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1.
N Engl J Med ; 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34614328

RESUMO

BACKGROUND: Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance. METHODS: We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons. RESULTS: Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637. CONCLUSIONS: The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.

2.
EBioMedicine ; 72: 103574, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34537449

RESUMO

BACKGROUND: The rapid vaccination campaign against COVID-19 in Israel relied on the BNT162b2 vaccine. We performed a longitudinal analysis of multiple cohorts, using individual data, to evaluate the effectiveness of the vaccine against new and breakthrough cases. METHODS: We estimated vaccine effectiveness (VE) for 27 consecutive cohorts, each comprised of individuals vaccinated on specific days. VE against new COVID-19 cases was evaluated for five SARS-CoV-2-related outcomes: infection, symptomatic disease, hospitalisation, severe/critical disease and death. For breakthrough cases, rate reduction was evaluated for hospitalisation, severe/critical disease and death. Outcomes were evaluated at predetermined time-periods after vaccination, the last one dedicated to individuals who became SARS-CoV-2-positive 22-28 days after the second dose. FINDINGS: The highest VE estimates against new cases in ≥16 year old individuals, for all outcomes, were reached at the 15-21 day period after the second dose, ranging between 97.7% (95% CI: 95.9-98.7%) for deaths and 98.6% (95% CI: 97.8-99.1%) for severe/critical disease. VE estimates of the 14-20 day period after the first dose ranged between 54.3% (95% CI: 50.6-57.8%) for infection and 77.3% (95% CI: 71.2-82.1%) for severe/critical disease. VE rose more slowly among ≥80 year old individuals. Rate reductions of breakthrough complications were highest at the 22-28 day period after the second dose, ranging between 47.4% (95% CI: 4.3-71.2%) for death and 66.2% (95% CI: 44.2-79.6%) for severe/critical disease. INTERPRETATION: The BNT162 vaccine is highly effective in preventing new SARS-CoV-2 cases. Among ≥80 year old individuals, high effectiveness develops more slowly. In breakthrough cases, vaccination reduces complications and death. FUNDING: None.

3.
Emerg Infect Dis ; 27(11)2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34570694

RESUMO

In Israel, the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 was approved for use in adolescents in June 2021, shortly before an outbreak of B.1.617.2 (Delta) variant-dominant infection. We evaluated short-term vaccine effectiveness and found the vaccine to be highly effective among this population in this setting.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34444117

RESUMO

Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002-2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI -1.97, -1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6-9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.


Assuntos
Comércio , Produtos do Tabaco , Adulto , Estudos Transversais , Humanos , Israel/epidemiologia , Fumar/epidemiologia , Impostos
5.
Eur J Nutr ; 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34406484

RESUMO

PURPOSE: Milk consumption is associated with increased height primarily in early childhood. However, in adolescents, data are scarce with inconsistent results. Since height is a proxy for overall health and well-being, this study evaluated the association of dairy intake with height in adolescents. METHODS: Students in 7th-12th grades, participating in the 2015-2016 Israeli Health and Nutrition Youth Survey, a school-based cross-sectional study, completed self-administered questionnaires, including a semi-quantitative food frequency questionnaire (n = 3529, 48% males, 15.2 ± 1.6 years). Anthropometric measurements were also performed. Dairy servings were calculated as the calcium equivalent of 1 cup of milk, and consumption was divided into four categories from very low (< 1 serving/day) to high (3 + servings/day). BMI- and Height-for-age z scores (HAZs) were calculated according to WHO growth standard; relatively short stature (RSS) was defined as HAZ < - 0.7 SD (< 25th percentile). Multivariable linear and logistic regression analyses were performed to evaluate the association of dairy intake with HAZ and prevalence of RSS, respectively. RESULTS: Median consumption of dairy products was 2 servings/day, 1.4 from unsweetened products (milk, cheese and yogurt). Controlling for age, sex, BMI-z-score and socioeconomic status, each increment of unsweetened dairy intake was associated with on average 0.04 higher HAZ (equivalent to 0.3-0.4 cm, p < 0.05), and with reduced risk for RSS: OR 0.90, 95%CI: 0.84, 0.97, p < 0.01. No such associations were found with sweetened dairy products. CONCLUSION: Consumption of unsweetened dairy products (3-4 servings/day) appears to contribute to achieving growth potential in adolescents. Intervention studies are necessary to determine the causal relationship between dairy intake and linear growth.

6.
J Pediatr ; 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34293373

RESUMO

OBJECTIVES: To evaluate the sex-specific effects of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) on body mass index (BMI) z and height z trajectories. STUDY DESIGN: A retrospective cohort study using the database of Israel Clalit Health Services was performed. Participants included 5- to 18-year-old insured patients with documentation of at least 2 consecutive prescriptions of stimulant drugs for ADHD. Participants were further compared with sex- and age-matched insured control patients without ADHD. RESULTS: A total of 4561 (66% boys) participants with ADHD were included. Of these, 2151 (70% boys) had follow-up data for ≥2 years of treatment. A decline of ≥1 SD in height and BMI z score was observed in 10.1% and 13.2% of the cohort, respectively. During ≥2 years follow-up, boys had a greater decline in height z score (~0.2 SD) than girls (~0.06 SD). Boys' height z score continued to decline after 1 and ≥2 years, and girls' height z score declined after 1 year, and then stabilized. The trajectory of BMI z score of boys and girls was similar, showing a greater decline after 1 year, followed by an incline after ≥2 years. Younger age at stimulants initiation, better adherence, longer treatment duration, and lower socioeconomic status were correlated with a greater impact on growth attenuation. The non-ADHD group (n = 4561, 66% boys) had baseline height z score and BMI z score similar to those in children with ADHD before treatment initiation. Height z score and BMI z score were greater in children without ADHD compared with children with ADHD following 1 year of treatment (P < .001). CONCLUSIONS: These findings highlight the importance of growth monitoring accompanied with dietary counseling in children with ADHD treated with stimulants.

7.
Int J Food Sci Nutr ; : 1-8, 2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34311654

RESUMO

Front-of-package labels (FOPL) are designed to simplify nutrition information and to help consumers make healthier food choices. The Israeli government has implemented new regulations requiring mandatory red warning FOPL for high levels of sodium, sugar, or saturated fats. A voluntary green positive FOPL for products fitting the national nutritional recommendations was concurrently encouraged. In order to characterise adult consumers' current use of Nutrition Facts Tables (NFT) and their attitudes towards the new FOPL, a nationally representative cross-sectional telephone survey was conducted. Most of the 1,042 survey respondents reported frequent NFT use (76.2%) and intentions to purchase fewer red-labelled (81.1%) and more green-labelled products (85.0%). Consumers with higher BMI and lower education expressed higher intentions to use the new FOPL, but not higher current use of NFT. This finding suggests that these high-risk groups, which the new labels are meant to target, may indeed benefit from the new policy.

8.
Isr Med Assoc J ; 23(4): 233-238, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33899356

RESUMO

BACKGROUND: Evaluation of children's anthropometrics poses challenges due to age-related changes. The main focus is on height and weight. However, since weight is height-dependent, body mass index (BMI) is the best surrogate measurement of adiposity. Israel has not developed national growth tables; therefore, researchers and clinicians utilize either World Health Organization (WHO) or U.S. Centers for Disease Control and Prevention (CDC) tables as benchmarks. OBJECTIVES: To evaluate the anthropometrics of Israeli children benchmarked by CDC and WHO tables. METHODS: A retrospective review was conducted of the 1987-2003 birth cohort (age 4-18 years) from Clalit Health Services databases. Anthropometrics were retrieved twice: at study entry and one year later. We evaluated them as separate cohorts. Gender-specific age-matched median height and BMI were compared with CDC and WHO height and BMI tables. RESULTS: he study consisted of 15,650, mean age at study entry 9.5 years (range 4-18). Gender-specific median heights of the Israeli children were similar to CDC and WHO values at younger ages, but were slightly shorter than the age-matched CDC and WHO toward the age of final height in both cohorts. However, gender-specific median BMI was considerably and statistically significant higher compared to CDC and WHO values consistently along the entire age range in both cohorts. CONCLUSIONS: Israeli children were slightly shorter toward the age of final height, compared to WHO and CDC. However, BMI in Israeli children was significantly higher compared to the CDC and WHO consistently along the age range, which raises an alarm regarding obesity patterns.


Assuntos
Antropometria/métodos , Estatura , Índice de Massa Corporal , Obesidade , Pediatria , Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/prevenção & controle , Pediatria/métodos , Pediatria/normas , Padrões de Referência , Fatores Sexuais , Organização Mundial da Saúde
9.
Artigo em Inglês | MEDLINE | ID: mdl-33809746

RESUMO

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19 and is mostly person-to-person transmitted through respiratory droplets. The implications of the strategies implemented to prevent COVID-19 transmission on other infectious diseases are unclear. We aimed to appraise trends in the incidence of salmonellosis, shigellosis and campylobacteriosis in Israel during COVID-19 pandemic. Positive stool samples for Salmonella, Shigella and Campylobacter are reported on a monthly basis to the Israel Center for Disease Control from sentinel laboratories, within the framework of a surveillance network of bacterial culture-proven enteric diseases. Age-adjusted incidence rates per 100,000 of shigellosis, salmonellosis and campylobacteriosis were calculated. Mean rates before and after the local onset of COVID-19 pandemic in Israel were compared and Relative Risk Reduction (RRR) was calculated. Joinpoint was used to evaluate secular trends. The mean age-adjusted incidence rate of shigellosis in March-July 2020 was lower than the rate observed in March-July 2018-2019 (RRR = 86.6%), but also decreased for salmonellosis (RRR = 33.0%) and campylobacteriosis (RRR = 30.0%). Using Joinpoint we have shown that the decrease observed for shigellosis was significantly sharper (Annual Percent Change (APC) = -77.7) between February 2020 and May 2020 than for salmonellosis (APC = -14.0) between July 2019 and April 2020 and for campylobacteriosis (APC = -1.1) between January 2018 and July 2020. The preventive measures applied to reduce transmission of COVID-19, including social distancing and hand washing, were ecologically associated with a decreased risk of bacterial enteric diseases in Israel. The association was strongest for shigellosis, a disease that is mostly person-to-person transmitted, as compared to salmonellosis and campylobacteriosis which are mostly foodborne transmitted.


Assuntos
COVID-19 , Disenteria Bacilar , Disenteria Bacilar/epidemiologia , Humanos , Incidência , Israel/epidemiologia , Pandemias , SARS-CoV-2
10.
J Nutr ; 151(5): 1249-1255, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33693862

RESUMO

BACKGROUND: Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. OBJECTIVE: We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. METHODS: This population-based cross-sectional study employed the 2014-2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (<27 kg for men and <16 kg for women). RESULTS: HGS measurements were completed by 704 participants. Following adjustment for several factors, higher prevalence of low HGS was significantly associated with age (OR: 1.14; 95% CI: 1.11, 1.18), whereas decreased prevalence was associated with higher levels of education (OR: 0.55; 95% CI: 0.32, 0.94) and meeting physical activity recommendations (OR: 0.53; 95% CI: 0.31, 0.88); P < 0.05 for all. Incremental increases of 100 kcal/d in energy intake and of 1 cm in midarm circumference were associated with decreased prevalence of low HGS (OR: 0.95; 95% CI: 0.91, 0.99 and OR: 0.91; 95% CI: 0.85, 0.97, respectively; P < 0.01 for both). Associations were not found of low HGS with ethnicity, comorbidity, BMI, smoking, or alcohol consumption or with protein, carbohydrate, or fat intakes. CONCLUSION: Energy intake, physical activity, midarm circumference, and education are associated with HGS in elderly Israeli adults. Further cohort studies are necessary to assess possible causal relations between these factors and HGS. Modifiable factors should be targeted in planning public health strategies for promoting a healthy aging population.


Assuntos
Ingestão de Energia , Força da Mão , Vida Independente , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
11.
Artigo em Inglês | MEDLINE | ID: mdl-33668988

RESUMO

The Israel National Sera Bank (INSB) was established in 1997 in the Israel Center for Disease Control. The purpose of the INSB was to provide policymakers with data on the immunity status of the Israeli population against vaccine-preventable diseases, and on the extent and characteristics of exposure to emerging and re-emerging infectious diseases. The aim of this paper is to describe the methods, representativeness, and challenges in maintaining the INSB. The INSB comprises residual sera collected in six laboratories. By the end of 2019, 138,898 samples had been deposited in the INSB. These include samples from four community laboratories: 30.7% from the National Blood Service, 22.2% from Haifa and the Western Galilee, 21.7% from Soroka, and 0.7% from Jerusalem; and from two medical center laboratories: 18.6% from Schneider and 6.1% from Mayanei Hayeshua. The demographic characteristics of the sample at the end of 2019 closely resembled those of the general population. The main challenges addressed in maintaining the INSB relate to its representativeness, the possibility of repeated donors, costs, stability of antibody levels after long-term storage, ethical aspects, and the data available for each sample. The INSB is a unique, powerful, and necessary tool for assessing population immunity levels, based on serum samples collected over a long period of time.


Assuntos
Laboratórios , Humanos , Israel
12.
J Gen Intern Med ; 36(6): 1525-1532, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33768501

RESUMO

BACKGROUND: Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown. OBJECTIVES: To explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT. DESIGN AND SETTING: A prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model. PARTICIPANTS: Adult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days. MAIN MEASURES: The Nijmegen Continuity Questionnaire was used to assess patients' perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence. KEY RESULTS: Better personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006-0.17). CONCLUSIONS: In a system where the PCP is the case manager, cancer patients' perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.


Assuntos
Oncologia , Médicos de Atenção Primária , Adulto , Continuidade da Assistência ao Paciente , Humanos , Israel , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Neuro Oncol ; 23(8): 1383-1392, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-33631004

RESUMO

BACKGROUND: Gliomas manifest in a variety of histological phenotypes with varying aggressiveness. The etiology of glioma remains largely unknown. Taller stature in adulthood has been linked with glioma risk. The aim of this study was to discern whether this association can be detected in adolescence. METHODS: The cohort included 2 223 168 adolescents between the ages of 16 and 19 years. Anthropometric measurements were collected at baseline. Incident cases of glioma were extracted from the Israel National Cancer Registry over a follow-up period spanning 47 635 745 person-years. Cox proportional hazard models were used to estimate the hazard ratio (HR) for glioma and glioma subtypes according to height, body mass index (BMI), and sex. RESULTS: A total of 1195 patients were diagnosed with glioma during the study period. Mean (SD) age at diagnosis was 38.1 (11.7) years. Taller adolescent height (per 10-cm increase) was positively associated with the risk for glioma of any type (HR: 1.15; P = .002). The association was retained in subgroup analyses for low-grade glioma (HR: 1.17; P = .031), high-grade glioma (HR: 1.15; P = .025), oligodendroglioma (HR: 1.31; P = .015), astrocytoma (HR: 1.12; P = .049), and a category of presumed IDH-mutated glioma (HR: 1.17; P = .013). There was a trend toward a positive association between height and glioblastoma, however this had borderline statistical significance (HR: 1.15; P = .07). After stratification of the cohort by sex, height remained a risk factor for men but not for women. CONCLUSIONS: The previously established association between taller stature in adulthood and glioma risk can be traced back to adolescence. The magnitude of association differs by glioma subtype.


Assuntos
Estatura , Glioma , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Glioma/epidemiologia , Humanos , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
Isr Med Assoc J ; 23(1): 23-27, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443338

RESUMO

BACKGROUND: The Israel National Cancer Registry (INCR) was established in 1960. Reporting has been mandatory since 1982. All neoplasms of uncertain/unknown behavior, in situ and invasive malignancies (excluding basal and squamous cell carcinomas of the skin), and benign neoplasms of the brain and central nervous system (CNS) are reportable. OBJECTIVES: To assess completeness and timeliness of the INCR for cases diagnosed or treated in 2005. METHODS: Abstractors identified cases of in situ and invasive malignancies and tumors of benign and uncertain behavior of the brain and CNS diagnosed or treated in 2005 in the files of medical records departments, pathology and cytology laboratories, and oncology and hematology institutes in 39 Israeli medical facilities. Cases were linked to the INCR database by national identity number. Duplicate cases, and those found to be non-reportable were excluded from analysis. Completeness was calculated as the percent of reportable cases identified by the survey that were present in the registry. Timeliness was calculated as the percent of reportable cases diagnosed in 2005, which were incorporated into the registry prior to 31 December 2007. RESULTS: The INCR's completeness is estimated at 93.7% for all reportable diseases, 96.8% for invasive solid tumors, and 88.0% for hematopoietic tumors. Incident cases for the calendar year 2005 were less likely to be present in the registry database than those diagnosed prior to 2005. CONCLUSIONS: Completeness and timeliness of the INCR are high and meet international guidelines. Fully automated reporting will likely improve the quality and timeliness of INCR data.


Assuntos
Neoplasias , Sistema de Registros , Bases de Dados Factuais , Humanos , Israel/epidemiologia , Notificação de Abuso , Neoplasias/classificação , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Melhoria de Qualidade/organização & administração , Sistema de Registros/normas , Sistema de Registros/estatística & dados numéricos , Inquéritos e Questionários
15.
Pediatr Nephrol ; 36(2): 333-340, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32761484

RESUMO

BACKGROUND: Diabetic kidney disease (DKD) is becoming increasingly common among children. We aimed to estimate the risk of end-stage renal disease (ESKD) and mortality among adolescents with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and normal renal function compared with non-diabetics. We hypothesized that childhood onset T1DM vs. T2DM would be associated with a different risk profile for developing ESKD and its complications. METHODS: A nationwide, population-based, retrospective cohort study, including 1,500,522 adolescents examined for military service between 1967 and 1997, which were classified according to the presence and type of diabetes. Data were linked to the Israeli ESKD registry. Cox proportional-hazards models were used to estimate the hazard ratio (HR) for ESKD. RESULTS: At study enrolment, 1183 adolescents had T1DM and 196 had T2DM. ESKD developed in 2386 non-diabetic individuals (0.2%) compared with 72 individuals (6.1%) with T1DM and 8 individuals (4.1%) with T2DM. Participants with T1DM were younger at ESKD onset than participants with T2DM (median age, 36.0 vs. 40.5 years, P < 0.05). In a multivariate model adjusted for age, sex, paternal origin, enrollment year, BMI, and blood pressure, T1DM and T2DM were associated with HR of 36.4 (95% CI 28.3-46.9) and 19.3 (95% CI 9.6-38.8) for ESKD, respectively. Stratification according to sex, ethnicity, immigration, and socioeconomic status did not materially change the HR. During the follow-up period, mortality rates were higher in T2DM as compared with T1DM and controls (8.7 %, 2.2%, and 2.7% respectively). CONCLUSIONS: T1DM and T2DM in adolescents with normal renal function confer a significantly increased risk for ESKD. T1DM is associated with younger age at ESKD onset while T2DM is associated with higher mortality rate.

16.
J Am Soc Nephrol ; 32(2): 495-501, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33184124

RESUMO

BACKGROUND: Increasing cancer incidence among children alongside improved treatments has resulted in a growing number of pediatric cancer survivors. Despite childhood cancer survivors' exposure to various factors that compromise kidney function, few studies have investigated the association between childhood cancer and future kidney disease. METHODS: To assess the risk of ESKD among childhood cancer survivors, we conducted a nationwide, population-based, retrospective cohort study that encompassed all Israeli adolescents evaluated for mandatory military service from 1967 to 1997. After obtaining detailed histories, we divided the cohort into three groups: participants without a history of tumors, those with a history of a benign tumor (nonmalignant tumor with functional impairment), and those with a history of malignancy (excluding kidney cancer). This database was linked to the Israeli ESKD registry to identify incident ESKD cases. We used Cox proportional hazards models to estimate the hazard ratio (HR) of ESKD. RESULTS: Of the 1,468,600 participants in the cohort, 1,444,345 had no history of tumors, 23,282 had a history of a benign tumor, and 973 had a history of malignancy. During a mean follow-up of 30.3 years, 2416 (0.2%) participants without a history of tumors developed ESKD. Although a history of benign tumors was not associated with an increased ESKD risk, participants with a history of malignancy exhibited a substantially elevated risk for ESKD compared with participants lacking a history of tumors, after controlling for age, sex, enrollment period, and paternal origin (adjusted HR, 3.2; 95% confidence interval, 1.3 to 7.7). CONCLUSIONS: Childhood cancer is associated with an increased risk for ESKD, suggesting the need for tighter and longer nephrological follow-up.

17.
J Psychiatr Res ; 134: 1-7, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33360219

RESUMO

BACKGROUND: Holocaust victims experienced extreme physical and mental stress that could lead to prolonged deficits in psychological and physiological well-being. We aimed to examine whether exposure to Holocaust conditions is associated with cognitive function and decline in a sample of old male adults with coronary heart disease (CHD). METHODS: The sample included 346 individuals with CHD who participated in a clinical trial in 1990-1997 (mean age 56.7 ± 6.5 y). During 2004-2008 (mean age 71.8 ± 6.5 y) and 2011-2013 (mean age 77.1 ± 6.4 y) participants underwent computerized cognitive assessments. Exposure to Holocaust conditions was based on self-report at the second assessment. Linear regression and mixed-effect models were conducted to evaluate the associations between Holocaust survivorship and subsequent cognitive performance and rate of cognitive decline. RESULTS: Forty-Three participants (12%) survived concentration camps/ghettos, 69 (20%) were Holocaust survivors who escaped concentration camps/ghettos, and 234 (68%) were not Holocaust survivors. After adjustment for potential confounders, concentration camp/ghetto survivors had poorer global cognitive performance and poorer attention (ß = -3.90; 95%CI: 7.11;-0.68 and ß = -4.11; 95%CI: 7.83;-0.38, respectively) compared to individuals who were not exposed to Holocaust conditions. Additionally, participants who reported being at concentration camps/ghettoes had increased cognitive decline in global performance and executive function (ß = -0.19; 95%CI: 0.37;-0.008 and ß = -0.29; 95%CI: 0.53;-0.06, respectively) compared to participants who were not Holocaust survivors. Lastly, those who were Holocaust survivors but not in concentration camps/ghettos had greater decline in attention (ß = -0.11; 95%CI: 0.21;-0.01). DISCUSSION: Exposure to Holocaust conditions in early-life may be linked with poorer cognitive function and greater cognitive decline decades later in old-adults with CHD.


Assuntos
Campos de Concentração , Doença das Coronárias , Holocausto , Adulto , Idoso , Idoso de 80 Anos ou mais , Cognição , Doença das Coronárias/complicações , Doença das Coronárias/epidemiologia , Humanos , Judeus , Masculino , Pessoa de Meia-Idade
18.
Isr J Health Policy Res ; 9(1): 73, 2020 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-33267873

RESUMO

BACKGROUND: Communication between health authorities and healthcare providers is an essential element of the response to public health emergencies. Although call centers can facilitate such communication, no published reports describing their outcomes exist. In advance of the expected COVID-19 outbreak in Israel, the Israel Center for Disease Control established a call center dedicated to queries from healthcare professionals. METHODS: The call center operated from February 5, 2020 (week 6) to May 14, 2020 (week 20). Data on calls received, including date and time, caller characteristics, questions and responses were recorded in a database designed for this purpose. The volume, sources and content of queries were analyzed. RESULTS: In 15 weeks of operation, the call center responded to 6623 calls. The daily number of calls ranged from 1 to 371 (mean 79.8, median 40), peaking on week 12, 2 weeks prior to a peak in new COVID-19 cases. Callers were predominantly physicians (62.4%), nurses (18.7%) and administrators (4.4%). Most worked in primary care clinics (74.2%) or hospitals (8.7%). Among physicians, 42.3% were family physicians or internists, and 10.0% were pediatricians. The issues most commonly addressed were home quarantine (21.6%), criteria for suspected cases (20.6%), and SARS-CoV2 testing (14.1%). Twenty-five percent of questions involved requests for clarifications of MOH guidelines regarding travel restrictions, clinic management, triage of symptomatic patients, routine medical and dental care, recommended precautions for health care workers with preexisting medical conditions, and other matters. A total of 119 queries were not resolved on the basis of existing guidelines and were referred to MOH headquarters. CONCLUSIONS: This is the first report of a call center established to serve the needs of healthcare providers seeking guidance on COVID-19 management, and to facilitate communication of providers' concerns to the central health authority. Our work indicates that a central call center for healthcare providers can facilitate the development, implementation and amendment of guidelines and should be an integral element of the early response to public health emergencies. Real-time analysis of the call data may reveal important trends requiring prompt attention.


Assuntos
COVID-19 , Call Centers/estatística & dados numéricos , Guias como Assunto , Pessoal de Saúde/estatística & dados numéricos , Política de Saúde , Saúde Pública , Gerenciamento Clínico , Humanos , Quarentena
19.
EClinicalMedicine ; 29: 100651, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33235985

RESUMO

Background: An Israeli national taskforce performed a multi-center clinical and analytical validation of seven serology assays to determine their utility and limitations for SARS-CoV-2 diagnosis. Methods: Serology assays from Roche, Abbott, Diasorin, BioMerieux, Beckman-Coulter, Siemens, and an in-house RBD ELISA were included. Negative samples from 2391 individuals representative of the Israeli population, and 698 SARS-CoV-2 PCR positive patients, collected between March and May 2020, were analyzed. Findings: Immunoassays sensitivities between 81.5%-89.4% and specificities between 97.7%-100% resulted in a profound impact on the expected Positive Predictive Value (PPV) in low (<15%) prevalence scenarios. No meaningful increase was detected in the false positive rate in children compared to adults. A positive correlation between disease severity and antibody titers, and no decrease in antibody titers in the first 8 weeks after PCR positivity was observed. We identified a subgroup of symptomatic SARS-CoV-2 positive patients (~5% of patients), who remained seronegative across a wide range of antigens, isotypes, and technologies. Interpretation: The commercially available automated immunoassays exhibit significant differences in performance and expected PPV in low prevalence scenarios. The low false-positivity rate in under 20's suggests that cross-reactive immunity from previous CoV strains is unlikely to explain the milder disease course in children. Finding no decrease in antibody titers in the first 8 weeks is in contrast to some reports of short half-life for SARS-CoV-2 antibodies. The ~5% who were seronegative non-responders, using multiple assays in a population-wide manner, represents the proportion of patients that may be at risk for re-infection. Funding: Israel Ministry of Health.

20.
Isr Med Assoc J ; 11(22): 681-683, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33249787

RESUMO

BACKGROUND: A thorough informed consent (IC) process is required before in vitro fertilization (IVF) treatments can begin because these treatments are by and large elective and they have expectable and preventable complications, such as ovarian hyper-stimulation syndrome and multi-fetal pregnancies. OBJECTIVES: To empirically examine whether patient knowledge and understanding of potential hazards associated with IVF treatment are better after the IC process compared to before. The authors hypothesized that patients' better understanding of potential complications would be translated and expressed as rational choices of treatment alternatives. METHODS: Responses of 48 IVF patients after IC process (study group) from two IVF units in northern Israel were compared to those of 46 patients before IVF (control group). Only women undergoing IVF for first time who were older than 18 years of age were eligible for the study. RESULTS: Socio-demographic parameters were found to be quite similar between the study group and the control group. Contrary to our expectations, in the study group 12 women (25.5%) considered delivery of a single baby as their optimal result, compared to 15 (32.6%) in the control group. Furthermore, preferences shifted toward triplets: eight patients (17%) after IC considered this option as their best result, compared to only five patients (11%) before IC. CONCLUSIONS: C process goals are not achieved under current practices, at least as far as IVF treatment are concerned. New tools and incentives should be implemented to meet the requirements dictated by the laws regarding patient rights.


Assuntos
Compreensão , Fertilização In Vitro/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Adulto , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Israel , Síndrome de Hiperestimulação Ovariana/etiologia , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
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