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Half EE, Levi Z, Mannalithara A, Leshno M, Ben-Aharon I, Abu-Freha N, Silverman B, Ladabaum U. Colorectal cancer screening at age 45 years in Israel: Cost-effectiveness and global implications. Cancer 2024; 130:901-912. [PMID: 38180788 DOI: 10.1002/cncr.35097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence at ages <50 years is increasing worldwide. Screening initiation was lowered to 45 years in the United States. The cost-effectiveness of initiating CRC screening at 45 years in Israel was assessed with the aim of informing national policy and addressing internationally relevant questions. METHODS A validated CRC screening model was calibrated to Israeli data and examined annual fecal immunochemical testing (FIT) or colonoscopy every 10 years from 45 to 74 years (FIT45-74 or Colo45-74) versus from 50 to 74 years (FIT50-74 or Colo50-74). The addition of a fourth colonoscopy at 75 years was explored, subanalyses were performed by sex/ethnicity, and resource demands were estimated. RESULTS FIT50-74 and Colo50-74 reduced CRC incidence by 57% and 70% and mortality by 70% and 77%, respectively, versus no screening, with greater absolute impact in Jews/Other versus Arabs but comparable relative impact. FIT45-74 further reduced CRC incidence and mortality by an absolute 3% and 2%, respectively. With Colo45-74 versus Colo50-74, CRC cases and deaths increased slightly as three colonoscopies per lifetime shifted to 5 years earlier but mean quality-adjusted life-years gained (QALYGs) per person increased. FIT45-74 and Colo45-74 cost 23,800-53,900 new Israeli shekels (NIS)/QALYG and 110,600-162,700 NIS/QALYG, with the lowest and highest values among Jewish/Other men and Arab women, respectively. A fourth lifetime colonoscopy cost 48,700 NIS/QALYG. Lowering FIT initiation to 45 years with modest participation required 19,300 additional colonoscopies in the first 3 years. CONCLUSIONS Beginning CRC screening at 45 years in Israel is projected to yield modest clinical benefits at acceptable costs per QALYG. Despite different estimates by sex/ethnicity, a uniform national policy is favored. These findings can inform Israeli guidelines and serve as a case study internationally.
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Affiliation(s)
- Elizabeth E Half
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zohar Levi
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Moshe Leshno
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Irit Ben-Aharon
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Naim Abu-Freha
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Barbara Silverman
- Israel National Cancer Registry, Ministry of Health, Ramat Gan, Israel
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California, USA
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Affiliation(s)
- D Leslie
- Harefield Hospital, Harefield, UK
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3
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Atia O, Harel S, Ledderman N, Greenfeld S, Kariv R, Dotan I, Balicer R, Silverman B, Matz E, Levi Z, Waterman M, Fried I, Rowe JM, Turner D. Risk of Cancer in Paediatric onset Inflammatory Bowel Diseases: A Nation-wide Study From the epi-IIRN. J Crohns Colitis 2022; 16:786-795. [PMID: 34791097 DOI: 10.1093/ecco-jcc/jjab205] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/05/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Paediatric onset IBD [PIBD] is characterised by a more extensive phenotype than adult-onset IBD and a higher utilisation of immunosuppressive medications; both may be associated with malignancy. We aimed to assess the risk of cancer in a nationwide cohort of PIBD and to explore the risks associated with medical treatments. METHODS PIBD patients [<18 years old] were included from the epi-IIRN cohort, covering 98% of the Israeli population from 2005, linked to the national cancer registry. We matched PIBD children to non-IBD children for calculating the cumulative incidence of cancer. RESULTS In all, 3944 PIBD cases were included (2642 [67%] Crohn's disease, 1302 [33%] ulcerative colitis) translating into 23 635 person-years of follow-up, individually matched to 13 005 non-IBD children. By 30 years of age, 14 IBD patients [0.35%, 5.9/10 000 patient-years] were diagnosed with cancer and one [0.03%] with haemophagocytic-lymphohistiocytosis [HLH], compared with 14 [0.11%, 1.9/10 000 patient-years] cases of cancer {relative risk (RR) 2.5 (95% confidence interval [CI] 1.05-6.2); p = 0.04} and no HLH in the comparison-group. There were no cases of hepatosplenic T cell lymphoma, adenocarcinoma, or cholangiocarcinoma. Cancer risk was 15.6 cases/10 000 person-years in those treated with thiopurines alone (RR compared with IBD patients never exposed to either thiopurines or anti-tumuor necrosis factor [TNF] 1.8 [95% CI 0.6-6.1]; p = 0.2), 11.1/10 000 in those treated with anti-TNF alone (RR 1.3 [95% CI 0.3-6.6]; p = 0.5), and 23.1/10 000 treated with combination therapy of anti-TNF and thiopurines (RR 2.8 [95% CI 0.6-13.8]; p = 0.2). CONCLUSIONS PIBD confers an increased risk for malignancy compared with non-IBD in children. However, the absolute risk is very low and no differences in risk with specific therapies were apparent in our data.
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Affiliation(s)
- Ohad Atia
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sasha Harel
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Natan Ledderman
- Meuhedet Health Services, Research Institute, Tel Aviv, Israel
| | - Shira Greenfeld
- Maccabi Health Services, Research institute, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Kariv
- Maccabi Health Services, Research institute, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | | | - Eran Matz
- Leumit Health Services, Research institute, Tel Aviv, Israel
| | - Zohar Levi
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matti Waterman
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Iris Fried
- Pediatric Hematology Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel, and the Technion, Israel Institute of Technology, Haifa, Israel
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Krashin E, Silverman B, Steinberg DM, Yekutieli D, Giveon S, Fabian O, Hercbergs A, Davis PJ, Ellis M, Ashur-Fabian O. Pre-diagnosis thyroid hormone dysfunction is associated with cancer mortality. Endocr Relat Cancer 2021; 28:705-713. [PMID: 34432646 DOI: 10.1530/erc-21-0187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/25/2021] [Indexed: 11/08/2022]
Abstract
Research on the association between thyroid hormone levels and cancer mortality remains limited and inconclusive. We determined the relation of thyroid stimulating hormone (TSH), free T4 (FT4), and free T3 (FT3) levels with mortality in overall cancer and specific tumor types. Thyroid hormone levels 1-5 years prior to cancer diagnosis, as well as multiple clinical and demographic parameters, were retrospectively collected for 10,325 Israeli cancer patients, diagnosed between 2000 and 2016. Patients treated with thyroid altering medications were excluded. Cancer diagnosis was determined via the Israel National Cancer Registry. Multivariate-adjusted Cox proportional hazards model was used to assess the hazard ratios (HRs) based on thyroid hormone function for cancer mortality. A total of 5265 patients died during the follow-up period (median of 4.4 years). TSH, FT4, and FT3 levels in the hypothyroid range were associated with increase in overall mortality (adjusted HR 1.20, 1.74, 1.87, respectively). We further analyzed the association between TSH and mortality in 14 cancer subgroups. Specifically, TSH in both the hyperthyroid and hypothyroid range was associated with melanoma mortality (adjusted HR 2.20, 4.47, respectively). In conclusion, pre-diagnosis of thyroid dysfunction is associated with increased cancer mortality, a relation likely driven by specific cancer types. These findings suggest that thyroid hormones may potentially serve as prognostic markers in cancer.
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Affiliation(s)
- Eilon Krashin
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barbara Silverman
- Israel National Cancer Registry, Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David M Steinberg
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Yekutieli
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | | | - Offer Fabian
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
| | - Aleck Hercbergs
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul J Davis
- Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Martin Ellis
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Ashur-Fabian
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Krashin E, Silverman B, Steinberg DM, Yekutieli D, Giveon S, Fabian O, Hercbergs A, Davis PJ, Ellis M, Ashur-Fabian O. Opposing effects of thyroid hormones on cancer risk: a population-based study. Eur J Endocrinol 2021; 184:477-486. [PMID: 33444229 DOI: 10.1530/eje-20-1123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/12/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The association between dysregulated thyroid hormone function and cancer risk is inconclusive, especially among different age groups and uncommon malignancies. We sought to determine the relation of TSH and free T4 levels with overall cancer risk as well as risk of specific cancer types. DESIGN AND METHODS Data on thyroid hormone profile was collected from 375 635 Israeli patients with no prior history of cancer. Cancer cases were identified via the Israel National Cancer Registry. Cox proportional hazards model was used to assess hazard ratios for overall cancer as well as 20 cancer subgroups. RESULTS In this study, 23 808 cases of cancer were detected over median follow up of 10.9 years. Among patients younger than 50 at inclusion, TSH in the hyperthyroid range, elevated free T4 and subclinical hyperthyroidism were associated with increased cancer risk (HR: 1.3, 1.28 and 1.31, respectively). In contrast, patients 50 or older with clinical hyperthyroidism were at lower cancer risk (HR: 0.64). Elevated TSH was associated with decreased risk of prostate cancer (HR: 0.67). Log-TSH elevation was associated with decreased risk of thyroid cancer (HR: 0.82) and increased risk of melanoma (HR: 1.11) and uterine cancer (HR: 1.27). Elevated free T4 was associated with increased lung cancer risk (HR: 1.54), while free T4 levels above the normal range and clinical hyperthyroidism were related to lower colorectal cancer risk (HR: 0.59 and 0.08, respectively). CONCLUSIONS Thyroid hormones display opposing effects on cancer risk, based on patient age and cancer type.
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Affiliation(s)
- Eilon Krashin
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barbara Silverman
- Israel National Cancer Registry, Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, Sackler School of Medicine
| | - David M Steinberg
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Yekutieli
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | | | - Offer Fabian
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
| | - Aleck Hercbergs
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul J Davis
- Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Martin Ellis
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Ashur-Fabian
- Translational Oncology Laboratory, Meir Medical Center, Kfar-Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bar J, Perelman M, Urban D, Gottfried M, Moskovitz M, Nechushtan H, Dudnik J, Zer A, Dudnik E, Merimsky O, Onn A, Silverman B. Rising Incidence of Lung Cancer in Arab Females, Jewish Females, and Arab Males from 1990 to 2014 in Israel. Isr Med Assoc J 2020; 22:788-793. [PMID: 33381954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer-related death. OBJECTIVES To identify changing patterns of lung cancer and its histologic subtypes among different population groups in Israel over a 25 year period. METHODS Primary lung cancers, all types and all stages, diagnosed during 1990-2014 were recorded in the Israel National Cancer Registry database. Demographic information was retrieved from the National Population Register. Age-standardized rates for the different subgroups were calculated for each year. Joinpoint software was used to analyze trends in incidence. RESULTS We identified 42,672 lung cancer cases. The most common histology was adenocarcinoma (34%), followed by squamous cell carcinoma (19%), large cell/not-otherwise-specified (19%), other histologies (15%), and small cell lung cancer (11%). The adenocarcinoma incidence rose from 25.7% to 48.2% during the examined period. Large cell/not-otherwise-specified incidence peaked around 2005-2006 and declined after. Lung cancer incidence increased significantly for the population overall and specifically in Arab females, followed by Jewish females and by Arab males. Adenocarcinoma and small cell lung cancer increased in Jewish females and in Arab males. A younger age of diagnosis was seen in Arab compared to Jewish patients. CONCLUSIONS Jewish females and Arab males and females living in Israel demonstrated a constant increase in lung cancer incidence, mostly in adenocarcinoma and small cell lung cancer incidence. In addition, a younger age of diagnosis in Arabs was noted. Smoking reduction interventions and screening should be implemented in those populations.
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Affiliation(s)
- Jair Bar
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Perelman
- Department of Pathology, Sheba Medical Center, Tel Hashomer, Israel
| | - Damien Urban
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Maya Gottfried
- Department of Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Mor Moskovitz
- Thoracic Oncology Service of the Institute of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Hovav Nechushtan
- Department of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Julia Dudnik
- Department of Oncology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alona Zer
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Dudnik
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Merimsky
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Onn
- Pulmonology Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Barbara Silverman
- Israel National Cancer Registry, Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Neeman Y, Perry C, Silverman B, Waintraub N, Avivi I. Rituximab is not associated with increased risk of second primary malignancies in Israeli patients with diffuse large B cell lymphoma treated with RCHOP regimen. Leuk Lymphoma 2020; 61:2638-2644. [PMID: 32611210 DOI: 10.1080/10428194.2020.1779257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It is unknown whether rituximab increases the risk of second primary malignancies (SPMs) in patients with diffuse large cell B-cell lymphoma (DLBCL). We assessed SPMs in DLBCL patients diagnosed between 1996 and 2014 in comparison with the general Israeli population and dependent on rituximab treatment. Jewish patients had no increased risk for SPMs. Arab-DLBCL females had a higher SPMs rate compared to the general Arab-females population [SIR (95%CI) 1.86 (1.08-2.98)]. Incidence and time to SPMs, in both Jewish and Arab patients, were unaffected by rituximab. Risk for breast and thyroid cancers, in Arab and Jewish females respectively, were higher in the pre-rituximab era [SIR(95%CI) 5.25 (1.41-13.43) and SIR(95%CI) 3.85 (1.41-8.38), respectively]. Age ≥60 years was the only predictor for increased risk of SPM (HR = 2.5, p < .01). The increased risk of SPMs in specific subgroups of patients that were treated in the pre-rituximab era may reflect stringent medical surveillance employed in these populations.
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Affiliation(s)
- Yuval Neeman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chava Perry
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sourasky Medical Center, Institute of Hematology, Tel-Aviv, Israel
| | - Barbara Silverman
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Nizan Waintraub
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Irit Avivi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sourasky Medical Center, Institute of Hematology, Tel-Aviv, Israel
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Novikov I, Olmer L, Keinan-Boker L, Silverman B, Robinson E, Freedman LS. A modified Prevalence Incidence Analysis Model method may improve disease prevalence prediction. J Clin Epidemiol 2020; 123:18-26. [PMID: 32201258 DOI: 10.1016/j.jclinepi.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/21/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The Prevalence Incidence Analysis Model method is used for predicting disease prevalence, using past data on incidence and relative survival. Our objective was to propose and evaluate a modified approach for choosing the Prevalence Incidence Analysis Model. STUDY DESIGN AND SETTING Instead of the standard approach using the likelihood ratio statistic, we find the model that predicts most successfully the prevalence in the last available Y years using data up to but not including those Y years and then use that model to predict future prevalence another Y years ahead using all the data. We also make an "alignment" adjustment using the last known prevalence level. We evaluate the relative performance of the modified and standard methods using data on cancer from Israel in 1983-2013. RESULTS In this example, the modified approach gave as good or better predictions than the standard. Using the modified approach, we forecast cancer prevalence in Israel for 2014-2024 to increase at a gradually accelerating rate from the current 10,000 per year to 12,000 per year by 2020, reaching a total of 380,000 by 2024. CONCLUSION The modified approach may offer improved forecasting, but further methodological work on forecasting cancer prevalence is needed.
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Affiliation(s)
- Ilya Novikov
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer 5265601, Israel
| | - Liraz Olmer
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer 5265601, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Gertner Institute Building, Sheba Medical Center, Tel HaShomer, Ramat Gan, 5265601, Israel; Department of Epidemiology, School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel
| | - Barbara Silverman
- Israel Center for Disease Control, Ministry of Health, Gertner Institute Building, Sheba Medical Center, Tel HaShomer, Ramat Gan, 5265601, Israel; Israel National Cancer Registry, Ministry of Health, Gertner Institute Building, Sheba Medical Center, Tel HaShomer 52621, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eliezer Robinson
- National Council for Oncology, Ministry of Health, Jerusalem, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer 5265601, Israel.
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Silverman B. M202 TREATMENT OF COUGH/COLD SYMPTOMS WITH SECOND GENERATION ANTIHISTAMINE, LEVOCETIRIZINE WITH INCREASED SAFETY AND RAPID RESPONSE. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.189] [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: 10/25/2022]
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Brenner R, Kivity S, Peker M, Reinhorn D, Keinan-Boker L, Silverman B, Liphsitz I, Kolitz T, Levy C, Shlomi D, Pillar G, Peled N. Increased Risk for Cancer in Young Patients with Severe Obstructive Sleep Apnea. Respiration 2018; 97:15-23. [PMID: 30419556 DOI: 10.1159/000486577] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies in animal models and human with obstructive sleep apnea syndrome (OSAS) demonstrated an increase in cancer aggressiveness and mortality. However, there is a need for further clinical evidence supporting a correlation between OSAS and cancer incidence. OBJECTIVES To reveal whether OSAS presence and severity is correlated with cancer incidence in a large homogenous patients' cohort. METHODS We analyzed a cohort of over 5,000 concurrently enrolled patients, age > 18, with suspected OSAS, from a tertiary medical academic center. Patients underwent whole night polysomnography, the gold standard diagnostic tool for OSAS, and were classified for severity according to the Apnea Hypopnea Index (AHI). Data on cancer incidence were obtained from the Israel National Cancer Registry. A multivariate Cox proportional-hazards analysis, adjusted for age, gender, and BMI, was performed to estimate the hazard-ratio of new cancer incidence. RESULTS Among 5,243 subjects with a median follow-up of 5.9 years, 265 were diagnosed with cancer. The most prevalent cancers were prostate (14.7%), hematological (12.8%), urothelial (9.4%), colorectal (9%), and breast (8.3%). In subjects who were diagnosed at age below 45 years (n = 1,533), a high AHI (> 57/h) was significantly associated with cancer (HR 3.7, CI 1.12-12.45, p = 0.008). CONCLUSIONS Patients younger than 45 with severe OSAS have a significantly higher all-type cancer incidence than the general population. These results should encourage clinicians to detect and diagnose young patients with suspected OSAS and to recommend cancer screening methods in this high-risk population.
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Affiliation(s)
- Ronen Brenner
- Oncology Institute, Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shaye Kivity
- Departments of Medicine A and C, The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marina Peker
- Davidoff Cancer Center, Rabin Medical Center, Petah-Tiqwa, Israel
| | - Daniel Reinhorn
- Davidoff Cancer Center, Rabin Medical Center, Petah-Tiqwa, Israel
| | - Lital Keinan-Boker
- The National Cancer Registry, Israel Ministry of Health, Jerusalem, Israel.,Israel Center for Disease Control, Israel Ministry of Health, Jerusalem, Israel
| | - Barbara Silverman
- The National Cancer Registry, Israel Ministry of Health, Jerusalem, Israel
| | - Irena Liphsitz
- The National Cancer Registry, Israel Ministry of Health, Jerusalem, Israel
| | - Tamara Kolitz
- Oncology Institute, Wolfson Medical Center, Holon, Israel
| | - Carmit Levy
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dekel Shlomi
- Clalit Health Services, Dan-Petah-Tiqwa District, Israel
| | - Giora Pillar
- Rambam Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Nir Peled
- Ben-Gurion University, Beer-Sheva, Israel, .,Oncology division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva, Israel,
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Hayek S, Dichtiar R, Shohat T, Silverman B, Ifrah A, Boker LK. Risk of second primary neoplasm and mortality in childhood cancer survivors based on a national registry database. Cancer Epidemiol 2018; 57:127-133. [PMID: 30399484 DOI: 10.1016/j.canep.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although overall childhood cancer survival has improved, survivors may still have an elevated risk for second primary neoplasm (SPN) and excess mortality. The aim of the current study was to estimate the risks for SPN and mortality in childhood cancer survivors in Israel as compared to the general population. METHODS All children aged 0-19 diagnosed with primary neoplasm between 1980-2007 who survived at least 5 years following diagnosis were included in the study. Follow-up continued until December 31st, 2013, or diagnosis of SPN, or death due to any cause (the earliest of these events). Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were calculated. Cox proportional hazards regression was employed to assess predictors of SPN and mortality. RESULTS The cohort consisted of 6637 childhood cancer survivors. A total of 244 all-site SPN cases were observed. Compared to the general population, the risks for SPN and for mortality were significantly increased (SIR = 5.48; 95%CI: 4.82-6.22 and SMR = 13.99; 95%CI = 12.54-15.56, respectively). Factors predicting SPN were sex (female), older age at first diagnosis, and initial cancer diagnosis (lymphomas). Factors predicting mortality were older age at first diagnosis, initial cancer diagnosis (myeloproliferative diseases) and earlier years, according to calendar period of initial diagnosis. CONCLUSIONS Although 5-year childhood cancer survival is high, survivors are at elevated risk for SPN and mortality, and the risks are associated with baseline characteristics of the patients. The increased risks should be considered when planning treatment, follow-up and surveillance of the survivors.
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Affiliation(s)
- Samah Hayek
- Israel Center for Disease Control, Israel Ministry of Health, Israel.
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Barbara Silverman
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Lital Keinan Boker
- Israel Center for Disease Control, Israel Ministry of Health, Israel; School of Public Health, University of Haifa, Israel
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12
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Eser S, Chang J, Charalambous H, Silverman B, Demetriou A, Yakut C, Nimri O, Pavlou P, Özgür S, Ziogas A, Stevens L, Ward K, Anton Culver H. Incidence patterns of colorectal cancers in four countries of the Middle East Cancer Consortium (Cyprus, Jordan, Israel, and İzmir, Turkey) compared with those in the United States Surveillance, Epidemiology, and End Results Program. Turk J Gastroenterol 2018; 29:36-44. [PMID: 29391306 DOI: 10.5152/tjg.2018.17263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS There are wide variations in colorectal cancer (CRC) incidence across the world. Historically, the highest incidence rates have been reported historically in more developed countries; however, increasing trends have been seen in developing countries. Here, we present the CRC incidence pattern in Cyprus, Israel, Jordan, and İzmir, Turkey, which are countries of the Middle East Cancer Consortium (MECC). MATERIALS AND METHODS We analyzed 2005-2010 CRC data from population-based registries and calculated crude and age standardized rates for CRC, colon and rectum subsites, and annual percent changes (APCs) for trends. RESULTS The age-adjusted incidence rates (AAIRs) for CRC were the highest in Israeli Jews (IJ) (46.7 for males and 35.5 for females), which exceeded those of the USA Surveillance, Epidemiology, and End Result (SEER) program registries. In both sexes, AAIRs in Cyprus and Israeli Arabs (IA) were close to those in SEER registries. For both sexes, AAIRs in İzmir and Jordan were substantially lower than those in other registries. Statistically significant decreasing trends over time were observed in AAIRs for both sexes in the SEER program (APCs: males, -3.24% and females, -2.54%), whereas the trends varied within the MECC registries. There were decreasing AAIR trends for males in IJ and IA and for females in Cyprus and IJ; APC for females in IJ (-4.29%) was significant. Conversely, increasing trends with the significant APCs were observed in males in İzmir (2.43%) and Jordan (7.57%). CONCLUSION MECC countries comprise both high- and low-risk populations for CRCs. However, increasing trends in low-risk populations have been alarming. Thus, the need for implementing tailored primary and secondary prevention programs in the region is essential.
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Affiliation(s)
- Sultan Eser
- Department of Public Health, Balıkesir University, Balıkesir, Turkey; PI of Regional Hub for Cancer Registration in Northern Africa, Central and Western Asia, WHO/ IACR GICR, İzmir, Turkey
| | - Jenny Chang
- Department of Epidemiology, University of California Irvine, USA
| | - Haris Charalambous
- Cyprus Ministry of Health, Health Monitoring Unit, National Cancer Registry of Cyprus, Nicosia, Cyprus
| | - Barbara Silverman
- Israel Ministry of Health, Israel Center for Disease Control, National Cancer Registry of Israel, Israel
| | - Anna Demetriou
- Cyprus Ministry of Health, Health Monitoring Unit, National Cancer Registry of Cyprus, Nicosia, Cyprus
| | - Cankut Yakut
- Turkish Ministry of Health, İzmir Cancer Registry, İzmir, Turkey
| | - Omar Nimri
- Jordan Ministry of Health, NCDs-Department of Cancer Prevention, National Cancer Registry of Jordan, Jordan
| | - Pavlos Pavlou
- Cyprus Ministry of Health, Health Monitoring Unit, National Cancer Registry of Cyprus, Nicosia, Cyprus
| | - Suriye Özgür
- PI of Regional Hub for Cancer Registration in Northern Africa, Central and Western Asia, WHO/ IACR GICR, İzmir, Turkey
| | - Argyrious Ziogas
- Department of Epidemiology, University of California Irvine, USA
| | - Lisa Stevens
- U.S. National Cancer Institute, Center for Global Health, USA
| | - Kevin Ward
- Department of Epidemiology, Georgia Center for Cancer Statistics, Emory University, Georgia
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13
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Ganzel C, Silverman B, Chemtob D, Ben Shoham A, Wiener-Well Y. The risk of tuberculosis in cancer patients is greatest in lymphoma and myelodysplastic syndrome/myeloproliferative neoplasm: a large population-based cohort study. Leuk Lymphoma 2018; 60:720-725. [PMID: 30188229 DOI: 10.1080/10428194.2018.1499904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Patients with cancer are at high risk for tuberculosis (TB). This study combined the Israeli databases of cancer and TB and examined the development of TB among all newly diagnosed cancer cases from 1993 to 2013. Patients were classified into groups according to their different malignancies. Among 495,335 cancer patients, 335 developed TB following cancer diagnosis. The cumulative incidence of TB following cancer diagnosis was highest among MDS/MPN (148.8/100,000 patients) and lymphoma (154.1/100,000 patients) (p = .023). The HR of TB following cancer among hematologic patients was 2.51 (p < .001), relative to patients with in situ carcinomas/skin cancer and highest among MDS/MPN and lymphoma patients (2.74, p = .012 and 2.70, p < .001, respectively). Among lymphoma patients, a significant increased HR was found only among NHL patients (2.72, p < .001). The limitations include lack of information regarding risk factors for TB and of anti-cancer treatments. In conclusion, these data may encourage a heightened awareness for TB among patients with a background of lymphoma and MDS/MPN.
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Affiliation(s)
- Chezi Ganzel
- a Department of Hematology , Shaare Zedek Medical Center , Jerusalem , Israel
| | - Barbara Silverman
- b Israel National Cancer Registry, Israel Ministry of Health , Israel
| | - Daniel Chemtob
- c Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel and Braun School of Public Health and Community Medicine, Faculty of Medicine , Hebrew University-Hadassah , Jerusalem , Israel
| | | | - Yonit Wiener-Well
- e Infectious Disease Unit , Shaare Zedek Medical Center , Jerusalem , Israel
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Brenner R, Ben-Zvi I, Shinar Y, Livneh A, Liphshitz I, Silverman B, Peled N, Levy C, Ben-Chetrit E, Kivity S. Reply. Arthritis Rheumatol 2018; 70:1167-1168. [DOI: 10.1002/art.40496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Avi Livneh
- Sheba Medical Center; Tel Hashomer Israel
| | | | | | - Nir Peled
- Rabin Medical Center; Petah Tikvah Israel
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15
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Tolwin Y, Silverman B, Peled N. 42P Is there a delay in diagnosis of lung cancer in women? J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30322-8] [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: 11/28/2022]
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16
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Hossain MZ, Hao T, Silverman B. Stillinger-Weber potential for elastic and fracture properties in graphene and carbon nanotubes. J Phys Condens Matter 2018; 30:055901. [PMID: 29271354 DOI: 10.1088/1361-648x/aaa3cc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper presents a new framework for determining the Stillinger-Weber (SW) potential parameters for modeling fracture in graphene and carbon nanotubes. In addition to fitting the equilibrium material properties, the approach allows fitting the potential to the forcing behavior as well as the mechanical strength of the solid, without requiring ad hoc modification of the nearest-neighbor interactions for avoiding artificial stiffening of the lattice at larger deformation. Consistent with the first-principles results, the potential shows the Young's modulus of graphene to be isotropic under symmetry-preserving and symmetry-breaking deformation conditions. It also shows the Young's modulus of carbon nanotubes to be diameter-dependent under symmetry-breaking loading conditions. The potential addresses the key deficiency of existing empirical potentials in reproducing experimentally observed glass-like brittle fracture in graphene and carbon nanotubes. In simulating the entire deformation process leading to fracture, the SW-potential costs several factors less computational time compared to the state-of-the-art interatomic potentials that enables exploration of the fracture processes in large atomistic systems which are inaccessible otherwise.
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Affiliation(s)
- M Z Hossain
- Laboratory of Mechanics and Physics of Heterogeneous Materials, Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, United States of America
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17
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Brenner R, Ben‐Zvi I, Shinar Y, Liphshitz I, Silverman B, Peled N, Levy C, Ben‐Chetrit E, Livneh A, Kivity S. Familial Mediterranean Fever and Incidence of Cancer. Arthritis Rheumatol 2017; 70:127-133. [DOI: 10.1002/art.40344] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/03/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Ronen Brenner
- Wolfson Medical Center Holon Israel
- Tel Aviv University Tel Aviv Israel
| | - Ilan Ben‐Zvi
- Tel Aviv University Tel Aviv Israel
- Sheba Medical Center Tel Hashomer Israel
| | | | - Irena Liphshitz
- Israel Ministry of Health Jerusalem Israel
- Soroka Medical Center Beer Sheva Israel
| | - Barbara Silverman
- Israel Ministry of Health Jerusalem Israel
- Soroka Medical Center Beer Sheva Israel
| | - Nir Peled
- Tel Aviv University Tel Aviv Israel
- Rabin Medical Center Petah Tikva Israel
| | | | | | - Avi Livneh
- Tel Aviv University Tel Aviv Israel
- Sheba Medical Center Tel Hashomer Israel
| | - Shaye Kivity
- Tel Aviv University Tel Aviv Israel
- Sheba Medical Center Tel Hashomer Israel
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18
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Brenner R, Kivity S, Peker M, Reinhorn D, Keinan-Boker L, Silverman B, Liphshiz I, Kolitz T, Shlomi D, Peled N, Pillar G. 0623 INCREASED RISK FOR CANCER IN YOUNG PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Anton-Culver H, Chang J, Bray F, Znaor A, Stevens L, Eser S, Silverman B, Nimri O, Pavlou P, Charalambous H, Demetriou A, Ward K, Ziogas A. Cancer burden in four countries of the Middle East Cancer Consortium (Cyprus; Jordan; Israel; Izmir (Turkey)) with comparison to the United States surveillance; epidemiology and end results program. Cancer Epidemiol 2016; 44:195-202. [PMID: 27502627 PMCID: PMC7853241 DOI: 10.1016/j.canep.2016.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
It is important that population-based cancer registries provide accurate and reliable data for public health purposes. These data are essential data for planning of cancer control and prevention. In this study, we examined cancer incidence rates (year 2005-2010) in four MECC registries (Cyprus, Jordan, Israel, Izmir (Turkey)) and compared with the rates in the US. The overall age-standardized incidence rates for males were highest in the US followed by Israeli Jews, Izmir (Turkey), Cyprus, Israeli Arabs, and lowest in Jordan. In women the rates of cancer of all sites were also highest in US women followed by Israeli Jews, Cyprus, Israeli Arabs, Izmir (Turkey), and lowest in Jordan. It is of interest that although site-specific cancer rates differ between the countries studied, prostate, lung and colorectal cancers are within the five most common cancers males in all countries studied. In females, breast colorectal and endometrium cancers are three of the five most common cancers in females in all countries studied. The results presented in this paper can have implications for opportunities in cancer control and prevention in these countries. Future studies on individual cancer sites with highest rates in these Countries are currently underway.
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Affiliation(s)
| | - Jenny Chang
- Department of Epidemiology, University of California Irvine, USA
| | - Freddie Bray
- International Agency of Research on Cancer, France
| | - Ariana Znaor
- International Agency of Research on Cancer, France
| | - Lisa Stevens
- Center for Global Health, National Cancer Institute, USA
| | - Sultan Eser
- Izmir Cancer Registry, Izmir & Hacettepe University, Ankara, Turkey
| | | | - Omar Nimri
- National Cancer Registry of Jordan, Jordan
| | | | | | | | - Kevin Ward
- Georgia Cancer Registry, Emory University, USA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California Irvine, USA
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20
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Dankner R, Boffetta P, Keinan-Boker L, Balicer RD, Berlin A, Olmer L, Murad H, Silverman B, Hoshen M, Freedman LS. Diabetes, prostate cancer screening and risk of low- and high-grade prostate cancer: an 11 year historical population follow-up study of more than 1 million men. Diabetologia 2016; 59:1683-91. [PMID: 27189066 PMCID: PMC4930460 DOI: 10.1007/s00125-016-3972-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS An inverse association has consistently been shown between diabetes and prostate cancer incidence. We investigated whether lower prostate cancer incidence among men with diabetes is attributable to lower detection due to prostate cancer screening patterns. METHODS We studied a population-based historical cohort of 1,034,074 Israeli men aged 21-90 years, without a previous history of cancer. The cohort was followed-up from 2002 to 2012, according to diabetes morbidity, for frequency of prostate-specific antigen (PSA) testing, mean PSA values and detection of prostate cancer, after adjustment for age, ethnic origin, socioeconomic status and PSA testing. RESULTS In January 2002, 74,756 men had prevalent diabetes. During the 11 year follow-up, 765,483 (74%) remained diabetes-free and 193,835 developed diabetes. Approximately 10% more PSA screening was performed in men with than without diabetes, but the rate of PSA positivity (>4 μg/l) was 20% lower in men with diabetes. PSA values were already significantly lower in men who developed diabetes than in those who did not, 3 years before diabetes diagnosis. Reduced prostate cancer risk was observed among men with incident diabetes only for low-moderate grade tumours (Gleason score 2-6: adjusted HR 0.83; 95% CI 0.77, 0.89). No association was observed for high-grade tumours (Gleason score 7-10: HR 0.99; 95% CI 0.88, 1.11). CONCLUSIONS/INTERPRETATION Our findings suggest that diabetes comorbidity is a factor to be considered in prostate cancer screening strategies, and specifically in the interpretation of PSA levels. Furthermore, our demonstration of reduced incidence of low-moderate grade but not high-grade prostate cancer tumours among men with diabetes supports the possibility that low PSA levels, rather than lower tumour risk, explains the observed reduced incidence of prostate cancer in men with diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT02072902.
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Affiliation(s)
- Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel.
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel.
- Patient Oriented Research, The Feinstein Institute for Medical Research, Manhasset, NY, USA.
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lital Keinan-Boker
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
- Public Health Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alla Berlin
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Liraz Olmer
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Havi Murad
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Barbara Silverman
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Tel Hashomer, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Laurence S Freedman
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
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21
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Tadmor T, Liphshitz I, Silverman B, Polliack A. Incidence and epidemiology of non-Hodgkin lymphoma and risk of second malignancy among 22 466 survivors in Israel with 30 years of follow-up. Hematol Oncol 2016; 35:599-607. [DOI: 10.1002/hon.2302] [Citation(s) in RCA: 5] [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] [Received: 12/30/2015] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Tamar Tadmor
- Hematology Unit; Bnai-Zion Medical Center; Haifa Israel
- The Ruth and Bruce Rappaport faculty of medicine, Technion; Haifa Israel
| | - Irena Liphshitz
- Israeli National Cancer Registry; Ministry of Health; Jerusalem Israel
| | - Barbara Silverman
- Israeli National Cancer Registry; Ministry of Health; Jerusalem Israel
| | - Aaron Polliack
- Department of Hematology; Hadassah University, Hospital and Hebrew University Medical School; Jerusalem Israel
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22
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Mandelzweig L, Chetrit A, Amitai T, Oberman B, Danieli NS, Silverman B, Sadetzki S. Identification of health care needs of long-term breast cancer survivors among Israeli women. Support Care Cancer 2015; 24:737-746. [PMID: 26190362 DOI: 10.1007/s00520-015-2836-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/22/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE Improvement in treatment has extended survival of breast cancer patients. Our study aimed to characterize health service use among long-term breast cancer survivors in Israel in order to identify and address specific needs of this subpopulation. METHODS The study population included 250 women diagnosed with breast cancer, 8-12 years prior to study initiation (cases), and 250 individually matched cancer-free controls. Participants were recruited from the second largest Israeli HMO, and data were collected through personal interviews. ORs and 95 % CIs were estimated using conditional logistic regression and generalized estimating equations. RESULTS Greater use of health services was observed among cases, compared to an age-matched comparison group, expressed by more visits to family physicians and specialists, longer duration of visits, more requests for referrals, more frequent contact with emergency services, and hospitalizations. The study groups were similar regarding socioeconomic variables, current smoking and physical activity, BMI, and prevalence of reported morbidity. Although 80 % of cases defined the family physician as their main treating physician, half still considered their oncologist responsible for cancer follow-up. Only 14.4 and 10.4 % of cases and controls, respectively, reported receiving psychological support during the year preceding the interview. CONCLUSIONS Further studies should assess the contribution of apprehension concerning health-related issues that still accompany breast cancer survivors, to the excess use of health services. Concern among family practitioners may contribute as well. In addition, our results emphasize the need to improve coordination between the disciplines of oncology and community medicine for the medical care of this group.
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Affiliation(s)
- Lori Mandelzweig
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel
| | - Angela Chetrit
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel
| | - Tova Amitai
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel
| | - Bernice Oberman
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel
| | | | | | - Siegal Sadetzki
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Chillag-Talmor O, Giladi N, Linn S, Gurevich T, El-Ad B, Silverman B, Friedman N, Peretz C. Use of a refined drug tracer algorithm to estimate prevalence and incidence of Parkinson's disease in a large israeli population. J Parkinsons Dis 2014; 1:35-47. [PMID: 23939255 DOI: 10.3233/jpd-2011-11024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Estimating rates of Parkinson's disease (PD) is essential for health services planning and studies of disease determinants. However, few PD registries exist. We aimed to estimate annual prevalence and incidence of PD in a large Israeli population over the past decade using computerized drug purchase data. Based on profiles of anti-parkinsonian drugs, age at first purchase, purchase density, and follow-up time, we developed a refined algorithm for PD assessment (definite, probable or possible) and validated it against clinical diagnoses. We used the prescription database of the second largest Health Maintenance Organization in Israel (covers ~25% of population), for the years 1998-2008. PD rates by age, gender and year were calculated and compared using Poisson models. The algorithm was found to be highly sensitive (96%) for detecting PD cases. We identified 7,134 prevalent cases (67% definite/probable), and 5,288 incident cases (65% definite/probable), with mean age at first purchase 69 ± 13 years. Over the years 2000-2007, PD incidence rate of 33/100,000 was stable, and the prevalence rate increased from 170/100,000 to 256/100,000. For ages 50+, 60+, 70+, median prevalence rates were 1%, 2%, 3%, respectively. Incidence rates also increased with age (RR = 1.76, 95%CI 1.75-1.77, ages 50+, 5-year interval). For ages 50+, rates were higher among men for both prevalence (RR = 1.38, 95%CI 1.37-1.39) and incidence (RR = 1.45, 95%CI 1.42-1.48). In conclusion, our refined algorithm for PD assessment, based on computerized drug purchases data, may be a reliable tool for population-based studies. The findings indicate a burden of PD in Israel higher than previously assumed.
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Peretz C, Chillag-Talmor O, Linn S, Gurevich T, El-Ad B, Silverman B, Friedman N, Giladi N. Parkinson's disease patients first treated at age 75 years or older: A comparative study. Parkinsonism Relat Disord 2014; 20:69-74. [DOI: 10.1016/j.parkreldis.2013.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/09/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
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Siegelmann-Danieli N, Silverman B, Zick A, Beit-Or A, Katzir I, Porath A. The impact of the Oncotype DX Recurrence Score on treatment decisions and clinical outcomes in patients with early breast cancer: the Maccabi Healthcare Services experience with a unified testing policy. Ecancermedicalscience 2013; 7:380. [PMID: 24386009 PMCID: PMC3869476 DOI: 10.3332/ecancer.2013.380] [Citation(s) in RCA: 6] [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: 07/20/2013] [Indexed: 12/05/2022] Open
Abstract
The Oncotype DX Recurrence Score is a validated prognosticator in oestrogen receptor positive (ER+) breast cancer. Our retrospective analysis of a prospectively defined cohort summarises the clinical implications associated with Oncotype DX testing according to the Maccabi Healthcare Services (MHS) policy. The MHS eligibility criteria for testing included ER+ N0/pN1mic invasive tumours, discussion of test implications with an oncologist, ductal carcinoma 0.6–1 cm Grade 2–3, HER2 negative ductal carcinomas with 1.1–4.0 cm Grade 1–2, or lobular carcinoma. Large (> 1 cm) Grade 3 tumours could have grade reassessed. We linked Recurrence Score results with patients’ information and used chi-squared tests to assess the associations thereof. Between January 2008 and December 2011, tests were performed on 751 patients (MHS-eligible, 713); 54%, 38%, and 8% of patients had low, intermediate, and high Recurrence Score results, respectively. Recurrence Score distribution varied significantly with age (P = 0.002), with increasing Recurrence Score values with decreasing age. The proportion of patients with high Recurrence Score results varied by grade/size combination and histology, occurring in 32% of small (≤ 1 cm) Grade 3 and 3% of larger (1.1–4 cm) Grade 1 ductal tumours and only in 2% of lobular carcinomas. Chemotherapy was administered to 1%, 13%, and 61% of patients with low, intermediate, and high Recurrence Score results, respectively (P < 0.0001), but only to 2% of intermediate score patients ≥ 65 years. Luteinising-hormone-releasing hormone agonists with tamoxifen were used in 27% of low Recurrence Score patients ≤ 50 years. With a median follow-up of 26 months, no systemic recurrences were documented, whereas four patients exhibited locoregional recurrences. In summary, in this low-to-moderate risk patient population, testing identified 46% of patients as intermediate/high risk. Treatment decisions were influenced by Recurrence Score results and patients’ age. The current MHS policy seems to achieve the goal of promoting chemotherapy use according to the test results in a prespecified patient population.
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Affiliation(s)
| | - Barbara Silverman
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| | - Aviad Zick
- Hadassah Medical Center, Ein Kerem, Jerusalem 91120, Israel
| | - Anat Beit-Or
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| | - Itzhak Katzir
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
| | - Avi Porath
- Maccabi Healthcare Services, 27 Hamered Street, Tel Aviv 68125, Israel
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Adelman M, Silverman B. Key Elements of a Robotic-Assisted Radical Hysterectomy. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.115] [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: 10/27/2022]
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Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. ACTA ACUST UNITED AC 2012; 64:943-54. [PMID: 22389040 DOI: 10.1002/art.34356] [Citation(s) in RCA: 211] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.
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Chillag-Talmor O, Giladi N, Linn S, Gurevich T, El-Ad B, Silverman B, Friedman N, Peretz C. Estimation of Parkinson’s disease survival in Israeli men and women, using health maintenance organization pharmacy data in a unique approach. J Neurol 2012; 260:62-70. [DOI: 10.1007/s00415-012-6584-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/08/2012] [Accepted: 06/09/2012] [Indexed: 11/24/2022]
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Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71:484-92. [PMID: 22388996 PMCID: PMC3298664 DOI: 10.1136/annrheumdis-2011-200329] [Citation(s) in RCA: 302] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes.
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Affiliation(s)
- Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Marco A Cimmino
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Wolfgang A Schmidt
- Department of Rheumatology, Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin–Buch Berlin, Berlin, Germany
| | - Michael Schirmer
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | - Carlo Salvarani
- Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Artur Bachta
- Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria
| | - Christina Duftner
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
- Department of Internal Medicine, General Hospital of Kufstein, Kufstein, Austria
| | | | | | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Novák Pál Kaposi
- Radiology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Peter Mandl
- General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Peter V Balint
- General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Zsuzsa Schmidt
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Annamaria Iagnocco
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | | | | | | | - Nicolò Pipitone
- Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | | | - Georgina Espígol-Frigolé
- Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maria C Cid
- Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Víctor M Martínez-Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - Elisabeth Nordborg
- Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
| | - Sibel Zehra Aydin
- Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
| | - Khalid Ahmed
- Department of Rheumatology, Princess Alexandra Hospital, Harlow, UK
| | - Brian Hazleman
- Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK
| | | | - Colin Pease
- Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
| | - Richard J Wakefield
- Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Andy Abril
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Clement J Michet
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ralph Marcus
- Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
| | - Neil J Gonter
- Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
| | - Mehrdad Maz
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric L Matteson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Loebstein R, Dushinat M, Vesterman-Landes J, Silverman B, Friedman N, Katzir I, Kurnik D, Lomnicky Y, Kokia E, Halkin H. Database evaluation of the effects of long-term rosiglitazone treatment on cardiovascular outcomes in patients with type 2 diabetes. J Clin Pharmacol 2010; 51:173-80. [PMID: 20484611 DOI: 10.1177/0091270010368281] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent meta-analyses suggest an increased risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) treated with rosiglitazone. These meta-analyses have drawn considerable criticisms. Retrospective observational studies do not consistently support this association. The objective of this study was to compare rates of adverse cardiovascular outcomes in T2DM patients treated with rosiglitazone alone or combined with metformin or metformin alone. This retrospective study, using the health maintenance organization database, included patients who were dispensed rosiglitazone (alone or with metformin) for at least 6 months as follows: rosiglitazone alone (n = 745), rosiglitazone and metformin (n = 2753), and metformin alone (n = 11 938). Adverse cardiovascular outcomes were new diagnosis of AMI, acute coronary syndrome (ACS), coronary revascularization (CRV), congestive heart failure (CHF), and all-cause mortality. Mean on-treatment follow-up was 30 months. After adjustment for covariates found to be significant in univariate analyses, rosiglitazone was associated only with CHF (hazard ratio [HR] = 2.23; 95% confidence interval [CI]: 1.41-1.95) with no increase of risk for AMI (HR = 1.13; 95%CI: 0.60-2.12), ACS (HR = 0.85; 95% CI: 0.57-1.26), coronary revascularization (HR = 1.22; 95% CI:0.82-1.54), or all-cause mortality (HR = 1.15; 95% CI: 0.85-1.56). In this community-based cohort, 30 months of therapy with rosiglitazone treatment was associated with increased risk of CHF but was not associated with increased risk of AMI, ACS, coronary revascularization, or all-cause mortality.
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Affiliation(s)
- Ronen Loebstein
- Department of Pharmaceutics and Clinical Pharmacology, Maccabi Healthcare Services, 27, Hamered St, Tel Aviv, Israel.
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Fitzpatrick S, Silverman B, Joks R, Schneider A. Physician Knowledge & Compliance with Updated Asthma Guidelines. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.262] [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: 10/19/2022]
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Dagan Y, Dushenat M, Silverman B. [Chronic use of sleep medications--how serious is it in Israel?]. Harefuah 2009; 148:292-351. [PMID: 19630357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The prevalence of chronic insomnia in the adult population in Israel is 29.8%, which is comparable to other Western countries. The consequences of insomnia include fatigue, accidents, low level of well-being, and a high need for medical services. One of the well-known treatments for insomnia is sleeping pills. Physicians are educated that hypnotics are an appropriate treatment for transient insomnia but not for chronic use. It is believed that transient users are at high risk of becoming addicted to sleep medications although research has not proven this theory. NonetheLess, physicians often try to convince insomnia patients not to use these medications. In the U.S.A., only 3% of chronic insomniacs use sleep medications. There are no data on the use of sleep medications in Israel. The present study was performed using a large database comprised of 1.1 million adult patients of Maccabi Health Services. It is the first study examining sleep medication usage habits of the adult population in IsraeL. The main findings are: 2.8% of Maccabi patients use sleep medications, however only 4.5% of this group are chronic users; most chronic users started sleep medications at the age of 65 or older and they suffer more than the transient users from medical conditions such as ischemic heart disease, hypertension, and diabetes mellitus, have higher usage of antidepressant and anxiolytic medication, receive greater national financial support and are more likely to be new immigrants. The results of this study should evoke physicians to reassess their position against prescribing sleep medications to patients for whom it may help in relieving their insomnia.
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Affiliation(s)
- Yaron Dagan
- Sleep Medicine Institutes, Assuta Medical Centers, Israel.
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33
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Smith A, Silverman B, Schneider A. Peak Tree Pollen Levels in New York City. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.520] [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: 11/30/2022]
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Li W, Paek I, Smith A, Silverman B, Schneider A. Referral Patterns and Comfort Level of Primary Care Physicians and Residents for Allergy and Immunology Disorders. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.149] [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: 10/21/2022]
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35
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Hemmers P, Amara S, Silverman B, Schneider A. Use of a Multimedia Presentation to Increase Knowledge and Safety of Allergen Immunotherapy. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.242] [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: 11/16/2022]
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Hutchings A, Hollywood J, Lamping DL, Pease CT, Chakravarty K, Silverman B, Choy EHS, Scott DGI, Hazleman BL, Bourke B, Gendi N, Dasgupta B. Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica. ACTA ACUST UNITED AC 2007; 57:803-9. [PMID: 17530680 DOI: 10.1002/art.22777] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [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: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of polymyalgia rheumatica (PMR) on clinical outcomes and quality of life (QOL); the relationship between laboratory measures and clinical outcomes, and changes in QOL; and agreement between rheumatologists in confirming the initial diagnosis. METHODS We conducted a prospective study of 129 participants in 8 hospitals in England who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy. The main outcome measures were response to steroids after 3 weeks (minimum 50% improvement in proximal pain, morning stiffness <30 minutes, acute-phase response not elevated), relapses, QOL as measured by the Short Form 36 and Health Assessment Questionnaire, and diagnosis reassessment at 1 year. RESULTS At 3 weeks, 55% of participants failed to meet our definition of a complete response to steroid therapy. Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 (95% confidence interval [95% CI] 10.8, 14.4) and 11.2 (95% CI 8.5, 13.8) points, respectively, at 1 year. Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup, whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup. There was moderate agreement between clinicians in confirming the PMR diagnosis (kappa coefficients 0.49-0.65). CONCLUSION PMR is a heterogeneous disease with a major impact on QOL. Ongoing monitoring should include disease activity based on symptoms, emergence of alternative diagnoses, and early referral of atypical and severe cases.
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Kapur P, Silverman B, Schneider A. Atypical Presentation of Eosinophilic Gastroenteritis (EGE). J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.12.139] [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: 11/26/2022]
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Padi A, Garrett-Szymanski K, Willis C, Silverman B, Giusti R, Schneider A. The Asthma Day Care Project: Identifying and Managing Asthma in Brooklyn Preschools. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.114] [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: 10/23/2022]
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39
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Gupta N, Emre U, Kearney S, Fermo R, Silverman B, Schneider A. Allergic Rhinitis and Inner-City Children–Is There a Relationship to Sleep-Disordered Breathing? J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.540] [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: 10/23/2022]
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40
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Amara S, Gupta N, Silverman B, Rao Y, Schneider A. Paradoxical Bronchospasm With a Near-Fatal Reaction to Albuterol-HFA and Levalbuterol inhalation solution leading to Intubation in an Adult Asthmatic. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.019] [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: 11/25/2022]
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41
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Halkin H, Dushenat M, Silverman B, Shalev V, Loebstein R, Lomnicky Y, Friedman N. Brand versus generic alendronate: gastrointestinal effects measured by resource utilization. Ann Pharmacother 2006; 41:29-34. [PMID: 17190847 DOI: 10.1345/aph.1h218] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 01/11/2023] Open
Abstract
BACKGROUND Adverse reactions related to the upper gastrointestinal tract (UGIT) that are associated with generic alendronate formulations may differ from those associated with the brand drug. OBJECTIVE To test the hypothesis that adverse UGIT effects of alendronate formulations may differ between generic and brand products. METHODS We conducted a database health resource utilization analysis of UGIT outcomes in patients who started treatment with generic or brand alendronate formulations during 2001-2005. We included 6962 patients who were treated continuously for 3 months with 1 of 4 alendronate formulations: brand 10 mg/day (Merck, Sharpe & Dohme, n = 1418), generic A 10 mg/day (Teva, Israel, n = 650), generic B 10 mg/day (Unipharm, Israel, n = 628), and brand 70 mg/wk (n = 4266). In these patients, who had neither filled a prescription for alendronate nor had any gastrointestinal problems in the year preceding the study, we compared incidence rates of new use of gastric medications (H2-blockers, proton-pump inhibitors, or antacids), gastroenterology visits, endoscopies, and hospital admissions. RESULTS Incident rate ratios (IRR) for treatment discontinuation were higher with both daily generic products (IRR 1.3; 95% CI 1.04 to 1.63). Adherence (medication possession ratio [MPR] >80%) was better with brand 10 mg/day (IRR 1.19; 95% CI 1.11 to 1.27). All comparisons were adjusted for use of concurrent corticosteroids, nonsteroidal antiinflammatory drugs, and potassium supplements. Hospitalization rates (2.7-3.2%) were similar in all groups. New use of gastric medications (3.4-4.9%) was lower with brand 10 mg/day (IRR 0.71; 95% CI 0.53 to 0.95). Rates of UGIT endoscopy (n = 49) in patients receiving 10 mg were 0.6% (brand), 1.1% (generic A), and 1.6% (generic B), with generic B higher (IRR 2.88; 95% CI 1.14 to 7.29) in the entire cohort, but not among new users (n = 273) of gastric drugs (IRR 2.46; 95% CI 0.55 to 11.05). Endoscopic findings were normal in 22 patients, hiatal hernia with no mucosal lesion was present in 10 patients, and there was mild-to-moderate esophagitis or gastritis in 17 patients; there were no significant differences among the formulations. CONCLUSIONS We found insufficient evidence to indicate major differences in UGIT adverse effects related to use of daily generic, as compared with brand, alendronates.
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Affiliation(s)
- Hillel Halkin
- Chairman, Formulary Committee, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University
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Hemmers P, Giusti R, Silverman B, Schneider A. Underlying Aspiration Exacerbating Asthma in a Boy Treated for IgG Subclass Deficiency. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.020] [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: 11/24/2022]
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Amara S, Tavartkiladze T, Persaud Y, Silverman B, Hemmers P, Gupta N, Schneider A. Prescribing of EpiPen to Patients Presenting to an Inner-City Hospital Emergency Room (ER) with Acute Allergic Reactions. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Khadavi A, Silverman B, Schneider A. Problem based leaning tools (PBLT) results in improved ACGME patient care general competencies in allergy/immunology programs. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.181] [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: 10/25/2022]
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45
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Persaud Y, Sood S, Silverman B, Aygun B, Schneider A. Kikuchi necrotizing lymphadenitis with clinical features consistent with forme fruste SLE. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Kearney S, Ellman M, Wertenbaker C, Mak W, Silverman B, Schneider A. Allergic fungal sinusitis presenting as visual loss and facial dysmorphia in New York City. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.804] [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: 10/25/2022]
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Tavarkiladze T, Kearney S, Garrett-Szymanski K, Khadavi A, Persaud Y, Mak W, Giusti R, Watson S, Silverman B, Schneider A. Compliance with NAEPP asthma guidelines in a hospital based pediatric clinic and school based health clinics after an asthma education program. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.592] [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: 10/25/2022]
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Nightingale S, Wanamaker V, Silverman B, McCurdy P, McMurtry L, Quarles P, Sandler SG, Triulzi D, Whitsett C, Hillyer C, McCarthy L, Goldfinger D, Satcher D. Use of sentinel sites for daily monitoring of the US blood supply. Transfusion 2003; 43:364-72. [PMID: 12675723 DOI: 10.1046/j.1537-2995.2003.00324.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This report describes the first year of a government-sponsored program that uses daily reports from 29 sentinel sites to monitor the capacity of the US blood supply to meet demand. STUDY DESIGN AND METHODS From August 15, 2001, to August 14, 2002, 29 sentinel sites provided daily reports of the number of units of RBCs in inventory, transfused, exported, and outdated by ABO and Rh, and platelets by random or apheresis donor. Days supply of each component category was calculated as the number of units in inventory reported on a day divided by the sum of units transfused, exported, and outdated on that day. Sites also provided daily responses to questions about threatened or actual shortages. RESULTS The median of the days supply of RBCs at the 26 hospital transfusion services was 7.2 days. However, median days supply varied substantially by site and by day of the week. A+, O+, and O- units accounted for 30, 35, and 12 percent of total inventory and were maintained at a median supply of 7.4, 6.4, and 9.5 days, respectively. Reports of threatened RBC shortages peaked in early January 2002 and again in early July 2002. The July 2002 peak was about twice the January 2002 peak. Inventories at community-based centers were similar to those at hospital transfusion services. Hospitals maintained only a 1-day supply of platelets. Eight percent of random and 4 percent of apheresis platelets were outdated. There were 20 reports that surgery had to be postponed or canceled because platelets were unavailable. CONCLUSIONS Inventories of RBCs maintained at the participating sites were sufficient, with only one brief exception, to meet local demand during the first year of this monitoring program. The weekly rate of threatened shortage reports was more sensitive than days inventory as a predictor of actual shortages of RBCs. Unlike RBCs, platelet days supply, reports of threatened or actual platelet shortages, and platelet outdate rates did not vary seasonally.
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Affiliation(s)
- Stephen Nightingale
- Office of Public Health and Science, Department of Health and Human Services, Washington, DC, USA.
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Affiliation(s)
- A Khan
- Department of Allergy and Immunology, Long Island College Hospital, Brooklyn, NY 11201, USA.
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