RESUMEN
BACKGROUND: Behçet's disease (BD) is a chronic vasculitic multi-systemic disease of unknown etiology. BD is characterized by recurrent attacks of oral aphthae, genital ulcers, and uveitis. BD is a multisystemic disorder and as such it may provoke various psychiatric manifestations, including depression. OBJECTIVES: To evaluate the association between BD and depression, adjusting for established risk factors for depression. METHODS: We executed a cross-sectional study based on the Clalit Health Services database, the largest healthcare organization in Israel, serving over 4.4 million members. For this study 873 BD patients were detected and matched with 4369 controls by age and sex. RESULTS: The rate of depression was higher among the BD patients compared with the control group (9.39% vs 5.49%, respectively, odds ratio [OR] 1.79, 95% confidence interval [95%CI] 1.37-2.31, P < 0.001). An association between BD and depression was also observed on multivariable analysis (OR 1.83, 95%CI 1.39-2.39, P < 0.001). When stratifying the data, according to established risk factors, the association between BD and depression was prominent in the youngest age group (18-39 years of age), low and high socioeconomical status, and non-smokers. CONCLUSIONS: Establishing the association between BD and depression should influence the attitude and the treatment of BD patients, as this relationship requires a more holistic approach and a multidisciplinary treatment regimen for all patient needs.
Asunto(s)
Síndrome de Behçet , Estomatitis Aftosa , Uveítis , Humanos , Adolescente , Adulto Joven , Adulto , Síndrome de Behçet/complicaciones , Síndrome de Behçet/epidemiología , Estudios Transversales , Depresión/epidemiología , Depresión/etiologíaRESUMEN
BACKGROUND: Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain and tenderness with associated neuropsychological symptoms such as fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and depression. Osteoporosis is defined as a reduction of bone density. Previous studies to determine an association of FMS with osteoporosis showed mixed results, partially due to small sample sizes and lack of statistical power. OBJECTIVES: To evaluate the association of FMS with osteoporosis. METHODS: We conducted a case-control study utilizing the database from Israel's largest health maintenance organization. FMS patients were compared to age- and sex-matched controls. Data were analyzed using chi-square and t-tests. Multivariable logistic regression models assessed the association between osteoporosis and FMS. Spearman's rho test was used for correlation. RESULTS: We utilized data from 14,296 FMS patients and 71,324 age- and sex-matched controls. Spearman's rho test showed a significant correlation between FMS and osteoporosis (correlation coefficient 0.55, P < 0.001). A logistic regression for osteoporosis showed an odds ratio [OR] of 1.94 (95% confidence interval [95%CI] 1.83-2.06, P < 0.001) for FMS compared to controls and found higher body mass index to be slight protective (OR 0.926, 95%CI 0.92-0.93, P < 0.001). CONCLUSIONS: There is a significant correlation between FMS and osteoporosis. Early detection of predisposing factors for osteoporosis in FMS patients and implementation of suitable treatments and prevention measures (such as dietary supplements, resistance or weight bearing exercise, and bone-mineral enhancing pharmacological therapy) may reduce both occurrence rate and severity of osteoporosis and its complications, such as fractures.
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Fibromialgia , Osteoporosis , Humanos , Fibromialgia/complicaciones , Fibromialgia/diagnóstico , Fibromialgia/epidemiología , Estudios de Casos y Controles , Osteoporosis/etiología , Osteoporosis/complicaciones , Densidad Ósea , Fatiga/diagnósticoRESUMEN
The risk of coronavirus disease (COVID-19) infection and its complications among patients with atopic dermatitis (AD) treated by dupilumab is yet to be determined. We aimed to assess the risk of SARS-CoV-2 infection, COVID-19-associated hospitalization, and mortality among patients with AD treated by dupilumab. A population-based cohort study was conducted to compare AD patients treated by dupilumab (n = 238) with those treated by prolonged systemic corticosteroids (≥ 3 months; n = 1,023), phototherapy (n = 461), and azathioprine or mycophenolate mofetil (MMF; n = 194) regarding the incidence of COVID-19 and its complications. The incidence rate of COVID-19, COVID-19-associated hospitalization, and mortality among patients treated by dupilumab was 70.1 (95% CI, 40.5-116.4), 5.0 (95% CI, 0.3-24.7), and 0.0 per 1,000 person-year, respectively. The use of dupilumab was not associated with an increased risk of SARS-CoV-2 infection [adjusted HR for dupilumab vs. prolonged systemic corticosteroids: 1.13 (95% CI, 0.61-2.09); dupilumab vs. phototherapy: 0.80 (95% CI, 0.42-1.53); dupilumab vs. azathioprine/MMF: 1.10 (95% CI, 0.45-2.65)]. Dupilumab was associated with a comparable risk of COVID-19-associated hospitalization [adjusted HR for dupilumab vs. prolonged systemic corticosteroids: 0.35 (95% CI, 0.05-2.71); dupilumab vs. phototherapy: 0.43 (95% CI, 0.05-3.98); dupilumab vs. azathioprine/MMF: 0.25 (95% CI, 0.02-2.74)]. When applicable, the risk of mortality was not elevated in patients with AD treated by dupilumab [HR for dupilumab vs. prolonged systemic corticosteroids: 0.04 (95% CI, 0.00-225.20)]. To conclude, dupilumab does not impose an increased risk of SARS-CoV-2 infection or COVID-19 complications in patients with AD. Dupilumab should be continued and considered as a safe drug for moderate-to-severe AD during the pandemic.
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Anticuerpos Monoclonales Humanizados/administración & dosificación , COVID-19/mortalidad , Dermatitis Atópica , Hospitalización , SARS-CoV-2 , Adulto , Anciano , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Tratamiento Farmacológico de COVID-19RESUMEN
In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002-2007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03-1.58]). In AS patients, insufficient levels of vitamin D (< 30 ng/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02-2.50]). This association was more prominent with the decrease in vitamin D levels (< 20 ng/mL, HR 1.63 [95% CI 1.03-2.60]; <10 ng/mL, HR 1.79 [95% CI 1.01-3.20]) and among male patients (< 30 ng/mL, HR 2.11 [95% CI 1.20-3.72]; <20 ng/mL, HR 2.12 [95% CI 1.19-3.80]; <10 ng/mL, HR 2.23 [95% CI 1.12-4.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.
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Espondilitis Anquilosante/mortalidad , Deficiencia de Vitamina D/mortalidad , Vitamina D/análogos & derivados , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Israel/epidemiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Espondilitis Anquilosante/sangre , Espondilitis Anquilosante/complicaciones , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicacionesRESUMEN
Purpose: To describe the risk of herpes zoster (HZ) in patients with psoriasis and its relation to non-biologic systemic therapies or biologic treatment. Materials and methods: Psoriasis Longitudinal Assessment and Registry (PSOLAR) is an international, prospective, registry that follows adult patients with psoriasis eligible to receive non-biologic systemic therapies or biologic therapies. Mutually exclusive therapy cohorts were defined. HZ incident rates were calculated for each therapy cohort and rates between cohorts were compared using hazard ratios (HR) adjusted for potential confounders, in new users and prevalent-exposure patients. Results: A total of 55 HZ events were identified in 10,469 patients in PSOLAR. The adjusted hazard ratio in the overall study population (new user and prevalent-exposed patients) was 2.22 (95% CI: 0.82-5.97; p = .116) for tumor necrosis factor-α (TNF) inhibitors, 2.73 (0.98-7.58; p = .054) for ustekinumab, and 1.04 (0.20-5.41; p = .966) for methotrexate versus reference (combined phototherapy, systemic steroids, topical therapy, and immunomodulators other than methotrexate). Conclusions: Exposure to ustekinumab, TNF-α inhibitors, and methotrexate was not associated with a statistically significant increased risk of HZ. However, HRs were elevated for ustekinumab and TNF-α inhibitors; a larger number of HZ events would be needed to assess the presence or absence of risk.
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Factores Biológicos/uso terapéutico , Herpes Zóster/diagnóstico , Psoriasis/tratamiento farmacológico , Adulto , Anciano , Femenino , Herpes Zóster/epidemiología , Humanos , Factores Inmunológicos/uso terapéutico , Infliximab/uso terapéutico , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Fototerapia , Prevalencia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Psoriasis/patología , Sistema de Registros , Factores de Riesgo , Ustekinumab/uso terapéuticoRESUMEN
BACKGROUND: Updated data regarding the epidemiology of psoriasis and related healthcare utilization are lacking. OBJECTIVE: To investigate the epidemiology, comorbidities, healthcare services utilization, and drug use in a large group of patients with psoriasis from Clalit Health Services (CHS) database. METHODS: A controlled cross-sectional study was performed. Case patients were defined when there was at least one documented diagnosis of psoriasis registered by a CHS dermatologist between the years 1998-2016. The extracted data included metabolic, cardiovascular and psychiatric comorbidities; community clinic visits; in- and outpatient services utilization profiles and drug use data, which included pharmacy claims of topical and systemic treatments, including phototherapy and climatotherapy. Comparative analysis was performed by a univariate and multivariate analysis, adjusting for age, gender, obesity, and smoking. RESULTS: The study included 118,680 patients with psoriasis (prevalence of 2.69%) and 118,680 age- and gender-matched controls. Patients with psoriasis had increased prevalence of metabolic, cardiovascular, and psychiatric illnesses. Psoriasis was significantly associated with an increased healthcare utilization. The mean (SD) number of annual dermatologist clinic visits and emergency room visits was 7.2 ± 12.4 and 2.9 ± 7.7 in psoriasis patients as compared to 2.9 ± 7.9 and 2.7 ± 7.4 in the control group (P < 0.001). Topical steroids were the most applied treatment in psoriasis patients (15.5%), and topical vitamin D analogs were second in use (14.6%). Traditional systemic treatment for psoriasis was used in 3.8% of the patients, and biologic treatments were used in 1.6% of the patients. CONCLUSIONS: Our study quantifies healthcare services utilization and drug use in patients with psoriasis.
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Enfermedades Cardiovasculares/epidemiología , Dermatología/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/epidemiología , Enfermedades Metabólicas/epidemiología , Psoriasis/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Psoriasis/terapiaRESUMEN
OBJECTIVES: Several reports have indicated an association between systemic lupus erythematosus (SLE) and low levels of vitamin D. We examined several blood work parameters in SLE patients and controls and performed an extensive data analysis in order to investigate the links between blood levels of calcium, vitamin D, and SLE disease. METHODS: 4,278 SLE patients and 16,443 age and sex-matched controls were selected from a national health insurer database in Israel. Patients with no blood work results or having renal disease were excluded. Retrospective data from five consecutive years of routine blood work results were then analysed for mean serum calcium, albumin, albumin-corrected calcium, vitamin D levels, and the presence of a hypocalcaemic episode (Corrected Ca <8.5 mg/dL). RESULTS: The mean levels of corrected serum calcium levels were slightly higher among SLE patients than controls (9.23±0.34 vs. 9.19±0.36 mg/dL p≤.001 respectively). In contrast to results of published studies, SLE patients had slightly higher levels of 25(OH)-vitamin D (SLE patients: 22.2±9.06 ng/ml, controls: 20.0±8.76 ng/ml, p≤.001). The most impressive finding entailing SLE patients was that they were twice as likely to experience episodes of hypocalcaemia in comparison to controls (SLE patients: 13.8%, controls: 6.4%, OR 2.34; 95% CI 2.33-2.83). CONCLUSIONS: Calcium levels may play a significant role in the SLE disease process, more than originally thought, since SLE patients are at a higher risk for hypocalcaemic events. Specific changes in vitamin D and calcium homeostasis in SLE patients may be responsible for the severity of symptoms. Further research is required to determine the role of calcium supplementation.
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Calcio/sangre , Lupus Eritematoso Sistémico/sangre , Vitamina D/sangre , Adulto , Anciano , Femenino , Humanos , Hipocalcemia/sangre , Hipocalcemia/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Albúmina Sérica/análisisRESUMEN
Drug survival has recently become an important clinical issue in psoriasis. However, there has been little research into factors associated with drug survival of methotrexate and acitretin. The aim of this study was to investigate factors associated with drug survival of methotrexate and acitretin treatment for psoriasis. Survival analysis was performed in patients who received methotrexate or acitretin for the treatment of psoriasis, drawn from the Clalit Health Services database. Investigated factors included demographic variables, obesity, metabolic syndrome, psoriatic arthritis, administration route and folic acid supplementation. Among 6,256 patients, factors associated with treatment drop-out were: younger age (p <0.001) and psoriatic arthritis (acitretin p < 0.001). For methotrexate, metabolic syndrome (p = 0.033), intramuscular administration route of injection (p <0.001) and lack of folic acid supplementation (p <0.001) were associated with treatment drop-out. In patients with psoriasis, some ancillary factors may modify the drug survival of acitretin and methotrexate.
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Acitretina/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Queratolíticos/uso terapéutico , Metotrexato/uso terapéutico , Psoriasis/tratamiento farmacológico , Acitretina/administración & dosificación , Administración Oral , Adulto , Factores de Edad , Anciano , Artritis Psoriásica/complicaciones , Bases de Datos Factuales , Fármacos Dermatológicos/efectos adversos , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Ácido Fólico/uso terapéutico , Humanos , Israel , Estimación de Kaplan-Meier , Queratolíticos/administración & dosificación , Masculino , Cumplimiento de la Medicación , Síndrome Metabólico/complicaciones , Metotrexato/administración & dosificación , Persona de Mediana Edad , Psoriasis/complicacionesRESUMEN
IMPORTANCE: The risk for herpes zoster (HZ) in patients with psoriasis treated with biologic medications or other systemic treatments has been given little attention to date. OBJECTIVE: To describe the risk for HZ in patients with psoriasis and its relation to treatment. DESIGN, SETTING, AND PARTICIPANTS: A cohort study was performed using the administrative database of Clalit Health Services, the largest public health care provider organization in Israel, in the setting of general community clinics, primary care and referral centers, and ambulatory and hospitalized care. We extracted information for all patients who received a psoriasis diagnosis from January 2002 to June 2013. Follow-up was conducted until the end of July 2013. The study included 95,941 patients with psoriasis in the analysis, with 522,616 person-years of follow-up. Incidence of HZ events was calculated for each systemic antipsoriatic medication provided, during a follow-up period of 11 years and 7 months. We used a generalized estimating equation Poisson regression model to examine the effect of each systemic treatment for psoriasis on HZ incidence, adjusting for age, sex, psoriasis severity, Charlson comorbidity index, steroid treatment, and socioeconomic status. MAIN OUTCOMES AND MEASURES: Incidence of HZ associated with systemic therapies. RESULTS: In a multivariate analysis, it was observed that treatment with phototherapy (rate ratio [RR], 1.09 [95% CI, 0.62-1.93]; P = .99), methotrexate (RR, 0.98 [95% CI, 0.78-1.23]; P = .83), cyclosporine (RR, 1.16 [95% CI, 0.48-2.80]; P = .49), and biologic medications as a single agent (RR, 2.67 [95% CI, 0.69-10.3]; P = .14) was not associated with HZ. The use of combination treatment with biologic medications and methotrexate was significantly associated with an increased incidence of HZ (RR, 1.66 [95% CI, 1.08-2.57]; P = .02). The use of acitritin was associated with decreased incidence of HZ (RR, 0.69 [95% CI, 0.49-0.97]; P = .004). CONCLUSIONS AND RELEVANCE: Physicians may need to consider offering an HZ preventive vaccine to patients receiving combination treatment with biologic medications and methotrexate, particularly if they have additional risk factors for HZ.
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Herpes Zóster/epidemiología , Psoriasis/tratamiento farmacológico , Psoriasis/epidemiología , Corticoesteroides/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Factores Biológicos/administración & dosificación , Factores Biológicos/efectos adversos , Causalidad , Estudios de Cohortes , Comorbilidad , Ciclosporina/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Quimioterapia Combinada/efectos adversos , Femenino , Estudios de Seguimiento , Herpes Zóster/prevención & control , Vacuna contra el Herpes Zóster/administración & dosificación , Humanos , Incidencia , Isoxazoles/administración & dosificación , Isoxazoles/efectos adversos , Masculino , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Análisis Multivariante , Fototerapia , Factores de Riesgo , Distribución por Sexo , UstekinumabRESUMEN
AIM: To combine community and hospital services in order to enable improvements in patient management, an integrated gastroenterology service (IGS) was established. METHODS: Referral patterns to specialist clinics were optimized; open access route for endoscopic procedures (including esophago-gastro-duodenoscopy, sigmoidoscopy and colonoscopy) was established; family physicians' knowledge and confidence were enhanced; direct communication lines between experts and primary care physicians were opened. Continuing education, guidelines and agreed instructions for referral were promoted by the IGS. Six quality indicators were developed by the Delphi method, rigorously designed and regularly monitored. Improvement was assessed by comparing 2010, 2011 and 2012 indicators. RESULTS: An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination. In this paper we describe a new integrated gastroenterology service established in April 2010. Waiting time for procedures decreased: 3 mo in April 30th 2010 to 3 wk in April 30th 2011 and stayed between 1-3 wk till December 30th 2012. Average cost for patient's visit decreased from 691 to 638 NIS (a decrease of 7.6%). Six health indicators were improved significantly comparing 2010 to 2012, 2.5% to 67.5%: Bone densitometry for patients with inflammatory bowel disease, preventive medications for high risk patients on aspirin/NSAIDs, colonoscopy following positive fecal occult blood test, gastroscopy in Barrett's esophagus, documentation of family history of colorectal cancer, and colonoscopy in patients with a family history of colorectal cancer. CONCLUSION: Establishment of an IGS was found to effectively improve quality of care, while being cost-effective.
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Centros Médicos Académicos/organización & administración , Servicios de Salud Comunitaria/organización & administración , Relaciones Comunidad-Institución , Prestación Integrada de Atención de Salud/organización & administración , Gastroenterología/organización & administración , Atención Primaria de Salud/organización & administración , Centros Médicos Académicos/economía , Centros Médicos Académicos/normas , Comunicación , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/normas , Relaciones Comunidad-Institución/economía , Relaciones Comunidad-Institución/normas , Conducta Cooperativa , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/normas , Técnica Delphi , Gastroenterología/economía , Gastroenterología/normas , Adhesión a Directriz , Costos de la Atención en Salud , Humanos , Comunicación Interdisciplinaria , Modelos Organizacionales , Médicos de Atención Primaria/organización & administración , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/organización & administración , Atención Primaria de Salud/economía , Atención Primaria de Salud/normas , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud/organización & administración , Derivación y Consulta/organización & administración , Factores de TiempoRESUMEN
BACKGROUND: In 2005, an innovative system of hospital-community on-line medical records ("OFEK") was established at Clalit Health Services to reduce costs and improve medical care. GOALS: To examine the utilization of OFEK and its impact on quality indicators and medical-service utilization. METHOD: Examining frequency of use of OFEK with OFEK's own track-log data; "before" and "after" data were used to compare changes in quality indicators and service utilization for experimental versus control groups. RESULTS: Use of OFEK in primary-care clinics increased by hundreds of percent from 2005 to 2006 and continued rising in 2007 and 2008, albeit more slowly. At clinics in hospital catchment areas using OFEK extensively, the system reduced utilization of imaging services and, to a lesser extent laboratory use, and improved several quality measures. Analyses of the data from all catchment areas and from all study clinics revealed much weaker effects. In hospitals, the use of OFEK increased by tens of percent each year internal medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in surgical wards. CONCLUSIONS: The introduction of OFEK affected some of the outcome measures examined. OFEK affects community clinics and hospital wards differently, with more consistent effects in the community. DISCUSSION AND SUMMARY: The study helps assess the extent to which OFEK's targets were achieved. In addition, it contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of electronic-medical-information systems.
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Prestación Integrada de Atención de Salud/organización & administración , Sistemas de Información en Hospital/organización & administración , Atención Primaria de Salud/organización & administración , Prestación Integrada de Atención de Salud/economía , Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/organización & administración , Sistemas de Información en Hospital/economía , Humanos , Israel , Evaluación de Resultado en la Atención de Salud , Atención Primaria de Salud/economía , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de SaludRESUMEN
BACKGROUND: Pre-conceptional folic acid supplementation is an effective way to reduce the incidence of neural tube defects (NTDs). Primary care providers are an important source of information to promote folic acid intake. This study aimed at evaluating primary care physicians' knowledge and attitudes regarding folic acid supplementation for childbearing women. MATERIAL/METHODS: A questionnaire on physicians' knowledge and attitudes, mostly including multiple-choice questions, was delivered by mail to all physicians (n=370) in a large health provider organization in southern Israel in 2006. Data regarding demographics as well as type of specialty, experience, and place of work were collected. RESULTS: Eighty-seven physicians were included in the study (response rate: 24%). Seventy physicians out of 81 (94%) reported routine recommendation of folic acid for their patients. Most physicians admitted that they needed more information regarding folic acid supplementation. Knowledge about folic acid's role in preventing congenital anomalies was suboptimal, with 2% of the physicians correctly estimating the efficacy of folic acid in decreasing the risk of NTDs and 8% recognizing the association between folic acid supplementation and decreased prevalence of malformations other than NTDs. Knowledge about the correct timing (12%) and dosage (47%) of folic acid preparations for average-risk women was also lacking. CONCLUSIONS: Primary care physicians report that they routinely prescribe folic acid to women in childbearing age in order to prevent congenital anomalies, but their knowledge about folic acid supplementation is insufficient.
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Ácido Fólico/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Médicos de Familia , Adulto , Anomalías Congénitas/prevención & control , Suplementos Dietéticos , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Defectos del Tubo Neural/prevención & control , Atención Preconceptiva , Embarazo , Encuestas y CuestionariosAsunto(s)
Balneología/métodos , Climatoterapia/métodos , Helioterapia/métodos , Psoriasis/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Océanos y Mares , Psoriasis/patología , Índice de Severidad de la Enfermedad , Piel/patología , Resultado del TratamientoRESUMEN
QoolSkin is novel herbal topical medication indicated for the treatment of patients with psoriasis and we endeavored to determine the efficacy of QoolSkin in patients with chronic plaque psoriasis. In an open-label, parallel-group study conducted at four sites in Israel, patients with chronic plaque psoriasis were treated by application of QoolSkin two to three times per day, for a period of 16 weeks. Clinical assessment was performed using the Psoriasis Area and Severity Index (PASI) and the Beer-Sheva Psoriasis Severity Score (BPSS). The study included 100 patients (48 men, 52 women; age 18-65 years). QoolSkin was well tolerated and there were no local or systemic side effects. There was a 19% reduction in PASI, from a mean of 9.8 +/- 9.5 before treatment to 8.0 +/- 9.6 after treatment (p = 0.09). There was a 20% reduction in BPSS, from a mean of 16.1 +/- 9.8 before treatment to 12.8 +/- 10.6 after treatment (p = 0.01). The reduction in PASI and BPSS was pronounced in women (32 and 31%, respectively) as compared to men (9 and 11%, respectively). The reduction in PASI and BPSS was parallel to the length of time the patients were treated by QoolSkin. In patients treated by one of the investigators, who applied QoolSkin three times per day and for a long period of time (mean 101.1 days), the reduction in PASI was 32.0% and the reduction in BPSS was 37.8%. In patients with chronic plaque psoriasis, QoolSkin treatment was well tolerated. Application of QoolSkin was associated with a decrease in disease severity, as assessed by the patients and physicians. Application of QoolSkin three times per day for long period is associated with a better response to treatment.
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Fármacos Dermatológicos/administración & dosificación , Medicamentos Herbarios Chinos/uso terapéutico , Psoriasis/tratamiento farmacológico , Administración Tópica , Adolescente , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Previous reports demonstrated an association between psoriasis and other diseases including heart failure and diabetes mellitus. OBJECTIVES: Our aim was to describe the association between psoriasis, diabetes mellitus, and atherosclerosis in Israel. METHODS: A cross-sectional study was performed utilizing the database of Maccabi Healthcare Services (MHS), a large health provider organization in Israel. Case patients were defined as subjects who were diagnosed with psoriasis. Patients with diabetes and atherosclerosis were identified by using the MHS diabetes and cardiovascular registries, respectively. The control group included MHS enrollees without psoriasis. The proportion of diabetes and atherosclerosis among case and control groups was compared. Chi-square tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. RESULTS: The study included 46,095 patients with psoriasis (case patients) and 1,579,037 subjects without psoriasis (control patients). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared with the control group (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.1-1.48). The age-adjusted proportion of atherosclerosis was significantly higher in psoriasis patients as compared with the control group (OR 1.28, 95% CI 1.04-1.59). In patients with psoriasis, a multivariate logistic regression model demonstrated an association between diabetes and the multiple use of very potent topical steroids (P < .05) or use of systemic medication for psoriasis (methotrexate, cyclosporine or acitretin) (P < .001). A similar model demonstrated an association between atherosclerosis and the use of phototherapy (P < .001). LIMITATIONS: Our study was based on a computerized database. The diagnosis of psoriasis was based on digitally transmitted data. Therefore overestimation (false-positive cases) and underestimation (false-negative cases) of psoriasis patients may exist, thereby being a source for information bias. A second limitation is selection bias that may occur due to the possibility that reporting of both psoriasis and associated illnesses is higher in individuals who are seeking medical care. A third limitation concerns the causal effect between occurrence of psoriasis and atherosclerosis or diabetes. The dataset of MHS records diagnoses only from 1997 and does not record the date of disease onset. CONCLUSIONS: Our study supports previous reports for an association between psoriasis and atherosclerosis and psoriasis and diabetes. Further study is needed to support this observation.
Asunto(s)
Aterosclerosis/epidemiología , Diabetes Mellitus/epidemiología , Psoriasis/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Aterosclerosis/diagnóstico , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Preescolar , Comorbilidad , Intervalos de Confianza , Estudios Transversales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Israel/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Psoriasis/diagnóstico , Valores de Referencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por SexoRESUMEN
BACKGROUND: Climatotherapy at the Dead Sea (CDS) is a therapeutic modality for moderate to severe psoriasis vulgaris. OBJECTIVE: To evaluate the effectiveness of CDS in patients with psoriasis, using the PASI score and a novel simplified tool for the assessment of psoriasis - the Beer Sheva Psoriasis Severity Score (BPSS). METHODS: A total of 70 patients with psoriasis vulgaris were treated by CDS. In all patients, the severity of psoriasis was assessed before and after CDS using PASI score and BPSS. BPSS includes eight items that are recorded by the physician (total severity of the disease, and seven items relating to the physical distribution of the disease) and eight items that are recorded by the patient (total severity, physical and psychological severity, pruritus and assessment of involvement in the face, nails, palms and soles and genital regions). RESULTS: The study included 70 patients (40 men, 30 women; age 19-78 years). There was a 75.9% reduction in PASI score, from a mean of 16.6+/-11.0 before treatment to 4.0+/-4.2 after treatment (p<0.001). There was a 57.5% reduction in BPSS, from a mean of 72.8+/-19.6 before treatment to 31.0+/-21.2 after treatment (p<0.001). PASI score significantly correlated with BPSS before CDS treatment (r = 0.59, p<0.001) and after CDS treatment (r = 0.53, p<0.001). CONCLUSION: CDS is an effective therapy for patients with psoriasis, as evaluated by either PASI score or BPSS. BPSS was considered shorter and more user-friendly by the participating physicians.