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Mor Z, Shachar C, Shai U, Sheffer R. Re-admission after early discharge from involuntary hospitalization of psychiatric patients. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.262] [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
State psychiatrics in Public Health Departments in Israel can involuntary hospitalize patients (IHP) in psychotic status. IHP who are unsatisfied with the involuntary hospitalization can appeal to a Psychiatric Committee (PC) in the institution to ask to shorten their hospitalization. The PC can decide to discharge the patient to ambulatory treatment. This cohort study aimed to assess re-admission of IHP among patients who shortened their involuntary hospitalization in Tel-Aviv.
Methods
IHP whose involuntary hospitalization was shortened by PC (research arm) were compared to IHP patients who completed the entire hospitalization length, as was initially recommended by the psychiatrist (control arm). Re-admission was defined as hospitalization within one year after release by the PC/end of hospitalization.
Results
From 3,160 IHR between 2010 and 2015, 1,338 were re-hospitalized during a year after release, 317 (41.7%) from the research arm and 1,012 (42.6%) from the control arm, p < 0.7. Discharge of IHP by PC during first month of the involuntary hospitalization resulted in a higher re-admission rates than IHR from the control group (58.4% vs. 46.4%, respectively, p < 0.001). Yet, discharge of IHR by the PC after one month of hospitalization (or end of the hospitalization) resulted in lower re-admission rates (14.8% vs. 53.6%, respectively, p < 0.001). Risks factors for re-admission included male gender, Israeli born, single and diagnosis of schizophrenia.
Conclusions
Re-admission rates were higher in IHR who were released by the PC during the first month of hospitalization. The first month is important for mental and therapeutic stabilization of IHP. After 30 days, release of IHP can be re-assessed according to the patients’ situation. Early discharge of males who were diagnosed with schizophrenia should be carefully assessed.
Key messages
• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
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Affiliation(s)
- Z Mor
- Public Health, Ministry of Health , Tel Aviv, Israel
- School of Health Sciences, Ashkelon Academic College , Ashkelon, Israel
| | - C Shachar
- Medical School, Tel Aviv University , Tel Aviv, Israel
| | - U Shai
- Public Health, Ministry of Health , Tel Aviv, Israel
| | - R Sheffer
- Public Health, Ministry of Health , Tel Aviv, Israel
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Mor Z, Davidi N, Alroy Preis S. Civil-military cooperation to contain COVID-19 epidemic in Israel- Lesson learned. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.059] [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
Issue
Public Health Services (PHS) has a major role in controlling COVID-19. As the epidemic propagated, and due to limited resources, PHS in Israel reached it capacity to contain the outbreak. Following a political decision in June 2020, the Home Front Command (HFC) of the Israeli Army was assigned to integrate in operating the National epidemiological efforts, while the PHS remained responsible for policy, setting guidelines and supervision.
Problem
The civilian PHS and the military HFC had to establish cooperation, institute new hierarchical structure and divide the responsibility, despite the differences in organizational cultures, financial and human resources. Additionally, inter and intra organizational interests had to be resolved.
Results
Formal and informal efforts were needed to bridge between the two organizations, while utilizing the comparative advantage of each agency. PHS has experience in controlling outbreaks, well-established intra-organizational communication, high professional identity, commitment and familiarity with different populations in Israel. HFC is a flexible, creative, learning and fast-responding organ, experienced in controlling emergencies and has well-established chains of command. HFC is supported by IT and intelligence officers. Organizational disadvantages had to be resolved. PHS is deficient in resources, has limited capacity in operating staff during irregular hours, and is obliged to share the health leadership and authority with the army. HFC has to confront high rotation of its manpower, difficulty in succumbing to non-military guidelines and regulations and possible mistrust between the army and special populations, such as Arabs or ultra-religious Jews.
Lessons
Civil-military epidemiological cooperation can boost the National response in containing epidemics. Policymakers from each agency should use leadership skills to encourage integration while being sensitive to the needs and expectations of all participants.
Key messages
• Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.
• Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.
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Affiliation(s)
- Z Mor
- Public Health, Ministry of Health , Tel Aviv, Israel
- School of Health Sciences, Ashkelon Academic College , Ashkelon, Israel
| | - N Davidi
- Home Front Defence, Israeli Defence Forces , Ramla, Israel
| | - S Alroy Preis
- Public Health, Ministry of Health , Tel Aviv, Israel
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Margineanu I, Mor Z, Garcia D, Gilpin C, Dhawan S, Ritz N, Zenner D. TB and COVID-19 in migrants - the need to focus on both conditions. Int J Tuberc Lung Dis 2021; 25:333-335. [PMID: 33977899 DOI: 10.5588/ijtld.21.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- I Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Rijksuniversiteit Groningen, Groningen, the Netherlands
| | - Z Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel, Ashkelon Academic College, School of Health Sciences, Ashkelon, Israel
| | - D Garcia
- Migrant Clinicians Network, Austin, TX, USA
| | - C Gilpin
- International Organization for Migration, Geneva, Switzerland
| | - S Dhawan
- Partasia Biopharm, New Delhi, India, SHARE INDIA, Delhi, India
| | - N Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, Mycobacterial and Migrant Health Research, University Children´s Hospital Basel, University of Basel, Basel, Switzerland
| | - D Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University of London, London, UK
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Shachaf S, Davidovitch N, Halpern P, Mor Z. Utilization profile of emergency department by irregular migrants and hospitalization rates: lessons from a large urban medical center in Tel Aviv, Israel. Int J Equity Health 2020; 19:56. [PMID: 32349751 PMCID: PMC7191790 DOI: 10.1186/s12939-020-1152-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Irregular migrants (IMM) are excluded from the National health insurance in most developed countries and may use the emergency department (ED) as a source for medical care. This study aims to compare the use of ED by IM with that of Israeli citizens (IC) in a large urban hospital in Tel Aviv, including socio-demographic characteristics, hospitalization proportion and medical conditions on admission. Methods This cross-sectional study included all IM and IC patients older than 18 years who attended the ED between 2007 and 2011, and compared their socio-demographic characteristics, the administrative details of the visit and clinical variables upon admission. Hospitalization proportion was calculated by dividing the number of patients who were admitted to the hospital ward by the number of all patients who attended the ED. Results IM who attended the ED were younger compared to IC (mean 39 ± 17 versus 52 ± 22 years, respectively), mostly males (1.4 Male/Female ratio) and mainly originated from developing countries. IM were more commonly self-referred, more likely to attend the ED during evening hours and weekends, complained of occupational injuries and frequented the surgical rather the medical ward of the ED compared with IC. IM stayed at the ED for longer periods than IC, yet the proportion of their hospitalization was lower than that of IC (19.4% versus 23.5%, respectively). Conclusion IM stayed in the ED for longer periods and were less likely to be admitted to the hospital wards, suggesting presentation of non-severe medical conditions or possible barriers in ensuring care continuity in the community following discharge. Minimizing the barriers of IM to primary care in the community can reduce unnecessary referrals to the ED. Additionally, hospitals managements should respond to the high-volume of IM by shifting staff to busy hours and improving the communication with IM.
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Affiliation(s)
- S Shachaf
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel. .,Department of Emergency Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - N Davidovitch
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel
| | - P Halpern
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Mor
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkleon, Israel
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Chemtob D, Mor Z, Harel N, Averick N. HIV infection among men who have sex with men in Israel: a 35-year epidemiological and clinical overview, 1981-2015. BMC Public Health 2019; 19:747. [PMID: 31196014 PMCID: PMC6567630 DOI: 10.1186/s12889-019-7000-1] [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: 08/08/2018] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is the first to describe major epidemiological trends and clinical characteristics among Israeli men who have sex with men (MSM), who are at a higher risk for HIV infection. METHODS This retrospective study includes all individuals reported to the Israeli Ministry of Health with HIV and self-identified as MSM between 1981 and 2015. The incidence rates of HIV infection and AIDS-defining diseases were analyzed and Kaplan-Meier survival estimates were calculated from time of HIV infection notification to AIDS diagnosis and death across three consecutive periods representing antiretroviral treatment availability. RESULTS The trend of increase in HIV incidence is similar to Western Europe, although Israeli rates are lower. Of 2052 HIV/AIDS Israeli MSM diagnosed during the follow-up, 296 (14.6%) developed AIDS. MSM constitute 28.4% of all HIV/AIDS cases and 41.5% of cases among men. Average times from HIV-notification until AIDS diagnosis were 15.5 [14.0-16.9], 16.0 [15.5-16.4], and 6.7 [6.7-6.8] years, within 1981-1996, 1997-2007, and 2008-2015, respectively. The HIV-incidence rate among Israeli MSM slightly declined from 2012, after peaking in 2011 at 6.2 per 100,000. CONCLUSIONS The recent reduction in HIV-incidence and in AIDS diagnoses among Israeli MSM is encouraging. Nevertheless, the disproportionate incidence of HIV among MSM requires sustained efforts to abate further infections.
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Affiliation(s)
- D Chemtob
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel. .,Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Z Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - N Harel
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel
| | - N Averick
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel
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Mor Z, Nuss N, Savion M, Nissan I, Lidji M, Maneshcu S, Kaidar-Shwartz H, Amitai Z, Rorman E, Sheffer R. Tuberculosis outbreak in a nursing home involving undocumented migrants and Israeli citizens. Isr J Health Policy Res 2018; 7:36. [PMID: 30007410 PMCID: PMC6046096 DOI: 10.1186/s13584-018-0219-y] [Citation(s) in RCA: 4] [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: 01/04/2018] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
ABSTRACK OBJECTIVES: Israel has absorbed > 60,000 migrant from the horn of Africa (MHOA) since 2006. No cross-transmission of Mycobacterium tuberculosis from MOHA to Israeli citizens has yet been reported. This study describes the results of contact investigation and laboratory work-out of a unique mixed cluster which included both MOHA and Israeli citizens. METHODS Description of the results of epidemiological investigation including laboratory confirmation. RESULTS This unique Mycobacterium tuberculosis strain included 29 patients: 26 were MOHA and three citizens who immigrated to Israel from the former Soviet Union. This is the first mixed cluster described in Israel, which has not been represented in the SITVIT international database of genotyping markers. The transmission from non-citizens to citizens occurred in a nursing institution, when MOHA infected three other contacts- two of whom were retarded residents, one of them died. The index case was screened before employment, and was permitted to return to wok although his chest X-ray demonstrated radiological findings compatible with tuberculosis. Epidemiological links were found in other 12 MOHA members of the cluster. CONCLUSION This report describes cross-transmission of Mycobacterium tuberculosis from non-citizens MOHA to Israeli citizens who were residents of a nursing home, which may be the first sign for an epidemiological shift. Although cross-ethnical transmission is still rare in Israel, medical settings should employ efficient infection control measures to protect both patients and staff from Mycobacterium tuberculosis.
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Affiliation(s)
- Z Mor
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - N Nuss
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel.
| | - M Savion
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
| | - I Nissan
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - M Lidji
- Tel Aviv Tuberculosis clinic, Tel Aviv, Israel
| | - S Maneshcu
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
| | - H Kaidar-Shwartz
- National Tuberculosis Reference Laboratory, Ministry of Health, Tel Aviv, Israel
| | - Z Amitai
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
| | - E Rorman
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - R Sheffer
- Tel Aviv Department of Health, Ministry of health, 12 Ha'arba'a Street, 6473912, Tel Aviv, Israel
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Lönnroth K, Mor Z, Erkens C, Bruchfeld J, Nathavitharana RR, van der Werf MJ, Lange C. Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points. Int J Tuberc Lung Dis 2018; 21:624-637. [PMID: 28482956 DOI: 10.5588/ijtld.16.0845] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
As tuberculosis (TB) rates continue to decline in native populations in most low TB incidence countries, the proportion of TB patients born outside their country of residence ('foreign-born') increases. Some low-incidence countries have experienced a substantial increase in TB rates related to recent increases in the number of asylum seekers and other migrants from TB-endemic countries. However, average TB rates among the foreign-born in low-incidence countries declined moderately in 2009-2015. TB in foreign-born individuals is commonly the result of reactivation of latent infection with Mycobacterium tuberculosis acquired outside the host country. Transmission is generally low in low-incidence countries, and transmission from migrants to the native population is often modest. Variations in levels and trends in TB notifications among the foreign-born are likely explained by differences and fluctuations in the number and profile of migrants, as well as by variations in TB control, health and social policies in the host countries. To optimise TB care and prevention in migrants from endemic to low-incidence countries, we propose a framework for identifying possible TB care and prevention interventions before, during and after migration. Universal access to high-quality care along the entire migration pathway is critical. Screening for active TB and latent tuberculous infection should be tailored to the TB epidemiology, adapted to the needs of specific migrant groups and linked to treatment. Ultimately, the long-term TB elimination goal can be reached only if global health and socio-economic inequalities are dramatically reduced. Low-incidence countries, most of which are among the wealthiest nations, need to contribute through international assistance.
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Affiliation(s)
- K Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Z Mor
- Research Branch, Tel Aviv Department of Health, Tel Aviv, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - J Bruchfeld
- Unit of Infectious Diseases, Department of Medicine Solna, Department of Infectious Diseases Karolinska University Hospital, Stockholm, Sweden
| | - R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, Division of Infectious Diseases and Immunity, Imperial College, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research, Clinical Tuberculosis Center, Borstel, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
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Abstract
BACKGROUND Several studies have suggested that the incidence of tuberculosis (TB) varies with the seasons. OBJECTIVE To determine the seasonality of TB in Israel and to explore possible associations with climatic variables. METHODS Laboratory-confirmed TB cases reported between 2001 and 2011 in individuals resident in Israel for at least 1 year before diagnosis were included in the study. Climatic variables included average temperature and average ultraviolet radiation. The mean serum 25-hydroxyvitamin D level of the population was also recorded. RESULTS Of all 2653 TB cases, incidence peaked during spring (n = 712) and reached its nadir during the fall (n = 577), with a case proportion amplitude (CPA) of 5.1% (P = 0.036). Individuals born in the Horn of Africa exhibited a CPA of 9.5% (P = 0.077). Mean population 25-hydroxyvitamin D level was significantly correlated with the seasonal pattern of the disease. Southern Israel had the highest global radiation and, counter-instinctively, the highest TB incidence. CONCLUSIONS TB exhibited a seasonal tendency in Israel, with the spring peak/fall nadir pattern found elsewhere. Vitamin D is suspected to be an explanatory variable for this seasonal phenomenon. The finding that the highest incidence is in the area receiving the highest global radiation suggests population-related vulnerability to vitamin D deficiency.
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Affiliation(s)
- I Margalit
- The Hebrew University-Hadassah Medical School, Jerusalem
| | - C Block
- The Hebrew University-Hadassah Medical School, Jerusalem, Department of Clinical Microbiology & Infectious Diseases, Hadassah-Hebrew University Medical Centre, Jerusalem
| | - Z Mor
- Ramla Department of Health, Ministry of Health, Ramla, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shuldiner J, Leventhal A, Chemtob D, Mor Z. Mortality after anti-tuberculosis treatment completion: results of long-term follow-up. Int J Tuberc Lung Dis 2016; 20:43-8. [PMID: 26688527 DOI: 10.5588/ijtld.14.0427] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycobacterium tuberculosis affects the lung parenchyma even after successful treatment. OBJECTIVE To assess long-term mortality in a cohort of individuals who had recovered from tuberculosis (TB), and to compare their mortality rate and causes of death with those of the general population. METHODS This retrospective cohort study of all Israeli citizens who recovered from tuberculosis between 2000 and 2010 included all patient files and death certificates and/or hospitalisation records of deceased individuals. Death rates were computed using standard mortality rates (SMR). Cox proportional hazard regression was conducted to identify risk factors for death, and causes of death were compared with those in the general Israeli population. RESULTS Over 11 years of follow-up, comprising 18,246 person-years, 389 (12.0%) Israeli citizens died after completion of anti-tuberculosis treatment, giving an SMR of 3.7. The SMR was strongly correlated with age, and was highest in males and individuals aged 25-44 years. Compared to the general population, among individuals who recovered from TB there were more deaths due to septicaemia and pneumonia, and fewer deaths due to cerebrovascular diseases, stroke and diabetes (P < 0.05). CONCLUSIONS Individuals who recover from TB are at higher risk of long-term mortality than the general population, and their causes of death are different. Periodical follow-up might be beneficial for individuals to facilitate early diagnosis.
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Affiliation(s)
- J Shuldiner
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem, Israel
| | - A Leventhal
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem, Israel; Department of International Relations, Ministry of Health, Jerusalem, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel; Ramla Department of Health, Ministry of Health, Ramla, Israel
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Goldblatt D, Rorman E, Chemtob D, Freidlin PJ, Cedar N, Kaidar-Shwartz H, Dveyrin Z, Mor Z. Molecular epidemiology and mapping of tuberculosis in Israel: do migrants transmit the disease to locals? Int J Tuberc Lung Dis 2016; 18:1085-91. [PMID: 25189557 DOI: 10.5588/ijtld.14.0186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Israel receives migrants from various countries, some of which have high tuberculosis (TB) prevalence. OBJECTIVE To assess the predominant Mycobacterium tuberculosis strains in Israel isolated during 2008-2010 among Israeli-born and migrant patients, and to investigate possible transmission of TB from migrants to the local population. METHODS Molecular characterisation employed 43-spacer spoligotyping and 16-loci mycobacterial interspersed repetitive units-variable number of tandem repeats typing. All patients were classified according to those who were members of a cluster and those who were not. RESULTS Among 684 M. tuberculosis strains isolated from new patients genotyped and assigned to their specific cohort populations during the study period, major spoligotype families were Central Asian (CAS) (n = 140, 20%), Beijing (n = 101, 15%) and T (n = 160, 23%). Most Beijing strains (66%) were isolated from patients from the former Soviet Union (FSU), while CAS strains were mainly (74%) from Ethiopia, Eritrea and Sudan (EES). For the heterogeneous T-clade, patient countries of origin were 38% EES and 33% FSU. CONCLUSIONS Predominant M. tuberculosis genotypes in Israel in 2008-2010 were similar to genotypes endemic to the migrants' countries of origin. Epidemiological investigations did not demonstrate transmission between migrants and Israeli-born patients sharing the same cluster.
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Affiliation(s)
- D Goldblatt
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - E Rorman
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - P J Freidlin
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - N Cedar
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - H Kaidar-Shwartz
- National Mycobacterium Reference Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - Z Dveyrin
- National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
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Abstract
OBJECTIVES Arab men who have sex with men (AMSM) are becoming visible in society, and reports of HIV infection and sexually transmitted infections (STIs) are emerging. This study aimed to assess the knowledge of AMSM regarding HIV transmission, their attitudes towards condom use and their sexual practices compared with Jewish MSM (JMSM), and to evaluate AMSM-JMSM friendships and sexual encounters. METHODS Participants in this cross-sectional study completed questionnaires in Arabic or Hebrew. The outcome variable was unprotected anal sex (UAI) in the previous 6 months with a partner(s) whose HIV status was discordant or unknown. AMSM and JMSM indicated if they had friends or sexual encounters from the other ethnic group. RESULTS The questionnaires were completed by 342 (16.2%) AMSM and 1775 (83.8%) JMSM in 2012. AMSM were more likely to be religious, 'closeted' and married than JMSM; their knowledge regarding HIV transmission was inferior and attitudes towards condom use were less favourable. AMSM reported less alcohol and drug use than JMSM, were more likely to be attracted to and have sex with women, and reported a greater number of sexual partners and more UAI. Being AMSM was a predictive variable for UAI in the multivariate model. While 178 AMSM (52.0%) reported that most of their close friends were JMSM, 251 (73.4%) had only/mostly sexual encounters with JMSM. Among JMSM, 41 (2.3%) reported that their close friends were AMSM, and 308 (17.3%) had only/mostly sexual encounters with AMSM. CONCLUSIONS The knowledge of AMSM regarding HIV transmission and their attitudes towards condom use were less favourable than those of JMSM, and they performed more UAI. AMSM may benefit from targeted interventions, including reconciling their same-sex attraction in positive terms. Same-sex attraction and gay identity may provide common ground to strengthen Arab-Jew communication in Israel.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.,Ramla Department of Health, Ministry of Health, Ramla, Israel
| | - E Grayeb
- Bone Marrow Transplantation Department, Hadassah Medical Centre, Jerusalem, Israel.,Al-Qaws for Sexual and Gender Diversity in the Palestinian Society, Jerusalem, Israel
| | - A Beany
- Department of Internal Medicine C, Bnai Zion Medical Centre, Haifa, Israel
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12
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Abstract
SETTING Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. OBJECTIVES To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. DESIGN Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. RESULTS During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged ≥65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. CONCLUSION Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.
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Affiliation(s)
- J Shuldiner
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem
| | - A Leventhal
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem
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13
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Bishara H, Rorman E, Mor Z, Shechter-Amram D, Weiler-Ravell D. Tuberculosis Beijing strain outbreak in an Israeli Arab rural community linked to an incarcerated immigrant. Int J Tuberc Lung Dis 2014; 18:1502-4. [DOI: 10.5588/ijtld.14.0429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Abstract
OBJECTIVE Lifestyle may be associated with risk behaviours. This study compares gym exercise and sexual risk behaviour between men who have sex with men (MSM) and heterosexual men. The research was based on the assumption that men who become muscular and physically attractive increase their number of sex partners and consequently their risk of HIV or other sexually transmitted infections (STIs). SETTING Five gyms in central Tel Aviv, Israel. PARTICIPANTS In 2012, a sample of 182 (48%) MSM and 197 (52%) heterosexual men who train in gyms completed anonymous questionnaires regarding their training, health and sexual behaviours. OUTCOMES Participants in this cross-sectional study who exercised more than the median number of anaerobic training hours were defined as performing intensive anaerobic training (IAT), and those who had performed more than one act of unprotected anal/vaginal intercourse in the preceding 6 months with a partner whose HIV status was unknown were defined as high risk. RESULTS MSM showed a stronger desire to become muscular than heterosexual men, were more likely to perform IAT, and used protein powders or anabolic steroids. They reported that improving their body shape and increasing their self-confidence were their main reasons for training, whereas heterosexual men indicated weight loss and health improvement as the main reasons for training. MSM engaged in riskier sexual behaviour than heterosexual men. Of all the high-risk men, 61.9% (N=70) performed IAT, while 38.1% (N=43) performed moderate anaerobic training (p<0.01). The association between IAT and sexual risk was stronger in MSM than in heterosexual men (p<0.01 vs p=0.05, respectively). The interaction between MSM and IAT in high-risk participants was multiplicative. CONCLUSIONS MSM practised more IAT than heterosexual men, and their interaction between IAT and sexual risk was multiplicative. The MSM community could benefit from a holistic approach to sexual health and its association with body image and IAT. The gym MSM culture demonstrates how internal dynamics and social norms are possible factors driving MSM to high-risk behaviour for HIV/STI. STUDY REGISTRATION The study was approved by the Wolfson Hospital Review Board, Holon, Israel (WOMC-0058-09).
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Affiliation(s)
- Z Mor
- Ramla Health Department, Ministry of Health, Ramla, Israel
| | - K Parfionov
- Eating Disorders Unit, Sheba Medical Center, Tel Hashomer, Israel Department of Epidemiology, Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel
| | - N Davidovitch
- Department of Health Policy, Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel
| | - I Grotto
- Department of Epidemiology, Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel Public Health Services, Ministry of Health, Jerusalem, Israel
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Mor Z, Goldblatt D, Kaidar-Shwartz H, Cedar N, Rorman E, Chemtob D. Drug-resistant tuberculosis in Israel: risk factors and treatment outcomes. Int J Tuberc Lung Dis 2014; 18:1195-201. [DOI: 10.5588/ijtld.14.0192] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
SETTING The Israeli national tuberculosis (TB) surveillance system. OBJECTIVES To describe the epidemiology of extra-pulmonary tuberculosis (EPTB) in Israel between 1999 and 2010 and identify more susceptible populations. DESIGN Data were retrieved from the National Tuberculosis Registry and the Israeli Bureau of Statistics. RESULTS During the study period, 995 EPTB patients were notified, corresponding to 19.6% of all TB cases. The average annual male:female ratio was 0.8, and the human immunodeficiency virus (HIV) infection rate was 5%. Most EPTB affected the lymph nodes (39.8%), pleura (16.9%) and urinary system (11.1%). Most EPTB patients (81.8%) were non-Israeli born. The estimated average annual incidence in Israeli-born citizens, non-Israeli-born citizens and migrant workers was respectively 0.23, 2.2 and 7.5 per 100,000 population. The ratio of non-Israeli-born migrant workers to non-Israeli-born citizens with EPTB decreased from 1:6.3 in 1999 to 1:0.78 in 2010. Culture results were obtained for 624 (62.9%) of all cases. Of these, 41 (6.6%) were resistant to at least one first-line anti-tuberculosis drug and 8 (1.3%) were multidrug-resistant. Treatment success was achieved in 86.5%. CONCLUSIONS Physicians should be aware of the possibility of EPTB in older patients, especially in the non-Israeli-born. Innovative screening procedures should be implemented for migrants from high-burden countries.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
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Mor Z, Shani A, Dan M, Shohat T. P2.110 Risk Factors For Bacterial Vaginosis Among Symptomatic Women Attending STI Clinic in Tel Aviv, Israel. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0374] [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] [Indexed: 11/03/2022]
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Mor Z, Parfionov K, Davidovitch N, Grotto I. P4.061 Physical Activity and Risky Sexual Behaviour in Men Who Have Sex with Men and Heterosexual Males in Tel Aviv, Israel. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0959] [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] [Indexed: 11/04/2022]
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Mor Z, Dan M. P3.114 Are Male Sex Workers in Tel-Aviv, Israel at Higher Risk to Getting STI and HIV Than Men Who Have Sex with Men. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0573] [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] [Indexed: 11/04/2022]
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Mor Z, Pinsker G, Cedar N, Lidji M, Grotto I. Adult tuberculosis in Israel and migration: trends and challenges between 1999 and 2010. Int J Tuberc Lung Dis 2013; 16:1613-8. [PMID: 23131258 DOI: 10.5588/ijtld.12.0296] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Israel absorbs many migrants from countries with a high prevalence of tuberculosis (TB). OBJECTIVES To describe the epidemiology of TB among adults in Israel between 1999 and 2010 and identify populations with a high TB burden. DESIGN Data were retrieved from the National Tuberculosis Registry and the Israeli Bureau of Statistics. RESULTS A total of 4652 adult TB patients were notified during the study period, with rates decreasing annually from 7.5 per 100,000 population in 1999 to 4.3 in 2010. Most (n = 3745, 80.5%) had pulmonary TB, the average female:male ratio was 1:1.4, and 227 (5.1%) were infected with the human immunodeficiency virus. Of all TB patients, 4079 (87.6%) were born outside Israel; of these, 3338 were citizens and 741 non-citizen migrant workers (MWs). The average annual rates of TB among Israeli-born citizens, foreign-born citizens and MWs were respectively 0.86, 11.9 and 27/100,000. The ratio of MWs to foreign-born citizens fell from 1:11.7 in 1999 to 1:1.5 in 2010. TB was diagnosed 13.9 ± 7.5 years following entry to Israel, mostly during the first year. Of 3551 isolates, 222 (4.5%) were multidrug-resistant; most (95.6%) were from foreign-born patients. The average treatment success rate for smear-positive pulmonary TB was 84.3%. CONCLUSION TB rates have decreased, while the proportion of foreign-born subjects, particularly MWs, has increased. Adherence to preventive treatment can prevent TB in these cases.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
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Mor Z, Kolb H, Lidji M, Migliori GB, Leventhal A. Tuberculosis diagnostic delay and therapy outcomes of non-national migrants in Tel Aviv, 1998-2008. Euro Surveill 2013. [DOI: 10.2807/ese.18.12.20433-en] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Non-national migrants have limited access to medical therapy. This study compares diagnostic delay and treatment outcomes of non-insured non-national migrants (NINNM) with insured Israeli citizens (IC) in the Tel Aviv tuberculosis (TB) clinic between 1998 and 2008. Patient delay was the time from symptoms onset to doctor's visit, while system delay was measured from doctor visit to anti-TB therapy administration. We randomly sampled 222 NINNM and 265 IC. NINNM were younger than IC, had lower male to female ratio and fewer smoked. They had less drug/alcohol abuse, more cavitations on chest radiography, longer patient and shorter system delay. Mean patient and system delays of all patients were 25±14 and 79±42 days, respectively. In multivariate analysis, being NINNM, asymptomatic or smoking predicted longer patient delay, while being asymptomatic or having additional co-morbidity predicted longer system delay. Treatment success in sputum smear-positive pulmonary TB NINNM was 81% and 95.7% in IC (p=0.01). Treatment success was not associated with patient or system delay. In multivariate analysis, work security and treatment adherence predicted treatment success. NINNM had longer patient delay and worse therapy outcome, while IC had longer system delay. Both delays should be reduced. NINNM should be informed that TB therapy is free and unlinked with deportation.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - H Kolb
- Ben Gurion University in the Negev, Beer Sheva, Israel
| | - M Lidji
- Tel Aviv Tuberculosis Clinic, Israeli Lung Association, Tel Aviv, Israel
| | - G B Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy
| | - A Leventhal
- Braun School of Public Health, Hebrew University, Jerusalem, Israel
- Department of International Relations, Ministry of Health, Jerusalem, Israel
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Mor Z, Kolb H, Lidji M, Migliori G, Leventhal A. Tuberculosis diagnostic delay and therapy outcomes of non-national migrants in Tel Aviv, 1998-2008. Euro Surveill 2013; 18:20433. [PMID: 23557947] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Non-national migrants have limited access to medical therapy. This study compares diagnostic delay and treatment outcomes of non-insured non-national migrants (NINNM) with insured Israeli citizens (IC) in the Tel Aviv tuberculosis (TB) clinic between 1998 and 2008. Patient delay was the time from symptoms onset to doctor's visit, while system delay was measured from doctor visit to anti-TB therapy administration. We randomly sampled 222 NINNM and 265 IC. NINNM were younger than IC, had lower male to female ratio and fewer smoked. They had less drug/alcohol abuse, more cavitations on chest radiography, longer patient and shorter system delay. Mean patient and system delays of all patients were 25 ± 14 and 79 ± 42 days, respectively. In multivariate analysis, being NINNM, asymptomatic or smoking predicted longer patient delay, while being asymptomatic or having additional co-morbidity predicted longer system delay. Treatment success in sputum smear-positive pulmonary TB NINNM was 81% and 95.7% in IC (p=0.01). Treatment success was not associated with patient or system delay. In multivariate analysis, work security and treatment adherence predicted treatment success. NINNM had longer patient delay and worse therapy outcome, while IC had longer system delay. Both delays should be reduced. NINNM should be informed that TB therapy is free and unlinked with deportation.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
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Mor Z, Grayeb E, Beany A, Grotto I. Increasing trend of HIV/AIDS among Arab and Jewish male persons in Israel, 1986-2010. HIV Med 2012; 14:316-20. [DOI: 10.1111/hiv.12003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - A Beany
- Department of Internal Medicine C; Bnai Zion Medical Center; Haifa; Israel
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Moran-Gilad J, Lazarovitch T, Mentasti M, Harrison T, Weinberger M, Mordish Y, Mor Z, Stocki T, Anis E, Sadik C, Amitai Z, Grotto I. Humidifier-associated paediatric Legionnaires' disease, Israel, February 2012. Euro Surveill 2012; 17:20293. [PMID: 23078810] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We report a fatal case of community-acquired Legionnaires' disease in an infant aged under six months. Epidemiological and microbiological investigations suggested that a free-standing cold water humidifier using domestic tap water contaminated with Legionella pneumophila serogroup 1 served as a vehicle for infection. These findings were corroborated by sequence-based typing (SBT). Humidifier-associated Legionnaires' disease can be prevented by appropriate control measures. This case also illustrates the emerging role of SBT in the investigation of legionellosis.
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Affiliation(s)
- J Moran-Gilad
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel.
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Moran-Gilad J, Lazarovitch T, Mentasti M, Harrison T, Weinberger M, Mordish Y, Mor Z, Stocki T, Anis E, Sadik C, Amitai Z, Grotto I. Humidifier-associated paediatric Legionnaires' disease, Israel, February 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.41.20293-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a fatal case of community-acquired Legionnaires' disease in an infant aged under six months. Epidemiological and microbiological investigations suggested that a free-standing cold water humidifier using domestic tap water contaminated with Legionella pneumophila serogroup 1 served as a vehicle for infection. These findings were corroborated by sequence-based typing (SBT). Humidifier-associated Legionnaires' disease can be prevented by appropriate control measures. This case also illustrates the emerging role of SBT in the investigation of legionellosis.
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Affiliation(s)
- J Moran-Gilad
- Public Health Services, Ministry of Health, Jerusalem, Israel
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - T Lazarovitch
- Department of Clinical Microbiology, Assaf Harofeh Medical Centre, Zerifin, Israel
| | - M Mentasti
- Reference Microbiology Services, Health Protection Agency (HPA), London, United Kingdom
| | - T Harrison
- Reference Microbiology Services, Health Protection Agency (HPA), London, United Kingdom
| | - M Weinberger
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Disease Unit, Assaf Harofeh Medical Centre, Zerifin, Israel
| | - Y Mordish
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Disease Unit, Assaf Harofeh Medical Centre, Zerifin, Israel
| | - Z Mor
- Ramla sub-District Health Office, Ministry of Health, Ramla, Israel
| | - T Stocki
- Reference Microbiology Services, Health Protection Agency (HPA), London, United Kingdom
| | - E Anis
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - C Sadik
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Z Amitai
- Tel Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - I Grotto
- Public Health Services, Ministry of Health, Jerusalem, Israel
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Abstract
Hepatitis A virus (HAV) vaccination is recommended for men who have sex with men (MSM) and other susceptible populations, who are at increased risk for HAV infection, such as HIV-positive persons. Vaccines failures are uncommon, and in HIV-positive individuals whose CD4 count is ≥500 cells/mm2, seroconversion is achieved in 73–94% of vaccinees following the second dose. Data were retrieved from the patient's file at the sexually transmitted disease clinic and the AIDS clinic describing this rare case of vaccine failure. A 35-year-old, HIV-positive MSM was vaccinated against HAV on 2007, while his CD4 count was 551 cells/mm2. Two years later, he was hospitalized due to acute HAV. The patient's serum drawn two months prior to the onset of acute HAV was retrospectively tested and showed no response to the vaccine. The source of the HAV infection was not identified. The patient's partner who was HIV-negative and had been vaccinated simultaneously with the same batch developed protective antibodies. In conclusion, HIV-positive patients and their providers should be informed about HAV vaccine failure, and post-immunization serologies to hepatitis should be considered to evaluate immunization response. Alternative approaches to develop immunity are needed for non-responders.
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Affiliation(s)
- Z Mor
- Levinsky STI Clinic, Ministry of Health, Sorasky Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Y Lurie
- Hepatitis Clinic, Sorasky Tel Aviv Medical Centre, Tel Aviv, Israel
| | - E Katchman
- AIDS Clinic, Sorasky Tel Aviv Medical Centre, Tel Aviv, Israel
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Mor Z, Gefen D, Linhart Y, Amitai ZS, Dan M, Shohat T. The contribution of oral sex to male urethral Neisseria gonorrhoeae infections in Tel-Aviv district, Israel. Int J STD AIDS 2011; 22:251-5. [PMID: 21571972 DOI: 10.1258/ijsa.2009.009202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incidence of Neisseria gonorrhoeae (NG) in Tel-Aviv district, Israel has increased since the mid-1990s. This study aimed to address behavioural attributes and identify the sources of NG infection. Of 1234 NG cases in men reported between 2000 and 2004, 379 (31%) were interviewed. Most were single, heterosexual and Israeli-born. Insertive oral sex (OS) was reported by 77% patients and vaginal intercourse by 69%, where condoms were used by 4% and 40% for these practices, respectively. Unprotected OS was performed by 95% of the 151 men involved in protected vaginal sex. OS was the most common practice among the younger age group, and in sexual contacts with casual partners or commercial sex workers (CSWs): behaviours that were reported by 37% and 36% of patients, respectively. Unprotected OS is a common route for NG transmission, and it is suggested that the rise in NG may be attributed to unprotected OS with casual partners or CSWs.
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Affiliation(s)
- Z Mor
- Tel-Aviv Department of Health, Ministry of Health, E Wolfson Medical Centre, Holon, Israel.
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Levy I, Mor Z, Anis E, Maayan S, Leshem E, Pollack S, Chowers M, Mor O, Riesenberg K, Sthoeger Z, Ram D, Grossman Z. Men Who Have Sex With Men, Risk Behavior, and HIV Infection: Integrative Analysis of Clinical, Epidemiological, and Laboratory Databases. Clin Infect Dis 2011; 52:1363-70. [DOI: 10.1093/cid/cir244] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Abstract
The incidence of acute hepatitis A in Israel has decreased 25 folds in less than a decade, following the introduction of a two-dose universal toddler's hepatitis A immunization in July 1999. This retrospective study describes demographic data and behavioural determinants of hepatitis A patients following the implementation of a vaccination programme. All records of hepatitis A patients reported to the Ministry of Health during the years 2003 through 2005 were reviewed, and an epidemiological investigation was conducted. During the study period, 420 hepatitis A patients were reported, representing an average annual incidence of two per 100,000 population. Case fatality rate was 0.5%. The majority of the patients were younger than 15 years of age, males and non-Jewish. The highest incidence was recorded in east Jerusalem, where vaccine coverage is relatively low. After exclusion of 165 east Jerusalem patients, 133 (52.2%) patients were available for an interview. Of those, 16 (6%) had possible occupational exposure, 37 (27.8%) travelled to endemic areas, 44 (17%) were contacts of hepatitis A cases, and 3 male patients had sex with men. No known risk determinant was identified in 33 (24.8%) patients. Four patients (3%) were previously immunized with one dose, and none had two doses. The introduction of universal toddler hepatitis A vaccination decreased morbidity. Most of the patients who were detected 4-6 years after the implementation of the vaccination programme could be classified into one of the known risk groups for hepatitis A infection or living in a partly vaccinated community.
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Affiliation(s)
- Z Mor
- Ramla Sub-District Health Office, Ministry of Health, Ramla, Israel.
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Mor Z, Davidovich U, McFarlane M, Feldshtein G, Chemtob D. Gay men who engage in substance use and sexual risk behaviour: a dual-risk group with unique characteristics. Int J STD AIDS 2008; 19:698-703. [PMID: 18824624 DOI: 10.1258/ijsa.2008.008061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
'Recreational' substances used among men having sex with men, and their association with risky unprotected anal intercourse (RUAI) were examined--for the first time in Israel--in an internet-based questionnaire assessing knowledge, practices and motivation. Between March and May 2005, 2873 participants completed the entire questionnaire. Of the total, 669 (23%) reported RUAI during the last six months, and 1319 (46%) used substances during sex. Use of substance was significantly higher among those performing RUAI than those who did not (31.5% versus 26.4%, P=0.03). Involvement in both substance use and RUAI was reported by 366 participants (13%). HIV rates were higher in this dual-risk group (P<0.01), and individuals reported more partners in the last six months than those not part of this dual risk (11.6 versus 8.2, P=0.02). In multivariate analyses, Tel-Aviv residency, lower education, performing receptive RUAI, misperception of HIV transmission and limited negotiation skills were positively associated with this dual-risk behaviour.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Public Health Services, Ministry of Health, Jerusalem, Israel.
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Mor Z, Migliori GB, Althomsons SP, Loddenkemper R, Trnka L, Iademarco MF. Comparison of tuberculosis surveillance systems in low-incidence industrialised countries. Eur Respir J 2008; 32:1616-24. [PMID: 18684850 DOI: 10.1183/09031936.00042908] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The comparative analysis of National Tuberculosis Control Programmes (NTPs) in industrialised, low-tuberculosis-incidence countries is limited. Analysis of applied methods, function and accumulated experience contributes to improving global tuberculosis control. A questionnaire addressing NTP surveillance infrastructure and characteristics was completed in 19 industrialised countries, with populations of >3 million and annual notified tuberculosis incidence rates of <16 cases per 100,000 population (2003 data). All European countries surveyed adopted World Health Organization Collaborating Centre for the Surveillance of Tuberculosis in Europe (EuroTB) definitions. Surveillance information, which usually includes names, was transferred electronically to the national level in 17 out of the 19 countries. Surveillance systems capture process and social determinants. Case notification to the central level occurred within a median period of 7 days, independent of mandatory notification requirements. The mean completeness of tuberculosis case-reporting was estimated to be 93.5% (range 65-100%). Integration between HIV and tuberculosis registries was performed in two countries, and, in seven others, both databases were cross-matched periodically. National Tuberculosis Control Programme function in industrialised low-incidence countries utilises well-established infrastructure and relies upon centralised operations. Approaches are consistent with current World Health Organization surveillance recommendations. The present study lays collaborative groundwork for additional multinational analyses for the enhancement of global tuberculosis surveillance, which may assist policy-makers in countries moving from medium to low rates of incidence.
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Affiliation(s)
- Z Mor
- Public Health Services, Ministry of Health, Jerusalem, Israel
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Mor Z, Lerman Y, Leventhal A. Pre-immigration screening process and pulmonary tuberculosis among Ethiopian migrants in Israel. Eur Respir J 2008; 32:413-8. [DOI: 10.1183/09031936.00145907] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mor Z, Roth Y, Harell M. [Acute laryngeal trauma]. Harefuah 2000; 138:595-8. [PMID: 10883193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Affiliation(s)
- Z Mor
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel
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Sperber AD, Geftler A, Goren M, Cohen H, Levi G, Raz I, Mor Z, Yachelevich N, Malik T, Shubin A. Medical students' contribution to the development of a smoke-free hospital policy in a university medical centre: a relevant learning experience. Med Educ 1995; 29:43-47. [PMID: 7623685 DOI: 10.1111/j.1365-2923.1995.tb02799.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In a research methodology course, second-year medical students conducted a survey on 'Enforcing a Smoking Ban in the Soroka Medical Center: a Survey of Hospital Employees on Facilitating Factors and Obstacles'. They defined the study objectives and design, developed the study instrument, carried out the survey, coded and entered the data into mainframe computers, analysed the computer output, and prepared oral and written reports. The aims of the project were twofold: to survey employees' attitudes to a hospital smoking ban and to train medical students in the planning and conduct of a research project on public health or preventive medicine. Twelve students conducted a cross-sectional survey of 208 hospital employees (10% of the hospital staff). Employees were surveyed regarding smoking status, interest in quitting smoking, knowledge of the law banning smoking in public places, knowledge of the health effects of passive smoking, attitudes towards a hospital smoking ban and potential obstacles to its implementation. The students rated the course as excellent. They gained important research skills, as well as practical medical and public health experience through active participation in the design and execution of a study project with public health implications. At the first meeting of the hospital committee appointed to enforce a smoke-free hospital, the students' findings were reported in full, and their recommendations have guided policy decisions.
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Affiliation(s)
- A D Sperber
- Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Seva, Israel
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Abstract
We have previously reported that diaphyseal bone of prepubertal rats responds in a sex-specific manner to gonadal steroids, 24 h after steroid injection, by increases in creatine kinase (CK) specific activity and the rate of DNA synthesis. We have also shown that hormonal intervention abolished the sex-specific response of diaphyseal bone to sex steroids. In the present study, we examined the responsiveness of diaphyseal bone and cartilage to gonadal steroids in male and female Wistar-derived rats at ages between 5 days and 1 yr. In both diaphyseal bone and cartilage of untreated control rats, a peripubertal peak of CK specific activity was seen, which was more pronounced in females. Diaphyseal bone, unlike epiphyseal cartilage, responded specifically to a single injection of 17 beta-estradiol (E2; 5 micrograms/rat) in females and to 5 alpha-dihydrotestosterone (DHT; 50 micrograms/rat) in males. The highest response occurred peripubertally, but was skewed toward prepubertal ages in males and postpubertal ages in females. To study the effect of gonadectomy on this sex-specific response of diaphyseal bone, rats were gonadectomized at the age of 24 or 180 days and from 4 days to 4 weeks thereafter were challenged with either E2 or DHT. Diaphyseal bones of gonadectomized rats of either sex responded to both E2 and DHT, beginning 7 days after surgery. Thus, in gonadectomized rats, there was a loss of the sex specificity of response to steroid hormones, which could be restored by replenishment, by five daily injections, of the characteristic hormone of each sex. In the epiphyseal cartilage, the same replenishment schedule resulted in acquisition of a sex-specific response in both sexes, not seen previously. These data in conjunction with the previously reported hormonal modulation of sex-specific responses, are consistent with a developmental acquisition of diaphyseal sex steroid specificity that requires for its maintenance the presence of appropriate amounts of the characteristic gonadal steroid in each sex.
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Affiliation(s)
- D Sömjen
- Endocrine Unit, Ichilov Hospital, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Ron-El R, Mor Z, Weinraub Z, Schreyer P, Bukovsky I, Dolphin Z, Goldberg M, Caspi E. Triplet, quadruplet and quintuplet pregnancies. Management and outcome. Acta Obstet Gynecol Scand 1992; 71:347-50. [PMID: 1326209 DOI: 10.3109/00016349209021071] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The management and outcome of 46 pregnancies, 37 triplets, 7 quadruplets and 2 quintuplets, were analysed. Management of pregnancies, initiated upon diagnosis of multiple pregnancy, included bed rest, beta-mimetic agents, dexamethasone late in the second trimester and selective cerclage. The mean gestational age at labor was 235 days in triplet pregnancies, 241 for quadruplets and 220 days for quintuplets. Fifty-four percent of the deliveries were by cesarean section and the remainder per vaginam. The mean weight of the neonates was 1809 g for the triplets, 1837 g for quadruplets and 1284 g for the quintuplets. The mean overall Apgar score was 8.13, total perinatal mortality 14.8% and 9.4% in cases more than 28 weeks. There was no statistically significant difference in the outcome for triplets born vaginally or by cesarean section. In recent years there has been a pronounced reduction in neonatal mortality, dropping from 17.3% during 1970-78 to 5.9% from 1979 to 1983 (p less than 0.05), probably due to the improved neonatal treatment.
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Affiliation(s)
- R Ron-El
- Department of Obstetrics & Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
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Abstract
We have demonstrated previously that 17 beta-estradiol (E2) stimulates proliferation of skeletal tissues, both in vivo and in vitro, as measured by increased DNA synthesis and creatine kinase (CK) specific activity. The effect of E2 on bone is sex specific. E2 is active only in females and androgens only in males. By contrast, in cartilage of both sexes, dihydrotestosterone (DHT) as well as E2 stimulates CK specific activity and DNA synthesis. In bone, we find that sex steroids stimulate skeletal cell proliferation in gonadectomized as well as in immature rats. Ovariectomized (OVX) rats, between 1 and 4 weeks after surgery, show stimulation of CK by E2. The basal activity and response of CK changes with the varying endogenous levels of E2 in cycling rats, in which the highest basal activity is at proestrus and estrus and the highest response is in diestrus. In rats of all ages tested, both the basal and stimulated specific activity of CK is higher in diaphysis and epiphysis than in the uterus, or in the adipose tissue adjacent to the uterus, which has a response similar to that of the uterus itself. The effect of E2 in vivo, and in chrondroblasts and osteoblasts in vitro, is inhibited by high levels of the antiestrogen tamoxifen which, by itself, in similar high concentrations, shows stimulatory effects. In addition to the sex steroids, skeletal cells are also stimulated by secosteroid and peptide calciotrophic hormones. The interactions of the sex steroids with these hormones modulate the response of cartilage and bone cells to both sex steroids and the other calciotrophic hormones. These results provide the first steps towards understanding the regulation of bone cell proliferation and growth by the concerted action of a variety of hormones and growth factors.
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Affiliation(s)
- D Sömjen
- Endocrine Unit, Ichilov Hospital, Tel Aviv, Israel
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41
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Mor Z, Golan A, Bukovsky I, Caspi E. [Gynecological risk factors for osteoporosis]. Harefuah 1990; 119:385-7. [PMID: 2289719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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42
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Caspi E, Schneider DF, Mor Z, Langer R, Weinraub Z, Bukovsky I. Cervical internal os cerclage: description of a new technique and comparison with Shirodkar operation. Am J Perinatol 1990; 7:347-9. [PMID: 2222626 DOI: 10.1055/s-2007-999520] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Internal os cerclage for cervical incompetence was performed in 90 patients who had previous McDonald procedure failure (70 patients) or had unfavorable cervical anatomy (short or lacerated cervix) for primary McDonald type cerclage (20 patients). Two different techniques were used: the Shirodkar operation (n = 44) with Mersilene band, and a simpler new technique (n = 46). The new technique is characterized by anterior colpotomy for exposure of the internal os, and a 0.6 mm nylon suture encircling the cervix to be tied high in the posterior fornix. The pregnancy outcome for both groups was similar. Late abortions of 8.7 and 11% and premature deliveries of 13 and 18% occurred in the new technique and the Shirodkar groups, respectively. The removal of the suture was generally difficult in the Shirodkar group and in eight patients analgesia and sedation were required. In the new technique group, the removal was easier and in only one patient was sedation required (p less than 0.0001). Severe vaginal discharge was found in 52% of the Shirodkar patients and none in the other group. Apparently the monofilament nylon suture prevented this side effect. It seems that the new technique is simpler to perform, involves fewer side effects, the removal of the suture is easier, and it is as effective as the Shirodkar procedure.
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Affiliation(s)
- E Caspi
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, University of Tel-Aviv, Sackler School of Medicine, Zerifin, Israel
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Mor Z, Schreyer P, Wainraub Z, Hayman E, Caspi E. Nonimmune hydrops fetalis associated with angioosteohypertrophy (Klippel-Trenaunay) syndrome. Am J Obstet Gynecol 1988; 159:1185-6. [PMID: 2847530 DOI: 10.1016/0002-9378(88)90443-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case of nonimmune hydrops fetalis in association with angioosteohypertrophy (Klippel-Trenaunay) syndrome is reported for the first time.
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Affiliation(s)
- Z Mor
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel
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