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Guedalia J, Lipschuetz M, Cahen-Peretz A, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal hybrid immunity and risk of infant COVID-19 hospitalizations: national case-control study in Israel. Nat Commun 2024; 15:2846. [PMID: 38565530 PMCID: PMC10987618 DOI: 10.1038/s41467-024-46694-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Hybrid immunity, acquired through vaccination followed or preceded by a COVID-19 infection, elicits robust antibody augmentation. We hypothesize that maternal hybrid immunity will provide greater infant protection than other forms of COVID-19 immunity in the first 6 months of life. We conducted a case-control study in Israel, enrolling 661 infants up to 6 months of age, hospitalized with COVID-19 (cases) and 59,460 age-matched non-hospitalized infants (controls) between August 24, 2021, and March 15, 2022. Infants were grouped by maternal immunity status at delivery: Naïve (never vaccinated or tested positive, reference group), Hybrid-immunity (vaccinated and tested positive), Natural-immunity (tested positive before or during the study period), Full-vaccination (two-shot regimen plus 1 booster), and Partial-vaccination (less than full three shot regimen). Applying Cox proportional hazards models to estimate the hazard ratios, which was then converted to percent vaccine effectiveness, and using the Naïve group as the reference, maternal hybrid-immunity provided the highest protection (84% [95% CI 75-90]), followed by full-vaccination (66% [95% CI 56-74]), natural-immunity (56% [95% CI 39-68]), and partial-vaccination (29% [95% CI 15-41]). Maternal hybrid-immunity was associated with a reduced risk of infant hospitalization for Covid-19, as compared to natural-immunity, regardless of exposure timing or sequence. These findings emphasize the benefits of vaccinating previously infected individuals during pregnancy to reduce COVID-19 hospitalizations in early infancy.
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Affiliation(s)
- Joshua Guedalia
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine Jerusalem, Jerusalem, Israel.
- The Jerusalem Center for Personalized Computational Medicine Jerusalem, Jerusalem, Israel.
| | - Adva Cahen-Peretz
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Neonatology Department Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- The Jerusalem Center for Personalized Computational Medicine Jerusalem, Jerusalem, Israel.
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Shapiro I, Youssim I, Paltiel O, Calderon-Margalit R, Manor O, Friedlander Y, Hochner H. Perinatal exposures and adolescence overweight: The role of shared maternal-offspring pathways. Atherosclerosis 2024; 389:117438. [PMID: 38241794 PMCID: PMC10872218 DOI: 10.1016/j.atherosclerosis.2023.117438] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND AIMS Early life exposures affect offspring health across the life-course. We aimed to examine whether prevalent perinatal exposures and obstetric complications are independently associated with offspring overweight in adolescence. We then assessed whether shared maternal-offspring pathways drive the association of perinatal exposures with offspring overweight. METHODS Using data from the Jerusalem Perinatal Study birth cohort, two perinatal scores were constructed: obstetric complications (OC) and prevalent perinatal exposures (PPE) scores. PPE score, generated by principal component analysis, included three primary components. Logistic regressions were used to assess associations of scores with offspring overweight, with and without adjustment for maternal life-course survival. RESULTS OC and PPE scores were independently associated with offspring overweight (OROC = 1.15, 95%CI:1.07,1.25; ORPPE1- SEP and lifestyle = 0.85, 95%CI:0.79,0.91; ORPPE2- Maternal body size = 1.20, 95%CI: 1.13,1.28; ORPPE3-Fetal growth = 1.18, 95%CI:1.11,1.26). Maternal survival was associated with offspring overweight (OR = 1.38, 95%CI:1.08,1.76), yet introducing PPE score to the same model attenuated this association (OR = 1.16, 95%CI:0.90, 1.49). When OC score and maternal survival were included in the same model, their associations with offspring overweight remained unchanged. CONCLUSIONS Mother-offspring shared factors, captured by maternal life-course survival, underlie the effect of prevalent perinatal exposures on offspring overweight. However, the effect of obstetric complications was independent, highlighting the contribution of additional pathways.
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Affiliation(s)
- Ilona Shapiro
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel.
| | - Iaroslav Youssim
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
| | - Hagit Hochner
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, 99112102, Israel
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Luria S, Khatib H, Pardo A, El Haj M, Volk I, Calderon-Margalit R. Corrigendum to 'Occupational hand trauma - Mechanism of injury and transient risk factors in Jerusalem' [Injury, vol 54 issue 8 (2023), 110,854]. Injury 2024; 55:111273. [PMID: 38134488 DOI: 10.1016/j.injury.2023.111273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Shai Luria
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel.
| | - Hosam Khatib
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | - Asher Pardo
- Israeli Institute for Occupational Safety and Hygiene, Tel Aviv, Israel
| | - Madi El Haj
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | - Ido Volk
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | - Ronit Calderon-Margalit
- School of Public Health, Hebrew University School of Medicine, Hadassah Medical Organization, Israel
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Barasche-Berdah D, Ein-Mor E, Calderon-Margalit R, Rose AJ, Krieger M, Brammli-Greenberg S, Ben-Yehuda A, Manor O, Cohen AD, Bar-Ratson E, Bareket R, Matz E, Paltiel O. Nationwide Evaluation of Quality of Care Indicators for Individuals with Severe Mental Illness and Diabetes Mellitus, Following Israel's Mental Health Reform. Community Ment Health J 2024; 60:354-365. [PMID: 37697183 DOI: 10.1007/s10597-023-01178-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
Diabetes Mellitus (DM) is more common among individuals with severe mental illness (SMI). We aimed to assess quality-of-care-indicators in individuals with SMI following the 2015 Israel's Mental-Health-reform. We analyzed yearly changes in 2015-2019 of quality-of-care-measures and intermediate-DM-outcomes, with adjustment for gender, age-group, and socioeconomic status (SES) and compared individuals with SMI to the general adult population. Adults with SMI had higher prevalences of DM (odds ratio (OR) = 1.64; 95% confidence intervals (CI): 1.61-1.67) and obesity (OR = 2.11; 95% CI: 2.08-2.13), compared to the general population. DM prevalence, DM control, and obesity rates increased over the years in this population. In 2019, HbA1c testing was marginally lower (OR = 0.88; 95% CI: 0.83-0.94) and uncontrolled DM (HbA1c > 9%) slightly more common among patients with SMI (OR = 1.22; 95% CI: 1.14-1.30), control worsened by decreasing SES. After adjustment, uncontrolled DM (adj. OR = 1.02; 95% CI: 0.96-1.09) was not associated with SMI. Cardio-metabolic morbidity among patients with SMI may be related to high prevalences of obesity and DM rather than poor DM control. Effective screening for metabolic diseases in this population and social reforms are required.
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Affiliation(s)
- Deborah Barasche-Berdah
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel.
| | - Eliana Ein-Mor
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Michal Krieger
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arye Ben-Yehuda
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arnon D Cohen
- Clalit Health Services, 101 Arlozorov St., POB 16250, 62098, Tel Aviv, Israel
| | | | - Ronen Bareket
- Meuhedet Health Fund, 124 Ibn Gvirol St, 62038, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Matz
- Leumit Health Fund, 23 Sprinzak St, 64738, Tel Aviv, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Abdel-Rahman N, Manor O, Elran E, Siscovick D, Calderon-Margalit R. Implications of Patient-Reported Outcome Measures among patients with recently diagnosed type 2 diabetes. Isr J Health Policy Res 2024; 13:6. [PMID: 38297393 PMCID: PMC10829200 DOI: 10.1186/s13584-024-00592-1] [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: 06/27/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND For the past two decades, the assessment of the quality of diabetes care has mostly relied on clinical quality indicators. These have not included Patient-Reported Outcome Measures (PROMs) which provide information on outcomes deemed valuable by patients. We aimed to examine the potential utility of PROMs in type 2 diabetes care and to study the association of PROMs with patients' characteristics and clinical quality indicators. METHODS A cross-sectional survey of recently (≤ 4 years) diagnosed patients with type 2 diabetes (n = 392) in the setting of a large health plan. PROMs were based on two well-validated questionnaires, the Problem Areas in Diabetes (PAID) one-page questionnaire that measures diabetes-related distress, and the ten item PROMIS-10 global health questionnaire that measures general health. Additional items were added following a previous qualitative study among Israeli patients with diabetes. The survey was carried out using phone interviews, and data collected were linked to the electronic medical records. Multivariable regression models were used to assess the associations of socio-demographic variables and clinical quality indicators with the PROMs. RESULTS About a fifth of participants (22%) had high diabetes-related distress (PAID score ≥ 40), a third reported that they did not feel confident in self-management of diabetes and about a third reported having sexual dysfunction. Women, younger patients, and those with a low education level (≤ 12 years) reported worse general health, were more likely to experience high diabetes-related distress, and to have low confidence in diabetes self-management. Interestingly, performance of all seven diabetes quality indicators was associated with worse general health and high diabetes-related distress. Of note, levels of glycated hemoglobin, LDL-cholesterol, or blood pressure were not associated with PROMs. CONCLUSIONS PROMs provide important information on patient self-reported health status and are likely to reflect aspects of the quality of care that are not otherwise available to clinicians. Thus, the use of PROMs has the potential to expand the evaluation of diabetes care and promote patient-centered care. We recommend that policy-makers in the Ministry of Health and health maintenance organizations implement PROMs for assessing and improving the care for patients with type 2 diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel.
| | - Orly Manor
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel
| | - Einat Elran
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel
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Vu THT, Pirzada A, Lewis CE, Schreiner PJ, Liu K, Sternfeld B, Calderon-Margalit R, Merkin SS, Wellons M, Williams OD, Kim C, Siscovick DS, Daviglus ML. Androgenicity in Young Women and Development of Metabolic Syndrome Before Menopause: The CARDIA and CARDIA Women's Studies. J Endocr Soc 2024; 8:bvad174. [PMID: 38213908 PMCID: PMC10783251 DOI: 10.1210/jendso/bvad174] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 01/13/2024] Open
Abstract
Context There are no reported data from prospective long-term studies on the relation of androgen levels in young women with development of metabolic syndrome (MetS) before menopause. Objective We investigated associations of androgens and SHBG with incident MetS during 23 years of follow-up. Methods We included 366 White and 375 Black women ages 20 to 32 years participating in the CARDIA study and CARDIA Women's study, free of MetS at baseline examination (1987-1988), and premenopausal 23 years later. Androgens and SHBG were categorized into quartiles. MetS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute 2009 Joint Scientific Statement. Cox proportional hazards models were used. Results By year 23, 30% of women developed MetS. Adjusting for baseline age, race, and education, hazard ratios (95% CI) of developing MetS were 1.46 (1.02-2.10) and 2.22 (1.53-3.21) for women in the highest vs lowest total testosterone (T) and free T quartile, respectively. The hazards of developing MetS were 47%, 59%, and 53% lower for women with SHBG in the second, third, and fourth quartiles (vs lowest quartile), respectively. Associations were attenuated for total T with further adjustments for smoking, physical activity, menstrual status, oral contraceptive/hormone (OCHM) use, insulin level, oligomenorrhea, and age at menarche, but remained statistically significant for free T and SHBG. Associations were similar for both Blacks and Whites, and OCHM nonusers, but not for OCHM users. Conclusion High androgenicity in young premenopausal women is associated with higher risk of future MetS, suggesting that early assessment of androgens may contribute to prevention.
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Affiliation(s)
- Thanh-Huyen T Vu
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Diabetes Research and Training Center School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Ronit Calderon-Margalit
- Hebrew University-Hadassah Braun School of Public Health and Social Medicine, Jerusalem 91120, Israel
| | - Sharon S Merkin
- Division of Geriatrics, Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Melissa Wellons
- Division of Diabetes, Endocrinology, & Metabolism, Vanderbilt Eskind Diabetes Clinic, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - O Dale Williams
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33174, USA
| | - Catherine Kim
- Medical School and School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - David S Siscovick
- New York Academy of Medicine, New York, NY 10029, USA
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Martha L Daviglus
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL 60612, USA
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Alterman N, Youssim I, Nevo D, Calderon-Margalit R, Yuval, Broday D, Hauzer M, Raz R. Prenatal and postnatal exposure to NO 2 and rapid infant weight gain - A population-based cohort study. Paediatr Perinat Epidemiol 2023; 37:669-678. [PMID: 37565531 DOI: 10.1111/ppe.13000] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Childhood overweight and obesity is a global public health problem. Rapid infant weight gain is predictive of childhood overweight. Studies found that exposure to ambient air pollution is associated with childhood overweight, and have linked prenatal exposure to air pollution with rapid infant weight gain. OBJECTIVES To examine the association between prenatal and postnatal ambient NO2 exposure, a traffic-related marker, with rapid weight gain in infants. METHODS We carried out a population-based historical cohort study using data from the Israeli national network of maternal and child health clinics. The study included 474,136 infants born at term with birthweight ≥2500 g in 2011-2019 in central Israel. Weekly averages of NO2 concentration throughout pregnancy (prenatal) and the first 4 weeks of life (postnatal) were assessed using an optimized dispersion model and were linked to geocoded home addresses. We modelled weight gain velocity throughout infancy using the SuperImposition by Translation and Rotation (SITAR) method, a mixed-effects nonlinear model specialized for modelling growth curves, and defined rapid weight gain as the highest velocity tertile. Distributed-lag models were used to assess critical periods of risk and to measure relative risks for rapid weight gain. Adjustments were made for socioeconomic status, population group, subdistrict, month and year of birth, and the alternate exposure period - prenatal or postnatal. RESULTS The cumulative adjusted relative risk for rapid weight gain of NO2 exposure was 1.02 (95% confidence intereval [CI] 1.00, 1.04) for exposure throughout pregnancy and 1.02 (95% CI 1.01, 1.04) for exposure during the first four postnatal weeks per NO2 interquartile range increase (7.3 ppb). An examination of weekly associations revealed that the critical period of risk for the prenatal exposure was from mid-pregnancy to birth. CONCLUSIONS Prenatal and postnatal exposures to higher concentrations of traffic-related air pollution are each independently associated with rapid infant weight gain, a risk factor for childhood overweight and obesity.
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Affiliation(s)
- Neora Alterman
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
| | - Iaroslav Youssim
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
| | - Yuval
- Civil and Environmental Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - David Broday
- Civil and Environmental Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Michael Hauzer
- Bonen Clinic, Haifa and Western Galilee District, Israel
- Clalit Health Services Community Division, Haifa, Israel
| | - Raanan Raz
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
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Rose A, Mor EE, Krieger M, Ben-Yehuda A, Revel-Vilk S, Cohen AD, Matz E, Bar-Ratson E, Bareket R, Paltiel O, Calderon-Margalit R. Pediatric overweight and obesity increased in Israel during the COVID-19 period. PLoS One 2023; 18:e0290961. [PMID: 37669279 PMCID: PMC10479915 DOI: 10.1371/journal.pone.0290961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
Reports from many settings suggest that pediatric overweight and obesity increased in 2020 and 2021, presumably due to lifestyle changes associated with the COVID-19 pandemic. Many of these previous reports have relied on convenience samples or subsets of the population. Here, we present results of a longitudinal study of the entire population of Israel, a nation of approximately 9 million people, with the proportion with underweight, normal weight, overweight, and obesity at age 7 and at age 14-15, across the years 2017-2021. Our results show that the prevalence of overweight and obesity, which had been steady or improving through 2019, increased relatively quickly in 2020 and 2021. For example, among 7-year-olds, the percentage of children with obesity in 2019 was 6.8% (99% CI: 6.69-7.05), and by 2021, it had increased to 7.7% (99% CI: 7.53-7.93). There were important disparities in overweight and obesity based on SES; for example, the rate ratio for obesity comparing the poorest with the wealthiest 14-15-year-olds in 2019 was 1.63 (99% CI: 1.55-1.72). However, these disparities did not change meaningfully in 2020 and 2021, implying that while obesity did become more prevalent, this increase in prevalence was not differential across socioeconomic status. Like many other nations, Israel too experienced considerable increases in pediatric overweight and obesity in 2020-2021, erasing the improvements of the previous years among younger children.
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Affiliation(s)
- Adam Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Eliana Ein Mor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Michal Krieger
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arie Ben-Yehuda
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Hadassah Medical Organization, Jerusalem, Israel
| | - Shoshana Revel-Vilk
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Pediatric Hematology/Oncology Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Arnon D. Cohen
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Eran Matz
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Leumit Health Services, Tel Aviv, Israel
| | - Edna Bar-Ratson
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Maccabi Health Services, Tel Aviv, Israel
| | - Ronen Bareket
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Meuhedet Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
- Hadassah Medical Organization, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Cohen-Eliraz L, Ornoy A, Ein-Mor E, Bar-Nitsan M, Pilowsky Peleg T, Calderon-Margalit R. Prenatal exposure to phthalates and emotional/behavioral development in young children. Neurotoxicology 2023; 98:39-47. [PMID: 37536470 DOI: 10.1016/j.neuro.2023.07.006] [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: 06/12/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Endocrine disrupting chemicals (EDCs) such as phthalates, found in our daily environment, are nowadays suggested to be associated with adverse outcomes. Prenatal exposure was found associated with neurodevelopmental complications such as behavioral difficulties in school age children. AIM To explore the association between intrauterine exposure to phthalates and emotional/behavioral development of 24 months old toddlers. METHODS Women were recruited at 11-18 weeks of gestation and provided spot urine samples, analyzed for phthalate metabolites (DEHP, DiNP, MBzBP). Offspring were examined at 24 months of age, using standard maternal report, regarding developmental and behavioral problems (CBCL, ASQ-3, HOME questionnaires) (N = 158). To explore the associations between metabolite levels and developmental outcomes, multivariate GLM analysis (General Linear Model) was used according to tertiles and developmental scores on each developmental outcome. RESULTS Associations of Di-(2-ethylhexyl) phthalate (DEHP) maternal exposure with behavioral-developmental outcomes were found only in boys. Compared with boys with lower DEHP maternal exposure, boys with high DEHP maternal exposure had lower developmental score in personal social abilities in the ASQ-3 questionnaire (50.68 + 8.06 and 44.14 + 11.02, high and low DEHP, respectively, p = 0.03), and more internalizing problems (for example, emotionally reactive score in high and low DEHP: 53.77 + 7.41 and 50.50 + 1.19, respectively, p = 0.029; anxious or depressed score: 53.38 + 5.01 and 50.75 + 1.34, respectively, p = 0.009; and somatic complaints scores 64.03 + 10.1 and 55.84 + 7.84, respectively, p = 0.003), and externalizing problems (49.28 + 8.59 and 43.33 + 9.11, respectively, p = 0.039). No differences were found in the development and behavior problems between high and low DEHP maternal exposure level in girls. CONCLUSION Maternal DEHP metabolite concentrations measured in first trimester urine was associated with children's emotional/behavioral developmental problems in 24-months old boys, supporting accumulating evidence of DEHP as a potentially harming chemical and call for environmental attention.
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Affiliation(s)
- Liron Cohen-Eliraz
- Psychology Department Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Asher Ornoy
- Department of Medical Neurobiology Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eliana Ein-Mor
- Hadassah-Hebrew University, Braun School of Public Health, P.O. Box 12272, Jerusalem 91120, Israel
| | - Moriah Bar-Nitsan
- Psychology Department Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tammy Pilowsky Peleg
- Psychology Department Hebrew University of Jerusalem, Jerusalem, Israel; The Neuropsychological Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ronit Calderon-Margalit
- Hadassah-Hebrew University, Braun School of Public Health, P.O. Box 12272, Jerusalem 91120, Israel
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Krichevski M, Calderon-Margalit R, Carmi S, Raz R. The heritability of weight gain in infancy: A population-based twin study. Paediatr Perinat Epidemiol 2023; 37:577-585. [PMID: 37282801 DOI: 10.1111/ppe.12991] [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: 01/26/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Rapid weight gain during infancy is a strong predictor of childhood obesity and is affected by genetic and environmental factors. Identifying ages with low heritability will allow for targeted interventions that might be able to prevent the adverse effects of childhood obesity. OBJECTIVES The objective of the study is to estimate the heritability of weight gain from birth to defined ages during infancy, as well as during 6-month periods from birth to 18 months of age. We address this by leveraging large-scale computerised anthropometric data from the state-run network of well-baby clinics in Israel. METHODS We performed a population-based twin study. We extracted weight measurements recorded between birth to 24 months from well-baby clinics for 9388 twin pairs born in Israel between 2011 and 2015. The reported sexes of the twins were used as a proxy for their zygosity status. We estimated the heritability of the weight z-score change from birth to specific ages and during particular periods in infancy. To assess the validity of the results, we repeated the analysis in a sub-cohort of twin pairs with complete weight measurements. RESULTS During the first 2 years of life, heritability was lowest for birthweight (h 2 = 0.40 ± 0.11 ). Heritability for weight gain since birth was highest at 4 months (h 2 = 0.87 ± 0.13 ), and then gradually decreased until age 18 months (h 2 = 0.62 ± 0.13 ). Estimating the heritability in 6-month intervals from birth to 18 months, heritability was highest during the 6-12-month interval (h 2 = 0.84 ± 0.14 ), and was substantially lower during the subsequent 12-18-month interval (h 2 = 0.43 ± 0.16 ). CONCLUSIONS Heritability of weight gain decreases substantially in the second year of life, suggesting that this period could be an appropriate time for interventions for infants who are at an increased risk of childhood obesity.
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Affiliation(s)
- Masha Krichevski
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem - Hadassah, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem - Hadassah, Jerusalem, Israel
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem - Hadassah, Jerusalem, Israel
| | - Raanan Raz
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem - Hadassah, Jerusalem, Israel
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11
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Luria S, Khatib H, Haj ME, Volk I, Calderon-Margalit R. Occupational hand trauma - Mechanism of injury and transient risk factors in Jerusalem. Injury 2023; 54:110854. [PMID: 37302872 DOI: 10.1016/j.injury.2023.110854] [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: 01/04/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Although prevalent, and variable geographically, there is little information on the incidence and risk factors for occupation hand trauma in our health care system. This pilot study was designed to determine the optimal data collection methods for transient risk factors locally METHODS: All adult patients with occupational hand trauma treated at an emergency department (ED) during a three-month period were interviewed, either in person or by phone, using a case crossover designed questionnaire, regarding occupation and exposure to potential transient risk factor. RESULTS Of 206 patients treated with occupational trauma during the study period, 94 had trauma distal to the elbow (46%). Patient compliance was high - 89% of the patients consented to phone interviews and 83% completed in-person ED interviews. In the 75 patients which participated in the study, several risk factors were found to be significant, including machine maintenance and being distracted, including by a cellular phone. We found lack of job experience, limited training on the job site and reports of previous injuries in these workplaces to be prevelent. DISCUSSION The risk factors implicated in this study are similar to those reported in previous studies at other locations and are modifiable although this is the first report linking cellular phone use and occupation trauma. This finding should be further examined in a larger group and according to occupational categories. Compliance with the study was high, in person or with phone interviews, making these options viable for further studies. Several minor changes to the questionnaire were suggested although it did conform with the case-crossover study design. According to this study, standard preventive measures may be lacking in Jerusalem and should be implemented more uniformly, including specific workplace safety plans and education and taking into consideration the risk factors documented here.
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Affiliation(s)
- Shai Luria
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel.
| | - Hosam Khatib
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | - Madi El Haj
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | - Ido Volk
- Faculty of Medicine, Hebrew University of Jerusalem; the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | - Ronit Calderon-Margalit
- School of Public Health, Hebrew University School of Medicine, Hadassah Medical Organization, Israel
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Lipschuetz M, Guedalia J, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization. Nat Med 2023; 29:1155-1163. [PMID: 36959421 DOI: 10.1038/s41591-023-02270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Abstract
Infants are at a higher risk of Coronavirus Disease 2019 (COVID-19)-related hospitalizations compared to older children. In this study, we investigated the effect of the recommended third maternal dose of BNT162b2 COVID-19 vaccine during pregnancy on rates of infant COVID-19-related hospitalizations. We conducted a nationwide cohort study of all live-born infants delivered in Israel between 24 August 2021 and 15 March 2022 to estimate the effectiveness of the third booster dose versus the second dose against infant COVID-19-related hospitalizations. Data were analyzed for the overall study period, and the Delta and Omicron periods were analyzed separately. Cox proportional hazard regression models estimated hazard ratios and 95% confidence intervals (CIs) for infant hospitalizations according to maternal vaccination status at delivery. Among 48,868 live-born infants included in the analysis, rates of COVID-19 hospitalization were 0.4%, 0.6% and 0.7% in the third-dose, second-dose and unvaccinated groups, respectively. Compared to the second dose, the third dose was associated with reduced infant hospitalization with estimated effectiveness of 53% (95% CI: 36-65%). Greater protection was associated with a shorter interval between vaccination and delivery. A third maternal dose during pregnancy reduced the risk of infant hospitalization for COVID-19 during the first 4 months of life, supporting clinical and public health guidance for maternal booster vaccination to prevent infant COVID-19 hospitalization.
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Affiliation(s)
- Michal Lipschuetz
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Joshua Guedalia
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | | | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
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13
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Regev-Epstein LC, Frishberg Y, Davidovits M, Landau D, Magen D, Weismann I, Stern-Zimmer M, Beckerman P, Keinan-Boker L, Calderon-Margalit R, Vivante A. Dialysis in Israeli Children between 1990 and 2020: Trends and International Comparisons. Clin J Am Soc Nephrol 2023; 18:363-373. [PMID: 36722361 PMCID: PMC10103217 DOI: 10.2215/cjn.0000000000000063] [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: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood kidney failure is a rare condition with worldwide clinical variability. We used a nationwide multicenter analysis to study the pretransplant course of the entire Israeli pediatric kidney failure population over 30 years. METHODS In this nationwide, population-based, historical cohort study, we analyzed medical and demographic data of all children treated with KRT and reported to the Israeli kidney failure registry in 1990-2020. Statistical analysis was performed with incidence rate corrected for age, ethnicity, and calendar year, using the appropriate age-related general population as denominator. RESULTS During the last 30 years, childhood incidence of kidney failure decreased. Average incidence in 2015-2019 was 9.1 cases per million age-related population (pmarp). Arab and Druze children exhibited higher kidney failure incidence rates than Jewish children (18.4 versus 7.0 cases pmarp for minorities versus Jews). The most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary tract (approximately 27%), followed by cystic kidney diseases among Arab children (13%) and glomerulonephritis among Jewish children (16%). The most common etiology among Druze children was primary hyperoxaluria type 1 (33%). Israel's national health insurance provides access to primary health care to all citizens. Accordingly, waiting time for deceased-donor transplantation was equal between all ethnicities. Living-donor kidney transplantation rates among minority populations remained low in comparison with Jews over the entire study period. Although all patient groups demonstrated improvement in survival, overall survival rates were mainly etiology dependent. CONCLUSIONS In Israel, Arab and Druze children had a higher incidence of kidney failure, a unique etiological distribution, and a lower rate of living-donor kidney transplantations compared with Jewish children.
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Affiliation(s)
- Lilach C. Regev-Epstein
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaacov Frishberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniella Magen
- Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weismann
- Pediatric Nephrology Unit, Galilee Medical Center, Nahariya, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Pazit Beckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ramat Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | | | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Guedalia J, Lipschuetz M, Calderon-Margalit R, Cohen SM, Goldman-Wohl D, Kaminer T, Melul E, Shefer G, Sompolinsky Y, Walfisch A, Yagel S, Beharier O. Effectiveness of a third BNT162b2 mRNA COVID-19 vaccination during pregnancy: a national observational study in Israel. Nat Commun 2022; 13:6961. [PMID: 36379951 PMCID: PMC9664047 DOI: 10.1038/s41467-022-34605-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/14/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
The Centers for Disease Control (CDC) recommend a third dose of COVID-19 vaccine for pregnant women, although data regarding effectiveness during pregnancy are lacking. This national, population-based, historical cohort study of pregnant women in Israel, delivering between August 1, 2021 and March 22, 2022, aims to analyze and compare the third and second doses' vaccine effectiveness in preventing COVID-19-related hospitalizations during pregnancy during two COVID-19 waves (Delta variant in the summer of 2021 and Omicron, BA.1, variant in the winter of 2022). Time-dependent Cox proportional-hazards regression models estimate the hazard ratios (HR) and 95% confidence intervals (CI) for COVID-related outcomes according to vaccine dose, and vaccine effectiveness as 1-HR. Study includes 82,659 and 33,303 pregnant women from the Delta and Omicron waves, respectively. Compared with the second dose, the third dose effectively prevents overall hospitalizations with SARS-CoV-2 infections, with estimated effectiveness of 92% (95% CI 83-96%) during Delta, and enhances protection against significant disease during Omicron, with effectiveness of 92% (95% CI 26-99%), and 48% (95% CI 37-57%) effectiveness against hospitalization overall. A third dose of the BNT162b2 mRNA COVID-19 vaccine during pregnancy, given at least 5 months after the second vaccine dose, enhances protection against adverse COVID-19-related outcomes.
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Affiliation(s)
- Joshua Guedalia
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- grid.9619.70000 0004 1937 0538Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M. Cohen
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Kaminer
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Galit Shefer
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Yishai Sompolinsky
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asnat Walfisch
- grid.12136.370000 0004 1937 0546Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simcha Yagel
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
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15
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Abdel-Rahman N, Manor O, Valinsky L, Mosenzon O, Calderon-Margalit R, Roberman S. What is important for people with type 2 diabetes? A focus group study to identify relevant aspects for Patient-Reported Outcome Measures in diabetes care. PLoS One 2022; 17:e0277424. [PMCID: PMC9662717 DOI: 10.1371/journal.pone.0277424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background
Patient-Reported Outcome Measures (PROMs) aim to evaluate the quality of care based on the perspectives of patients rather than clinical indicators. Qualitative research is needed to identify these perspectives in people with type 2 diabetes.
Objective
To identify, for the first time in Israel, aspects valuable for people with type 2 diabetes that can be relevant for PROMs in diabetes care.
Methods
A qualitative study included three focus groups totalling 19 people with type 2 diabetes. Inclusion criteria were: (1)type 2 diabetes, (2)diabetes duration of at least six months, and (3)adults aged 45–80 years. Purposive sampling enabled recruitment of heterogeneous participants. Also, two experts’ panels with healthcare providers involved in diabetes care (n = 23) were conducted to provide triangulation of information (more testimony about what is valuable for people with type 2 diabetes). Discussions were recorded, transcribed and thematically analysed.
Results
Four domains were deemed valuable for people with type 2 diabetes: (1)challenges of living with diabetes, including reduced physical function, healthy lifestyle struggles, sexual dysfunction, and financial burden, (2)mental health issues, including depression, distress, anxiety, frustration, and loneliness, (3)self-management ability, including management of lifestyle modifications and treatment, knowledge about the disease and treatment, and (4)patient-clinician relationships, including the devotion of clinicians, trust in clinicians and treatment, shared decision-making, and multidisciplinary care under one roof. Experts favour using PROMs in diabetes routine care and even acknowledged their necessity to improve the treatment process. However, only some of the domains raised by people with type 2 diabetes were identified by the experts.
Conclusions
There are content gaps between perspectives of people with type 2 diabetes and their healthcare providers. PROMs are essential in addressing issues largely not addressed in routine diabetes care. We recommend that researchers and healthcare providers, who intend to utilize PROMs for diabetes care, consider the aforementioned domains.
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Affiliation(s)
- Nura Abdel-Rahman
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
| | | | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
- * E-mail:
| | - Sveta Roberman
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
- Gordon Academic College of Education, Haifa, Israel
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16
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Abdel-Rahman N, Calderon-Margalit R, Cohen A, Elran E, Golan Cohen A, Krieger M, Paltiel O, Valinsky L, Ben-Yehuda A, Manor O. Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population-Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes. J Am Heart Assoc 2022; 11:e025603. [PMID: 36129044 DOI: 10.1161/jaha.122.025603] [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: 11/16/2022]
Abstract
Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006-2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011-2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose-response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49-1.72) and 1.23 (95% CI, 1.14-1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50-1.69) for cardiac outcomes. Conclusions Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ronit Calderon-Margalit
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | | | - Michal Krieger
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ora Paltiel
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | - Orly Manor
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
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17
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Velosa M, Hochner H, Yerushalmi B, Harel S, Friss C, Calderon-Margalit R, Paltiel O, Manor O, Balicer RD, Greenfeld S, Kariv R, Ledderman N, Matz E, Peter I, Friedlander Y, Turner D. Pre- and Perinatal Factors Predicting Inflammatory Bowel Disease: A Population-Based Study with Fifty Years of Follow-Up. J Crohns Colitis 2022; 16:1397-1404. [PMID: 35299254 DOI: 10.1093/ecco-jcc/jjac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/22/2021] [Revised: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pre- and perinatal events may be associated with an increased risk of inflammatory bowel disease [IBD]. We aimed to investigate the role of pre- and perinatal factors as potential risk factors for the development of IBD in a population with a follow-up of 50 years. METHODS We conducted a nested case-control study, reporting IBD incidence among individuals born in 1964-76, for whom pre- and perinatal exposures were reported as part of the Jerusalem Perinatal Study [JPS], by linking them to the database of the epidemiology group of the Israeli IBD Research Nucleus [epi-IIRN], including all IBD patients in Israel since 2005 and their matched controls. RESULTS We identified 2789 individuals within the epi-IIRN cohort who were also included in the JPS cohort [n = 90 079]: 746 IBD patients (405 with Crohn's disease [CD] and 341 with ulcerative colitis [UC]) and 2043 non-IBD controls. Those with a 'Non-western' family origin had decreased odds of developing CD and UC. High socioeconomic status was associated with CD but not UC. Low birth weight [≤2500 g] occurred less frequently in IBD cases compared to controls, especially in UC patients, showing a protective effect. Being the first born was associated with CD, and having older siblings lowered the odds of developing CD, decreasing 7% with each additional sibling. Smoking and breastfeeding data were available for a subset of individuals, but neither was associated with IBD development. CONCLUSION This population-based study identifies several pre- and perinatal variables as predictors of IBD development. This information may be helpful to facilitate implementation of early diagnosis interventions and family follow-up protocols.
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Affiliation(s)
- Monica Velosa
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Baruch Yerushalmi
- Department of Gastroenterology and Hepatology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sasha Harel
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
| | - Chagit Friss
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
| | | | - Ora Paltiel
- Hadassah, Hebrew University Braun School of Public Health, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran D Balicer
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | | | | | | | - Eran Matz
- Leumit Health Services, Tel Aviv, Israel
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yechiel Friedlander
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Turner
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
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18
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Harari-Kremer R, Calderon-Margalit R, Yuval, Broday D, Kloog I, Raz R. Exposure errors due to inaccurate residential addresses and their impact on epidemiological associations: Evidence from a national neonate dataset. Int J Hyg Environ Health 2022; 246:114032. [PMID: 36084355 DOI: 10.1016/j.ijheh.2022.114032] [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: 04/28/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies assessing the associations between prenatal air pollution exposures and birth outcomes commonly use maternal addresses at the time of delivery as a proxy for residency throughout pregnancy. Yet, in large-scale epidemiology studies, maternal addresses commonly originate from an administrative source. OBJECTIVE This study aimed to examine the use of population registry addresses to assign exposure estimations and to evaluate the impact of inaccurate addresses on exposure estimates and association measures of prenatal exposures with congenital hypothyroidism. METHODS We used morbidity data for congenital hypothyroidism from the national program for neonatal screening for 2009-2015 and address data from two sources: population registry and hospital records. We selected neonates with geocoded addresses from both sources (N = 685,491) and developed a comparison algorithm for these addresses. Next, we assigned neonates with exposures from ambient air pollution of PM and NO2/NOX, evaluated exposure assessment differences, and used multivariable logistic regression models to assess the impact that these differences have on association measures. RESULTS We found that most of the exposure differences between neonates with addresses from both sources were around zero and had a leptokurtic distribution density, with most values being zero. Additionally, associations between exposure and congenital hypothyroidism were comparable, regardless of address source and when we limited the model to neonates with identical addresses. CONCLUSIONS We found that ignoring residential inaccuracies results in only a small bias of the associations towards the null. These results strengthen the validity of addresses from population registries for exposure assessment, when detailed residential data during pregnancy are not available.
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Affiliation(s)
- Ruthie Harari-Kremer
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Israel; The Advanced School for Environmental Studies, The Hebrew University at Jerusalem, Israel.
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Israel
| | - Yuval
- Civil and Environmental Engineering, Technion, and Technion Center of Excellence in Exposure Science and Environmental Health, Israel
| | - David Broday
- Civil and Environmental Engineering, Technion, and Technion Center of Excellence in Exposure Science and Environmental Health, Israel
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Israel
| | - Raanan Raz
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Israel
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19
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Rose AJ, Mor EE, Krieger M, Ben-Yehuda A, Cohen A, Matz E, Ratson EB, Bareket R, Paltiel O, Calderon-Margalit R. Israeli COVID Lockdowns Mildly Reduced Overall Use of Preventive Health Services, But Exacerbated Some Disparities. Int J Qual Health Care 2022; 34:6692292. [PMID: 36062971 PMCID: PMC9494393 DOI: 10.1093/intqhc/mzac071] [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: 03/13/2022] [Revised: 06/09/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background During 2020, Israel experienced two COVID-19-related lockdowns that impacted the provision of primary and secondary preventive care. Methods We examined the month-by-month performance of selected preventive care services using data from Israel’s national Quality Indicators in Community Healthcare program. Process of care measures included hemoglobin A1c (HbA1c) testing, cholesterol testing, colon cancer screening and mammography. Intermediate outcome measures included low-density lipoprotein control and HbA1c control. Measures were stratified by sex and by area-level socioeconomic position (SEP). Diabetes and mammography are presented in this abstract due to space limitations. Results Annual HbA1c testing among persons with diabetes decreased from 90.9% in 2019 to 88.0% in 2020. Performance of HbA1c tests during lockdown months was as low as half the usual amount. There were compensatory increases in testing during post-lockdown months that did not quite make up for the missed tests. In 2019, 9.0% of Israelis with diabetes had poor glycemic control (HbA1c ≥ 9.0); in 2020, it was 8.8%. In total, 4.5% fewer mammograms were performed in 2020 compared with 2019. Women in the lowest SEP level performed 10.4% fewer mammograms in 2020 than in 2019, while women in the highest SEP level performed 3.1% more mammograms. Conclusions Prolonged COVID lockdowns in 2020 were associated with marked decreases in the performance of preventive health services during those months. Compensatory spikes following the end of lockdowns partly, but did not completely, make up for the missed care. COVID lockdowns may have exacerbated socioeconomic disparities in some preventive health services.
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Affiliation(s)
- Adam J Rose
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Eliana Ein Mor
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Michal Krieger
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arie Ben-Yehuda
- Hadassah Medical Organization, Jerusalem, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arnon Cohen
- Clalit Health Services, Tel Aviv, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Eran Matz
- Leumit Health Services, Tel Aviv, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Edna Bar Ratson
- Maccabi Health Services, Tel Aviv, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Ronen Bareket
- Meuhedet Health Services, Tel Aviv, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel.,Hadassah Medical Organization, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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20
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Luria S, Liba G, Zimmerman D, Polliack G, Volk I, Calderon-Margalit R. Nationwide community based emergency centers reveal scale of hand trauma. Injury 2022; 53:2102-2109. [PMID: 35184819 DOI: 10.1016/j.injury.2022.02.030] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/08/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study describes the characteristics of hand trauma treated in community-based emergency centers (CBECs) in Israel. It was hypothesized that the rate of hand trauma, as well as patient and injury characteristics, would differ from a recent study of patients treated in hospital emergency departments (EDs) in Jerusalem. METHODS Data on all hand injury patients treated at any of the CBECs belonging to a large nationwide chain in 2017 were retrieved from the electronic medical records of the treatment centers, including demographic and clinical characteristics. RESULTS Over the course of 2017, 53,574 individuals were treated for forearm, wrist and hand injuries (35% of all trauma patients treated during this period). The majority of the patients were male (62%). Contusions and fractures were common (80%) with a minority of lacerations (10%). Crush injuries and amputations were rare. Dog bites accounted for 1.5% of the injuries under the age of 10. Females were treated more with painkillers and opioids, especially over the age of 65, with variability between centers. Although the rate of fractures was similar between teens and the elderly, the elderly were treated with immobilization less frequently, and were referred to EDs for further care. Hospital referral rates differed significantly between centers. DISCUSSION A higher rate of hand trauma was found in the CBECs in comparison to the hospital ED report (35% vs. 20% of all trauma patients, respectively). Patients treated at the CBECs, in comparison to the ED, were less often male, less often young adults, and differed in terms of type of injury. In the CBECs there were more contusions, as well as fewer lacerations and open wound injuries. In contrast, dog bites in children were found to be much more prevalent than previously reported. Hospital referral indications, the use of immobilization and pain management were found to vary according to age, gender and treatment center. Due to the high rate of hand trauma in CBECs, specific protocols are needed for these patients. The use of opioids should be specifically addressed, considering recent changes in treatment protocols. Thus, the prevalence and characteristics of hand trauma may be biased in studies based on hospital records.
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Affiliation(s)
- Shai Luria
- Hand and Microvascular Surgery Unit, Department of Orthopedics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Guy Liba
- Hand and Microvascular Surgery Unit, Department of Orthopedics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | - Ido Volk
- Hand and Microvascular Surgery Unit, Department of Orthopedics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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21
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Calderon-Margalit R, Strahilevitz J, Paltiel O. Questioning the justification for a fourth SARS-CoV-2 vaccine. Clin Microbiol Infect 2022; 28:905-907. [PMID: 35339674 PMCID: PMC8940721 DOI: 10.1016/j.cmi.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ora Paltiel
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
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22
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Youssim I, Israel S, Shapiro I, Calderon-Margalit R, Manor O, Paltiel O, Friedlander Y, Hochner H. Independent associations of inter-spousal gaps in age and education with long-term mortality and cancer survival: the Jerusalem Perinatal Study 1964 – 2016. Ann Epidemiol 2022; 70:32-36. [DOI: 10.1016/j.annepidem.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
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23
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Shafrir A, Benson AA, Katz LH, Hershcovici T, Bitan M, Paltiel O, Calderon-Margalit R, Safadi R, Shauly-Aharonov M. The Association Between Proton Pump Inhibitors and COVID-19 is Confounded by Hyperglycemia in a Population-Based Study. Front Pharmacol 2022; 13:791074. [PMID: 35185561 PMCID: PMC8854493 DOI: 10.3389/fphar.2022.791074] [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: 10/07/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: There is conflicting evidence regarding the association between proton pump inhibitors (PPI) and the risk of acquisition and severity of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aim: To evaluate the association between PPI exposure and infection and development of severe disease in patients infected with SARS-CoV2in a large population-based historical cohort. Methods: Data were extracted from a health maintenance organization database in Israel that insures over 1,200,000 individuals from across the country. All patients who underwent SARS-CoV-2 testing between March and November 2020 were included. Logistic regression and matched analyses were used to compare patients prescribed and exposed to PPIs to those not prescribed PPIs regarding SARS-CoV-2 positivity. In addition, among SARS-CoV-2 positive patients (n = 44,397) the likelihood of developing severe disease, defined by a composite endpoint of death, ICU admission and prolonged hospitalization, was compared in those exposed and not exposed to PPIs. Results: Among 255,355 adult patients who underwent SARS-CoV-2 testing by PCR, 44,397 (17.4%) were positive for SARS-CoV-2 and 12,066 (4.7%) patients were prescribed PPIs in the 3 months before testing. In a multivariable logistic regression model controlling for age, gender, smoking status, BMI, diabetes mellitus, hypertension, COPD, history of ischemic heart disease and fasting blood glucose (FBG) levels, no significant association was found between PPIs and SARS-CoV-2 positivity (p = 0.09 aOR 0.94, 95% CI – 0.88–1.01). Among SARS-CoV-2 positive patients, 910 (2%) had a severe infection. Multivariate logistic regression controlling for the abovementioned confounders, showed no such association between PPIs and severe COVID-19 (p = 0.28). Elevated FBG levels were significantly associated with both PPI exposure (p < 0.001) and severe COVID-19 infection (p < 0.001). These results were reinforced by a matched analysis (n = 655 pairs). Conclusion: PPIs are spuriously associated with severe COVID-19 due to the presence of elevated FBG as a confounder. Our study accounted for the FBG levels of patients and known risk factors for severe COVID-19 infection, which may be the reason for the discrepancy in prior studies. These results may aid in understanding potential confounders when evaluating potential associations of PPIs with other respiratory or viral diseases.
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Affiliation(s)
- Asher Shafrir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Meuhedet Health Medical Organization, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ariel A. Benson
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Lior H. Katz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
- *Correspondence: Lior H. Katz,
| | - Tiberiu Hershcovici
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Menachem Bitan
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Meuhedet Health Medical Organization, Jerusalem, Israel
| | - Ora Paltiel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Hematology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rifaat Safadi
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Michal Shauly-Aharonov
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Jerusalem College of Technology, Jerusalem, Israel
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24
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Dionicio López CF, Alterman N, Calderon-Margalit R, Hauzer M, Kloog I, Raz R. Postnatal exposure to ambient temperature and rapid weight gain among infants delivered at term gestations: a population-based cohort study. Paediatr Perinat Epidemiol 2022; 36:26-35. [PMID: 34951026 DOI: 10.1111/ppe.12819] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The global prevalence of childhood obesity has risen dramatically recently. Previous studies found an association between rapid infant weight gain and childhood overweight. Evidence suggests that exposure to high ambient air temperatures during prenatal life and during adulthood is associated with birthweight and obesity respectively. OBJECTIVE The objective of this study was to examine whether exposure to high ambient temperatures during infancy is associated with rapid infant weight gain in Israel. METHODS This is a population-based historical cohort study using data from the Israeli national public network of maternal and child health clinics between 2008 and 2013. We assessed exposure to ambient temperature in the first year of life using a high-resolution hybrid spatio-temporal model and calculated annual mean and minimum temperatures for each infant based on daily mean and minimum temperatures at the community clinic location. We defined rapid infant weight gain as a World Health Organization weight z-score difference >0.67 between birthweight and weight at age one year. We estimated these associations using log-linear and general additive models and adjusted for population group, district, maternal age, parental education, parity, sex, gestational age, birthweight, calendar year and calendar month of birth. RESULTS The study population included 217,310 singleton-term infants. Adjusted models demonstrated a positive association between ambient temperature exposure and rapid infant weight gain. Compared to the third quintile of minimum temperature, infants exposed to the first and second quintile had an adjusted relative risk of 0.98 (95% CI 0.96, 1.00) and 0.97 (95% CI 0.95, 0.98), respectively, while those exposed to the fourth and fifth quintiles had an adjusted relative risk of 1.06 (95% CI 1.04, 1.07) and 1.02 (95% CI 1.00, 1.04) respectively. The associations with mean temperature were similar but slightly weaker. CONCLUSIONS Exposure to higher ambient temperatures, of emerging importance in the climate change era, is associated with rapid infant weight gain in Israel. Future studies should use additional exposure, covariate, and outcome data to analyse the nature and the source of this association in more detail.
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Affiliation(s)
| | - Neora Alterman
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev (BGU), Beer-Sheva, Israel
| | - Raanan Raz
- Braun School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
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25
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Harari-Kremer R, Calderon-Margalit R, Korevaar TIM, Nevo D, Broday D, Kloog I, Grotto I, Karakis I, Shtein A, Haim A, Raz R. Associations Between Prenatal Exposure to Air Pollution and Congenital Hypothyroidism. Am J Epidemiol 2021; 190:2630-2638. [PMID: 34180983 DOI: 10.1093/aje/kwab187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/27/2022] Open
Abstract
Adequate thyroid hormone availability is required for normal brain development. Studies have found associations between prenatal exposure to air pollutants and thyroid hormones in pregnant women and newborns. We aimed to examine associations of trimester-specific residential exposure to common air pollutants with congenital hypothyroidism (CHT). All term infants born in Israel during 2009-2015 were eligible for inclusion. We used data on CHT from the national neonatal screening lab of Israel, and exposure data from spatiotemporal air pollution models. We used multivariable logistic regression models to estimate associations of exposures with CHT, adjusting for ethnicity, socioeconomic status, geographical area, conception season, conception year, gestational age, birth weight, and child sex. To assess residual confounding, we used postnatal exposures to the same pollutants as negative controls. The study population included 696,461 neonates. We found a positive association between third-trimester nitrogen oxide exposure and CHT (per interquartile-range change, odds ratio = 1.23, 95% confidence interval: 1.08, 1.41) and a similar association for nitrogen dioxide. There was no evidence of residual confounding or bias by correlation among exposure periods for these associations.
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26
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Lubotzky-Gete S, Gete M, Levy R, Kurzweil Y, Calderon-Margalit R. Comparing the Different Manifestations of Postpartum Mental Disorders by Origin, among Immigrants and Native-Born in Israel According to Different Mental Scales. Int J Environ Res Public Health 2021; 18:ijerph182111513. [PMID: 34770030 PMCID: PMC8582687 DOI: 10.3390/ijerph182111513] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022]
Abstract
We conducted a prospective study, aimed to study whether the prevalence of mental disorders after birth differs by country of origin. Parturient mothers of Ethiopian origin, Former-USSR (FSU) origin, or nonimmigrant, native-Israeli origin (n = 974, all Jewish) were recruited in hospitals in Israel and were followed 6–8 weeks and one year after birth. General linear models were used to study the associations between origin and mental health, comparing Ethiopian and FSU origin with native-Israeli. Ethiopian and FSU mothers were more likely to report on somatic symptoms, compared with native-Israeli women. Ethiopian origin was negatively and significantly associated with anxiety in all three interviews (β = −1.281, β = −0.678 and β = −1.072, respectively; p < 0.05 in all). FSU origin was negatively associated with depression after birth (β = −0.709, p = 0.036), and negatively associated with anxiety after birth and one-year postpartum (β = −0.494, and β = −0.630, respectively). Stressful life events were significantly associated with all mental disorders in the three time points of interviews. Our findings suggest that immigrants tend to express higher mental distress with somatic symptoms. Additional tools are needed for mental distress screening among immigrants.
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Affiliation(s)
- Shakked Lubotzky-Gete
- Hadassah Braun School of Public Health, Hebrew University, Jerusalem 9112102, Israel;
- Correspondence: ; Tel.: +972-2-6778647 or +972-528-586201
| | - Maru Gete
- Otolaryngology (ENT) and Head-Neck Surgery, Shaarei-Tzedek Medical Center, Jerusalem 9103102, Israel;
| | - Roni Levy
- Hadasa School of Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Yaffa Kurzweil
- The Nursing Administration, Shamir Medical Center, Zeriffin 60930, Israel;
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27
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Turunc O, Zwas DR, Calderon-Margalit R, Unal B. Sex differences in the risk of coronary heart disease associated with socioeconomic status in Turkey. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.108] [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: 11/12/2022] Open
Abstract
Abstract
Background
Studies in high-income countries have demonstrated that low SES status is associated with increased risk of CHD, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries.
Methods
The database of the Chronic Diseases and Risk Factors Survey In Turkey from 2013 and 2019 was used. Education level and employment status were chosen as proxy indicators for SES. Cox regression analyses were conducted to assess the effect of SES on incident CHD controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess multiplicative interaction between sex and SES on the occurrence of stroke.
Results
The study included 13 975 participants (7 450 females (53.3%) and 6525 males (46.7%)). During 74.2±9.87 months of follow-up, 474 CHD cases occurred among females (10.28 cases per 1000 person-year) and 445 CHD cases occurred among males (11.05 cases per 1000 person-year). Incident CHD was not associated with education level among either sex. Retirement was associated with increased risk of CVD (HR = 1.31, 95%Cl: 1.18-1.66) among males. Both retirement (HR = 2.12, 95%Cl: 1.16-3.88) and unemployment (HR = 1.93, 95%Cl: 1.14-3.25) were associated with increased risk of CHD in females after adjustment for behavioral and biological risk factors. There was no multiplicative interaction between sex and employment status on the risk of CHD (p = 0.091).
Conclusions
This study of health outcomes in Turkey did not find sex differences in CVD in association with educational status but did show sex differences in association with employment status. This finding suggests that social determinants in middle-income countries may affect men and women differently than in high-income countries.
Key messages
Social determinants in middle-income countries may affect men and women differently with regards to the risk of CHD than in high-income countries. Employment status can predict the risk of CHD in middle-income countries.
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Affiliation(s)
- O Turunc
- Public Health Department, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - DR Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, D, Hadassah University Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel
| | - B Unal
- Public Health Department, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
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28
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Turunc O, Zwas DR, Calderon-Margalit R, Unal B. Sex differences in the associations of socioeconomic status with stroke in the Turkish Population. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.337] [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: 11/14/2022] Open
Abstract
Abstract
Background
Low SES status is associated with the risk of stroke, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries. We explored this association in the Turkish population.
Methods
The database of the Chronic Diseases and Risk Factors Survey in Turkey from 2013 and 2019 was used. The education level and employment status of the participants were chosen as a proxy indicator for SES. Cox regression analyses were conducted to assess the effect of SES on incident stroke controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess the multiplicative interaction between sex and SES on the risk of stroke.
Results
The study included 13 975 participants; 7 450 females (53.3%) and 6525 males (46.7%). During 74.2±9.87 months of follow-up, 108 strokes occurred among females (2.34 cases per 1000 person-years) and 81 stroke cases occurred among males (2.01 cases per 1000 person-years). Completion of primary school education was associated with decreased risk of stroke (HR = 0.46, 95%Cl: 0.25-0.84) among males. Education level had a linear protective effect against stroke among females after adjustment for behavioral and biological risk factors (HR = 0.50, 95%Cl: 0.30-0.81; HR = 0.30, 95%Cl: 0.12-0.71; respectively for primary education and secondary or higher education). Employment status did not predict the incident stroke for both sexes. There was no evidence of an interaction between sex and education (p = 0.68).
Conclusions
In this Turkish population, stroke risk was greater in women than in men. Increasing education was associated with a reduced risk of stroke in Turkish women, whereas the only completion of primary education was protective for men, with no further protection at increased educational levels. Further exploration of sex and gender risk differences in moderate-income countries may lead to improved efforts at risk reduction.
Key messages
Education level as a social determinant of health in middle-income countries may affect men and women differently with regards to the risk of stroke Understanding sex differences in the associations of socioeconomic status with stroke may lead to improved efforts at risk reduction of stroke in MICs.
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Affiliation(s)
- O Turunc
- Public Health Department, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - DR Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, D, Hadassah University Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel
| | - B Unal
- Public Health Department, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
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29
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Weisband YL, Torres L, Paltiel O, Sagy YW, Calderon-Margalit R, Manor O. Socioeconomic Disparity Trends in Cancer Screening Among Women After Introduction of National Quality Indicators. Ann Fam Med 2021; 19:396-404. [PMID: 34546946 PMCID: PMC8437575 DOI: 10.1370/afm.2715] [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: 02/23/2020] [Revised: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care-based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data. RESULTS In 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening. CONCLUSIONS We found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel's quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.
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Affiliation(s)
| | - Luz Torres
- Research Department, Cardioinfantil Foundation-Cardiology Institute, Bogotá, Colombia
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Yael Wolff Sagy
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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30
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Paltiel O, Hochner H, Chinitz D, Clarfield AM, Gileles-Hillel A, Lahad A, Manor O, Nir-Paz R, Paltiel A, Stein-Zamir C, Yazhemsky E, Calderon-Margalit R. Academic activism on behalf of children during the COVID-19 pandemic in Israel; beyond public health advocacy. Isr J Health Policy Res 2021; 10:48. [PMID: 34407864 PMCID: PMC8371603 DOI: 10.1186/s13584-021-00485-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022] Open
Abstract
Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC’s activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society’s vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - David Chinitz
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - A Mark Clarfield
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and Sleep Unit, Department of Pediatrics, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amnon Lahad
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Clalit Health Services, Jerusalem District, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ari Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chen Stein-Zamir
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ekaterina Yazhemsky
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,School of Business Administration, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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31
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Youssim I, Gorfine M, Calderon-Margalit R, Manor O, Paltiel O, Siscovick DS, Friedlander Y, Hochner H. Holocaust Experience and Mortality Patterns: 4-Decade Follow-up in a Population-Based Cohort. Am J Epidemiol 2021; 190:1541-1549. [PMID: 33564866 DOI: 10.1093/aje/kwab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 02/01/2023] Open
Abstract
Research on mortality associated with exposure to the Holocaust is relevant for a better understanding of the effects of genocides on survivors. To our knowledge, previous studies have not investigated the long-term cause-specific mortality of Holocaust survivors. We compared mortality rates among Israelis born in European countries controlled by the Nazis during World War II with those among Israelis of European descent who did not have this exposure. Records of 22,671 people (45% women; 5,042 survivors) from the population-based Jerusalem Perinatal Study (1964-1976) were linked to the Israeli Population Registry, which was updated through 2016. Cox models were used for analysis, with 2-sided tests of statistical significance. Risk of all-cause mortality was higher among exposed women (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.05, 1.27) than in unexposed women. No association was found between Holocaust exposure and male all-cause mortality. In both sexes, survivors had higher cancer-specific mortality (HR = 1.17 (95% CI: 1.01, 1.35) in women and HR = 1.14 (95% CI: 1.01, 1.28) in men). Exposed men also had excess mortality due to coronary heart disease (HR = 1.39, 95% CI: 1.09, 1.77) and lower mortality from other known causes combined (HR = 0.86, 95% CI: 0.75, 0.99). In summary, experiencing the Holocaust was associated with excess all-cause and cancer-specific mortality in women and cancer- and coronary heart disease-specific mortality in men.
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Schtrechman-Levi G, Ioscovich A, Hart J, Bar J, Calderon-Margalit R, Nir EA, Ginosar Y. Correction to: Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand. Isr J Health Policy Res 2021; 10:30. [PMID: 33823891 PMCID: PMC8025336 DOI: 10.1186/s13584-021-00463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gal Schtrechman-Levi
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Department of General and Oncological Surgery - Surgery C, The Haim Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine, and Pain Treatment, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Hart
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Health Services Management School, Netanya Academic College, Netanya, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | | | - Eshel A Nir
- Department of Anesthesia and Operating Rooms, Kaplan Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, and Wohl Institute of Translational Medicine, Hadassah-Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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33
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Schtrechman-Levi G, Ioscovich A, Hart J, Bar J, Calderon-Margalit R, Nir EA, Ginosar Y. Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand. Isr J Health Policy Res 2021; 10:24. [PMID: 33722282 PMCID: PMC7958695 DOI: 10.1186/s13584-021-00460-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/05/2021] [Indexed: 01/22/2023] Open
Abstract
Background We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. Methods Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS. Results Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival. Conclusions Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00460-2.
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Affiliation(s)
- Gal Schtrechman-Levi
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Department of General and Oncological Surgery - Surgery C, The Haim Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine, and Pain Treatment, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Hart
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Health Services Management School, Netanya Academic College, Netanya, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | | | - Eshel A Nir
- Department of Anesthesia and Operating Rooms, Kaplan Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel.
| | - Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, and Wohl Institute of Translational Medicine, Hadassah-Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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Calderon-Margalit R, Pleniceanu O, Tzur D, Stern-Zimmer M, Afek A, Erlich T, Verhovsky G, Keinan-Boker L, Skorecki K, Twig G, Vivante A. Childhood Cancer and the Risk of ESKD. J Am Soc Nephrol 2021; 32:495-501. [PMID: 33184124 PMCID: PMC8054900 DOI: 10.1681/asn.2020071002] [Citation(s) in RCA: 6] [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: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Increasing cancer incidence among children alongside improved treatments has resulted in a growing number of pediatric cancer survivors. Despite childhood cancer survivors' exposure to various factors that compromise kidney function, few studies have investigated the association between childhood cancer and future kidney disease. METHODS To assess the risk of ESKD among childhood cancer survivors, we conducted a nationwide, population-based, retrospective cohort study that encompassed all Israeli adolescents evaluated for mandatory military service from 1967 to 1997. After obtaining detailed histories, we divided the cohort into three groups: participants without a history of tumors, those with a history of a benign tumor (nonmalignant tumor with functional impairment), and those with a history of malignancy (excluding kidney cancer). This database was linked to the Israeli ESKD registry to identify incident ESKD cases. We used Cox proportional hazards models to estimate the hazard ratio (HR) of ESKD. RESULTS Of the 1,468,600 participants in the cohort, 1,444,345 had no history of tumors, 23,282 had a history of a benign tumor, and 973 had a history of malignancy. During a mean follow-up of 30.3 years, 2416 (0.2%) participants without a history of tumors developed ESKD. Although a history of benign tumors was not associated with an increased ESKD risk, participants with a history of malignancy exhibited a substantially elevated risk for ESKD compared with participants lacking a history of tumors, after controlling for age, sex, enrollment period, and paternal origin (adjusted HR, 3.2; 95% confidence interval, 1.3 to 7.7). CONCLUSIONS Childhood cancer is associated with an increased risk for ESKD, suggesting the need for tighter and longer nephrological follow-up.
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Affiliation(s)
| | - Oren Pleniceanu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Kidney Research Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tomer Erlich
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Guy Verhovsky
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Urology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Karl Skorecki
- Department of Nephrology, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Vivante
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
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35
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Calderon-Margalit R, Efron G, Pleniceanu O, Tzur D, Stern-Zimmer M, Afek A, Erlich T, Derazne E, Kark JD, Keinan-Boker L, Twig G, Vivante A. Congenital Anomalies of the Kidney and Urinary Tract and Adulthood risk of Urinary Tract Cancer. Kidney Int Rep 2021; 6:946-952. [PMID: 33912744 PMCID: PMC8071628 DOI: 10.1016/j.ekir.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/27/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common kidney diseases in childhood. Alterations in genes governing nephrogenesis may cause CAKUT, and in some cases may contribute to development of urinary tract (UT) tumors later in life. We aimed to assess the association between CAKUT and UT cancer in adulthood. Methods We conducted a population-based historical cohort study encompassing 1,510,042 recruits to the Israeli army between 1967 and 1997. CAKUT exposure was determined by army medical coding of CAKUT in childhood. Incidence of UT cancer (kidney, ureter, or bladder) was available through record linkage with the Israeli Cancer Registry. Recruits were followed from the prerecruitment assessment until cancer diagnosis, death, or study termination, in 2012. Cox proportional hazards models were constructed to estimate the hazard ratios (HRs) for UT cancer in participants with vs. without CAKUT. Results During a mean follow-up of 30.4 years, 2959 participants (2573 men and 386 women) developed UT cancer. Men with CAKUT exhibited an increased risk of UT cancer compared with men without CAKUT, yielding an adjusted HR of 1.98 (95% confidence interval [CI] 1.03-3.82). Among women CAKUT was associated with a HR of 5.88 (95% CI 2.19-15.76). Notably, upon stratification according to age of cancer diagnosis, the association between CAKUT and UT cancer was statistically significant only before 45 years of age in women and only after 45 years of age in men. Conclusion CAKUT is associated with a significantly increased risk of UT cancer, although the incidence and absolute risk remained quite low.
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Affiliation(s)
| | - Gil Efron
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Oren Pleniceanu
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Nephrology Research Lab, Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Michal Stern-Zimmer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tomer Erlich
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy D Kark
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel.,Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Vivante
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
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36
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Nano J, Carinci F, Okunade O, Whittaker S, Walbaum M, Barnard-Kelly K, Barthelmes D, Benson T, Calderon-Margalit R, Dennaoui J, Fraser S, Haig R, Hernández-Jimenéz S, Levitt N, Mbanya JC, Naqvi S, Peters AL, Peyrot M, Prabhaharan M, Pumerantz A, Raposo J, Santana M, Schmitt A, Skovlund SE, Garcia-Ulloa AC, Wee HL, Zaletel J, Massi-Benedetti M. A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach. Diabet Med 2020; 37:2009-2018. [PMID: 32124488 DOI: 10.1111/dme.14286] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
AIMS To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patient-reported outcomes. METHODS We conducted a structured systematic review of outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus-driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals. RESULTS The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient-reported outcome measures: the WHO Well-Being Index for psychological well-being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case-mix adjustment. CONCLUSIONS We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient-reported outcomes enables people living with diabetes to report directly on their condition in a structured way.
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Affiliation(s)
- J Nano
- Institute of Epidemiology, Helmholtz Zentrum-Munich, German Research Centre for Environmental Health, Munich, Germany
- German Centre for Diabetes Research, Munich, Germany
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - F Carinci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - O Okunade
- International Consortium for Health Outcomes Measurement, Boston, MA, USA
| | - S Whittaker
- International Consortium for Health Outcomes Measurement, Boston, MA, USA
| | - M Walbaum
- Institute of Epidemiology, University College London, London, UK
| | | | - D Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - T Benson
- Patient member of the ICHOM diabetes Working Group, Jerusalem, Israel
- WHO Patients for Patient Safety Champion, Jerusalem, Israel
- Senior representative Consumers Health Forum of Australia, Jerusalem, Israel
- Senior Representative for Health Consumers Council of Western Australia, Jerusalem, Israel
| | | | - J Dennaoui
- National Health Insurance Company, Daman, United Arab Emirates, Belize
| | - S Fraser
- Belize Diabetes Association, Belize
| | - R Haig
- Patient member of the ICHOM diabetes Working Group, Jerusalem, Israel
| | - S Hernández-Jimenéz
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México
| | - N Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - J C Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - S Naqvi
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - A L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - M Peyrot
- Loyola University Maryland, Baltimore, MD, USA
| | - M Prabhaharan
- Patient member of the ICHOM diabetes Working Group, Jerusalem, Israel
| | - A Pumerantz
- Department of Population Health, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, United States
| | - J Raposo
- APDP-Diabetes Portugal and Nova Medical School, Lisbon, Portugal
| | - M Santana
- Cumming School of Medicine, Libin Cardiovascular Institute Alberta, Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - A Schmitt
- Diabetes Centre Mergentheim, Bad Mergentheim, Germany
| | - S E Skovlund
- Clinical Institute, Aalborg University, Aalborg, Denmark
- Steno Diabetes Centre North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - A C Garcia-Ulloa
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México
| | - H-L Wee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - J Zaletel
- National Institute of Public Health, Ljubljana, Slovenia
- University Medical Centre Ljubljana, Slovenia
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Dior UP, Karavani G, Bursztyn M, Paltiel O, Calderon-Margalit R, Friedlander Y, Youssim I, Manor O, Hochner H. Birth Weight and Maternal Body Size as Determinants of Blood Pressure at Age 17: Results from the Jerusalem Perinatal Study Cohort. Matern Child Health J 2020; 25:162-171. [PMID: 33247825 DOI: 10.1007/s10995-020-03096-x] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of birth weight (BW) and maternal pre-pregnancy BMI (mBMI) on blood pressure (BP) in adolescence. METHODS A Population-based cohort of 11,729 births in Jerusalem during 1974-1976, with archival data on maternal and birth characteristics was performed. Measurements at age 17 were assessed and linear regression models were used to evaluate the associations of birth characteristics with BP outcomes. RESULTS BW was inversely associated with both systolic (SBP) and diastolic (DBP) BP at age 17 (SBP: B = - 0.829, p = 0.002; DBP: B = - 0.397, p = 0.033). The interaction term between BW and weight at age 17 was significant for DBP (p = 0.017) and pulse pressure (p = 0.005). mBMI yielded significant positive associations with BP, independent of BW. CONCLUSIONS FOR PRACTICE Our findings indicate that there are at least two distinct pathways linking early life characteristics with subsequent BP: Intrauterine growth, as reflected by BW and other genetic or environmental factors, reflected by mBMI and maternal education, contribute to offspring adolescent BP. These results warrant replication in other birth cohorts and underline the need to explore specific mechanisms that account for these associations.
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Affiliation(s)
- Uri P Dior
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel. .,Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Michael Bursztyn
- Hypertension Unit, Department of Medicine, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yechiel Friedlander
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Iaroslav Youssim
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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38
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Pleniceanu O, Twig G, Tzur D, Sherman G, Afek A, Erlich T, Keinan-Boker L, Skorecki K, Vivante A, Calderon-Margalit R. Acute pyelonephritis in children and the risk of end-stage kidney disease. J Nephrol 2020; 34:1757-1765. [PMID: 32875542 DOI: 10.1007/s40620-020-00841-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/18/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pyelonephritis is the most common serious bacterial infection during childhood. The long-term importance of kidney scarring is unclear. OBJECTIVE To assess the risk of end-stage kidney disease (ESKD) in adolescents and young adults with history of pyelonephritis. STUDY DESIGN A nationwide, population-based, historical cohort study, including 1,509,902 persons (62% male) examined for military service between 1967 and 1997. Participants with a history of pyelonephritis were sub-grouped according to presence of kidney scarring and baseline kidney function. Data were linked to the Israeli ESKD registry to identify incident ESKD cases. Cox proportional hazards models were used to estimate the hazard ratio (HR) of treated ESKD (dialysis or kidney transplant). RESULTS Pyelonephritis was diagnosed in 6979 participants (0.46%). 6479 had normal kidney function and no evidence of kidney scarring, 400 had normal kidney function with evidence of scarring, and 100 demonstrated reduced baseline kidney function. Treated ESKD developed in 2352 individuals (0.2%) without history of pyelonephritis, 58 individuals (0.9%) with normal kidney function, history of pyelonephritis and no kidney scarring, 14 individuals (3.5%) with normal kidney function, history of pyelonephritis and kidney scarring, and 23 individuals (23.0%) with history of pyelonephritis and reduced baseline kidney function, yielding HR of 3.3, 34.8 and 43.2, respectively, controlling for age, gender, paternal origin, enrollment year, body mass index, and blood pressure, and accounting for death as a competing risk. CONCLUSION History of pyelonephritis was associated with significantly increased risk of treated ESKD, particularly when associated with kidney scarring or reduced baseline kidney function.
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Affiliation(s)
- Oren Pleniceanu
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gilad Twig
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Dorit Tzur
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | - Gilad Sherman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Pediatrics B and Pediatric Infectious diseases Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tomer Erlich
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Urology Department, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Karl Skorecki
- Department of Nephrology, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Asaf Vivante
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
- Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, 5265601, Israel.
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Loewenberg Weisband Y, Krieger M, Calderon-Margalit R, Manor O. Trends and socioeconomic disparities in diabetes prevalence and quality of care among Israeli children; 2011-2018. Isr J Health Policy Res 2020; 9:41. [PMID: 32819418 PMCID: PMC7439517 DOI: 10.1186/s13584-020-00399-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/07/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Despite Israel's universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time. METHODS We used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel's four health maintenance organizations. The study population included all Israeli children aged 2-17 years in 2011-2018 (2018: N = 2,404,856). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). We used logistic regression to assess the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1c > 9%), and assessed whether these changed over time. RESULTS Diabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67-3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40-0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18-0.34). Disparities were especially apparent among children aged 2-9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018. CONCLUSIONS While poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
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Affiliation(s)
- Yiska Loewenberg Weisband
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel.
| | - Michal Krieger
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
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40
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Weisband YL, Manor O, Friedlander Y, Hochner H, Paltiel O, Calderon-Margalit R. Interpregnancy and interbirth intervals and all-cause, cardiovascular-related and cancer-related maternal mortality: findings from a large population-based cohort study. J Epidemiol Community Health 2020; 74:957-963. [PMID: 32655002 DOI: 10.1136/jech-2020-214242] [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: 04/03/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Scarce research is available regarding the association between interbirth intervals (IBI) and long-term maternal health outcomes, particularly cardiovascular disease (CVD) mortality. We aimed to assess whether IBIs were associated with all-cause, CVD-related and cancer-related mortality. METHODS We conducted a cohort study in the setting of the Jerusalem Perinatal Study. Women with at least two consecutive singleton live births in 1964-1976 (N=18 294) were followed through 2016. IBIs were calculated as the interval between women's first and second cohort birth. We estimated associations between IBIs and mortality using Cox's proportional hazards models, adjusting for age, parity, maternal education, maternal origin and paternal socioeconomic status. Date of last menstrual period was available for a subset of women. We assessed the interpregnancy interval (IPI) for these women and compared the models using IPI and IBI. RESULTS During 868 079 years of follow up (median follow-up: 49.0 years), 3337 women died. Women with IBIs <15 months had higher all-cause mortality rates (HR 1.18; 95% CI 1.05 to 1.33) compared to women with 33-month to 68-month IBIs (reference category). IBI and CVD mortality appeared to have a J-shaped association; IBIs of <15, 15-20, 21-2626-2632, 33-68 and ≥69 months had HRs of 1.44, 1.40, 1.33, 1.14, 1.00 and 1.30, respectively. No substantial association was found with cancer mortality. Models using IPIs and those using IBI were similar. CONCLUSION Our results support the WHO recommendations for IPIs of ≥24 months and add additional evidence regarding long-term CVD mortality.
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Affiliation(s)
- Yiska Loewenberg Weisband
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Yechiel Friedlander
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.,Hadassah Medical Organization, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.,Hadassah Medical Organization, Jerusalem, Israel
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41
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Paltiel O, Keidar Tirosh A, Paz Stostky O, Calderon-Margalit R, Cohen AD, Elran E, Valinsky L, Matz E, Krieger M, Yehuda AB, Jaffe DH, Manor O. Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records. J Med Screen 2020; 28:25-33. [PMID: 32356670 DOI: 10.1177/0969141320919152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/17/2022]
Abstract
OBJECTIVES To assess time trends in colorectal cancer screening uptake, time-to-colonoscopy completion following a positive fecal occult blood test and associated patient factors, and the extent and predictors of longitudinal screening adherence in Israel. SETTING Nation-wide population-based study using data collected from four health maintenance organizations for the Quality Indicators in Community Healthcare Program. METHODS Screening uptake for the eligible population (aged 50-74) was recorded 2003-2018 using aggregate data. For a subcohort (2008-2012, N = 1,342,617), time-to-colonoscopy following a positive fecal occult blood test and longitudinal adherence to screening guidelines were measured using individual-level data, and associated factors assessed in multivariate models. RESULTS The annual proportion screened rose for both sexes from 11 to 65%, increasing five-fold for age group 60-74 and >six-fold for 50-59 year olds, respectively. From 2008 to 2012, 67,314 adults had a positive fecal occult blood test, of whom 71% eventually performed a colonoscopy after a median interval of 122 (95% confidence interval 110.2-113.7) days. Factors associated with time-to-colonoscopy included age, socioeconomic status, and comorbidities. Only 25.5% of the population demonstrated full longitudinal screening adherence, mainly attributable to colonoscopy in the past 10 years rather than annual fecal occult blood test performance (83% versus 17%, respectively). Smoking, diabetes, lower socioeconomic status, cardiovascular disease, and hypertension were associated with decreased adherence. Performance of other cancer screening tests and frequent primary care visits were strongly associated with adherence. CONCLUSIONS Despite substantial improvement in colorectal cancer screening uptake on a population level, individual-level data uncovered gaps in colonoscopy completion after a positive fecal occult blood test and in longitudinal adherence to screening, which should be addressed using focused interventions.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Aravah Keidar Tirosh
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Orit Paz Stostky
- Pharmacy Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Einat Elran
- Quality Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liora Valinsky
- Quality Department, Meuhedet Health Care, Tel Aviv, Israel
| | - Eran Matz
- Community Health Services, Leumit Health Services, Tel Aviv, Israel
| | - Michal Krieger
- Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Arye Ben Yehuda
- Quality Indicators in Community Healthcare Program, Jerusalem, Israel.,Department of Internal Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Dena H Jaffe
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
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42
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Leiter E, Finkelstein A, Donchin M, Greenberg KL, Keidar O, Wetzler S, Siemiatycki S, Calderon-Margalit R, Zwas DR. Integration of Mixed Methods in Community-Based Participatory Research: Development of a Disease Prevention Intervention for Ultra-Orthodox Jewish Women. Am J Health Promot 2020; 34:479-489. [DOI: 10.1177/0890117120906965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To describe the development of the first disease prevention intervention with ultra-Orthodox Jewish (UOJ) women in Israel using mixed methods and community-based participatory research (CBPR). Design: This collaborative, 7-staged development process used an exploratory sequential mixed methods design integrated into a community-based participatory approach. Setting: The UOJ community in Israel, a high-risk, low socioeconomic, culturally insular minority that practices strict adherence to religious standards, maintains determined seclusion from mainstream culture and preserves traditional practices including extreme modesty and separation between the sexes. Participants: Women from a targeted UOJ community in Israel with distinct geographic, religious, and cultural parameters. These included 5 key informant interviewees, 5 focus groups with 6 to 8 participants in each, a cluster randomized sample of 239 questionnaire respondents (an 87% response rate), and 11 steering committee participants. Method: Qualitative data were analyzed through Interpretative Phenomenological Analysis by 2 researchers. Quantitative data were collected via questionnaire (designed based on qualitative findings) and analyzed utilizing descriptive statistics. Results: Barriers to health behavior engagement and intervention preferences were identified. The final intervention included walking programs, health newsletters, community leader trainings, teacher and student trainings, and health integration into schools. Conclusion: Utilizing mixed methods in CBPR improved cultural tailoring, potentially serving as a model for intervention design in other difficult to access, low socioeconomic, and culturally insular populations.
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Affiliation(s)
- Elisheva Leiter
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| | - Adi Finkelstein
- Program of Medical Humanities, Hebrew University Hadassah Medical School, Jerusalem, Israel
- Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| | - Milka Donchin
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Keren L. Greenberg
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| | - Osnat Keidar
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Sima Wetzler
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| | - Sara Siemiatycki
- Bishvilaych, The Evelyne Barnett Women’s Medical Center, Jerusalem, 9548311, Israel
| | - Ronit Calderon-Margalit
- Hebrew University of Jerusalem, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Donna R Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
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Sagy YW, Krieger M, Horwitz E, Paltiel O, Ravel-Vilk S, Ben-Yehuda A, Manor O, Calderon-Margalit R. Diabetes care in individuals with severe mental Illnesses in Israel. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.193] [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: 11/15/2022] Open
Abstract
Abstract
Background
Cardiovascular disease and risk factors are more common in people with severe mental illness (SMI; schizophrenia, schizoaffective disorders, and bi-polar disorders). For instance, diabetes mellitus (DM) prevalence was reported to be 2-3 times higher, with higher incidence and severity of complications. In 2015, following a reform in mental health services in Israel, services were transferred to the responsibility of the health plans, allowing a comprehensive healthcare. We aimed to compare quality of care indicators and intermediate DM outcomes in individuals with SMI compared to the general population.
Methods
The Israel national program for quality indicators in community healthcare obtains data from electronic medical records from the four health plans, covering the entire civilian population. In 2017, n = 74,226 individuals aged ≥18 years had a registered diagnosis of SMI (prevalence 1.37%). DM prevalence, hemoglobin A1c (HbA1c) testing yearly, and DM control in individuals with SMI were compared with the general population.
Results
DM prevalence in adults with SMI in 2017 was 14.3%, compared with 9.7% among all Israeli adults (RR of 1.5). rates of HbA1c testing and control (HbA1c<7-8%, depending on age and duration of disease) were similar among DM patients with SMI and the general population (testing: 90.1% and 90.9%; Control: 70.8% and 69.7%, SMI and general population, respectively); Similarly, uncontrolled DM (HbA1c>9%) was observed in 10.8% of individuals with SMI and in 10.0% of the general population.
Conclusions
Along with the expected excess of DM prevalence in individuals with SMI, quality of care DM indicators rates were alike among those with SMI as in the general population, suggesting non-inferior quality of care. This is consistent with results reported by the British national diabetes audit for England and Wales. However, our results are limited by a possible under-registration or diagnosis of SMI in the Israeli population.
Key messages
Higher diabetes mellitus prevalence is observed in individuals with severe mental illness. Hemoglobin A1c testing and diabetes mellitus control rates are alike in individuals with severe mental illness compared with the general population, suggesting non-inferior quality of care.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare-Zedek, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Abstract
Abstract
Background
Most studies on the association between the mental health of mothers and the development of their offspring have focused on maternal depression, but only a few have investigated the association between maternal anxiety and child development. We aimed to compare the associations between maternal depression and anxiety symptoms 6-8 weeks postpartum and infant development at 1 year.
Methods
We conducted a longitudinal study of 396 mother-child dyads. The mothers were recruited after birth in 3 different hospitals in Israel in 2017 and were followed for one year. Mothers were assessed by completing the General Anxiety Disorder-7 (GAD-7) questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) 6-8 weeks postpartum. Child development was assessed by the Ages & Stages Questionnaires (ASQ-3) at 12 months. Multivariate linear regressions were used to explore the relationship between the EPDS and GAD-7 scores and child development, all as continuous variables, adjusting for maternal education, parity, and gender.
Results
Depressive symptoms postpartum were only associated with poor personal-social skills (β=-0.5, 95% CI: -0.91, -0.08). Increasing maternal anxiety was associated with poorer development in communication skills (β =-0.48, 95% CI: -0.93, -0.04), personal-social skills (β =-1.02, 95% CI: -1.58, -0.46), solving problems skills (β =-0.7, 95% CI: -1.27, -0.14) and fine motor skills (β =-0.46, 95% CI: -0.9, -0.02). Neither anxiety nor depressive symptoms were associated with gross motor skills. Controlling for quality of attachment, the associations of depression and anxiety with development were no longer significant, suggesting mediation.
Conclusions
Postpartum anxiety was a stronger predictor of low developmental scores than depression, and associations were probably mediated by impaired attachment. Identifying and supporting mothers experiencing anxiety after birth may mitigate the risk of developmental delays in children.
Key messages
Maternal anxiety was found to be a significant risk factor for developmental delay at 1 year of age. The association between maternal anxiety and child development was probably mediated by attachment.
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Affiliation(s)
- S Gete
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - I Grotto
- Public Health, Ministry of Health, Jerusalem, Israel
| | - A Ornoy
- School of Medicine-IMRIC-Medical Neurobiology, Hebrew University-Hadassah, Jerusalem, Israel
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45
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Wolff Sagy Y, Krieger M, Horwitz E, Ben-Yehuda A, Paltiel O, Ravel-Vilk S, Manor O, Calderon-Margalit R. Diabetes in Israel- do all patients receive equal care? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.223] [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: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators.
Methods
The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged >18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses.
Results
DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c<7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level.
Conclusions
These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP.
Key messages
Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Weisband YL, Calderon-Margalit R, Wolff-Sagy Y, Krieger M, Abu-Ahmed W, Ben-Yehuda A, Horwitz E, Manor O. Socioeconomic disparities in diabetes prevalence and quality of care among Israeli children. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.035] [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: 11/12/2022] Open
Abstract
Abstract
Background
Despite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess trends in these over time.
Methods
Repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare that receives data based on electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2-19 years in 2011-2017 (for 2017: N = 2,364,374, including 2,914 with diabetes). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). Using logistic regression, we assessed the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1C> 9%), and assessed whether these changed over time. Models were adjusted for age, and sex.
Results
Diabetes prevalence increased with age and SEP. SEP was positively associated with visiting a specialized diabetes clinic (OR SEP 4 vs. 1 2.53, 95% CI 1.72 - 3.70). Odds of HbA1C testing and odds of poor glycemic control were negatively associated with SEP (OR SEP 4 vs. 1: 0.54, 95% CI 0.40 - 0.72 and OR SEP 4 vs. 1: 0.25, 95% CI 0.18 - 0.34 respectively). Disparities were especially apparent among children aged 2-9 (4.6% poor glycemic control in SEP 4 vs. 40.8% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.8% in 2017.
Conclusions
While poor glycemic control rates among children have improved, significant socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
Key messages
Major socioeconomic inequalities in the control of diabetes among children in Israel remain despite universal health care coverage. The rate of uncontrolled diabetes among Israeli children has improved over time.
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Affiliation(s)
- Y Loewenberg Weisband
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Y Wolff-Sagy
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - M Krieger
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - W Abu-Ahmed
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - A Ben-Yehuda
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - E Horwitz
- Pharmacy Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Ein-Mor E, Berman T, Barnett-Itzhaki Z, Göen T, Ergaz-Shaltiel Z, Natsheh J, Ben-Chetrit A, Haimov-Kochman R, Calderon-Margalit R. Newborn infant urinary cotinine and birth outcomes in the Jerusalem Environment Mother and Child Cohort Study. Int J Hyg Environ Health 2019; 222:1054-1058. [PMID: 31324382 DOI: 10.1016/j.ijheh.2019.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/20/2019] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure during pregnancy can cause preterm delivery and childhood cancer. The aim of this study was to measure ETS exposure in pregnant women and in newborn infants in Israel using urinary cotinine measurements, to assess predictors of ETS exposure in these vulnerable groups, and to assess associations with birth effects (birth weight, birth length, head circumference) in newborn infants. METHODS We analyzed urinary cotinine and creatinine in 265 non-smoking pregnant women and 97 newborns, and analyzed associations with self-reported exposure to ETS, paternal smoking, sociodemographic variables and with birth outcomes (birth weight, birth length, head circumference). RESULTS 37.7% of pregnant women and 29.0% of infants had urinary cotinine concentrations above the level of quantification (LOQ) of 1 μg/L, whereas 63.8% and 50.5%, respectively, had urinary cotinine concentrations above the level of detection (LOD) of 0.5 μg/L. Median unadjusted and creatinine adjusted urinary concentrations of cotinine in pregnant women were 0.7 μg/L, and 0.9 μg/g creatinine, respectively, and in newborn infants were 0.5 μg/L, and 1.3 μg/g creatinine, respectively. We did not find an association between maternal and infant urinary cotinine level. Maternal (but not infant) urinary cotinine was significantly associated with paternal smoking (p < 0.05). Infant (but not maternal) cotinine above the LOQ was negatively associated with birth weight (p < 0.05). CONCLUSIONS In this high socioeconomic cohort, almost a third of newborn infants born to non-smoking mothers had quantifiable levels of urinary cotinine. This is the first study showing that newborns with quantifiable urinary cotinine levels have lower birth weight.
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Affiliation(s)
- Eliana Ein-Mor
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, Jerusalem, 91120, Israel
| | - Tamar Berman
- Public Health Services, Ministry of Health, Jerusalem, Israel; Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Zohar Barnett-Itzhaki
- Public Health Services, Ministry of Health, Jerusalem, Israel; Bioinformatics Department, School of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel.
| | - Thomas Göen
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Juma Natsheh
- Neonatology Department Hadassah Medical Center, Jerusalem, Israel
| | | | - Ronit Haimov-Kochman
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Hadassah-Hebrew University Braun School of Public Health, POB 12272, Jerusalem, 91120, Israel
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Krieger M, Abu Ahmad W, Wolff-Sagy Y, Horwitz E, Ben-Yehuda A, Paltiel O, Manor O, Calderon-Margalit R. [ANTIBIOTIC USE IN COMMUNITY HEALTHCARE IN ISRAEL AS REFLECTED IN THE NATIONAL PROGRAM FOR QUALITY INDICATORS]. Harefuah 2019; 158:299-304. [PMID: 31104389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS We sought to evaluate the extent of overall and second-line systemic antibiotic use in the Israeli community, to compare them to international data and to monitor temporal trends. BACKGROUND Antibiotic overuse is prevalent and has grave implications, primarily the emergence of resistant pathogens - an urgent public health concern worldwide. METHODS The Israel National Program for Quality Indicators in Community Healthcare (QICH) obtains data from electronic medical records from the 4 health-plans, covering the entire civilian population. We assessed 2 quality indicators, compatible with those of the OECD: 1. Overall volume of antibiotics for systemic use dispensed. 2. Volume of second-line antibiotics as a proportion of all systemic antibiotics. Analysis was stratified by gender, age and socio-economic position (SEP). RESULTS The volume of systemic antibiotics dispensed in 2016 was 20.76 DDD/1000 person/day, with second-line antibiotics comprising 22.0% of the total. These values have been stable since 2014, and are higher compared with the OECD averages (20.61 DDD/1000 person/day, and 17.02% in 2015). Both overall volume and the proportion of second-line antibiotics rose with age and were higher among women especially in the 20-40 years age bracket (overall volume of 23.98 DDD/1000 person/day, proportion of second-line antibiotics of 23.98% VS 17.41 and 19.17% in men). Higher overall use was observed among patients of low SEP. CONCLUSIONS The observed volume of systemic antibiotics and the proportion of second-line antibiotics dispensed in the Israeli community were stable and high. Higher use was observed among older individuals, women and patients of low SEP. Our results call for the implementation of a national-level, community-based antibiotic stewardship program. QICH might serve to monitor such a program.
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Affiliation(s)
- Michal Krieger
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Yael Wolff-Sagy
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Ehud Horwitz
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
- Pharmacy Division, Hadassah Medical Center, Hebrew University
| | - Arie Ben-Yehuda
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- Department of Internal Medicine, Hadassah Medical Center, Hebrew University
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Orly Manor
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University- Hadassah
- National Program for Quality Indicators in Community Healthcare
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Luria S, Talmud D, Volk I, Liebergall M, Calderon-Margalit R. The epidemiology of wrist and hand injury in two hospitals in Jerusalem: substantial differences between population subgroups. Isr J Health Policy Res 2019; 8:7. [PMID: 30626435 PMCID: PMC6327559 DOI: 10.1186/s13584-018-0278-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/29/2018] [Accepted: 12/19/2018] [Indexed: 12/15/2022] Open
Abstract
Background Wrist and hand injuries are common and constitute a major economic burden. General injury prevention programs have failed to demonstrate a decrease in injury rates. We hypothesized that there are differences in injury patterns in culturally diverse subpopulations of a metropolitan area treated within the same medical system, which may partly explain the difficulties associated with injury prevention. Methods We conducted a survey of patients admitted to emergency departments of two hospitals in Jerusalem for wrist and hand injuries during a 3 month period. Patients were asked to complete a questionnaire regarding demographic data, injury type and mechanism. Injury type and mechanism were then compared for age, gender, level of education and degree of religiosity. Results The questionnaire was completed by 799 patients (response rate 62%; 75% male; average age 27). Thirty-one percent reported they were injured at work, 33% at home and 36% during leisure activities. Data analysis showed that several subpopulations were found to be at risk as compared to their corresponding groups and relative proportion in the overall population of the city. These included contusions after falls in non-ultra-Orthodox Jewish women aged 65 years and over, crush injuries in ultra-Orthodox Jews under the age of 10 (53% vs. 14% for non ultra-Orthodox Jews, respectively) and Muslim teens. Muslims were injured more, especially at work, in comparison to their relative proportion in the population as a whole. Conclusion Different subpopulations at risk and different injury patterns of wrist and hand injuries were found in this culturally heterogeneous population. Awareness of these differences may be the first step when designing specific injury prevention programs in a culturally diverse population. A combined effort of community leaders and government agencies is needed to deal with the specific populations at risk, although legislation may be needed to limit some of the risks such as teens and specific work related hazards and exposures.
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Affiliation(s)
- Shai Luria
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
| | - Daniel Talmud
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Ido Volk
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Meir Liebergall
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
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Bar-Meir M, Friedlander Y, Calderon-Margalit R, Hochner H. Mode of delivery and offspring adiposity in late adolescence: The modifying role of maternal pre-pregnancy body size. PLoS One 2019; 14:e0209581. [PMID: 30605457 PMCID: PMC6317793 DOI: 10.1371/journal.pone.0209581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/26/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To study the association between mode of delivery and offspring BMI in late adolescence in a large cohort that predated the obesity epidemic, and assess the role of maternal pre-pregnancy BMI (ppBMI) in this association. Study design We conducted a historical prospective study in the setting of the Jerusalem Perinatal Study (JPS), a population-based cohort that includes all 17,003 births to residents of West Jerusalem, between 1974 and 1976. Offspring’s BMI at age 17 was obtained upon army recruitment and was available for 11,001 of cohort participants. The associations were examined using logistic regressions, adjusting for socio-demographic characteristics and for proxies for indication for C-Section birth. Analyses were then stratified by quartiles of ppBMI. Results C-Section was associated with offspring overweight/obesity, with adjusted OR of 1.44 (95%CI:1.14–1.82). Significant interaction of ppBMI with mode of delivery was observed, such that the associations of C-Section with overweight/obesity were limited to the upper quartile of ppBMI (adjusted OR = 1.70, 95%CI:1.18–2.43). Restricting the analyses to singleton first births and excluding pregnancies complicated with toxemia and gestational diabetes yielded similar findings. Conclusions C-Section was positively associated with being overweight/obese at age 17. Importantly, ppBMI modified this association, with a significant association between C-Section and overweight/obesity evident only among offspring born to mothers in the highest ppBMI quartile. In light of the growing rates of obesity in women of reproductive age, these results should be considered in patient-doctor shared decisions related to selection of mode of delivery, in the absence of a clear medical indication.
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Affiliation(s)
- Maskit Bar-Meir
- Infectious Diseases, Shaare-Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- * E-mail: (MBM); (HH)
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Hagit Hochner
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
- * E-mail: (MBM); (HH)
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