led by Prof. Siegal Sadetzki, provides comprehensive information to various target audiences (the general public, the government, researchers and commercial enterprises). This knowledge allows making informed decisions, policy and legislation based on scientific facts.

The Center is guided by the precautionary principle and promotes educated use of technologies involving NIR, while maintaining a balance between rapid technological advances and protection of public health.