Global Health Research Global Health Research projectproject

Contents:Contents:

GeographicGeographicPoliticalPoliticalInfrastructure and EconomyInfrastructure and EconomyCultural/EthnicCultural/EthnicHealthcare systemHealthcare systemStatisticsStatistics

GeographicGeographic

World map World map

Climate and geographic terrainClimate and geographic terrain

World mapWorld map

Israel is at the eastern end of the Israel is at the eastern end of the Mediterranean Sea, bounded by Mediterranean Sea, bounded by Lebanon to the north, Syria to the Lebanon to the north, Syria to the northeast, Jordan to the east, and northeast, Jordan to the east, and Egypt to the southwest. It lies Egypt to the southwest. It lies between latitudes 29° and 34° N, between latitudes 29° and 34° N, and longitudes 34° and 36° E. and longitudes 34° and 36° E.

Climate and geographic terrain Climate and geographic terrain Temperatures in Israel vary widely, especially during the Temperatures in Israel vary widely, especially during the winter. The more mountainous regions can be windy, cold, winter. The more mountainous regions can be windy, cold, and sometimes snowyand sometimes snowy

Meanwhile, coastal cities, such as Tel Aviv and Haifa, have Meanwhile, coastal cities, such as Tel Aviv and Haifa, have a typical Mediterranean climate with cool, rainy winters and a typical Mediterranean climate with cool, rainy winters and long, hot summers. long, hot summers.

The area of Beersheba and the Northern Negev has a The area of Beersheba and the Northern Negev has a semi-arid climate with hot summers, cool winters and fewer semi-arid climate with hot summers, cool winters and fewer rainy days than the Mediterranean climate. rainy days than the Mediterranean climate.

The Southern Negev and the Arava areas have desert The Southern Negev and the Arava areas have desert climate with very hot and dry summers, and mild winters climate with very hot and dry summers, and mild winters with few days of rain. with few days of rain.

The highest temperature in the continent of Asia (53.7 The highest temperature in the continent of Asia (53.7 °C/128.7 °F) was recorded in 1942 at Tirat Zvi kibbutz in °C/128.7 °F) was recorded in 1942 at Tirat Zvi kibbutz in the northern Jordan river valley. From May to September, the northern Jordan river valley. From May to September, rain in Israel is rare.rain in Israel is rare.

January is the coldest month, with temperatures from 5 C January is the coldest month, with temperatures from 5 C to 10 C, and August is the hottest month at 18 C to 38 C. to 10 C, and August is the hottest month at 18 C to 38 C.

PoliticalPolitical

System of governmentSystem of government

Any recent or current civil, political unrest Any recent or current civil, political unrest or wars and effects on country or wars and effects on country

System of governmentSystem of government

Israel is a parliamentary democracy, divided Israel is a parliamentary democracy, divided into six administrative districts. into six administrative districts. There is no formal constitution; instead, there is There is no formal constitution; instead, there is the Declaration of Establishment, from 1948, the Declaration of Establishment, from 1948, the Basic Laws of the parliament ( the Basic Laws of the parliament ( Knesset Knesset ), ), and the Israel citizenship law. and the Israel citizenship law. The head of government is the prime minister, The head of government is the prime minister, elected by popular vote for a four-year term. elected by popular vote for a four-year term. Executive power is exercised by the Executive power is exercised by the government.government.The 120 members of the Knesset also are The 120 members of the Knesset also are elected for four years. The Knesset selects the elected for four years. The Knesset selects the president, who serves as chief of state. president, who serves as chief of state. The political system of the State of Israel and its The political system of the State of Israel and its main principles are set out in 11 Basic Laws. main principles are set out in 11 Basic Laws.

Any recent or current civil, political unrest or Any recent or current civil, political unrest or wars and effects on countrywars and effects on country

The Israeli–Palestinian conflictThe Israeli–Palestinian conflict is is the ongoing struggle between Israelis the ongoing struggle between Israelis and Palestinians that began in the and Palestinians that began in the early 20th century.early 20th century.

Arab–Israeli conflictArab–Israeli conflict refers to the refers to the political tension and military conflicts political tension and military conflicts between the Arab League and Israel between the Arab League and Israel and between Arabs and Israelis. The and between Arabs and Israelis. The roots of the modern Arab–Israeli roots of the modern Arab–Israeli conflict lie in the rise of Zionism and conflict lie in the rise of Zionism and Arab nationalism towards the end of Arab nationalism towards the end of the 19th century. the 19th century.

Iran–Israel relationsIran–Israel relations: : Iran may launch Iran may launch pre-emptive strike on Israel, conflict pre-emptive strike on Israel, conflict could grow into WWIII could grow into WWIII

Green color shows countries, that are in Arab leagueGreen color shows countries, that are in Arab league

Yitzhak Yitzhak RabinRabin and Yasser Arafat and Yasser Arafat shake hands at the signing of the shake hands at the signing of the

Oslo Accords, with Bill Clinton Oslo Accords, with Bill Clinton behind them, 1993 them, 1993

Infrastructure and EconomyInfrastructure and Economy

Major industries Major industries

Level of personal incomeLevel of personal income

Level of development:Level of development:1. Safe Food and Water availability1. Safe Food and Water availability

2. Water/Sewer/Waste management system2. Water/Sewer/Waste management system

3. Transportation and communication system3. Transportation and communication system

4. Education system4. Education system

5. protection system5. protection system

Major industriesMajor industriesIsrael has a well-developed Israel has a well-developed chemical chemical industryindustry with many of its products aimed at with many of its products aimed at the export market. the export market.

The Dead Sea Works in Sdom is the world's The Dead Sea Works in Sdom is the world's fourth largest producer and supplier of fourth largest producer and supplier of potashpotash products. products.

Israel is one of the world's three major Israel is one of the world's three major centers for polished centers for polished diamondsdiamonds..

During the past two decades Israel's During the past two decades Israel's industrial sector has made a major shift to industrial sector has made a major shift to the areas of the areas of medical electronicsmedical electronics, , agro-agro-technologytechnology,, telecommunications telecommunications, , computercomputer hardwarehardware and and softwaresoftware..

Level of personal incomeLevel of personal income

BasisBasis - Israeli residents are taxed on their worldwide income, - Israeli residents are taxed on their worldwide income, while non-residents are taxed only on their Israeli sourced while non-residents are taxed only on their Israeli sourced income. income.

Taxable IncomeTaxable Income - All income from employment and business - All income from employment and business is taxable. Passive income from bank deposits and savings, is taxable. Passive income from bank deposits and savings, both in Israel and abroad are also taxable. both in Israel and abroad are also taxable.

Capital GainsCapital Gains - Capital gains may arise on the sale of assets; - Capital gains may arise on the sale of assets; for individuals this is generally 25%. for individuals this is generally 25%.

Level of developmentLevel of developmentTap water is safe and drinkable in Israel, except at The Dead Sea.Tap water is safe and drinkable in Israel, except at The Dead Sea.Jews are bound by a set of dietary laws called Jews are bound by a set of dietary laws called kashrut kashrut , which, , which, among other restrictions, forbid the consumption of among other restrictions, forbid the consumption of pork and pork and shellfishshellfish, as well as the consumption of both meat and milk products , as well as the consumption of both meat and milk products at the same meal. Not all Israelis observe these rules, but many at the same meal. Not all Israelis observe these rules, but many restaurants do.restaurants do.The system, called Meitavit, is an end-to-end The system, called Meitavit, is an end-to-end water and sewage water and sewage services management systemservices management system. Meitavit includes various SAP-based . Meitavit includes various SAP-based components including financial, logistics, procurement, inventory, components including financial, logistics, procurement, inventory, control, billing and collections, customer relationship management control, billing and collections, customer relationship management (CRM), project management and human resources.(CRM), project management and human resources.Transportation in IsraelTransportation in Israel is based mainly on private motor vehicles and bus is based mainly on private motor vehicles and bus service and an expanding railway network. Demands of population growth, service and an expanding railway network. Demands of population growth, political factors, the Israel Defense Forces, tourism and increased traffic set political factors, the Israel Defense Forces, tourism and increased traffic set the pace. All facets of transportation in Israel are under the supervision of the pace. All facets of transportation in Israel are under the supervision of the Ministry of Transport and Road Safety.the Ministry of Transport and Road Safety.The Communications systemThe Communications system in Israel in Israel is the most developed in the is the most developed in the Middle East, although it is not the biggest. Israel's system consists of Middle East, although it is not the biggest. Israel's system consists of Coaxial cables, Optical fibers, and Microwave radio relay.Coaxial cables, Optical fibers, and Microwave radio relay.

Level of developmentLevel of developmentEducation in IsraelEducation in Israel refers to the comprehensive education system of Israel. Expenditure refers to the comprehensive education system of Israel. Expenditure on education accounts for approximately 10% of GDP, and most schools are subsidized on education accounts for approximately 10% of GDP, and most schools are subsidized by the state. The education system consists of three tiers: primary education (grades 1-6, by the state. The education system consists of three tiers: primary education (grades 1-6, approx. ages 6–12), middle school (grades 7-9, approx. ages 12–15) and high school approx. ages 6–12), middle school (grades 7-9, approx. ages 12–15) and high school (grades 10-12, approx. ages 15–18). (grades 10-12, approx. ages 15–18). In 2012, Israel was named the second mostIn 2012, Israel was named the second most educated country in the world according to the Organization for Economic Cooperation educated country in the world according to the Organization for Economic Cooperation and Development's Education at a Glance report.and Development's Education at a Glance report.

Protection systemProtection system Based on its latest Based on its latest combat experiences, the Israel Defense combat experiences, the Israel Defense Forces (IDF) is moving forward with the Forces (IDF) is moving forward with the development and fielding of active development and fielding of active protection systems (APS) for tanks and protection systems (APS) for tanks and armored infantry fighting vehicles (AIFV). armored infantry fighting vehicles (AIFV).

Cultural/EthnicCultural/Ethnic

Main ethnic groups within countryMain ethnic groups within country

Major religion of country and their beliefs Major religion of country and their beliefs (any ritual, ideas or practices that may influence health)(any ritual, ideas or practices that may influence health)

Culture Culture

Main ethnic groups within countryMain ethnic groups within country

Jewish 76.4% (of which Israel-born Jewish 76.4% (of which Israel-born 67.1%, Europe/America-born 22.6% 67.1%, Europe/America-born 22.6%

Africa-born 5.9%, Asia-born 4.2%)Africa-born 5.9%, Asia-born 4.2%)

non-Jewish 23.6% (mostly Arab) (data non-Jewish 23.6% (mostly Arab) (data from 2004) from 2004)

Major religion of country and their beliefs Major religion of country and their beliefs (any ritual, ideas or practices that may influence health)(any ritual, ideas or practices that may influence health)

Religion in IsraelReligion in Israel is a central feature of the country and plays a is a central feature of the country and plays a major role in shaping Israeli culture and lifestyle, and religion has major role in shaping Israeli culture and lifestyle, and religion has played a central role in Israel's history. played a central role in Israel's history.

Israel has no entrenched constitution, but freedom of religion is Israel has no entrenched constitution, but freedom of religion is anchored in law. anchored in law.

Most citizens in the State of Israel are Jewish, and most Israeli Jews Most citizens in the State of Israel are Jewish, and most Israeli Jews practice Judaism in some form. In the last two centuries the largest practice Judaism in some form. In the last two centuries the largest Jewish community in the world, in the United States, has divided Jewish community in the world, in the United States, has divided into a number of Jewish denominations. into a number of Jewish denominations.

The largest and most influential of these denominations are The largest and most influential of these denominations are Orthodox Judaism, Reform Judaism, and Conservative Judaism. All Orthodox Judaism, Reform Judaism, and Conservative Judaism. All of the above denominations exist, to varying degrees, in the State of of the above denominations exist, to varying degrees, in the State of Israel. Nevertheless, Israelis tend to classify Jewish identity in ways Israel. Nevertheless, Israelis tend to classify Jewish identity in ways that are strikingly different from American Jewry. that are strikingly different from American Jewry.

What What JewsJews Believe Believe

Jews believe that one person cannot die for the sins of another.Jews believe that one person cannot die for the sins of another.

We do not need a blood sacrifice for the forgiveness of sins.We do not need a blood sacrifice for the forgiveness of sins.

Jews believe that Jesus was not the messiah.Jews believe that Jesus was not the messiah.

Jews believe that God hates human sacrifices. Jews believe that God hates human sacrifices.

Jews believe that one is born into the world with original purity.Jews believe that one is born into the world with original purity.Jews do not believe in original sin.Jews do not believe in original sin.Jews believe that God is one and indivisible. Jews believe that God is one and indivisible. Jews do not believe in a trinity.Jews do not believe in a trinity.Jews believe in The Satan, but not in a devil. Jews believe in The Satan, but not in a devil. There is a difference between The Satan and the devil.There is a difference between The Satan and the devil.Jews believe that God is God, and humans are humans. Jews believe that God is God, and humans are humans. God does not become human nor do humans become God.God does not become human nor do humans become God.Jews believe that "Jews for Jesus," "Messianic Jews," and "Hebrew Jews believe that "Jews for Jesus," "Messianic Jews," and "Hebrew Christians" are no longer Jews, even if they were once Jews.Christians" are no longer Jews, even if they were once Jews.The "Jewish roots" of Christianity?The "Jewish roots" of Christianity?

Culture Culture

Israeli literatureIsraeli literature is primarily poetry and prose written in Hebrew, as is primarily poetry and prose written in Hebrew, as part of the renaissance of Hebrew as a spoken language since the part of the renaissance of Hebrew as a spoken language since the mid-19th century, although a small body of literature is published in mid-19th century, although a small body of literature is published in other languages, such as English. other languages, such as English. Israeli musicIsraeli music contains musical influences from all over the world; contains musical influences from all over the world; Sephardic music, Hasidic melodies, Belly dancing music, Greek Sephardic music, Hasidic melodies, Belly dancing music, Greek music, jazz, and pop rock are all part of the music scene.music, jazz, and pop rock are all part of the music scene.Ten Israeli Ten Israeli filmsfilms have been final nominees for Best Foreign have been final nominees for Best Foreign Language Film at the Academy Awards since the establishment of Language Film at the Academy Awards since the establishment of Israel. The 2009 movie Israel. The 2009 movie AjamiAjami was the third consecutive nomination was the third consecutive nomination of an Israeli film. of an Israeli film. Israeli cuisineIsraeli cuisine includes local dishes as well as dishes brought to includes local dishes as well as dishes brought to the country by Jewish immigrants from around the world. Since the the country by Jewish immigrants from around the world. Since the establishment of the State in 1948, and particularly since the late establishment of the State in 1948, and particularly since the late 1970s, an Israeli fusion cuisine has developed. 1970s, an Israeli fusion cuisine has developed.

Healthcare systemHealthcare system

Level of development and structure of Level of development and structure of health care delivery systemshealth care delivery systems

Safety and quality Safety and quality

Health care providersHealth care providers

DoctorsDoctors

Emergency servicesEmergency services

Level of development and structure Level of development and structure of health care delivery systemsof health care delivery systems

Health care in IsraelHealth care in Israel is universal and participation in a is universal and participation in a medical insurance plan is compulsory. medical insurance plan is compulsory.

Health careHealth care coverage is administered by a small number coverage is administered by a small number of organizations, with funding from the government. of organizations, with funding from the government.

Generally, Generally, health carehealth care in Israel is of high-quality and is in Israel is of high-quality and is delivered in an efficient and effective manner. Partly as a delivered in an efficient and effective manner. Partly as a result of this, at an overall 82 years, Israelis enjoy the result of this, at an overall 82 years, Israelis enjoy the fourth-longest life expectancy in the world as of 2012.fourth-longest life expectancy in the world as of 2012.

Safety and quality Safety and quality

Israel has one of the most technologically advanced and highest-Israel has one of the most technologically advanced and highest-quality healthcare systems in the world. quality healthcare systems in the world.

  Hospitals in Israel are equipped with modern facilities and high-Hospitals in Israel are equipped with modern facilities and high-quality medical technology quality medical technology

Medical staff are trained from four to six years in one of the Medical staff are trained from four to six years in one of the country's five university medical schools. country's five university medical schools.

The country is a world leader in advanced infrastructure of medical The country is a world leader in advanced infrastructure of medical and paramedical research and paramedical research

Health care providersHealth care providers

Providers in the Israeli healthcare system consist of a Providers in the Israeli healthcare system consist of a mixture of private, semi-private and public entities mixture of private, semi-private and public entities

Generally, family and primary medicine facilities are run Generally, family and primary medicine facilities are run directly by Clalit Health Care Services for its members directly by Clalit Health Care Services for its members while the other HMOs operate their own family practice while the other HMOs operate their own family practice clinics in the larger cities and contract with privately clinics in the larger cities and contract with privately operated family practice clinics in smaller communities. operated family practice clinics in smaller communities.

DoctorsDoctors

In 2010, there were 25,542 doctors in In 2010, there were 25,542 doctors in Israel - 3.36 doctors for every 1,000 Israel - 3.36 doctors for every 1,000 people. This ratio is one of the highest of people. This ratio is one of the highest of all industrialized countries. all industrialized countries.

Emergency servicesEmergency services

Emergency medical services in Israel are provided by Emergency medical services in Israel are provided by the Magen David Adom (MDA) organization, which staffs the Magen David Adom (MDA) organization, which staffs approximately 1,200emergency medical approximately 1,200emergency medical technicians, paramedics, and emergency physicians, technicians, paramedics, and emergency physicians, and 10,000 volunteers. and 10,000 volunteers.

The organizations operates 95 stations and a fleet of The organizations operates 95 stations and a fleet of over 700 ambulances.  over 700 ambulances. 

  The majority of the fleet consists of Basic Life Support The majority of the fleet consists of Basic Life Support (is the level of medical care which is used for victims of (is the level of medical care which is used for victims of life-threatening illnesses or injuries until the victims can life-threatening illnesses or injuries until the victims can be given full medical care at a hospital. ) ambulances. be given full medical care at a hospital. ) ambulances.

CANCER RANK BY TYPE CANCER RANK BY TYPE

0

5

10

15

20

25

30

1

1 Breast Cancer

2 Lung Cancers

3 Colon-Rectum Cancers

4 Pancreas Cancer

5 Lymphomas

6 Stomach Cancer

7 Leukemia

8 Prostate Cancer

9 Skin Cancers

10 Ovary Cancer

ISRAEL TOTAL DEATHS BY CAUSEISRAEL TOTAL DEATHS BY CAUSE NUMBER OF DEATHSNUMBER OF DEATHS

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

1

1 Coronary Heart Disease

2 Diabetes Mellitus

3 Stroke

4 Lung Cancers

5 Colon-Rectum Cancers

6 Kidney Disease

7 Breast Cancer

8 Alzheimers/Dementia

9 Influenza & Pneumonia

10 Lung Disease

ISRAEL TOTAL DEATHS BY CAUSEISRAEL TOTAL DEATHS BY CAUSE PERCENTAGEPERCENTAGE

0

2

4

6

8

10

12

14

16

18

1 2 3 4 5 6 7 8 9 10

CAUSE

Percentage

1 Coronary Heart Disease

2 Diabetes Mellitus

3 Stroke

4 Lung Cancers

5 Colon-Rectum Cancers

6 Kidney Disease

7 Breast Cancer

8 Alzheimers/Dementia

9 Influenza & Pneumonia

10 Lung Disease

Compare summaryCompare summary

Diabetes:Diabetes: In High-income counties percentage of diabetes deaths is 2.6%, in Israel it’s 8.42% (3,2 times higher). Israel is a high-income country and this statistics shows, that people of Israel can have a genetic predisposition for this disease.

Kidney:Kidney: Israel has kidney’s diseases on 6-th place, although average statistic of High-income countries doesn’t include this disease in top 10. It may mean, that not all water is good for drink or other diseases can occur kidney illness.

Colon and rectal cancersColon and rectal cancers:: there are different causes: genetics there are different causes: genetics (less then 5-15% of all causes), older age, male gender, high intake (less then 5-15% of all causes), older age, male gender, high intake of fat, alcohol or red meat, obesity, smoking and a lack of physical of fat, alcohol or red meat, obesity, smoking and a lack of physical exercise. In Israel these diseases are higher then in average exercise. In Israel these diseases are higher then in average statistics. statistics.

Breast cancer:Breast cancer: in Israel this disease 2.2 times higher then in avg stat-s. The main cause may be genetics.

Smoking StatisticsSmoking Statistics

6000 people6000 people die each year in Israel from cigarettes, that's about die each year in Israel from cigarettes, that's about 16 16 people a day! people a day! 28%28% of Israel populationof Israel population are smokers. In 1973 smokers were are smokers. In 1973 smokers were 42%42% of the population. of the population. Although the decrease in the amount of smokers, the starting age of Although the decrease in the amount of smokers, the starting age of the smokers is decreasing. Today even the smokers is decreasing. Today even 11 years old11 years old start to smoke. start to smoke. 4.5%4.5% of the of the boysboys and and 1%1% of the of the girlsgirls aged aged 11-12 11-12 claim to be regular claim to be regular smokers. smokers. 9.5%9.5% of the of the boysboys and and 6.4%6.4% of the of the girlsgirls aged aged 14-1514-15 claim to be claim to be regular smokers. regular smokers. 16%16% of the of the boysboys and 9% of the and 9% of the girlsgirls aged 16-17 claim to be regular aged 16-17 claim to be regular smokers. smokers. 90% of all smokers90% of all smokers starts smoking before they are 18. starts smoking before they are 18. 90% of the Israelis90% of the Israelis support No-Smoking areas in work places. support No-Smoking areas in work places.

Top 10 causes of death in Top 10 causes of death in High-income countriesHigh-income countries

(average statistics)(average statistics)

00.080.160.240.320.4

0.480.560.640.720.8

0.880.961.041.121.2

1.281.361.441.52

Deaths in millions % of deaths

Ischaemic heart disease

Stroke and other cerebrovascular disease

Trachea, bronchus, lung cancers

Alzheimer and other dementias

Lower respiratory infections

Chronic obstructive pulmonary disease

Colon and rectum cancers

Diabetes mellitus

Hypertensive heart disease

Breast cancer

MEN IncidenceMEN Incidence

0

2000

4000

6000

8000

10000

12000

Prostate(18.6%)

Colorectum(15.7%)

Lung (10.8) Other(54.9%)

Incidence (number)

Incidence (number)

Cancer Incidence (number)

Prostate (18.6%) 2326

Colorectum (15.7%) 1965

Lung (10.8) 1345

Other (54.9%) 10265

MEN Mortality MEN Mortality

0

200

400

600

800

1000

1200

1400

1600

1800

Prostate(7.9%)

Colorectum(13.5%)

Lung(21.1%)

Others(57.5%)

Mortality (number)

Mortality (number)

Cancer Mortality (number)

Prostate (7.9%) 415

Colorectum (13.5%) 711

Lung (21.1%) 1110

Others (57.5%) 1619

Women IncidenceWomen Incidence

0

1000

2000

3000

4000

5000

6000

7000

8000

Breast (31.8%) Colorectum(14.9%)

Lung (6.1%) Others (47.2%)

Incidence (number)

Incidence (number)

Cancer Incidence (number)

Breast (31.8%) 4203

Colorectum (14.9%) 1963

Lung (6.1%) 807

Others (47.2%) 7863

Women MortalityWomen Mortality

0

500

1000

1500

2000

2500

3000

3500

Breast (18.5%) Colorectum(12.8%)

Lung (9.8%) Others (58.9%)

Incidence (number)

Incidence (number)

Cancer Incidence (number)

Breast (18.5%) 968

Colorectum (12.8%) 672

Lung (9.8%) 511

Others (58.9%) 3083

MEN MEN Israel vs. USAIsrael vs. USA

Women Women Israel vs. USAIsrael vs. USA

Pancreatic Cancer in Israel

Statistics, rankStatistics, rankSymptomsSymptomsRisk factorRisk factorEarly detection, screening and preventionEarly detection, screening and preventionTreatment and futureTreatment and future

Statistics, rankStatistics, rank

Cancer

Incidence Mortality 5-year prevalence

Number (%) ASR (W) Number (%) ASR (W) Number (%) Prop.

Pancreas 487 3.9 11.7 443 8.5 10.2 362 1.1 14.6

Pancreatic cancer is not a common malignancy in Israel, but it is the third most common cause of cancer mortality

In contrast, it ranks 6th in the United States and 13th worldwide. But pancreatic cancer ranks third in cancer mortality in Israel, fourth in the U.S. and eighth worldwide.

Incidence rates and trends 1980–2006 The incidence rates were significantly higher in European-born Jews of both genders and in both the European and non-European-born males. Among Jewish male immigrants who arrived after 1990, the incidence is insignificantly higher than among other Israelis

SymtomsSymtoms

CBD

MPD

MaP

MiP(it hidden)

MiPMiP-Minor Papilla; -Minor Papilla; MaPMaP-Major Papilla; -Major Papilla; MPDMPD-Major Pancreas Duct; -Major Pancreas Duct; CBDCBD-Common Bile Duct-Common Bile Duct

SymptomsSymptoms

Pancreatic cancer does not cause symptoms in its earliest stages. By the time symptoms are noted, the By the time symptoms are noted, the disease has already been growing for some time. disease has already been growing for some time.

Initial symptoms of pancreatic cancer tend to be rather Initial symptoms of pancreatic cancer tend to be rather vague, so patients often ignore them for a certain length vague, so patients often ignore them for a certain length of time. of time. Decreased appetiteDecreased appetite - Most patients experience a greatly decreased - Most patients experience a greatly decreased appetite (This may be one of the first symptoms of pancreatic appetite (This may be one of the first symptoms of pancreatic cancer). cancer).

Unintended weight lossUnintended weight loss - Over time, up to 100% of patients with - Over time, up to 100% of patients with pancreatic cancer tend to fall about 10% below their ideal body pancreatic cancer tend to fall about 10% below their ideal body weight.weight.

SymptomsSymptomsPainPain - About 95% of all patients with pancreatic cancer have pain - About 95% of all patients with pancreatic cancer have pain

JaundiceJaundice - Jaundice consists of a yellow discoloration of the skin, - Jaundice consists of a yellow discoloration of the skin, mucus membranes (tissue including that which lines the mouth), mucus membranes (tissue including that which lines the mouth), and whites of the eyes. and whites of the eyes. (When pancreatic cancer strikes the head of the (When pancreatic cancer strikes the head of the pancreas, jaundice may occur earlier in the disease because the tumor puts pancreas, jaundice may occur earlier in the disease because the tumor puts pressure on the common bile duct, the tube that connects the pancreas, pressure on the common bile duct, the tube that connects the pancreas, liver, and gallbladder to the intestine. When the cancer is located in the liver, and gallbladder to the intestine. When the cancer is located in the body or tail of the pancreas, however, jaundice may occur later in the body or tail of the pancreas, however, jaundice may occur later in the course of the disease)course of the disease)

Nausea and vomitingNausea and vomiting - About 30% of patients with pancreatic - About 30% of patients with pancreatic cancer experience nausea and vomiting. cancer experience nausea and vomiting.

Dark urine, light-colored stoolDark urine, light-colored stool – Reasons like with jaundice – Reasons like with jaundice aforesaidaforesaid

Depression, mood swingsDepression, mood swings - Depression and mood swings occur in - Depression and mood swings occur in nearly 30% of patients. nearly 30% of patients.

Itching generalizedItching generalized - Itching, which is difficult to treat, is a common - Itching, which is difficult to treat, is a common symptom in patients. symptom in patients.

Risk factorsRisk factors

Epidemiological studies have identified environmental and familial risk factors for the disease:

male gender

aging

obesity

diabetes (type 2 or hyperglycemia occurring as a paraneoplastic phenomenon)

tobacco smoking

high consumption of fried/grilled/processed meats

chronic pancreatitis

Genetic risk factors are believed responsible for 5–10% of pancreatic cancer cases They include both genetic disorders where pancreatic involvement is not the usual target organ and also pancreas-specific genetic mutations causing cancer

Risk factorsRisk factors

ScreeningScreening

There are no sensitive non-evasive screening modalities or early diagnostic tests. These include: Blood tests

Standard and high resolution pancreas-dedicated abdominal computed tomography

Ultrasonography

Advanced imaging techniques using magnetic resonance might be useful but are not readily available in Israel.

PreventionPreventionPreventive advice on lifestyle habits will be given to patients and family members at risk for pancreatic cancer

The meeting in August 2009, called by the Pancreas Subcommittee of the Israel Gastroenterology Society decided that EUS (endoscopic ultrasound sonography) would be their standard test for pancreatic cancer

They adopted the following standard protocol as used in an American multicenter study for examination, documentation and follow-up of these lesions and/or patients at high risk for the disease. Similar protocols are used in Europe.

Treatment and futureTreatment and future

A clinical trial with A clinical trial with TL-118TL-118--a new treatment for --a new treatment for metastatic pancreatic cancer--that has been ongoing at metastatic pancreatic cancer--that has been ongoing at the Hadassah University Medical Center and three other the Hadassah University Medical Center and three other oncology centers in Israel, has been expanded to the oncology centers in Israel, has been expanded to the United States. United States. TL-118TL-118. produced by Tiltan Pharma Ltd., belongs to the . produced by Tiltan Pharma Ltd., belongs to the family of angiogenesis-inhibiting drugs, which means it family of angiogenesis-inhibiting drugs, which means it inhibits new blood vessel formation in tumors and thus inhibits new blood vessel formation in tumors and thus cuts off their blood supply and growth. cuts off their blood supply and growth. AngiogenesisAngiogenesis, the process by which new blood vessels , the process by which new blood vessels are formed, is a hallmark capability of cancer cells. Anti-are formed, is a hallmark capability of cancer cells. Anti-angiogenic therapy has, therefore, emerged as a most angiogenic therapy has, therefore, emerged as a most promising strategy with solid tumors, which rely on promising strategy with solid tumors, which rely on aggressive angiogenesis for their growth. aggressive angiogenesis for their growth.

TL-118TL-118 was initially tested in a mouse model of was initially tested in a mouse model of pancreatic cancer. In these pre-clinical studies,pancreatic cancer. In these pre-clinical studies, TL-118 TL-118 monotherapy inhibited tumor growth significantly, as monotherapy inhibited tumor growth significantly, as compared to the standard-of-care chemotherapy. compared to the standard-of-care chemotherapy. Moreover, when Moreover, when TL-118TL-118 therapy was combined with therapy was combined with standard-of-care chemotherapy, the tumors were standard-of-care chemotherapy, the tumors were eliminated in all the treated animals.eliminated in all the treated animals.

To date, over 100 cancer patients have been treated To date, over 100 cancer patients have been treated with with TL-118TL-118 for up to four years, according to Tiltan for up to four years, according to Tiltan Pharma, jointly owned by Yissum, the Hebrew Pharma, jointly owned by Yissum, the Hebrew University's Technology Transfer Company, and other University's Technology Transfer Company, and other investors from Israel and Canada.investors from Israel and Canada.

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