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Akpanekpo EI, Kariminia A, Srasuebkul P, Trollor JN, Greenberg D, Kasinathan J, Schofield PW, Kenny DT, Simpson M, Gaskin C, Chowdhury NZ, Jones J, Ekanem AM, Butler T. Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study. BMJ Ment Health 2024; 27:e300958. [PMID: 38538031 PMCID: PMC11021745 DOI: 10.1136/bmjment-2023-300958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Mental health services are available for young people involved with the criminal justice system. However, they have unmet mental health needs after the expiration of criminal justice supervision. OBJECTIVE To determine the incidence rate and identify predictors of psychiatric hospitalisations within 24 months after the expiration of criminal justice supervision among young people involved with the New South Wales (NSW) criminal justice system. METHODS Retrospective data from 1556 individuals aged 14-22 years who participated in four surveys of justice-involved young people in NSW were harmonised and linked to four NSW data collections. We calculated the incidence rates of psychiatric hospitalisations within 24 months postsupervision and identified predictors of these hospitalisations using a competing risks regression analysis. RESULTS Within 24 months postsupervision, 11.4% had a psychiatric hospitalisation compared with 3.5% during supervision. 20.7% of those admitted had a known history of mental illness and engaged with community-based and outpatient mental health services postsupervision. Predictors of psychiatric hospitalisations were: female sex (adjusted subdistribution HR (asHR) 1.84, 95% CI 1.24 to 2.73); previous incarceration (highest asHR for ≥4 episodes 1.67, 95% CI 1.01 to 2.78); head injury (asHR 1.63, 95% CI 1.20 to 2.21); personality disorder (asHR 3.66, 95% CI 2.06 to 6.48) and alcohol and substance use disorder (asHR 1.89, 95% CI 1.29 to 2.77). CONCLUSION Justice-involved youth have higher rates of psychiatric admissions after criminal justice supervision. Engagement with mental health services postsupervision is important in addressing emerging or persisting mental health needs.
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Affiliation(s)
- Emaediong Ibong Akpanekpo
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian N Trollor
- National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Greenberg
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - John Kasinathan
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Peter W Schofield
- The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Dianna T Kenny
- The University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Simpson
- New South Wales Department of Communities and Justice, Parramatta, New South Wales, Australia
| | - Claire Gaskin
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nabila Z Chowdhury
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | | | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Hazan G, Goldstein Y, Greenberg D, Khalde F, Mahajna R, Keren-Naos A, Hershkovitz E, Faingelernt Y, Givon-Lavi N, Danino D. Comparing single versus multiple virus detection in pediatric acute gastroenteritis postimplementation of routine multiplex RT-PCR diagnostic testing. J Med Virol 2024; 96:e29344. [PMID: 38149453 DOI: 10.1002/jmv.29344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Utilizing multiplex real time polymerase chain reaction (RT-PCR) for rapid diagnosis of gastroenteritis, enables simultaneous detection of multiple pathogens. A comparative analysis of disease characteristics was conducted between cases with single and multiple viruses. Rotavirus vaccine was introduced in 2010, reaching a 70% coverage in 2 years. All rectal swabs collected from diarrheic children (<5 years) between December 2017 and March 2022 were included. Detection of the same viruses within 2 months was considered a single episode. Episodes with positive stool bacterial PCR were excluded. A total of 5879 samples were collected, revealing 86.9% (1509) with single virus detection and 13.1% (227) with multiple viruses. The most frequent combination was rotavirus and norovirus (27.8%), these infections followed a winter-spring seasonality akin to rotavirus. Children with multivirus infections exhibited higher immunodeficiency (OR 2.06) rates, but lower food allergy (OR 0.45) and prematurity rates (OR 0.55) compared to single infections. Greater disease severity, evaluated by the Vesikari score, was observed in multivirus episodes (p < 0.001, OR 1.12). Multivirus infections accounted for 13.1% of symptomatic cases in hospitalized young children. Despite vaccination efforts, rotavirus remained prominent, frequently in co-infections with norovirus. Overall, multivirus infections were linked to more severe diseases than single virus cases.
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Affiliation(s)
- Guy Hazan
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Yoav Goldstein
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - David Greenberg
- Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Firas Khalde
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Rofaida Mahajna
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Ayelet Keren-Naos
- Clinical Virology Laboratory, Soroka University Medical Center, Beer Sheva, Israel
| | - Eli Hershkovitz
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Yaniv Faingelernt
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Pediatric Gastroenterology Hepatology and Nutrition Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Noga Givon-Lavi
- Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Dana Danino
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
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3
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Jurist E, Greenberg D, Pizziferro M, Alaluf R, Perez Sosa M. Virtue, well-being, and mentalized affectivity. Res Psychother 2023; 26:710. [PMID: 38189466 PMCID: PMC10849072 DOI: 10.4081/ripppo.2023.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024]
Abstract
Virtue ethics, featuring the claim that virtue leads to wellbeing, has been imported by psychologists from philosophy. In the first part of the paper, we re-examine the source of virtue ethics in Aristotle's philosophy and question whether virtues can be the path to eudaimonistic well-being for us, given that contemporary society differs from ancient society in terms of a lack of consensus about virtues. We focus on the modulation of emotions as a good starting place for reconstruing virtue ethics, and we affirm a connection to well-being through the construct of "mentalized affectivity", which is a specific kind of emotion regulation. In the second half of this hybrid paper, we provide evidence for the link between mentalized affectivity and well-being, based upon an empirical study with an adult sample (N=558). Our study examined how the Mentalized Affectivity Scale (MAS) predicts subjective well-being compared to five commonly used and related measures: Difficulty with Emotion Regulation Scale; Emotion Regulation Questionnaire; Flexibility Regulation of Emotional Expression scale; Reflective Functioning Questionnaire; Toronto Alexithymia Scale. The most important finding is that the MAS and Difficulties in Emotion Regulation Scale are most predictive of satisfaction with life. A second finding, less relevant for the present paper, is that the MAS (namely, its components of Identifying and Processing) strongly predicted psychopathology, including anxiety and mood disorders. This suggests that the MAS is a valuable tool for research on emotion regulation, well-being, and psychopathology, and that mentalized affectivity ought to be regarded as a promising construct for re-describing and specifying the contemporary relevance of virtue ethics.
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Affiliation(s)
- Elliot Jurist
- The City College of New York, NY; The Graduate Center of the City University of New York, NY.
| | - David Greenberg
- Iterdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel; Department of Music, Bar-Ilan University, Ramat Gan, Israel; Autism Research Centre, Department of Psychiatry, University of Cambridge.
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4
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Levany S, Shahar G, Greenberg D. Calling for an immediate release of captive children in Gaza. Lancet 2023; 402:2070-2071. [PMID: 37977171 DOI: 10.1016/s0140-6736(23)02519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Shani Levany
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
| | - Golan Shahar
- Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Yale University School of Medicine, New Haven, CT, USA
| | - David Greenberg
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; Saban Children Hospital, Soroka University Medical Center, Beer-Sheva, Israel
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Domínguez-Rodríguez S, Liz-López H, Panizo-LLedot A, Ballesteros Á, Dagan R, Greenberg D, Gutiérrez L, Rojo P, Otheo E, Galán JC, Villanueva S, García S, Mosquera P, Tagarro A, Moraleda C, Camacho D. Testing the performance, adequacy, and applicability of an artificial intelligence model for pediatric pneumonia diagnosis. Comput Methods Programs Biomed 2023; 242:107765. [PMID: 37704545 DOI: 10.1016/j.cmpb.2023.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/07/2023] [Accepted: 08/13/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Community-acquired Pneumonia (CAP) is a common childhood infectious disease. Deep learning models show promise in X-ray interpretation and diagnosis, but their validation should be extended due to limitations in the current validation workflow. To extend the standard validation workflow we propose doing a pilot test with the next characteristics. First, the assumption of perfect ground truth (100% sensitive and specific) is unrealistic, as high intra and inter-observer variability have been reported. To address this, we propose using Bayesian latent class models (BLCA) to estimate accuracy during the pilot. Additionally, assessing only the performance of a model without considering its applicability and acceptance by physicians is insufficient if we hope to integrate AI systems into day-to-day clinical practice. Therefore, we propose employing explainable artificial intelligence (XAI) methods during the pilot test to involve physicians and evaluate how well a Deep Learning model is accepted and how helpful it is for routine decisions as well as analyze its limitations by assessing the etiology. This study aims to apply the proposed pilot to test a deep Convolutional Neural Network (CNN)-based model for identifying consolidation in pediatric chest-X-ray (CXR) images already validated using the standard workflow. METHODS For the standard validation workflow, a total of 5856 public CXRs and 950 private CXRs were used to train and validate the performance of the CNN model. The performance of the model was estimated assuming a perfect ground truth. For the pilot test proposed in this article, a total of 190 pediatric chest-X-ray (CXRs) images were used to test the CNN model support decision tool (SDT). The performance of the model on the pilot test was estimated using extensions of the two-test Bayesian Latent-Class model (BLCA). The sensitivity, specificity, and accuracy of the model were also assessed. The clinical characteristics of the patients were compared according to the model performance. The adequacy and applicability of the SDT was tested using XAI techniques. The adequacy of the SDT was assessed by asking two senior physicians the agreement rate with the SDT. The applicability was tested by asking three medical residents before and after using the SDT and the agreement between experts was calculated using the kappa index. RESULTS The CRXs of the pilot test were labeled by the panel of experts into consolidation (124/176, 70.4%) and no-consolidation/other infiltrates (52/176, 29.5%). A total of 31/176 (17.6%) discrepancies were found between the model and the panel of experts with a kappa index of 0.6. The sensitivity and specificity reached a median of 90.9 (95% Credible Interval (CrI), 81.2-99.9) and 77.7 (95% CrI, 63.3-98.1), respectively. The senior physicians reported a high agreement rate (70%) with the system in identifying logical consolidation patterns. The three medical residents reached a higher agreement using SDT than alone with experts (0.66±0.1 vs. 0.75±0.2). CONCLUSIONS Through the pilot test, we have successfully verified that the deep learning model was underestimated when a perfect ground truth was considered. Furthermore, by conducting adequacy and applicability tests, we can ensure that the model is able to identify logical patterns within the CXRs and that augmenting clinicians with automated preliminary read assistants could accelerate their workflows and enhance accuracy in identifying consolidation in pediatric CXR images.
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Affiliation(s)
- Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Helena Liz-López
- Computer Systems Engineering Department, Universidad Politécnica de Madrid, Spain
| | - Angel Panizo-LLedot
- Computer Systems Engineering Department, Universidad Politécnica de Madrid, Spain.
| | - Álvaro Ballesteros
- Pediatric Research and Clinical Trials Unit (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel
| | - Lourdes Gutiérrez
- Pediatric Research and Clinical Trials Unit (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Rojo
- Pediatric Research and Clinical Trials Unit (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain; Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Enrique Otheo
- Hospital Universitario Ramón y Cajal. Pediatrics Department, Madrid, Spain
| | - Juan Carlos Galán
- Hospital Universitario Ramón y Cajal, Microbiology Department, Madrid, Spain
| | - Sara Villanueva
- Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sonsoles García
- Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Mosquera
- Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alfredo Tagarro
- Pediatric Research and Clinical Trials Unit (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain; Fundación para la Investigación e Innovación Biomédica del Hospital Universitario Infanta Sofía y Hospital Universitario del Henares. Madrid, Spain; Pediatrics Research Group. Universidad Europea de Madrid. Pediatrics, Madrid, Spain
| | - Cinta Moraleda
- Pediatric Research and Clinical Trials Unit (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain; Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Camacho
- Computer Systems Engineering Department, Universidad Politécnica de Madrid, Spain
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Danino D, van der Beek BA, Givon-Lavi N, Ben-Shimol S, Greenberg D, Dagan R. Dynamics of Pediatric Antibiotic Use Differ between High- and Low-Prescribing Clinics after Pneumococcal Conjugate Vaccines. J Pediatr 2023; 263:113679. [PMID: 37611733 DOI: 10.1016/j.jpeds.2023.113679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/23/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To compare dispensed oral antibiotic prescription rates (DAPRs) after implementation of pneumococcal conjugate vaccine (PCV) in high antibiotic-prescribing clinics (HPC) with low antibiotic-prescribing clinics (LPC) in 2 distinct ethnic groups of children (Jewish and Bedouin children) <5 years of age. METHODS Clinics with ≥50 insured children, active both pre-PCV (2005-2009) and post-PCV (2010-2018) implementation, were included. HPC and LPC were defined by DAPRs above or below the median in each age and ethnic group. Monthly dispensed antibiotic prescription rate (DAPR) trends (adjusted for age and ethnicity) were calculated using interrupted time series. Mean yearly incidence rate-ratios (late PCV13 vs pre-PCV) were calculated. RESULTS Bedouin HPC had the highest pre-PCV overall-DAPR per 1000 child-years ± SD (2520.4 ± 121.2), followed by Jewish HPC (1885.5 ± 47.6), Bedouin LPC (1314.8 ± 81.6), and Jewish LPC (996.0 ± 19.6). Shortly after PCV implementation, all DAPRs and amoxicillin/amoxicillin-clavulanate DAPRs declined in all groups except Jewish LPC, stabilizing within 4-5 years post-PCV. The rates and magnitudes of declines were directly proportional to the pre-PCV DAPR magnitudes, achieving near-complete closure of the pre-PCV DAPR gaps between the 4 groups (rates during late-PCV13 ranging from 1649.4 ± 23.5 [Bedouin HPC] to 1200.3 ± 72.4 [Jewish LPC]). CONCLUSIONS PCVs are a powerful tool in reducing outpatient antibiotic consumption among young children, especially in HPC, resulting in partial closure of DAPR gap between HPC and LPC. The higher impact on HPC suggests that PCV-associated declines of respiratory disease may strongly contribute to a judicious antibiotic approach in clinics with high antibiotic consumption.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Bart Adriaan van der Beek
- The Shraga Segal Dept. of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Ron Dagan
- The Shraga Segal Dept. of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Gullotta M, Greenberg D, Adily A, Albalawi O, Karminia A, Knight L, Butler TG. Physical health status of individuals convicted of sexual offences: Results from an Australian prisoner cohort. J Forensic Leg Med 2023; 100:102610. [PMID: 37944416 DOI: 10.1016/j.jflm.2023.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/14/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Although the poor health of prisoners poses a serious public health problem, very little is known about the health of specific offender groups. Three waves of an Australian Inmate Health Survey were used to describe the self-reported and objectively tested health of men incarcerated for sexual offences against children only (ISOC), adults only (ISOA), and against both (age-polymorphous; ISOP) compared to men incarcerated without sexual offences. ISOC and ISOP were found to have the poorest self-reported health of all groups, with higher rates of eyesight and cardiovascular problems; however, lower rates of Hepatitis B and Hepatitis C as objectively measured. There are important implications for the correctional and public health systems for addressing the health needs of specific offenders.
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Affiliation(s)
- Mathew Gullotta
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia; The Wellbeing Group, Sydney, NSW, 2040, Australia.
| | - David Greenberg
- Justice Health and Forensic Mental Health Network, Sydney, NSW, 2036, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Armita Adily
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Olayan Albalawi
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia; Department of Statistics, Science Faculty, Tabuk University, Saudi Arabia.
| | - Azar Karminia
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Lee Knight
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Tony Gerard Butler
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
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Danino D, Hazan G, Mahajna R, Khalde F, Farraj L, Avni YS, Greenberg D, Hershkovitz E, Faingelernt Y, Givon-Lavi N. Implementing a multiplex-PCR test for the diagnosis of acute gastroenteritis in hospitalized children: Are all enteric viruses the same? J Clin Virol 2023; 167:105577. [PMID: 37651826 DOI: 10.1016/j.jcv.2023.105577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Multiplex-PCR is a valuable tool for diagnosing viral acute gastroenteritis (AGE), enabling the detection of multiple pathogens. However, distinguishing between active disease and shedding poses challenges. This study aimed to evaluate viral AGE epidemiology and compare clinical characteristics among the five most common viruses. METHODS Rotavirus vaccine was introduced in 2010, with 70% coverage achieved in southern Israel in two years. All rectal swabs for multiplex-PCR targeting rotavirus, norovirus, adenovirus, astrovirus and sapovirus from hospitalized diarrheic children <5 years were included, from December 2017 through March 2022. Detection of the same virus within two months was considered a single episode. Clinical analysis included episodes with single-virus detection and negative bacterial PCR. RESULTS Among 5,879 rectal swabs, 2,662 (45.3%) tested positive for at least one virus, with 245 (9.2%) showing multiple virus detection. Rotavirus was the most prevalent. While rotavirus exhibited typical winter-spring seasonality in 2018-19, an unusual off-season surge was observed during the second year of the COVID-19 pandemic. Among negative bacterial PCR episodes, 34.6% had mucus stool, 5.9% had bloody stool, and 29.3% received antibiotics. Astrovirus or sapovirus infections were associated with higher rates of hospital-acquired AGE and immunodeficiency (P<0.05), whereas rotavirus infections had higher rates of dehydration severity and acute kidney injury (P<0.05). DISCUSSION Enteric viruses were detected in 45.3% of rectal swabs from hospitalized children with diarrhea. Despite vaccination efforts, rotavirus remained prevalent and caused more severe disease. Continuous surveillance using multiplex-PCR is crucial for accurate management and future prevention strategies for viral AGE.
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Affiliation(s)
- Dana Danino
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel; Soroka University Medical Center, Pediatric Infectious Diseases Unit, Beer Sheva, Israel.
| | - Guy Hazan
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel; Soroka University Medical Center, Pediatric Department D, Beer Sheva, Israel
| | - Rofaida Mahajna
- Soroka University Medical Center, Pediatric Department D, Beer Sheva, Israel
| | - Firas Khalde
- Soroka University Medical Center, Pediatric Department D, Beer Sheva, Israel
| | - Lama Farraj
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel
| | - Yonat Shemer Avni
- Soroka University Medical Center, Clinical Virology Laboratory, Beer-Sheva, Israel
| | - David Greenberg
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel; Soroka University Medical Center, Pediatric Infectious Diseases Unit, Beer Sheva, Israel
| | - Eli Hershkovitz
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel; Soroka University Medical Center, Clinical Virology Laboratory, Beer-Sheva, Israel
| | - Yaniv Faingelernt
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel; Soroka University Medical Center, Pediatric Gastroenterology Hepatology and Nutrition Unit, Beer Sheva, Israel
| | - Noga Givon-Lavi
- Ben Gurion University, Faculty of Health Sciences, Beer Sheva, Israel
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9
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Danino D, van der Beek BA, Greenberg D, Ben-Shimol S, Dagan R. The impact of pneumococcal conjugate vaccine on ceftriaxone consumption in the community among young children. Int J Infect Dis 2023; 135:21-27. [PMID: 37567556 DOI: 10.1016/j.ijid.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES Following pneumococcal conjugate vaccine (PCV) introduction, community pediatric dispensed prescription rates (DPR) of oral antibiotics declined, in parallel to respiratory tract infection (RTI). We assessed the dynamics of outpatient parenteral ceftriaxone DPR. METHODS Computerized data for children <5 years were examined during 13 years (including 4 pre-PCV years). DPR from clinics with ≥50 insured children, active both before and after PCV implementation were included. Interrupted time series with segmented regression stratified by age and ethnicity, and adjusted for seasonality was applied to show monthly DPR trends. RESULTS A total of 29,226 prescriptions were dispensed. No significant trends in ceftriaxone DPR were seen pre-PCV. Shortly after PCV implementation, DPR abruptly and significantly declined, stabilizing in late-PCV period (5 years postimplementation). The dynamics were compared between the two ethnic groups in the region, Jewish and Bedouin children (the latter with higher crowding and respiratory disease rates). Among Jewish children, ceftriaxone was mainly dispensed during winter vs no seasonality among Bedouin children. CONCLUSIONS In southern Israel, outpatient ceftriaxone DPR declined post-PCV in young children, similar to the trends of RTIs and oral antibiotic prescriptions, suggesting a causative role of PCVs. The differences between the two ethnic groups suggest possible involvement of additional factors.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Bart Adriaan van der Beek
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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10
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Challakere Ramaswamy VM, Butler T, Ton B, Wilhelm K, Mitchell PB, Knight L, Greenberg D, Ellis A, Gebski V, Schofield PW. Neuropsychiatric correlates of olfactory identification and traumatic brain injury in a sample of impulsive violent offenders. Front Psychol 2023; 14:1254574. [PMID: 37842698 PMCID: PMC10570745 DOI: 10.3389/fpsyg.2023.1254574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Olfactory deficits have a diverse etiology and can be detected with simple olfactory tests. Key olfactory pathways are located within the frontal and temporal lobes where they are vulnerable to damage due to head trauma. Orbitofrontal cortex (OFC) integrity is important for olfaction and aspects of behavioral regulation. We measured olfactory identification ability in a sample of impulsive violent offenders to determine its associations with history of traumatic brain injury (TBI) and a range of neuropsychiatric indices, including proxies for cognitive ability, impulsivity and social connectedness. Methods Male participants were drawn from the ReINVEST study, a randomized controlled trial of sertraline to reduce recidivism in violent impulsive offenders. Criteria for participation in the study included a minimum age of 18 years, a documented history of two or more violent offenses, and a score of 70 or above on the Barratt Impulsiveness Scale (BIS-11). The 16-item "Sniffin sticks" (SS) odor identification test (OI) was administered as were standardized questionnaires regarding previous TBI, additional measures to screen cognition [word reading test of the Wechsler Individuals Achievement Test (WIAT), social connectedness (the Duke Social Support Scale), and a range of other neuropsychiatric conditions or symptoms]. The sample SS scores were compared against published age-specific norms. Univariate and multivariate analyses were performed with SS score (linear regression, within those without hyposmia) or hyposmia (logistic regression) as the outcome. Results The mean OI scores were lower than population norms and 16% of participants were classified as hyposmic. Univariate analyses showed associations of SS score with age, WIAT score, impulsivity, TBI and TBI severity, social connectedness, childhood sexual abuse, suicidality and current use of heroin. In multivariate analyses, age, TBI severity and WIAT remained as significant independent predictors of SS score (within the normosmic range) or hyposmia (logistic regression). Conclusion Olfactory performance was associated with multiple behavioral phenomena in a pattern that would be consistent with this serving as a proxy for orbitofrontal functioning. As such, OI testing may have utility in further studies of offenders. In future, we will examine whether olfactory score predicts recidivism or response to the administration of sertraline, in terms of reducing recidivism.
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Affiliation(s)
| | - Tony Butler
- University of New South Wales, Sydney, NSW, Australia
| | - Bianca Ton
- University of New South Wales, Sydney, NSW, Australia
| | - Kay Wilhelm
- University of New South Wales, Sydney, NSW, Australia
| | | | - Lee Knight
- University of New South Wales, Sydney, NSW, Australia
| | - David Greenberg
- University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Andrew Ellis
- University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Val Gebski
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Peter William Schofield
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Neuropsychiatry Service, Hunter New England Mental Health, Newcastle, NSW, Australia
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11
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Dubnov S, Yayon N, Yakov O, Bennett DA, Seshadri S, Mufson E, Tzur Y, Bennet ER, Greenberg D, Kuro-O M, Paldor I, Abraham CR, Soreq H. Knockout of the longevity gene Klotho perturbs aging- and Alzheimer's disease-linked brain microRNAs and tRNA fragments. bioRxiv 2023:2023.09.10.557032. [PMID: 37745362 PMCID: PMC10515819 DOI: 10.1101/2023.09.10.557032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Overexpression of the longevity gene Klotho prolongs, while its knockout shortens lifespan and impairs cognition via altered fibroblast growth factor signaling that perturbs myelination and synapse formation; however, comprehensive analysis of Klotho's knockout consequences on mammalian brain transcriptomics is lacking. Here, we report the altered levels under Klotho knockout of 1059 long RNAs, 27 microRNAs (miRs) and 6 tRNA fragments (tRFs), reflecting effects upon aging and cognition. Perturbed transcripts included key neuronal and glial pathway regulators that are notably changed in murine models of aging and Alzheimer's Disease (AD) and in corresponding human post-mortem brain tissue. To seek cell type distributions of the affected short RNAs, we isolated and FACS-sorted neurons and microglia from live human brain tissue, yielding detailed cell type-specific short RNA-seq datasets. Together, our findings revealed multiple Klotho deficiency-perturbed aging- and neurodegeneration-related long and short RNA transcripts in both neurons and glia from murine and human brain.
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12
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Challakere Ramaswamy VM, Butler T, Ton B, Wilhelm K, Mitchell PB, Knight L, Greenberg D, Ellis A, Allnutt S, Jones J, Gebski V, Carr V, Scott RJ, Schofield PW. Self-reported traumatic brain injury in a sample of impulsive violent offenders: neuropsychiatric correlates and possible "dose effects". Front Psychol 2023; 14:1243655. [PMID: 37780150 PMCID: PMC10540069 DOI: 10.3389/fpsyg.2023.1243655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a major public health problem that may be associated with numerous behavioral problems, including impulsivity, aggression and violence. Rates of self-reported TBI are high within offender populations, but the extent to which TBI is causally implicated in causing illegal behavior is unclear. This study examined the psychological and functional correlates of histories of traumatic brain injury in a sample of impulsive violent offenders. Methods Study participants, all men, had been recruited to participate in a randomized controlled trial of sertraline to reduce recidivism. Study entry criteria were an age of at least 18 years, a documented history of two or more violent offenses and a score of 70 or above on the Barratt Impulsiveness Scale. An extensive list of standardized questionnaires was administered to obtain information on previous TBI and other neuropsychiatric conditions or symptoms. Results In the sample of 693 men, 66% were aged between 18 and 35 years old, and 55% gave a history of TBI ("TBI+"). Overall, 55% of study participants reported at least one TBI. High levels of neuropsychiatric symptomatology were reported. In 75% of TBI+ individuals, their most severe TBI (by self-report) was associated with loss of consciousness (LOC) < 30 min. Compared to TBI- (those without history of TBI) participants, TBI+ individuals were more impulsive (Eysenck Impulsivity), irritable, angry, and reported higher levels of assaultive behavior, depressive symptomology, alcohol use disorder, suicidal ideation, suicide attempts, and lower quality of life. Potential "dose effects" of TBI severity and frequency in terms of neuropsychiatric symptomatology were identified. Conclusion Like other studies of offender populations, single and multiple TBIs were very common. The associations of TBI, TBI severity, and TBI frequency (i.e., TBI "burden") with adverse neuropsychiatric phenomena suggest TBI contributes importantly to offender morbidity but the select nature of the sample and cross-sectional study design constrain the interpretation of these findings.
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Affiliation(s)
| | - Tony Butler
- University of New South Wales, Sydney, NSW, Australia
| | - Bianca Ton
- University of New South Wales, Sydney, NSW, Australia
| | - Kay Wilhelm
- University of New South Wales, Sydney, NSW, Australia
| | | | - Lee Knight
- University of New South Wales, Sydney, NSW, Australia
| | - David Greenberg
- University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Andrew Ellis
- University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | | | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Vaughan Carr
- University of New South Wales, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Rodney J. Scott
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Peter William Schofield
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Neuropsychiatry Service, Hunter New England Mental Health, Newcastle, NSW, Australia
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13
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Banniettis N, Horn M, Sadarangani M, Patel SM, Greenberg D, Oberdorfer P, Klein NP, Rupp R, Dagan R, Richmond P, Lumley J, Zhou W, Shi Y, Tamms G, Feemster K, Lupinacci R, Musey L, Bickham K. Safety and Tolerability of V114 Pneumococcal Vaccine in Infants: A Phase 3 Study. Pediatrics 2023:191503. [PMID: 37309607 DOI: 10.1542/peds.2022-060428] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Disease caused by Streptococcus pneumoniae is associated with considerable morbidity and mortality in children. Pneumococcal conjugate vaccines (PCVs) are well tolerated and effective at reducing pneumococcal disease caused by vaccine serotypes. VAXNEUVANCE (V114) is a 15-valent PCV containing 13 serotypes in Prevnar 13 (PCV13), plus serotypes 22F and 33F. This large phase 3 study evaluated safety and tolerability of V114 in infants. METHODS In total, 2409 infants were randomized to receive V114 or PCV13 at 2, 4, 6, and 12 to 15 months of age. Safety was evaluated as the proportion of participants with adverse events (AEs). Solicited and unsolicited injection-site and systemic AEs were collected for 14 days after each study vaccination, and serious AEs up to 6 months after the last PCV dose. RESULTS The proportions of participants with injection-site, systemic, vaccine-related, and serious AEs were generally comparable between recipients of V114 and PCV13. The most frequently reported AEs were solicited, with irritability and somnolence being the most frequent in both groups. Although the incidence of some AEs was higher in the V114 group, the between-group differences were small. The majority of experienced AEs were of mild-to-moderate intensity and lasted ≤3 days. There were 2 vaccine-related serious AEs of pyrexia in the V114 group, and 2 nonvaccine-related deaths, 1 in each group. No participant discontinued study vaccine because of AEs. CONCLUSIONS V114 is well tolerated and has a generally comparable safety profile to that of PCV13. These study results support routine use of V114 in infants.
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Affiliation(s)
| | | | - Manish Sadarangani
- University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | | | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Richard Rupp
- University of Texas Medical Branch, Galveston, Texas
| | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; and
| | | | | | - Wei Zhou
- Merck & Co., Inc., Rahway, New Jersey
| | - Yaru Shi
- Merck & Co., Inc., Rahway, New Jersey
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14
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Hazan G, Duek OA, Alapi H, Mok H, Ganninger AT, Ostendorf EM, Gierasch C, Chodick G, Greenberg D, Haspel JA. Biological rhythms in COVID-19 vaccine effectiveness in an observational cohort study of 1.5 million patients. J Clin Invest 2023:167339. [PMID: 37053011 DOI: 10.1172/jci167339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGOUND Basic immune processes exhibit circadian rhythms, but it is unclear if rhythms exist in clinical endpoints like vaccine protection. Here, we examined associations between Coronavirus Infectious Disease 2019 (COVID-19) vaccination timing and effectiveness. METHODS We retrospectively analyzed a large Israeli cohort with timestamped COVID-19 vaccinations (n=1,515,754 patients over 12 years-old, 99.2% receiving BNT162b2). Endpoints included COVID-19 breakthrough infection, COVID-19 associated emergency department (ED) visits, and hospitalizations. Our main comparison was between patients vaccinated during morning (8:00-11:59), afternoon (12:00-15:59), or evening hours (16:00-19:59). We employed Cox regression to adjust for differences in age, sex, and co-morbidities. RESULTS Breakthrough infections differed based on vaccination time, with lowest rates associated with late morning to early afternoon, and highest rates with evening vaccination. Vaccination timing remained significant after adjustment for patient age, sex, and co-morbidities. Results were consistent in patients who received the basic two-dose series and who received booster doses. The relationship between COVID-19 immunization time and breakthrough infections was sinusoidal, consistent with a biological rhythm that modifies vaccine effectiveness by 8.6-25%. The benefits of daytime vaccination were concentrated in younger (<20 years old) and older patients (>50 years old). COVID-19 related hospitalizations varied significantly with the timing of the second booster dose, an intervention reserved for older and immunosuppressed patients (HR=0.64 morning vs. evening, 0.43-0.97 95% CI, p=0.038). CONCLUSION We report a significant association between the time of COVID-19 vaccination and its effectiveness. This has implications for mass vaccination programs. FUNDING National Institutes of Health.
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Affiliation(s)
- Guy Hazan
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, United States of America
| | - Or A Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, United States of America
| | - Hillel Alapi
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Huram Mok
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, United States of America
| | - Alexander T Ganninger
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, United States of America
| | - Elaine M Ostendorf
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, United States of America
| | - Carrie Gierasch
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, United States of America
| | - Gabriel Chodick
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jeffrey A Haspel
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, United States of America
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15
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Macdonald C, Weatherburn D, Butler T, Albalawi O, Greenberg D, Farrell M. Who gets diverted into treatment? a study of defendants with psychosis. Psychiatr Psychol Law 2023; 31:132-145. [PMID: 38455267 PMCID: PMC10916916 DOI: 10.1080/13218719.2023.2175070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/23/2022] [Indexed: 03/09/2024]
Abstract
The current study aimed to advance our understanding of the factors that influence mental health diversion in Local Courts in New South Wales, Australia. Logistic regression was used to systematically identify the factors that are correlated with diversion in a cohort of individuals (N = 7283) diagnosed with psychosis. Those with a substance-induced psychotic disorder were less likely to be diverted than those with an affective psychosis or schizophrenia, after adjusting for age, gender, Indigenous status, offence seriousness, violence and criminal history. Unexpectedly, those with psychotic disorders committing violent or serious offences were more likely to be diverted than those committing non-violent, less serious offences. Legal representation should be provided to all individuals with serious mental illnesses facing criminal charges. The State-wide Community and Court Liaison Service should be expanded to more Local Courts. Further research is required into why Aboriginal defendants with a psychotic illness are less likely to be diverted.
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Affiliation(s)
- Christel Macdonald
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Don Weatherburn
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Olayan Albalawi
- Department of Statistic, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - David Greenberg
- Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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16
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Adily A, Albalawi O, Sara G, Kariminia A, Wand H, Allnutt S, Schofield P, Greenberg D, Grant L, Butler T. Mental health service utilisation and reoffending in offenders with a diagnosis of psychosis receiving non-custodial sentences: A 14-year follow-up study. Aust N Z J Psychiatry 2023; 57:411-422. [PMID: 35575185 DOI: 10.1177/00048674221098942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE While psychosis is considered a risk factor for offending, little is reported about mental health service utilisation in offenders with psychosis and its relationship with reoffending. We examined the association between contact with mental health services and reoffending in those diagnosed with psychosis. METHODS We linked health and offending records in New South Wales (Australia) and identified all individuals with a diagnosis of psychosis and a subsequent offence resulting in a non-custodial sentence between 2001 and 2012. We examined the incidence and risk factors for reoffending, and time to reoffending between 2001 and 2015 using Cox regression and Kaplan-Meier survival methods. We specifically examined the association between clinical contact with community mental health services following the index offence and reoffending. RESULTS Of the 7393 offenders with psychosis, 70% had clinical contact and 49% reoffended. There was a linear relationship between an increased number of clinical contacts and reduced risk of reoffending: those with no clinical contact had more than a fivefold risk of reoffending compared to those with the highest number of contacts (adjusted hazard ratio = 5.78, 95% confidence interval = [5.04, 6.62]). Offenders with substance-related psychosis and those convicted of non-violent offences had fewer clinical contacts and higher rates of reoffending when compared with controls (adjusted hazard ratio = 1.29, 95% confidence interval = [1.13, 1.47] and adjusted hazard ratio = 1.26, 95% confidence interval = [1.18, 1.35], respectively). CONCLUSION This study supports an association between more frequent mental health service use and reduced risk of reoffending. Efforts to enhance mental health service utilisation in those with psychosis who are at a higher risk of reoffending should be promoted.
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Affiliation(s)
- Armita Adily
- School of Population Health, UNSW Sydney, Kensington, NSW, Australia
| | - Olayan Albalawi
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia.,Department of Statistics, University of Tabuk, Tabuk, Saudi Arabia
| | - Grant Sara
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Azar Kariminia
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | - Handan Wand
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | - Stephen Allnutt
- Forensic Mental Health Program, UNSW Sydney, Kensington, NSW, Australia
| | - Peter Schofield
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - David Greenberg
- New South Wales Statewide Community and Court Liaison Service for Justice Health Forensic Mental Health Network and School of Psychiatry, UNSW, Sydney, NSW, Australia
| | - Luke Grant
- Department of Communities and Justice, Sydney, NSW, Australia
| | - Tony Butler
- School of Population Health, UNSW Sydney, Kensington, NSW, Australia
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17
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Danino D, Ashkenazi-Hoffnung L, Diaz A, Erps AD, Eliakim-Raz N, Avni YS, Greenberg D, Givon-Lavi N, Youngster I. Effectiveness of BNT162b2 Vaccination During Pregnancy in Preventing Hospitalization for Severe Acute Respiratory Syndrome Coronavirus 2 in Infants. J Pediatr 2023; 254:48-53.e1. [PMID: 36252864 PMCID: PMC9568274 DOI: 10.1016/j.jpeds.2022.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the clinical effectiveness of the BNT162b2 vaccine during pregnancy in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalizations of infants. STUDY DESIGN A retrospective, multicenter, 1:3 case-control (test-negative) study. Symptomatic hospitalized infants less than 6 months of age, with a positive SARS-CoV-2 polymerase chain reaction test between January 3, 2021, and March 11, 2021, were matched by age and time to negative controls, hospitalized with symptoms compatible with SARS-CoV-2 infection. Mothers were defined as fully vaccinated who received 2 doses of BNT162b2 with the second given 2 weeks to 6 months before delivery; or partially vaccinated, if they received only 1 dose or 2 doses with the second given more than 6 months or less than 2 weeks before delivery. Severe SARS-CoV-2 was defined as a need for assisted ventilation. RESULTS We matched 116 SARS-CoV-2 positive infants with 348 negative controls with symptoms compatible with SARS-CoV-2 infection. The effectiveness of fully vaccinated mothers was 61.6% (95% CI, 31.9-78.4) and the effectiveness of partially vaccinated mothers was not significant. Effectiveness was higher in infants 0-2 vs 3-6 months of age. The effectiveness (57.1%; 95% CI, 22.8-76.4) was similar when excluding mothers who were infected with SARS-CoV-2 during pregnancy. The OR of severe infection in infants born to unvaccinated vs fully vaccinated mothers was 5.8. CONCLUSIONS At least 2 doses of BNT162b2 vaccine administered during the second or third trimester of pregnancy had an effectiveness of 61.6% in decreasing hospitalization for SARS-CoV-2 infection in infants less than 6 months of age.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Liat Ashkenazi-Hoffnung
- Department of Day Hospitalisation, Schneider Children's Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Pediatric Infectious Diseases Unit, Schneider Children's Medical Center, Petach-Tikva, Israel
| | | | - Amir Dov Erps
- Department of Day Hospitalisation, Schneider Children's Medical Center, Petach-Tikva, Israel
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Yonat Shemer Avni
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ilan Youngster
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Pediatric Infectious Disease Unit, Shamir Medical Center, Zerifin, Israel
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18
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Dagan R, van der Beek BA, Ben-Shimol S, Greenberg D, Shemer-Avni Y, Weinberger DM, Danino D. The COVID-19 pandemic as an opportunity for unravelling the causative association between respiratory viruses and pneumococcus-associated disease in young children: a prospective study. EBioMedicine 2023; 90:104493. [PMID: 36857965 PMCID: PMC9970381 DOI: 10.1016/j.ebiom.2023.104493] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In young children, rates of lower respiratory infections (LRI) and invasive pneumococcal disease (IPD) have been associated with respiratory syncytial virus (RSV), human metapneumovirus (hMPV), influenza (flu), and parainfluenza (PIV) (collectively termed here as pneumonia and pneumococcal disease-associated viruses [PDA-viruses]). However, their contribution to the pathogenesis of these disease endpoints has not yet been elucidated. The COVID-19 pandemic provided a unique opportunity to examine the question. METHODS This prospective study comprised all children <5 years, living in southern Israel, during 2016 through 2021. The data were previously collected in multiple ongoing prospective surveillance programs and include: hospital visits for community-acquired alveolar pneumonia (CAAP), non-CAAP LRI; nasopharyngeal pneumococcal carriage (<3 years of age); respiratory virus activity; and nationwide, all-ages COVID-19 episodes and IPD in children <5 years. A hierarchical statistical model was developed to estimate the proportion of the different clinical endpoints attributable to each virus from monthly time series data, stratified by age and ethnicity. A separate model was fit for each endpoint, with covariates that included a linear time trend, 12-month harmonic variables to capture unexplained seasonal variations, and the proportion of tests positive for each virus in that month. FINDINGS During 2016 through 2021, 3,204, 26,695, 257, and 619 episodes of CAAP, non-CAAP LRI, pneumococcal bacteremic pneumonia and non-pneumonia IPD, respectively, were reported. Compared to 2016-2019, broad declines in the disease endpoints were observed shortly after the pandemic surge, coincident with a complete disappearance of all PDA-viruses and continued circulation of rhinovirus (RhV) and adenovirus (AdV). From April 2021, off-season and abrupt surges of all disease endpoints occurred, associated with similar dynamics among the PDA-viruses, which re-emerged sequentially. Using our model fit to the entire 2016-2021 period, 82% (95% CI, 75-88%) of CAAP episodes in 2021 were attributable to the common respiratory viruses, as were 22%-31% of the other disease endpoints. Virus-specific contributions to CAAP were: RSV, 49% (95% CI, 43-55%); hMPV, 13% (10-17%); PIV, 11% (7-15%); flu, 7% (1-13%). RhV and AdV did not contribute. RSV was the main contributor in all endpoints, especially in infants. Pneumococcal carriage prevalence remained largely stable throughout the study. INTERPRETATION RSV and hMPV play a critical role in the burden of CAAP and pneumococcal disease in children. Interventions targeting these viruses could have a secondary effect on the burden of disease typically attributed to bacteria. FUNDING There was no funding for this study.
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Affiliation(s)
- Ron Dagan
- The Shraga Segal Deptartment of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Bart Adriaan van der Beek
- The Shraga Segal Deptartment of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Yonat Shemer-Avni
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; Clinical Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Dana Danino
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
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19
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Feinstein Y, Kogan S, Dreiher J, Noham A, Harosh S, Lecht J, Sror T, Cohen N, Bar-Yosef E, Hershkowitz E, Lazar I, Schonmann Y, Greenberg D, Danino D. Implementing a screening algorithm for early recognition of sepsis in hospitalized children: a quality improvement project. Int J Qual Health Care 2023; 35:7008968. [PMID: 36715271 DOI: 10.1093/intqhc/mzad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/20/2022] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Sepsis is a leading cause of mortality in children. Utilizing a screening tool for early recognition of sepsis is recommended. Our centre had no screening tool for sepsis nor a standardized protocol for sepsis management. In December 2020, a screening algorithm for sepsis was implemented. The algorithm consisted of vital signs measurements in children with an abnormal body temperature, a pop-up alert, nurse's and physician's evaluation, and activation of a workup protocol. The project's primary aim was to increase vital signs measurement rates in hospitalized children with abnormal body temperature from 40% to >90% within 6 months, by 1 June 2021, and sustain until 31 December 2021. Adherence to the algorithm and performance were monitored during 2021, and the outcomes were compared to the preceding 5 years and a control ward. The alert identified 324 children and 596 febrile episodes. Vital signs measurement adherence increased from 42.7% to >90% in 2 months. A nurse evaluated 86.4% of episodes, and a physician evaluated 83.0% of these. Paediatric intensive care unit (PICU) admission rates were lower in the intervention period vs. the pre-intervention period vs. the control ward (4.6% vs. 5.6% vs. 6.0%, respectively); the median PICU length of stay was shorter in the intervention vs. the control ward [2.0 (IQR 1, 4) vs. 5.5 (IQR 2, 7), respectively]. These differences were not statistically significant. During the intervention period, the adherence to vital signs measurements reached the goal of >90%. The alert system prompted an evaluation by caregivers and management according to the protocol. Further monitoring is needed to improve outcomes.
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Affiliation(s)
- Yael Feinstein
- Pediatric Intensive Care Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Slava Kogan
- Pediatric Department, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Jacob Dreiher
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Hospital Administration, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Ayelet Noham
- Pediatric Division Administration, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Shimrat Harosh
- Information Technology Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Jenia Lecht
- Information Technology Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Tzipi Sror
- Pediatric Department, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Nurit Cohen
- Nursing Administration, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Eileen Bar-Yosef
- Nursing Administration, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Eli Hershkowitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Pediatric Department, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Isaac Lazar
- Pediatric Intensive Care Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Yochai Schonmann
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Department of Quality Measurements and Research, Clalit Health Services, 101 Arlozorov St., Tel Aviv-Jaffo 6209804, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Pediatric Division Administration, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Pediatric Infectious Diseases Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
| | - Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Pediatric Department, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.,Pediatric Infectious Diseases Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel
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20
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Shahar G, Ahronson-Daniel L, Greenberg D, Shalev H, Tendler A, Grotto I, Malone P, Davidovitch N. Anxiety in the face of the first wave of the spread of COVID-19 in Israel: Psychosocial determinants of a "Panic-to-complacency-continuum". Soc Sci Med 2023; 317:115585. [PMID: 36563585 PMCID: PMC9719843 DOI: 10.1016/j.socscimed.2022.115585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND METHODS Based on an established ongoing prospective-longitudinal study examining anxiety in response to COVID-19, a representative sample of 1018 Jewish-Israeli adults were recruited online. A baseline assessment was employed two days prior to the first spread of COVID-19, followed by six weekly assessments. Three classes of general anxiety and virus-specific anxiety were identified: (1) "Panic" (a very high and stable anxiety throughout the spread), (2) "Complacency" (a very low and stable anxiety throughout the spread), and (3) "Threat-Sensitivity" (a linear increase, plateauing at the 5th wave). For general-anxiety only, a fourth, "Balanced," class was identified, exhibiting a stable, middle-level of anxiety. We tested theory-based, baseline, social-cognitive predictors of these classes: self-criticism, perceived social support, and perceptions/attitudes towards the Israeli Ministry of Health. We also controlled for trait anxiety. Multinomial regression analyses in the context of General Mixture Modeling were utilized. RESULTS Baseline virus-specific anxiety linearly predicted emerging virus-specific anxiety classes. Virus-specific panic has higher trait anxiety than the other two classes. The general anxiety panic class was over-represented by women and exhibited higher baseline general anxiety and self-criticism than all other classes, and higher baseline virus-specific anxiety along with lower perceived support and less positive perceptions of the ministry of health than two of the three other classes. CONCLUSIONS Preexisting anxiety shapes subsequent anxious responses to the spread of COVID-19. The general-anxiety panic class may be markedly demoralized, requiring targeted public-health interventions.
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Affiliation(s)
- Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Limor Ahronson-Daniel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel,PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Greenberg
- Pediatrics Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Hadar Shalev
- Department of Psychiatry, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Itamar Grotto
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | | | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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21
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Danino D, van der Beek BA, Ben-Shimol S, Avni YS, Greenberg D, Dagan R. 2203. Involvement of Respiratory Viruses in Community-Acquired Alveolar Pneumonia (CAAP) in Children < 5 Years in Southern Israel, Before and During the COVID-19 Pandemic. Open Forum Infect Dis 2022. [PMCID: PMC9752555 DOI: 10.1093/ofid/ofac492.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) and to a lesser extent, parainfluenza and influenza viruses have been associated with pneumonia in young children. In contrast, adenovirus (AdV) and rhinovirus (RhV) are usually not associated with pneumonia. We aimed to evaluate the involvement of the four pneumonia associated viruses (grouped as PAV) in pediatric CAAP, before and during the COVID-19 pandemic. Methods CAAP incidence and viral activity surveillance in southern Israel in children < 5y and virological detection methods were described previously (Danino. CID 2022, https://doi.org/10.1093/cid/ciab1014). We reviewed the period of Jan 2016 - Mar 2022. Most cases of COVID-19 in children < 5y occurred during Dec 2021 - Mar 2022 (Figure 1); Over 95% of children admitted for respiratory disease were tested for COVID-19 (PCR). Since AdV and RhV activity was previously not associated with CAAP and tended to be equally involved in mixed and single infections, the current analysis was done for the four PAV only. Results CAAP incidence dynamics closely resembled the four PAV (grouped) activity dynamics (Figure 2A, 2B) with very low activity during the expected peak in winter 2020-2021, but with an off-season resurgence from spring 2021. Even though most CAAP episodes during the pandemic coincided with peak COVID-19 rates, only 9 CAAP episodes were COVID-19 positive (7 in 2022, of which 5 were RSV positive). Out of 3,430 CAAP episodes 55% were tested for PAV, of which 61% were positive, with similar rates before and during the pandemic. RSV was the most common involved virus, followed by hMPV. The virus distribution in CAAP during the entire period reflected their activity in the community (Figure 2C). Unlike pre-pandemic years where all four PAV appeared almost simultaneously, in 2021 PAV resurged sequentially, resulting in successive involvement in CAAP episodes, suggesting a causative association.
![]() Conclusion 1. SARS-CoV-2 was only rarely involved in CAAP in young children. 2. PAV were involved in 61% of CAAP episodes in children < 5y with predominance of RSV and hMPV. 3. The atypical dynamics imposed by the COVID-19 pandemic suggests a causative association between PAV and CAAP. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Dana Danino
- Soroka University Medical Center, Pediatric Infectious Disease Unit, Beer Sheva, HaDarom, Israel
| | | | | | | | - David Greenberg
- Soroka University Medical Center, Beer Sheva, HaDarom, Israel
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22
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Dagan R, van der Beek BA, Greenberg D, Avni YS, Ben-Shimol S, Weinberger DM. 2205. Potential Causative Association between Respiratory Viruses and Pneumococcus-Associated Disease in Young Children in Israel: Lessons from the COVID-19 Pandemic. Open Forum Infect Dis 2022. [PMCID: PMC9752790 DOI: 10.1093/ofid/ofac492.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background During the early Covid-19 pandemic, we observed a close-to-full disappearance of the activity of 4 respiratory viruses (RSV, hMPV, influenza, and parainfluenza), followed by an off-season sequential re-emergence in 2021. Surprisingly, a striking similarity between the dynamics of pneumococcus-associated disease (PAD; namely community-acquired alveolar pneumonia [CAAP; often considered pneumococcal] and bacteremic-pneumococcal pneumonia [IPD-Pneumonia]), was also observed. In contrast, adenovirus and rhinovirus activities did not change during COVID-19. We examined the association between PAD and RSV, hMPV, influenza, and parainfluenza (PAD-viruses). Methods Surveillance of CAAP and IPD-Pneumonia incidences and viral activity in children < 5 years was described in detail previously [Danino D. et al. Clin Infect Dis. 2022, https://doi.org/10.1093/cid/ciab1014]. We extended the observations until December 2021, to capture the sequential re-emergence of the 4 PAD-viruses. A hierarchical linear regression model was used to quantify the association between PAD-viruses (each virus individually and combined), adenovirus and PAD. After fitting the models, the contribution of each virus was estimated. Results The Figure shows striking similarities in the dynamics of CAAP, IPD-Pneumonia, and PAD-viruses both before and during the COVID-19 pandemic. During the expected peak season (Oct 2020 – Apr 2021) PAD episodes were extremely low. However, off-season peaks were seen during May – Dec 2021. Overall, 78% and 25% of all CAAP and IPD-Pneumonia episodes, respectively, were attributable to these viruses in children < 5 (Table). In CAAP, cases were attributable to each of the 4 PAD-viruses individually throughout the first 5 years of life: RSV and hMPV combined contributed 80%, 63%, and 42% of all CAAP episodes in children aged < 1, 1, and 2-4 years, respectively. The respective figures for influenza and parainfluenza combined were 13%, 21%, and 22%. Only RSV significantly contributed to IPD-Pneumonia (19%). Adenovirus did not contribute to PAD episodes.
![]() ![]() Conclusion Our model suggests an important causative association between RSV, hMPV, influenza, and parainfluenza viruses and CAAP, and between RSV and IPD-Pneumonia. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Ron Dagan
- Ben-Gurion University of the Negev, Beer Sheva, HaDarom, Israel
| | | | - David Greenberg
- Soroka University Medical Center, Beer Sheva, HaDarom, Israel
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23
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Confino H, Dirbas FM, Goldshtein M, Yarkoni S, Kalaora R, Hatan M, Puyesky S, Levi Y, Malka L, Johnson M, Chaisson S, Monson JM, Avniel A, Lisi S, Greenberg D, Wolf I. Gaseous nitric oxide tumor ablation induces an anti-tumor abscopal effect. Cancer Cell Int 2022; 22:405. [PMID: 36514083 PMCID: PMC9745717 DOI: 10.1186/s12935-022-02828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In-situ tumor ablation provides the immune system with the appropriate antigens to induce anti-tumor immunity. Here, we present an innovative technique for generating anti-tumor immunity by delivering exogenous ultra-high concentration (> 10,000 ppm) gaseous nitric oxide (UHCgNO) intratumorally. METHODS The capability of UHCgNO to induce apoptosis was tested in vitro in mouse colon (CT26), breast (4T1) and Lewis lung carcinoma (LLC-1) cancer cell lines. In vivo, UHCgNO was studied by treating CT26 tumor-bearing mice in-situ and assessing the immune response using a Challenge assay. RESULTS Exposing CT26, 4T1 and LLC-1 cell lines to UHCgNO for 10 s-2.5 min induced cellular apoptosis 24 h after exposure. Treating CT26 tumors in-situ with UHCgNO followed by surgical resection 14 days later resulted in a significant secondary anti-tumor effect in vivo. 100% of tumor-bearing mice treated with 50,000 ppm UHCgNO and 64% of mice treated with 20,000 ppm UHCgNO rejected a second tumor inoculation, compared to 0% in the naive control for 70 days. Additionally, more dendrocytes infiltrated the tumor 14 days post UHCgNO treatment versus the nitrogen control. Moreover, T-cell penetration into the primary tumor was observed in a dose-dependent manner. Systemic increases in T- and B-cells were seen in UHCgNO-treated mice compared to nitrogen control. Furthermore, polymorphonuclear-myeloid-derived suppressor cells were downregulated in the spleen in the UHCgNO-treated groups. CONCLUSIONS Taken together, our data demonstrate that UHCgNO followed by the surgical removal of the primary tumor 14 days later induces a strong and potent anti-tumor response.
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Affiliation(s)
| | - Frederick M. Dirbas
- grid.168010.e0000000419368956Department of General Surgery, Stanford University, Stanford, CA USA
| | | | | | | | | | | | - Yakir Levi
- Beyond Cancer Ltd., 7608801 Rehovot, Israel
| | | | | | | | - Jedidiah M. Monson
- Beyond Cancer Ltd., Atlanta, GA USA ,grid.476982.6California Cancer Associates for Research and Excellence, Fresno, CA USA
| | - Amir Avniel
- Beyond Air Ltd., 7608801 Rehovot, Israel ,Beyond Air Inc, Garden City, NY 11530 USA
| | - Steve Lisi
- Beyond Air Inc, Garden City, NY 11530 USA
| | - David Greenberg
- Beyond Air Ltd., 7608801 Rehovot, Israel ,Beyond Air Inc, Garden City, NY 11530 USA
| | - Ido Wolf
- grid.413449.f0000 0001 0518 6922Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Kujawski SA, Burgess C, Agi O, Attias-Geva Z, Pillsbury M, Greenberg D, Bencina G, Pawaskar M. The health and economic impact of switching vaccines in universal varicella vaccination programs using a dynamic transmission model: An Israel case study. Hum Vaccin Immunother 2022; 18:2124784. [PMID: 36315970 PMCID: PMC9746549 DOI: 10.1080/21645515.2022.2124784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Currently available health economic models for varicella infection are designed to inform the cost-effectiveness of universal varicella vaccination (UVV) compared with no vaccination. However, in countries with an existing UVV program, these models cannot be used to evaluate whether to continue with the current varicella vaccine or to switch to an alternative vaccine. We developed a dynamic transmission model that incorporates the historical vaccination program to project the health and economic impact of changing vaccination strategies. We applied the model to Israel, which initiated UVV in 2008 with a quadrivalent vaccine, MMRV-GSK, and switched to MMRV-MSD in 2016. The model was calibrated to pre-vaccination incidence data before projecting the impact of the historical and future alternative vaccination strategies on the clinical burden of varicella. Total costs and QALYs lost due to varicella infections were projected to compare continuing with MMRV-MSD versus switching to MMRV-GSK in 2022. Over a 50-year time horizon, continuing with MMRV-MSD reduced varicella incidence further by 64%, reaching 35 cases per 100,000 population by 2072, versus a 136% increase in incidence with MMRV-GSK. Continuing with MMRV-MSD reduced cumulative hospitalization and outpatient cases by 48% and 58% (vs. increase of 137% and 91% with MMRV-GSK), respectively. Continuing with MMRV-MSD resulted in 139 fewer QALYs lost with total cost savings of 3% compared with switching to MMRV-GSK, from the societal perspective. In Israel, maintaining the UVV strategy with MMRV-MSD versus switching to MMRV-GSK is projected to further reduce the burden of varicella and cost less from the societal perspective.
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Affiliation(s)
- Stephanie A. Kujawski
- Center for Observational and Real-World Evidence (CORE), Merck & Co. Inc, Rahway, NJ, USA
| | - Colleen Burgess
- Biostatistics and Research Decision Sciences - Health Economic Decision Sciences (BARDS-HEDS), Merck & Co. Inc, Rahway, NJ, USA,CONTACT Colleen Burgess Merck & Co. Inc, 309 N. Sumneytown Pike, North Wales, PA19454, USA
| | - Oren Agi
- Market Access and External Affairs, MSD, Hod HaSharon, Israel
| | | | - Matthew Pillsbury
- Biostatistics and Research Decision Sciences - Health Economic Decision Sciences (BARDS-HEDS), Merck & Co. Inc, Rahway, NJ, USA
| | - David Greenberg
- Pediatric Infectious Disease Unit, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Goran Bencina
- Center for Observational and Real-World Evidence (CORE), MSD, Madrid, Spain
| | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence (CORE), Merck & Co. Inc, Rahway, NJ, USA
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25
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Gok M, Madrer N, Zorbaz T, Bennett ER, Greenberg D, Bennett DA, Soreq H. Altered levels of variant cholinesterase transcripts contribute to the imbalanced cholinergic signaling in Alzheimer's and Parkinson's disease. Front Mol Neurosci 2022; 15:941467. [PMID: 36117917 PMCID: PMC9479005 DOI: 10.3389/fnmol.2022.941467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Acetylcholinesterase and butyrylcholinesterase (AChE and BChE) are involved in modulating cholinergic signaling, but their roles in Alzheimer's and Parkinson's diseases (AD and PD) remain unclear. We identified a higher frequency of the functionally impaired BCHE-K variant (rs1803274) in AD and PD compared to controls and lower than in the GTEx dataset of healthy individuals (n = 651); in comparison, the prevalence of the 5'-UTR (rs1126680) and intron 2 (rs55781031) single-nucleotide polymorphisms (SNPs) of BCHE and ACHE's 3'-UTR (rs17228616) which disrupt AChE mRNA targeting by miR-608 remained unchanged. qPCR validations confirmed lower levels of the dominant splice variant encoding the "synaptic" membrane-bound ACHE-S in human post-mortem superior temporal gyrus samples from AD and in substantia nigra (but not amygdala) samples from PD patients (n = 79, n = 67) compared to controls, potentially reflecting region-specific loss of cholinergic neurons. In contradistinction, the non-dominant "readthrough" AChE-R mRNA variant encoding for soluble AChE was elevated (p < 0.05) in the AD superior temporal gyrus and the PD amygdala, but not in the neuron-deprived substantia nigra. Elevated levels of BChE (p < 0.001) were seen in AD superior temporal gyrus. Finally, all three ACHE splice variants, AChE-S, AChE-R, and N-extended AChE, were elevated in cholinergic-differentiated human neuroblastoma cells, with exposure to the oxidative stress agent paraquat strongly downregulating AChE-S and BChE, inverse to their upregulation under exposure to the antioxidant simvastatin. The multi-leveled changes in cholinesterase balance highlight the role of post-transcriptional regulation in neurodegeneration. (235).
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Affiliation(s)
- Muslum Gok
- Department of Biochemistry, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Madrer
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Biological Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamara Zorbaz
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Biochemistry and Organic Analytical Chemistry Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Estelle R. Bennett
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Biological Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Greenberg
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Biological Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - David A. Bennett
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Hermona Soreq
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Biological Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
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26
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Gnanapragasam VJ, Greenberg D, Burnet N. Urinary symptoms and prostate cancer-the misconception that may be preventing earlier presentation and better survival outcomes. BMC Med 2022; 20:264. [PMID: 35922801 PMCID: PMC9351095 DOI: 10.1186/s12916-022-02453-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prostate cancer is an epidemic of the modern age, and despite efforts to improve awareness, it remains the case that mortality has hardly altered over the decades, driven largely by late presentation. There is a strong public perception that male urinary symptoms is one of the key indicators of prostate cancer, and this continues to be part of messaging from national guidelines and media health campaigns. This narrative, however, is not based on evidence and may be seriously hampering efforts to encourage early presentation. DISCUSSION Anatomically, prostate cancer most often arises in the peripheral zone, while urinary symptoms result from compression of the urethra by prostatic enlargement more centrally. Biopsy studies show that mean prostate volume is actually lower in men found to have (early) prostate cancer compared to those with benign biopsies. This inverse relationship between prostate size and the probability of cancer is so strong that PSA density (PSA corrected for prostate volume) is known to be significantly more accurate in predicting a positive biopsy than PSA alone. Thus, this disconnect between scientific evidence and the current perception is very striking. There is also evidence that using symptoms for investigating possible cancer may lead to higher proportions of men presenting with locally advanced or metastatic disease compared to PSA testing or screening programmes. Concerns about overwhelming health care services if men are encouraged to get tested without symptoms may also be overstated, with recent newer approaches to reduce over-investigation and treatment. In this article, we explore the link between urinary symptoms and prostate cancer and propose that public and professional messaging needs to change. CONCLUSION If rates of earlier diagnosis are to improve, we call for strong clear messaging that prostate cancer is a silent disease especially in the curable stages and men should come forward for testing regardless of whether or not they have symptoms. This should be done in parallel with other ongoing efforts to raise awareness including targeting men at highest risk due to racial ancestry or family history. While the current resurgence in interest and debate about prostate cancer screening is timely, change of this message by guideline bodies, charities and the media can be a first simple step to improving earlier presentation and hence cures rates.
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Affiliation(s)
- Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK. .,Division of Urology, Department of Surgery, University of Cambridge, Cambridge, CB2 0QQ, UK. .,Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK.
| | - David Greenberg
- (Retired) Public Health England, Public Health England, National Cancer Registration and Analysis Service (Eastern Office), England, UK
| | - Neil Burnet
- The Christie NHS Foundation Trust, Manchester, UK
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27
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Danino D, Ben-Shimol S, Sharf A, Greenberg D, Givon-Lavi N. Remote Versus In-person Outpatient Clinic Visits and Antibiotic Use Among Children During the COVID-19 Pandemic. Pediatr Infect Dis J 2022; 41:636-641. [PMID: 35544725 PMCID: PMC9281428 DOI: 10.1097/inf.0000000000003570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The proportion of remote clinic visits was expected to increase among children during the COVID-19 pandemic which might result in antibiotic overuse. METHODS In southern Israel, 2 ethnic groups, Jewish and Bedouin, live side-by-side. Computerized data on visits for children <18 years were examined from clinics with ≥50 insured children, active both pre-COVID-19 and during the COVID-19 pandemic. Visits were divided into in-person and remote. Monthly infectious diagnoses and dispensed antibiotic prescription rates were calculated by age (<5, 5-17 years) and ethnic groups. Mean monthly rates of 2 parallel seasons (pre-COVID-19 and COVID-19 periods) were compared. RESULTS Overall 2,120,253 outpatient clinic visits were recorded. Remote clinic visit rates (per 1000 children) increased from 97.04 and 33.86 in the pre-COVID-19 to 179.75 and 50.05 in the COVID-19 period in Jewish and Bedouin children, respectively ( P < 0.01) along with a reduction of in-person visit rates in both populations. Comparing pre-COVID-19 and COVID-19 periods, the rates of overall infectious diagnoses in remote visits increased. Nevertheless, dispensed antibiotic prescription rates in remote visits (per 1000 visits) remained unchanged (9.84 vs. 8.67, P = 0.70, in the Jewish population and 14.32 vs. 14.17, P = 1.00, in the Bedouin population in the pre-COVID-19 and COVID-19 periods, respectively) with a similar distribution of antibiotic categories. CONCLUSIONS COVID-19 pandemic resulted in an expansion of remote visits of children <18 years with an increase in infectious diagnoses. However, remote dispensed antibiotic prescription rates remained unchanged. These dynamics were more accentuated in Jewish children, characterized by higher socio-economic conditions, compared to Bedouin children.
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Affiliation(s)
- Dana Danino
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Amir Sharf
- Economics and Data Analysis, Clalit HMO South district, Israel
| | - David Greenberg
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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Gor D, Mehta R, Greenberg D, Angelova E. The Diagnostic and Treatment Challenges of Concomitant Mantle Cell Lymphoma and IgM Myeloma. Eur J Case Rep Intern Med 2022; 9:003463. [PMID: 36051172 PMCID: PMC9426968 DOI: 10.12890/2022_003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
It is rare for IgM multiple myeloma (MM) and mantle cell lymphoma (MCL) to coexist. Furthermore, it is challenging to demonstrate if there are two distinct types of neoplasia or if plasma cell differentiation of MCL is present. We discuss the case of a patient concomitantly diagnosed with MCL and IgM MM, and the subsequent diagnostic and management difficulties, and the positive treatment outcome.
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Affiliation(s)
- Dhairya Gor
- Internal Medicine Department, Jersey Shore Medical Center, Neptune, NJ, USA
| | - Rohan Mehta
- Hematology Oncology Department, Jersey Shore Medical Center, Neptune, NJ, USA
| | - David Greenberg
- Hematology Oncology Department, Jersey Shore Medical Center, Neptune, NJ, USA
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29
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Pillsbury M, Carias C, Samant S, Greenberg D, Pawaskar M. Comparison of performance of varicella vaccines via infectious disease modeling. Vaccine 2022; 40:3954-3962. [PMID: 35660037 DOI: 10.1016/j.vaccine.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Population-level infectious disease models for varicella require vaccine parameters, namely 'take' and 'duration of protection' (defined here as vaccine performance), to quantify the impact of vaccination. Current published models for varicella use vaccine parameters derived from various methodologies which does not allow for the direct comparison of different vaccines. METHODS We estimated take and duration of protection using deterministic compartmental models to simulate clinical trials of one- or two-dose varicella vaccination using Varivax® (V-MSD) and Varilrix® (V-GSK). We fit different models to clinical trial data on breakthrough infections and evaluated their respective goodness-of-fit using the Akaike Information Criterion (AIC). RESULTS Based upon the clinical trial data, we estimated that 90.3% (95% CI: 87.8-92.9%) of the cohort gained permanent protection from breakthrough varicella after the first dose of V-MSD compared to 61.7% (95% CI: 58.2-65.3%) with the first dose of V-GSK. We further estimated that a total of 97.0% (95% CI: 95.2-98.8%) and 93.8% (95% CI: 92.2-95.4%) of the cohort were permanently protected after two-doses of V-MSD and V-GSK, respectively. According to the AIC, our new model (V-MSD AIC = 92.7; V-GSK AIC = 170.3) provided a better fit than an existing model (V-MSD AIC = 108.9; V-GSK AIC = 216.1). CONCLUSIONS The model developed fits the long-term clinical trial data on breakthrough infections for both V-MSD and V-GSK, thus, allowing for the direct comparison of vaccine performance. We estimated that a single dose of V-MSD was more likely to provide permanent protection than a single dose of V-GSK, while the protection offered by two doses was similar for both vaccines.
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Affiliation(s)
- Matthew Pillsbury
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Cristina Carias
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Salome Samant
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - David Greenberg
- Ben Gurion University. Division of Pediatrics, Beer-Sheva, Israel
| | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA.
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30
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Givon-Lavi N, Danino D, van der Beek BA, Sharf A, Greenberg D, Ben-Shimol S. Disproportionate reduction in respiratory vs. non-respiratory outpatient clinic visits and antibiotic use in children during the COVID-19 pandemic. BMC Pediatr 2022; 22:254. [PMID: 35524208 PMCID: PMC9073498 DOI: 10.1186/s12887-022-03315-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background The COVID-19 pandemic led to improved hygiene and reduced social encounters. Near elimination of the activity of respiratory syncytial virus and influenza viruses were observed, worldwide. Therefore, we assessed the rates of pediatric outpatient clinic visits and medications prescribed at those visits during the coronavirus disease 2019 (COVID-19) pandemic and pre-COVID-19 period (2016–2019). Methods Monthly and annual incidence rates for respiratory and non-respiratory diagnoses and dispensed prescription rates were calculated. Acute gastroenteritis (AGE) visits were analyzed separately since the mode of transmission is influenced by hygiene and social distancing. Results Overall, 5,588,702 visits were recorded. Respiratory and AGE visits declined by 49.9% and 47.3% comparing the COVID-19 and pre-COVID-19 periods. The respective rate reductions for urinary tract infections, trauma, and skin and soft tissue infections were 18.2%, 19.9%, and 21.8%. Epilepsy visits increased by 8.2%. Overall visits rates declined by 21.6%. Dispensed prescription rates of antibiotics and non-antibiotics respiratory medications declined by 49.3% and 44.4%, respectively. The respective declines for non-respiratory antibiotics and non-antibiotics were 15.1% and 0.2%. Clinic visits and prescription rates reductions were highest in April–May, following the first lockdown in Israel. Conclusions COVID-19 pandemic resulted in a substantial reduction in respiratory outpatient clinic visits and dispensed respiratory drugs, with only a mild reduction seen for non-respiratory visits. These trends were probably driven by COVID-19 mitigation measures and by the profound disruption to non-SARS COV-2 respiratory virus activity. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03315-0.
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Affiliation(s)
- Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
| | | | - Amir Sharf
- Economics and Data Analysis Department, Clalit HMO South District, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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Gupta V, Singh V, Bajwa R, Meghal T, Sen S, Greenberg D, Anne M, Levitt MJ. Site-Specific Survival of Extra Nodal Diffuse Large B-Cell Lymphoma and Comparison With Gastrointestinal Diffuse Large B-Cell Lymphoma. J Hematol 2022; 11:45-54. [PMID: 35573751 PMCID: PMC9076143 DOI: 10.14740/jh984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) constitutes 30% of all non-Hodgkin’s lymphomas. It can present as a nodal disease or as an extra nodal disease. Based on the site of origin, extra nodal DLBCL (EN-DLBCL) may have a distinct clinical outcome. Apart from the site of origin, factors including demographics, stage, and presence of any other primary malignancy also affect the outcome. The purpose of our study was to characterize prognostically distinct groups based on the site of presentation of EN-DLBCL. Methods We used 18 registries in Surveillance, Epidemiology, and End Results database to identify the patients with EN-DLBCL for 2000 - 2015 with last follow-up till December 31, 2018. A total of 30,290 EN-DLBCL patients were selected and categorized based on 13 broad sites grouping. Demographic variables were summarized. We did overall survival analysis with univariate and multivariate Cox-proportional hazard modeling. Short-term survival trend was calculated as well. Results The percentage of EN-DLBCL of all DLBCLs is 34.48%. EN-DLBCL was comparatively seen more in males (54.94%) and non-Hispanic whites (71.52%). In terms of clinical characteristics, patients with EN-DLBCL were mostly diagnosed at age ≥ 60 years (66.11%), early stage (69.33%), and presentation as first primary cancer (81.89%). A higher risk of mortality was seen in non-Hispanic black (hazard ratio (HR) 1.36), with late age of onset (HR 2.69), late stage at presentation (HR 1.42), and with history of other malignancy (HR 1.29). Compared to the intestinal tract, the risk of overall mortality was higher in individuals with involvement of nervous system (HR 1.85), pancreas and hepatobiliary system (HR 1.22), and respiratory system (HR 1.18) and the best outcomes were seen in heart and mediastinal site (HR 0.58) of DLBCL. Conclusion Based upon our population-based study, we conclude that primary site of presentation of EN-DLBCL is an important prognostic factor with significant difference in survival based on histological and epidemiological characteristics.
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Affiliation(s)
- Varsha Gupta
- Department of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA
- Corresponding Author: Varsha Gupta, Department of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA.
| | - Vinit Singh
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA
| | - Ravneet Bajwa
- Department of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Trishala Meghal
- Department of Hematology and Oncology, Monmouth Medical Center, Long Branch, NJ, USA
| | - Shuvendu Sen
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - David Greenberg
- Department of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Madhurima Anne
- Department of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Michael J. Levitt
- Department of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA
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Hall DA, Pierzycki RH, Thomas H, Greenberg D, Sereda M, Hoare DJ. Systematic Evaluation of the T30 Neurostimulator Treatment for Tinnitus: A Double-Blind Randomised Placebo-Controlled Trial with Open-Label Extension. Brain Sci 2022; 12:brainsci12030317. [PMID: 35326273 PMCID: PMC8946033 DOI: 10.3390/brainsci12030317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Tinnitus is often triggered by cochlear damage and has been linked with aberrant patterns of neuronal activity. Acoustic Coordinated Reset (CR®) Neuromodulation is a sound therapy hypothesised to reduce tinnitus symptoms by desynchronising pathological brain activity using a portable acoustic device (the T30 neurostimulator). We report results of a pivotal trial to test the efficacy of this intervention. This two-centre, double-blind randomised controlled trial with long-term open-label extension, was undertaken between February 2012 and February 2014 in the UK. Participants were 100 adults with tinnitus as a primary complaint, recruited through hearing clinics and media advertisements. Intervention was the device programmed either with the proprietary sound sequence or placebo algorithm, fit by one of five trained audiologists. Minimisation software provided group allocation (1:1 randomisation), with groups matched for age, gender, hearing loss and tinnitus severity. Allocation was masked from participants and assessors during the trial. The primary measure of efficacy was change in tinnitus symptom severity between groups, measured using the Tinnitus Handicap Questionnaire at 12 weeks. Secondary outcomes were other measures of tinnitus symptom severity, health-related quality of life, and perceptual characteristics (pitch, loudness, bandwidth) at 12 weeks, and Tinnitus Handicap Questionnaire at 36 weeks (open-label extension). A statistician blinded to the allocation conducted an intention-to-treat analysis that employed linear regressions on minimisation variables, trial centre and intervention group, with multiple imputations for missing data. The study was registered on clinicaltrials.gov (NCT01541969). We screened 391 individuals and assigned interventions to 100 eligible participants. The primary outcome was not statistically significant between groups (mean group = −0.45, 95% CI −5.25 to 4.35; p = 0.85), nor were any of the secondary outcomes. Four adverse events occurred during the trial. Analysis of tinnitus symptom severity data collected across the 24-week open-label extension showed no statistically significant within-group changes after 12, 24, or 36 weeks treatment with the proprietary sound sequence. While individual participants may benefit from sound therapy, Acoustic CR® Neuromodulation did not lead to group-mean reductions on tinnitus symptom severity or other measures compared to placebo, or over time.
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Affiliation(s)
- Deborah Ann Hall
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- School of Social Sciences, Heriot-Watt University Malaysia, No. 1, Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Robert Henryk Pierzycki
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Holly Thomas
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Department of Ear, Nose and Throat (ENT), Nottingham University Hospitals (NHS) Trust, Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK
| | - David Greenberg
- Ear Institute, University College London (UCL), 332 Gray’s Inn Road, London WC1X 8EE, UK;
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Derek James Hoare
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Correspondence: ; Tel.: +44-115-823-2630
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33
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Husereau D, Drummond M, Augustovski F, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, de Bekker-Grob E, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BJOG 2022; 129:336-344. [PMID: 35014160 DOI: 10.1111/1471-0528.17012] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- D Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Institute of Health Economics, Edmonton, AB, Canada
| | - M Drummond
- Centre for Health Economics, University of York, York, UK
| | - F Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.,University of Buenos Aires, Buenos Aires, Argentina.,CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - A H Briggs
- London School of Hygiene and Tropical Medicine, London, UK
| | - C Carswell
- Adis Journals, Springer Nature, Auckland, New Zealand
| | - L Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - E de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - D Greenberg
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, School of Public Health, Israel
| | - E Loder
- Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK
| | - J Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C D Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R-F Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - S Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Faingelernt Y, Dagan R, Givon-Lavi N, van der Beek BA, Ben-Shimol S, Shany E, Greenberg D. The impact of the pneumococcal conjugate vaccines on the incidence of community-acquired alveolar pneumonia in premature compared with in term-born infants. Vaccine 2022; 40:568-573. [PMID: 34973848 DOI: 10.1016/j.vaccine.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preterm-born children are prone to respiratory infections and complications during infancy and early childhood. In Israel, pneumococcal conjugated vaccines (PCVs) were introduced in 2009-2010, with high vaccination coverage. We assessed the impact of PCV implementation on community-acquired alveolar pneumonia (CAAP) in children < 2 years old born prematurely, in comparison with term born infants. METHODS We conducted a prospective, active, population-based surveillance of children < 2 years old with radiologically-proven CAAP, visiting the only regional medical center. CAAP incidence in the pre-PCV and post-PCV eras were compared in early premature (29-32 weeks gestational age [WGA]), late premature (33-36 WGA) and term-born infants (>36 WGA). RESULTS Of 214,947 births during the study period, 6'791 CAAP episodes were diagnosed; 211, 653 and 5,806 were in early premature, late premature and term infants, respectively. After PCV implementation, overall CAAP visits were reduced by 44% (95% CI 36-51): 60%, 21% and 45% among those born early preterm, late preterm and at term, respectively (statistically significant for children born early preterm and at term). For outpatients, the respective rate reductions were 79%, 40% and 65% (statistically significant for the children born at term). Importantly, the mean annual rates in the post-PCV period became similar in all 3 groups. The rate reductions among the hospitalized children were lower those that among the non-hospitalized children, with reductions of 56%, 16% and 33% for the three groups, respectively (statistically significant for early preterm and at term children). CONCLUSIONS CAAP reduction trends after PCV implementation for preterm-born infants were similar to those for term-born infants. Whether this was because of similar direct PCV- protection, because of indirect (herd) protection or both, is unclear. Post-PCV implementation, the gaps in CAAP rates between infants born prematurely and at term were reduced.
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Affiliation(s)
- Yaniv Faingelernt
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Noga Givon-Lavi
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Shalom Ben-Shimol
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Eilon Shany
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Neonatal department Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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35
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Katz MA, Harlev EB, Chazan B, Chowers M, Greenberg D, Peretz A, Tshori S, Levy J, Yacobi M, Hirsch A, Amichay D, Weinberger R, Dor AB, Taraday EK, Reznik D, Chayat CB, Sagas D, Zvi HB, Berdinstein R, Rashid G, Avni YS, Mandelboim M, Zuckerman N, Rainy N, Akriv A, Dagan N, Kepten E, Barda N, Balicer RD. Early effectiveness of BNT162b2 Covid-19 vaccine in preventing SARS-CoV-2 infection in healthcare personnel in six Israeli hospitals (CoVEHPI). Vaccine 2022; 40:512-520. [PMID: 34903372 PMCID: PMC8662353 DOI: 10.1016/j.vaccine.2021.11.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate early real-world VE in a closely monitored population. METHODS We conducted a prospective study among HCP in 6 hospitals to estimate the effectiveness of the BNT162b2 mRNA Covid-19 vaccine in preventing SARS-CoV-2 infection. Participants filled out weekly symptom questionnaires, provided weekly nasal specimens, and three serology samples - at enrollment, 30 days and 90 days. We estimated VE against PCR-confirmed SARS-CoV-2 infection using the Cox Proportional Hazards model and against a combined PCR/serology endpoint using Fisher's exact test. RESULTS Of the 1567 HCP enrolled between December 27, 2020 and February 15, 2021, 1250 previously uninfected participants were included in the primary analysis; 998 (79.8%) were vaccinated with their first dose prior to or at enrollment, all with Pfizer BNT162b2 mRNA vaccine. There were four PCR-positive events among vaccinated participants, and nine among unvaccinated participants. Adjusted two-dose VE against any PCR-confirmed infection was 94.5% (95% CI: 82.6%-98.2%); adjusted two-dose VE against a combined endpoint of PCR and seroconversion for a 60-day follow-up period was 94.5% (95% CI: 63.0%-99.0%). Five PCR-positive samples from study participants were sequenced; all were alpha variant. CONCLUSIONS Our prospective VE study of HCP in Israel with rigorous weekly surveillance found very high VE for two doses of Pfizer BNT162b2 mRNA vaccine against SARS-CoV-2 infection in recently vaccinated HCP during a period of predominant alpha variant circulation. FUNDING Clalit Health Services.
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Affiliation(s)
- Mark A Katz
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Efrat Bron Harlev
- Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Bibiana Chazan
- Infectious Diseases and Infection Control Unit, Ha'Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Chowers
- Infectious Diseases, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit the Pediatric Division, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alon Peretz
- Occupational Medicine Clinic, Rabin Medical Center, Petah Tikva, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Levy
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Mili Yacobi
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Avital Hirsch
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Doron Amichay
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Ronit Weinberger
- Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Anat Ben Dor
- Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | | | - Dana Reznik
- Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Chen Barazani Chayat
- Multidisciplinary Laboratory, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Dana Sagas
- Clinical Microbiology Laboratory, Ha'Emek Medical Center, Afula, Israel
| | - Haim Ben Zvi
- Microbiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Rita Berdinstein
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Microbiology Department, Kaplan Medical Center, Rehovot, Israel
| | - Gloria Rashid
- Department of Clinical Laboratories, Meir Medical Center, Kfar Saba, Israel
| | | | - Michal Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel
| | - Nir Rainy
- Laboratory Division, Shamir Medical Center, Zerifin, Israel
| | - Amichay Akriv
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Ivan and Francesca Berkowitz Family Living Laboratory at Harvard Medical School, Boston, MA, USA
| | - Eldad Kepten
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Ivan and Francesca Berkowitz Family Living Laboratory at Harvard Medical School, Boston, MA, USA
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Greenberg D, Snyder KP, Filazzola A, Mastromonaco GF, Schoof VAM. Hormonal correlates of male dominance rank, age, and genital colouration in vervet monkey (Chlorocebus pygerythrus). Gen Comp Endocrinol 2022; 316:113948. [PMID: 34826430 DOI: 10.1016/j.ygcen.2021.113948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/02/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023]
Abstract
Primates are the most colourful members of the Mammalian clade. In vervet monkeys (Chlorocebus pygerythrus), males are characterized by their red penis and blue scrotum. Such colour signals are often used in conspecific communication, and thus could be used to convey signaller condition. We quantified scrotal and penile colour characteristics using digital photographs between May-June 2016 from males in two neighboring groups along the shores of Lake Nabugabo, Uganda. We examined the relationship between fecal hormones, male dominance rank, age (adult vs. immature), and colour. Adult males were higher ranking than immatures, but there were no rank or age differences in fecal hormone levels. Glucocorticoids and androgens were positively correlated in immature, but not adult males. All scrotal characteristics were predicted by age, with adult males having more teal (i.e., less blue, more green) and more luminant scrota. Within adult males, those with higher androgens levels had more saturated blue scrotal colouration and higher-ranking males were more luminant. Penile colouration was also associated with age and rank. High-ranking males had a more saturated red penis, and adult male penile colour was more luminant and bluer than in immature males. Our findings are consistent with previous reports that scrotal colouration advertises sexual or reproductive maturity (i.e., age), but we also find that within adult males, colour also advertises dominance rank and may be mediated by androgen levels. Penile colouration also appears to signal information about male age and dominance rank but does not appear to be mediated by hormones.
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Affiliation(s)
- D Greenberg
- Department of Biology, Faculty of Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - K P Snyder
- Department of Biology, Faculty of Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - A Filazzola
- Department of Biology, Faculty of Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; Department of Biological Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada
| | - G F Mastromonaco
- Reproductive Sciences Unit, Toronto Zoo, 361A Old Finch Avenue, Toronto, ON M1B 5K7, Canada
| | - V A M Schoof
- Department of Biology, Faculty of Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; Bilingual Biology Program, Department of Multidisciplinary Studies, Glendon College, York University, 2275 Bayview Avenue, Toronto, ON M4N 3M6, Canada.
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37
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Butler TG, Gullotta M, Greenberg D. Reliability of prisoners' survey responses: comparison of self-reported health and biomedical data from an australian prisoner cohort. BMC Public Health 2022; 22:64. [PMID: 35012501 PMCID: PMC8747873 DOI: 10.1186/s12889-021-12460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Prisoner health surveys primarily rely on self-report data. However, it is unclear whether prisoners are reliable health survey respondents. This paper aimed to determine the level of agreement between self-report and biomedical tests for a number of chronic health conditions. METHOD This study was a secondary analysis of existing data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey. The health surveys were cross-sectional in nature and included a stratified random sample of men (n=2,114) from all NSW prisons. Self-reported histories of hepatitis, sexually transmissible infections, and diabetes were compared to objective biomedical measures of these conditions. RESULTS Overall, the sensitivity (i.e., the respondents who self-reported having the condition also had markers indicative of the condition using biomedical tests) was high for hepatitis C (96%) and hepatitis B (83%), but low for all other assessed conditions (ranging from 9.1% for syphilis using RPR to 64% for diabetes). However, Kappa scores indicated substantial agreement only for hepatitis C. That is, there were false positives and false negatives which occurred outside of chance leading to poor agreement for all other assessed conditions. CONCLUSIONS Prisoners may have been exposed to serious health conditions while failing to report a history of infection. It may be possible that prisoners do not get tested given the asymptomatic presentation of some conditions, were unaware of their health status, have limited health-service usage preventing the opportunity for detection, or are subject to forgetting or misunderstanding prior test results. These findings demonstrate the importance of the custodial environment in screening for health conditions and referral for treatment should this be needed. Testing on entry, periodically during incarceration, and prior to release is recommended.
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Affiliation(s)
- Tony Gerard Butler
- School of Population Health, University of New South Wales, 2052, Sydney, NSW, Australia
| | - Mathew Gullotta
- School of Population Health, University of New South Wales, 2052, Sydney, NSW, Australia. .,The Wellbeing Group, 2040, Sydney, NSW, Australia.
| | - David Greenberg
- Statewide Community Court Liaison Service, Justice Health and Forensic Mental Health Network, 2036, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, 2052, Sydney, NSW, Australia
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Stein M, Ashkenazi-Hoffnung L, Greenberg D, Dalal I, Livni G, Chapnick G, Stein-Zamir C, Ashkenazi S, Hecht-Sagie L, Grossman Z. The Burden of COVID-19 in Children and Its Prevention by Vaccination: A Joint Statement of the Israeli Pediatric Association and the Israeli Society for Pediatric Infectious Diseases. Vaccines (Basel) 2022; 10:81. [PMID: 35062742 PMCID: PMC8781684 DOI: 10.3390/vaccines10010081] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/27/2023] Open
Abstract
As of October 2021, SARS-CoV-2 infections were reported among 512,613 children and adolescents in Israel (~33% of all COVID-19 cases). The 5-11-year age group accounted for about 43% (223,850) of affected children and adolescents. In light of the availability of the Pfizer-BioNTech BNT162b2 vaccine against COVID-19 for children aged 5-11 years, we aimed to write a position paper for pediatricians, policymakers and families regarding the clinical aspects of COVID-19 and the vaccination of children against COVID-19. The first objective of this review was to describe the diverse facets of the burden of COVID-19 in children, including the direct effects of hospitalization during the acute phase of the disease, multisystem inflammatory syndrome in children, long COVID and the indirect effects of social isolation and interruption in education. In addition, we aimed to provide an update regarding the efficacy and safety of childhood mRNA COVID-19 vaccination and to instill confidence in pediatricians regarding the benefits of vaccinating children against COVID-19. We reviewed up-to-date Israeli and international epidemiological data and literature regarding COVID-19 morbidity and its sequelae in children, vaccine efficacy in reducing COVID-19-related morbidity and SARS-CoV-2 transmission and vaccine safety data. We conducted a risk-benefit analysis regarding the vaccination of children and adolescents. We concluded that vaccines are safe and effective and are recommended for all children aged 5 to 11 years to protect them from COVID-19 and its complications and to reduce community transmissions. Based on these data, after weighing the benefits of vaccination versus the harm, the Israeli Ministry of Health decided to recommend vaccination for children aged 5-11 years.
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Affiliation(s)
- Michal Stein
- Infectious Diseases and Infection Control Unit, Hillel Yaffe Medical Center, Hadera 3810101, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Liat Ashkenazi-Hoffnung
- Department of Day Care Hospitalization, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka Medical Center, Be’er Sheva 8458900, Israel;
- The Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Be’er Sheva 8410501, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
- Pediatric Department, E. Wolfson Medical Center, Holon 5822012, Israel
| | - Gilat Livni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva 4920245, Israel
| | - Gil Chapnick
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Jerusalem 9137001, Israel;
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shai Ashkenazi
- Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
- Adelson School of Medicine, Ariel University, Ari’el 4070000, Israel
| | - Lior Hecht-Sagie
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
| | - Zachi Grossman
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
- Adelson School of Medicine, Ariel University, Ari’el 4070000, Israel
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Chowdhury NZ, Wand H, Albalawi O, Adily A, Kariminia A, Allnutt S, Sara G, Dean K, Ellis A, Greenberg D, Schofield PW, Butler T. Mental health service contact following release from prison or hospital discharge in those with psychosis. Front Psychiatry 2022; 13:1034917. [PMID: 36590622 PMCID: PMC9798427 DOI: 10.3389/fpsyt.2022.1034917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND An association exists between psychosis and criminal offending, which evidence suggests can be reduced by effective mental health care for this vulnerable population. However mental health services often lose contact with people after diagnosis. The association between the first episode of psychosis and criminal offending highlights the need for effective mental health care for this vulnerable population. AIMS To investigate the association between the first diagnosis of psychosis (FDP) in prison or hospital and subsequent mental health service contact following release from prison or discharge from hospital. MATERIALS AND METHODS Individuals with a FDP either in prison (n = 492) or hospital setting (n = 24,910) between July 2006 and December 2011 in NSW (Australia), were followed post-release or discharge until their first mental health service contact in the community, the occurrence of an offence, death, or completion of the study period at the end of December 2012. Cox regression models were used to examine the predictors for the mental health service contacts following release or discharge. RESULTS Over 70% of those with a FDP in prison or hospital had a psychosis-related or any community-based mental health service contact following release or discharge between July 2006 and December 2012. Those with a FDP in prison were more likely to have no contact with mental health services than those in hospital with no prior offence record (hazard ratio, HR = 3.14, 95% CI: 2.66-3.72 and adjusted hazard ratio, aHR = 3.05, 95% CI: 2.56-3.63) within a median follow-up time of 25 days for the prison group and 26 days for hospital group. Males, individuals of Aboriginal heritage and individuals diagnosed with substance-related psychoses compared to those with schizophrenia and related psychoses were less likely to have a mental health service contact following release or discharge in both the univariable and multivariable analysis. CONCLUSION This study suggests that prior offending or a previous prison episode represents a barrier to mental health service contact in the community for those with a FDP. Effective rehabilitation planning while exiting prison and discharge planning from hospital are essential to the successful reintegration of these individuals with a FDP.
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Affiliation(s)
- Nabila Z Chowdhury
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Olayan Albalawi
- Department of Statistics, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - Armita Adily
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stephen Allnutt
- Forensic Mental Health Program, University of New South Wales, Sydney, NSW, Australia
| | - Grant Sara
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales and Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
| | - Andrew Ellis
- NSW Justice Health & Forensic Mental Health Network, Newcastle, NSW, Australia
| | - David Greenberg
- NSW Justice Health & Forensic Mental Health Network, Newcastle, NSW, Australia
| | | | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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40
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Shahar G, Aharonson-Daniel L, Greenberg D, Shalev H, Malone PS, Tendler A, Grotto I, Davidovitch N. Changes in General and Virus-Specific Anxiety During the Spread of COVID-19 in Israel: A 7-Wave Longitudinal Study. Am J Epidemiol 2022; 191:49-62. [PMID: 34397093 PMCID: PMC8436394 DOI: 10.1093/aje/kwab214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
We compared three hypothetical trajectories of change in both general and COVID-19-specific anxiety during the 1st wave of the spread in the state of Israel: panic (very high anxiety, either from the outset or rapidly increasing), complacency (stable and low anxiety), and threat-sensitive (a moderate, linear increase compatible with the increase in threat). A representative sample of 1018 Jewish-Israeli adults was recruited online. A baseline assessment commenced two days prior to the identification of the first case, followed by six weekly assessments. Latent Mixture Modeling analyses revealed the presence of the three trajectories: (1) "threat-sensitivity" (29% and 66%, for general and virus-specific anxiety, respectively), (2) Panic (12% and 25%), and (3) Complacency (29% and 9%). Only for general anxiety, a fourth class representing a stable mid-level anxiety was identified ("balanced": 30%). For general anxiety, females and the initially anxious - both generally and specifically from the spread of the virus - were more likely to belong to the panic class. Men and older participants were more likely to belong to the complacency class. Findings indicate a marked heterogeneity in anxiety responses to the first wave of the spread of COVID-19, including a large group evincing a "balanced" response.
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Affiliation(s)
- Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
- Correspondence to: Prof. Golan Shahar, Department of Psychology, Ph.D., Ben-Gurion University of the Negev, 800 Ben-Gurion Avenues, Beer-Sheva, Israel, emails: , or Prof. Nadav Davidovitch, M.D., Ph.D., School of Public Health, Ben-Gurion University of the Negev, 800 Ben-Gurion Avenues, Beer-Sheva, Israel,
| | - Limor Aharonson-Daniel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Greenberg
- Pediatrics Unit, Soroka General Hospital, Beer-Sheva, Israel
| | - Hadar Shalev
- Department of Psychiatry, Soroka University Medical Center, Beer-Sheva, Israel
| | | | | | - Itamar Grotto
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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41
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Danino D, Ben-Shimol S, Van Der Beek BA, Givon-Lavi N, Avni YS, Greenberg D, Weinberger DM, Dagan R. Decline in Pneumococcal Disease in Young Children During the Coronavirus Disease 2019 (COVID-19) Pandemic in Israel Associated With Suppression of Seasonal Respiratory Viruses, Despite Persistent Pneumococcal Carriage: A Prospective Cohort Study. Clin Infect Dis 2021; 75:e1154-e1164. [PMID: 34904635 PMCID: PMC8754767 DOI: 10.1093/cid/ciab1014] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The incidence of invasive pneumococcal disease (IPD) declined during the COVID-19 pandemic. Previous studies hypothesized that this was due to reduced pneumococcal transmission resulting from nonpharmaceutical interventions. We used multiple ongoing cohort surveillance projects in children <5 years to test this hypothesis. METHODS The first SARS-CoV-2 cases were detected in February 2020, resulting in a full lockdown, followed by several partial restrictions. Data from ongoing surveillance projects captured the incidence dynamics of community-acquired alveolar pneumonia (CAAP), nonalveolar lower respiratory infections necessitating chest X-rays (NA-LRIs), nasopharyngeal pneumococcal carriage in nonrespiratory visits, nasopharyngeal respiratory virus detection (by polymerase chain reaction), and nationwide IPD. Monthly rates (January 2020 through February 2021 vs mean monthly rates 2016-2019 [expected rates]) adjusted for age and ethnicity were compared. RESULTS CAAP and bacteremic pneumococcal pneumonia were strongly reduced (incidence rate ratios [IRRs]: .07 and .19, respectively); NA-LRIs and nonpneumonia IPD were also reduced by a lesser magnitude (IRRs: .46 and .42, respectively). In contrast, pneumococcal carriage prevalence was only slightly reduced, and density of colonization and pneumococcal serotype distributions were similar to previous years. The decline in pneumococcus-associated disease was temporally associated with a full suppression of respiratory syncytial virus, influenza viruses, and human metapneumovirus, often implicated as co-pathogens with pneumococcus. In contrast, adenovirus, rhinovirus, and parainfluenza activities were within or above expected levels. CONCLUSIONS Reductions in pneumococcal and pneumococcus-associated diseases occurring during the COVID-19 pandemic in Israel were not predominantly related to reduced pneumococcal carriage and density but were strongly associated with the disappearance of specific respiratory viruses.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yonat Shemer Avni
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Clinical Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Corresponding author: Ron Dagan, MD, The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel, E-mail:
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Tashlizky Madar R, Goldberg A, Newman N, Waisman Y, Greenberg D, Adini B. A management model for admission and treatment of pediatric trauma cases. Isr J Health Policy Res 2021; 10:73. [PMID: 34903295 PMCID: PMC8670149 DOI: 10.1186/s13584-021-00506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pediatric trauma, particularly major trauma cases, are often treated in less than optimal facilities by providers who lack training and experience in treating severely injured children. We aimed to develop a management model for admission and treatment of pediatric trauma using the Theory of Constraints (TOC).
Methods We conducted interviews with 17 highly experienced policy makers, senior nursing managers and medical managers in pediatrics and trauma. The interviews were analyzed by qualitative methods. The TOC was utilized to identify undesirable effects (UDEs) and core challenges, and to design a focused current reality tree (CRT). Subsequently, a management model for optimal admission and treatment of pediatric trauma was constructed. Results The CRT was illustrated according to 4 identified UDEs focusing on lack of: (1) clear definitions of case manager in pediatric trauma; (2) uniform criteria regarding the appropriate site for admitting pediatric trauma, (3) standard guidelines and protocols for treatment of trauma cases and for training of trauma medical teams; and (4) standard guidelines for evacuating pediatric trauma patients. The management model for treatment and admission of pediatric trauma is based on 3 major elements: human resources, hospital policy concerning the appropriate emergency department (ED) for pediatric trauma patients and clear definitions regarding children and trauma levels. Each of the elements contains components that should be clearly defined in order for a medical center to be designated for admitting and treating pediatric trauma patients. Conclusions Our analysis suggests that the optimal ED for pediatric trauma cases is one with available operating rooms, intensive care beds, an imaging unit, laboratories and equipment suitable for treating children as well as with staff trained to treat children with trauma. To achieve optimal outcomes, medical centers in Israel should be classified according to their trauma treatment capabilities and their ability to treat varied severities of pediatric trauma cases. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00506-5.
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Affiliation(s)
| | - Avishay Goldberg
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.,PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Nitza Newman
- Pediatric Surgery Department, Soroka University Medical Center, Beer Sheva, Israel
| | - Yehezkel Waisman
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,School of Continuing Medical Education, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Pediatrics Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bruria Adini
- Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ajam F, Batchu P, Wiseman K, Gor D, Mason E, Alshami A, Douedi S, Mehra A, Bajwa R, Levitt M, Greenberg D, Raza M. Primary Cardiac Lymphoma: A Case Report. J Med Cases 2021; 12:433-437. [PMID: 34804301 PMCID: PMC8577611 DOI: 10.14740/jmc3773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Cardiac lymphoma is a rare neoplasm involving heart, pericardium or both, usually seen in immunocompromised patients. We report a 61-year-old male presenting with worsening shortness of breath and 20-pound weight loss. Investigations showed right-sided tumor with interatrial septal wall perforation and left atrial expansion. The diagnosis was confirmed with mediastinal mass biopsy. After receiving the appropriate treatment, there was a steady improvement clinically and on the transesophageal echocardiography.
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Affiliation(s)
- Firas Ajam
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Priyanka Batchu
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Kyle Wiseman
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Dhairya Gor
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Elisabeth Mason
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Steven Douedi
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Aditya Mehra
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Ravneet Bajwa
- Hematology/Oncology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Michael Levitt
- Hematology/Oncology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - David Greenberg
- Hematology/Oncology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Muhammad Raza
- Cardiology Department, Jersey Shore University Medical Center, Neptune, NJ, USA
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Weinstein J, Simon-Tuval T, Kiselnik D, Hemo Z, Amitai V, Stanovski Y, Sidi A, Kidman G, Sharf A, Greenberg D. Treating patients with advanced heart failure in a community-based multidisciplinary team clinic is associated with significant reduction of healthcare utilization and costs. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Heart failure (HF) care imposes a major economic burden, accounting for 1–3% of healthcare expenditure in developed countries. The greatest proportion of this cost (60%-70%) is accounted for by hospitalizations. A multidisciplinary team (MDT) approach in HF management is a key recommendation in international guidelines, to reduce mortality and HF hospitalization.
Purpose
To investigate whether a community-based MDT in an HF unit (HFU) had an impact on patients' healthcare utilization (HCU), and their associated costs.
Methods
A retrospective cohort study was conducted among members of the country's largest HMO, who visited at least once in a regional community-based HFU, established to provide ambulatory specialist care for patients with advanced HF, emphasizing patients in NYHA functional class III and IV, especially those with recurrent hospitalizations. HCU data were obtained from the HMO's claims data for 12 months before and after first HFU visit.
Results
Our cohort consisted of 962 patients, of whom 843 (87.6%) completed at least 12 months of follow-up, and 119 (12.4%) died during the 12 months following their first HFU visit. Both groups were comparable with regard to sex, socioeconomic status, Charlson comorbidity index, prevalence of IHD and/or carotid artery disease, AF, obesity, and chronic pulmonary disease. Those who died within 12 months were older, had more hypertension, hyperlipidaemia, diabetes, chronic renal disease and malignancy but were less likely to be smokers or to have supplementary health insurance coverage. There was a significant reduction in the total average HCU costs of the entire study population 12 months after the first HFU visit ($12,675 after vs. $13,188 before, p=0.014). However, while a reduction in these costs was observed among patients who completed 12 months of follow-up ($11,955 after vs. $13,112 before, p<0.001), an increase in these costs was observed among patients who died during follow-up ($17,774 after vs. $13,728 before, p=0.015). These opposite trends stem from a decrease ($3,540 after vs. $4,941 before, p<0.001) versus increase ($10,932 after vs. $6,733 before, p=0.002) in hospitalization costs of these groups, respectively, and an increase ($1,272 after vs. $928 before, p<0.001) versus decrease ($799 after vs. $1,116 before, p<0.001) in medication costs of these subgroups, respectively.
Conclusion(s)
Intensification of therapy by a dedicated MDT significantly reduced costs of HCU, predominantly because of a decrease in hospitalizations. This saving was noted even when including patients who died within a year of commencing treatment in our HFU (a group in whom healthcare costs are known to be excessive). A widespread establishment of dedicated community-based units, should be encouraged.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J.M Weinstein
- Soroka University Medical Center, Beer Sheva, Israel
| | - T Simon-Tuval
- Ben-Gurion University of the Negev, Department of Health Systems Management, Beer Sheva, Israel
| | - D Kiselnik
- Soroka University Medical Center, Beer Sheva, Israel
| | - Z Hemo
- Clalit Heath Services, Beer Sheva, Israel
| | - V Amitai
- Clalit Heath Services, Beer Sheva, Israel
| | | | - A Sidi
- Soroka University Medical Center, Beer Sheva, Israel
| | - G Kidman
- Clalit Heath Services, Beer Sheva, Israel
| | - A Sharf
- Clalit Heath Services, Beer Sheva, Israel
| | - D Greenberg
- Ben-Gurion University of the Negev, Department of Health Systems Management, Beer Sheva, Israel
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Butler T, Schofield PW, Knight L, Ton B, Greenberg D, Scott RJ, Grant L, Keech AC, Gebski V, Jones J, Ellis A, Weatherburn D, Wilhelm K, Jones A, Churchill A, Allnutt S, Mitchell PB, Chappell D, D'Este C, Villa D, Carr V. Sertraline hydrochloride for reducing impulsive behaviour in male, repeat-violent offenders (ReINVEST): protocol for a phase IV, double-blind, placebo-controlled, randomised clinical trial. BMJ Open 2021; 11:e044656. [PMID: 34475139 PMCID: PMC8413868 DOI: 10.1136/bmjopen-2020-044656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/31/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Considerable evidence supports an association between poor impulse control (impulsivity) and violent crime. Furthermore, impulsivity and aggression has been associated with reduced levels of serotonergic activity in the brain. Selective serotonin reuptake inhibitors (SSRIs) are a class of anti-depressants that aim to regulate brain serotonin concentrations. Several small studies in psychiatric populations have administered SSRIs to impulsive--aggressive individuals, resulting in reduced impulsivity, anger, aggression and depression. However, no clinical trial has been undertaken in a criminal justice population. This protocol describes the design and implementation of the first systematic study of the potential benefits of SSRIs in impulsive---violent offenders who are at high risk of reoffending. METHODS AND ANALYSIS A randomised, double-blinded, multicentre trial to test the clinical efficacy of an SSRI, sertraline hydrochloride, compared with placebo on recidivism and behavioural measures (including impulsivity, anger, aggression, depression and self-reported offending) over 12 months. 460 participants with histories of violence and screening positive for impulsivity are recruited at several local courts and correctional service offices in New South Wales, Australia. ETHICS AND DISSEMINATION Results will be submitted for publication in a peer-reviewed journal. Possible implications of the effectiveness of this pharmacological intervention include economic benefits of reducing prison costs and societal benefits of improving safety. This study has received ethical approval from the University of New South Wales, Aboriginal Health & Medical Research Council, Corrective Services NSW and the NSW Justice Health and Forensic Mental Health Network. TRIAL REGISTRATION NUMBER ACTRN12613000442707.
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Affiliation(s)
- Tony Butler
- University of New South Wales, Sydney, New South Wales, Australia
| | - Peter W Schofield
- The University of Newcastle, Callaghan, New South Wales, Australia
- Neuropsychiatry Service, Hunter New England Mental Health, Newcastle, New South Wales, Australia
| | - Lee Knight
- University of New South Wales, Sydney, New South Wales, Australia
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Bianca Ton
- University of New South Wales, Sydney, New South Wales, Australia
| | - David Greenberg
- University of New South Wales, Sydney, New South Wales, Australia
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Rodney J Scott
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Grant
- Corrective Services New South Wales, Sydney, New South Wales, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Andrew Ellis
- University of New South Wales, Sydney, New South Wales, Australia
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | | | - Kay Wilhelm
- University of New South Wales, Sydney, New South Wales, Australia
| | - Alison Jones
- Fiona Stanley and Fremantle Hospitals Group, South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Alison Churchill
- Community Restorative Centre, Canterbury, New South Wales, Australia
| | - Stephen Allnutt
- University of New South Wales, Sydney, New South Wales, Australia
- Private practice psychiatrist, Lindfield, New South Wales, Australia
| | | | - Duncan Chappell
- University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Vaughan Carr
- University of New South Wales, Sydney, New South Wales, Australia
- Monash University, Clayton, Victoria, Australia
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Lipsitz O, Di Vincenzo JD, Rodrigues NB, Cha DS, Lee Y, Greenberg D, Teopiz KM, Ho RC, Cao B, Lin K, Subramaniapillai M, Flint AJ, Kratiuk K, McIntyre RS, Rosenblat JD. Safety, Tolerability, and Real-World Effectiveness of Intravenous Ketamine in Older Adults With Treatment-Resistant Depression: A Case Series. Am J Geriatr Psychiatry 2021; 29:899-913. [PMID: 33478865 DOI: 10.1016/j.jagp.2020.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the safety, tolerability, and effectiveness of repeated doses of intravenous (IV) ketamine in older adults (i.e., ≥60 years of age) with treatment-resistant depression. METHOD In this case series, fifty-three older adults (Mage = 67, SD = 6; 57% female [n = 30]) received 4 IV ketamine infusions, administered over 1-2 weeks. Effectiveness of IV ketamine was measured using the Quick Inventory for Depressive Symptomatology-Self Report 16 (QIDS-SR16) approximately 2 days after infusions 1-3, and 1-2 weeks after infusion 4. Safety was measured as hemodynamic changes before, during, immediately after, and 20 minutes after each infusion. Tolerability was assessed via systematic reporting of treatment-emergent adverse events during and after each infusion, in addition to symptoms of dissociation measured using the Clinician Administered Dissociative States Scale. Partial response (25%-50% symptomatic improvement from baseline), response (≥50% symptomatic improvement from baseline), clinically significant improvements (≥25% symptomatic improvement from baseline), and remission rates (QIDS-SR16 ≤5) were also calculated. RESULTS Participants reported significant decreases in depressive symptoms (i.e., as measured by the QIDS-SR16) with repeated ketamine infusions (F(4, 92) = 7.412, p <0.001). The mean QIDS-SR16 score was 17.12 (SD = 5.33) at baseline and decreased to 12.52 (SD = 5.79) following 4 infusions. After 4 infusions, 31% (n = 8) of participants partially responded to IV ketamine, 27% (n = 7) responded, 58% (n = 15) experienced clinically significant improvements, and 10% (n = 3) met remission criteria. Thirty-six participants (69%) experienced treatment-emergent hypertension during at least 1 infusion, and 10 (19%) required intervention with an antihypertensive. Drowsiness was the most commonly reported adverse event (50% of infusions; n = 73). CONCLUSION Ketamine was associated with transient treatment-emergent hypertension. Response and remission rates were comparable to those reported in general adult samples. Findings are limited by the open-label, chart review nature of this study.
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Affiliation(s)
- Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto (JDV, RSM), Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; School of Medicine, Faculty of Medicine, University of Queensland (DSC), Brisbane, QLD, Australia
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - David Greenberg
- Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Kayla M Teopiz
- Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (RCH), Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore (RCH), Singapore
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University (BC), Chongqing, 400715, PR China
| | - Kangguang Lin
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University (KL), Guangzhou, China; Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University (KL), Guangzhou, China
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto (AJF, RSM, JDR), Toronto, ON, Canada; Centre for Mental Health, University Health Network (AJF), Toronto, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada; Department of Clinical Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada; Department of Psychiatry, University of Toronto (AJF, RSM, JDR), Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto (JDV, RSM), Toronto, ON, Canada.
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada; Department of Psychiatry, University of Toronto (AJF, RSM, JDR), Toronto, ON, Canada
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Gullotta M, Greenberg D, Albalawi O, Adily A, Karminia A, Knight L, Ellis A, Butler TG. Self-harm and suicidality among three subgroups of male sex offenders: results from an Australian prisoner cohort. Health Justice 2021; 9:19. [PMID: 34318345 PMCID: PMC8317271 DOI: 10.1186/s40352-021-00146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs). METHODS Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State's re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality. RESULTS Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99]). CONCLUSION Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide.
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Affiliation(s)
- Mathew Gullotta
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - David Greenberg
- Justice Health and Forensic Mental Health Network, Sydney, NSW 2036 Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
| | - Olayan Albalawi
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
- Department of Statistics, Tabuk University, Tabuk, 47512 Saudi Arabia
| | - Armita Adily
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Azar Karminia
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Lee Knight
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
- Justice Health and Forensic Mental Health Network, Sydney, NSW 2036 Australia
| | - Andrew Ellis
- Justice Health and Forensic Mental Health Network, Sydney, NSW 2036 Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
| | - Tony Gerard Butler
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
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Ben-Shimol S, Givon-Lavi N, Kotler L, Adriaan van der Beek B, Greenberg D, Dagan R. Post-13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children of Serotypes Included in Candidate Extended-Spectrum Conjugate Vaccines. Emerg Infect Dis 2021; 27:150-160. [PMID: 33350916 PMCID: PMC7774550 DOI: 10.3201/eid2701.201178] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
After worldwide implementation of 10-valent and 13-valent pneumococcal conjugate vaccines (PCV10/PCV13), a 20-valent PCV (PCV20) was developed. We assessed dynamics of non-PCV13 additional PCV20 serotypes (VT20–13), compared with all other non-VT20 serotypes, in children <2 years of age in late PCV13 (2015–2017) and early PCV (2009–2011) periods. Our prospective population-based multifaceted surveillance included isolates from carriage in healthy children, children requiring chest radiography for lower respiratory tract infections (LRTIs), and children with non-LRTI illness, as well as isolates from acute conjunctivitis, otitis media (OM), and invasive pneumococcal disease (IPD). After PCV13 implementation, VT20–13 increased disproportionally in OM, IPD, and carriage in LRTI. VT20–13/non-VT20 prevalence ratio range was 0.26–1.40. VT20–13 serotypes were more frequently antimicrobial-nonsusceptible than non-VT20 serotypes. The disproportionate increase of VT20–13 in respiratory infections and IPD points to their higher disease potential compared with all other non-VT20 as a group.
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Ben-Shimol S, Livni G, Megged O, Greenberg D, Danino D, Youngster I, Shachor-Meyouhas Y, Dabaja-Younis H, Scheuerman O, Mor M, Somekh E, Yakub Hanna H, Givon-Lavi N, Guri A, Leibovitz E, Alkan Y, Grupel D, Rubinstein U, Steinberg Ben Zeev Z, Bamberger E, Asher Kuperman A, Grisaru-Soen G, Tasher D, Gottesman G, Glikman D, Stein M. COVID-19 in a Subset of Hospitalized Children in Israel. J Pediatric Infect Dis Soc 2021; 10:757-765. [PMID: 34129032 PMCID: PMC8344587 DOI: 10.1093/jpids/piab035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. METHODS An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). RESULTS Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. CONCLUSIONS At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Corresponding Author: Shalom Ben-Shimol, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel. E-mail:
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Danino
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Youngster
- Pediatric Infectious Diseases Unit, Shamir Medical Center, Zerifin, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shachor-Meyouhas
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Halima Dabaja-Younis
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Meirav Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Infection Control Unit and Emergency Department, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Eli Somekh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Husam Yakub Hanna
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alex Guri
- Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Eugene Leibovitz
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Alkan
- Clalit Health Services, Sharon Shomron District, Israel
| | - Daniel Grupel
- Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | | | - Ellen Bamberger
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Asher Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Diana Tasher
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Giora Gottesman
- Pediatric Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Glikman
- Infectious Diseases Unit, The Baruch Padeh Medical Center, Poriya, Israel,Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Michal Stein
- Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel,Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
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Danino D, Van Der Beek BA, Givon-Lavi N, Greenberg D, Ben-Shimol S, Dagan R. Unravelling the Impact of Pneumococcal Conjugate Vaccines on Ambulatory Antibiotic Drug Consumption in Young Children: An Interrupted Time Series Analysis. Clin Infect Dis 2021; 73:1268-1278. [PMID: 34013338 DOI: 10.1093/cid/ciab413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) reduce respiratory infections in young children, the main antibiotic consumers. Following PCV implementation, dispensed antibiotic prescription (DAP) rates in young children were expected to decline. METHODS Computerized data on DAP for children <5 years were examined during a 13-year period (including 4 pre-PCV years). All DAPs from clinics with ≥50 insured children, active both pre- and post-PCV implementation were included. Interrupted time series with segmented regression was applied to analyze monthly DAP rate trends, adjusted for age, ethnicity and season. Incidence rate ratios (IRR) DAPs during late PCV13 period vs. 4 years pre-PCV were calculated both as absolute rate ratios (aIRR) and relative to expected rates (rIRR). RESULTS Of 1,090,870 DAPs, 57% were in children <2 years. All-DAP rates peaked in the cold season. Post-PCV7/PCV13 implementation, all DAP-rates abruptly and significantly declined, reaching a plateau within 5 years. This was largely driven by amoxicillin/amoxicillin-clavulanate (75% of DAPs). Age <2 years and Bedouin ethnicity were significantly associated with higher pre-PCV DAP rates but with faster and greater decline post-PCV, achieving near elimination of gaps between ages and ethnic groups. Overall reduction (and 95% CIs) in DAP rates per 1,000 was estimated between aIRR value (344.7 [370.9-358.4]) and rIRR value (110.4 [96.9-123.7]). CONCLUSIONS Shortly following PCV implementation, overall DAP rates showed an abrupt and steep decline, stabilizing within 5 years, in parallel to post-PCV respiratory infection trends previously described in this population, suggesting causality. The variable patterns of certain drug categories suggest additional influences beyond PCV.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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