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Abdel-Rahman N, Manor O, Elran E, Siscovick D, Calderon-Margalit R. Implications of Patient-Reported Outcome Measures among patients with recently diagnosed type 2 diabetes. Isr J Health Policy Res 2024; 13:6. [PMID: 38297393 PMCID: PMC10829200 DOI: 10.1186/s13584-024-00592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND For the past two decades, the assessment of the quality of diabetes care has mostly relied on clinical quality indicators. These have not included Patient-Reported Outcome Measures (PROMs) which provide information on outcomes deemed valuable by patients. We aimed to examine the potential utility of PROMs in type 2 diabetes care and to study the association of PROMs with patients' characteristics and clinical quality indicators. METHODS A cross-sectional survey of recently (≤ 4 years) diagnosed patients with type 2 diabetes (n = 392) in the setting of a large health plan. PROMs were based on two well-validated questionnaires, the Problem Areas in Diabetes (PAID) one-page questionnaire that measures diabetes-related distress, and the ten item PROMIS-10 global health questionnaire that measures general health. Additional items were added following a previous qualitative study among Israeli patients with diabetes. The survey was carried out using phone interviews, and data collected were linked to the electronic medical records. Multivariable regression models were used to assess the associations of socio-demographic variables and clinical quality indicators with the PROMs. RESULTS About a fifth of participants (22%) had high diabetes-related distress (PAID score ≥ 40), a third reported that they did not feel confident in self-management of diabetes and about a third reported having sexual dysfunction. Women, younger patients, and those with a low education level (≤ 12 years) reported worse general health, were more likely to experience high diabetes-related distress, and to have low confidence in diabetes self-management. Interestingly, performance of all seven diabetes quality indicators was associated with worse general health and high diabetes-related distress. Of note, levels of glycated hemoglobin, LDL-cholesterol, or blood pressure were not associated with PROMs. CONCLUSIONS PROMs provide important information on patient self-reported health status and are likely to reflect aspects of the quality of care that are not otherwise available to clinicians. Thus, the use of PROMs has the potential to expand the evaluation of diabetes care and promote patient-centered care. We recommend that policy-makers in the Ministry of Health and health maintenance organizations implement PROMs for assessing and improving the care for patients with type 2 diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel.
| | - Orly Manor
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel
| | - Einat Elran
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University of Jerusalem Hadassah Medical School, 91120, Jerusalem, Israel
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Abdel-Rahman N, Calderon-Margalit R, Cohen A, Elran E, Golan Cohen A, Krieger M, Paltiel O, Valinsky L, Ben-Yehuda A, Manor O. Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population-Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes. J Am Heart Assoc 2022; 11:e025603. [PMID: 36129044 DOI: 10.1161/jaha.122.025603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006-2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011-2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose-response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49-1.72) and 1.23 (95% CI, 1.14-1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50-1.69) for cardiac outcomes. Conclusions Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ronit Calderon-Margalit
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | | | - Michal Krieger
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ora Paltiel
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | - Orly Manor
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
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Azulay R, Valinsky L, Hershkowitz F, Elran E, Lederman N, Kariv R, Braunstein B, Heymann A. Barriers to completing colonoscopy after a positive fecal occult blood test. Isr J Health Policy Res 2021; 10:11. [PMID: 33573698 PMCID: PMC7879608 DOI: 10.1186/s13584-021-00444-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.
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Affiliation(s)
| | - Liora Valinsky
- Public Health Nursing, Ministry of Health, Jerusalem, Israel
| | | | - Einat Elran
- Maccabi Healthcare Services, Tel aviv, Israel
| | | | - Revital Kariv
- Maccabi Healthcare Services, Tel aviv, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony Heymann
- Meuhedet Health Care, 5 Pesach Lev, Lod, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
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Paltiel O, Keidar Tirosh A, Paz Stostky O, Calderon-Margalit R, Cohen AD, Elran E, Valinsky L, Matz E, Krieger M, Yehuda AB, Jaffe DH, Manor O. Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records. J Med Screen 2020; 28:25-33. [PMID: 32356670 DOI: 10.1177/0969141320919152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess time trends in colorectal cancer screening uptake, time-to-colonoscopy completion following a positive fecal occult blood test and associated patient factors, and the extent and predictors of longitudinal screening adherence in Israel. SETTING Nation-wide population-based study using data collected from four health maintenance organizations for the Quality Indicators in Community Healthcare Program. METHODS Screening uptake for the eligible population (aged 50-74) was recorded 2003-2018 using aggregate data. For a subcohort (2008-2012, N = 1,342,617), time-to-colonoscopy following a positive fecal occult blood test and longitudinal adherence to screening guidelines were measured using individual-level data, and associated factors assessed in multivariate models. RESULTS The annual proportion screened rose for both sexes from 11 to 65%, increasing five-fold for age group 60-74 and >six-fold for 50-59 year olds, respectively. From 2008 to 2012, 67,314 adults had a positive fecal occult blood test, of whom 71% eventually performed a colonoscopy after a median interval of 122 (95% confidence interval 110.2-113.7) days. Factors associated with time-to-colonoscopy included age, socioeconomic status, and comorbidities. Only 25.5% of the population demonstrated full longitudinal screening adherence, mainly attributable to colonoscopy in the past 10 years rather than annual fecal occult blood test performance (83% versus 17%, respectively). Smoking, diabetes, lower socioeconomic status, cardiovascular disease, and hypertension were associated with decreased adherence. Performance of other cancer screening tests and frequent primary care visits were strongly associated with adherence. CONCLUSIONS Despite substantial improvement in colorectal cancer screening uptake on a population level, individual-level data uncovered gaps in colonoscopy completion after a positive fecal occult blood test and in longitudinal adherence to screening, which should be addressed using focused interventions.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Aravah Keidar Tirosh
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Orit Paz Stostky
- Pharmacy Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Einat Elran
- Quality Management Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liora Valinsky
- Quality Department, Meuhedet Health Care, Tel Aviv, Israel
| | - Eran Matz
- Community Health Services, Leumit Health Services, Tel Aviv, Israel
| | - Michal Krieger
- Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Arye Ben Yehuda
- Quality Indicators in Community Healthcare Program, Jerusalem, Israel.,Department of Internal Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Dena H Jaffe
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Quality Indicators in Community Healthcare Program, Jerusalem, Israel
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Bronner G, Kitrey ND, Uziel N, Eli I, Raviv G, Ramon J, Elran E. Correlation between premature ejaculation and female vaginal penetration difficulties. Int J Impot Res 2015; 27:152-6. [PMID: 25716748 DOI: 10.1038/ijir.2015.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 11/29/2014] [Accepted: 01/07/2015] [Indexed: 01/16/2023]
Abstract
Male and female sexual dysfunctions encompass biological, psychological and interpersonal aspects. Premature ejaculation (PE) and female vaginal penetration difficulties (VPD) are problems that may concurrently impair the couple's sexual relationship. We have studied the correlation between PE and VPD in the female partner, in a cross-sectional study of 125 heterosexual couples (male age 35.01±10.63; female age 32.36±10.07). VPD included tampon insertion, gynecological examination, inserting self-finger or partner-finger and penile-vaginal intercourse. Female sexual function index (FSFI) and a validated PE questionnaire were used to measure the female sexual function and PE in their male partners. We found that female partners of men with anteportal ejaculation were found to experience significantly more VPDs, especially with regard to difficulties in penile penetration and tampon use. The intensity of pain in VPD was higher in females whose male partners presented anteportal ejaculation. No significant correlation was found between total male PE score and the total FSFI or separate domains of female sexual function. The results suggest that female VPD and male anteportal ejaculation are interrelated. Such severe couple sexual problems should be addressed in parallel. Further research is required to study the causation of PE and VPD.
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Affiliation(s)
- G Bronner
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
| | - N D Kitrey
- Department of Urology, Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Uziel
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - I Eli
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G Raviv
- Department of Urology, Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Ramon
- Department of Urology, Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - E Elran
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
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Gofine M, Paltiel O, Manor O, Cohen A, Elran E, Valinsky L, Matz E, Jaffe DH. Demographic, medical, and behavioral factors associated with colorectal cancer screening and diagnostic colonoscopy in Israel. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
557 Background: Colorectal cancer (CRC) is the third leading cause of cancer death worldwide and second leading cause of cancer death in Israel. Israel's universal health care system funds CRC screening (CRCS) (fecal occult blood testing or colonoscopy) for all adults aged 50-74. CRCS adherence is influenced by numerous factors including patient characteristics. In addition to screening asymptomatic individuals, those with anemia may have undiagnosed CRC and require aggressive case finding. This study’s goals were: 1) To compare the socio-demographic, health status, and health behavior characteristics of the eligible Israeli population who underwent any versus no CRCS (2009-2012); 2) To examine the relationship between anemia severity and CRCS likelihood; 3) To determine whether anemia status predicts time-to-CRCS. Methods: National retrospective cohort study of Israeli adults aged 51-71 on 1.1.2009 using electronic medical records from all 4 Israeli HMOs (n=1,009,898) over a 4-year period. Results: Differences in CRCS adherence were observed by patient characteristics. For example, ever-smokers comprised 17.9% of the screened population and 24.9% of the non-screened population (p<0.001). Increasing anemia severity was positively associated with any CRCS performance, especially colonoscopy. For example, severely anemic individuals (hemoglobin <10 g/dL for men, <8 g/dL for women) were significantly more likely to receive colonoscopy than those who were not anemic (OR = 3.23; 95% CI, 2.58-4.27). Anemia somewhat expedites CRCS. For example, 8.9% of those with anemia and 7.6% of those without anemia performed any CRCS within 30 days of hemoglobin level recording (p<0.001). Conclusions: Full CRCS adherence is not yet optimized in Israel. Particular attention directed at those at-risk for CRCS non-adherence may decrease CRC mortality. Although lower hemoglobin somewhat expedites colonoscopy performance, few individuals with anemia actually undergo colonoscopy. Further analysis accounting for confounding and effect modification is crucial for a more complete understanding of these relationships.
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Affiliation(s)
- Miriam Gofine
- Columbia University Mailman School of Public Health, New York, NY
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | | | | | | | - Eran Matz
- Leumit Health Fund, Tel Aviv, Israel
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Elran E, Bronner G, Uziel N, Eli I, Kitrey ND, Raviv G. The impact of vaginal penetration difficulties on the sexual functioning of women and their male partners. EUR J CONTRACEP REPR 2014; 19:352-8. [PMID: 24999222 DOI: 10.3109/13625187.2014.928686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare the sexual function of women with and without vaginal penetration difficulties (VPDs) and relate it to the sexual function of their male partners. METHODS All consenting women attending a sexual medicine centre during 2005-2007 completed the Female Sexual Function Index (FSFI) and answered questions about five VPDs (placement of a tampon, gynaecological examination, insertion of her or her partner's finger, and penile-vaginal intercourse). Male partners filled the International Index of Erectile Function (IIEF). RESULTS Full data were available for 223 women, and 118 male partners. Male partners of women with VPDs (n = 53) had lower sexual desire (p = 0.0225). The number of VPDs in the women concerned negatively correlated with their partners' desire (r = - 0.18339, p = 0.0468) and erectile function (r = - 0.19848, p = 0.0312). All women with at least one VPD (n = 109) reported significantly more sexual pain (p < 0.0001) and had worse sexual function scores (p = 0.014) than women with no VPDs (n = 114). Women with VPDs other than penile-vaginal penetration had worse orgasmic functioning (p = 0.0119). CONCLUSIONS The women's VPDs are correlated with worse sexual functioning for them and for their male partners. The five VPDs are a practical and useful tool for identifying impaired sexual functioning.
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Affiliation(s)
- Einat Elran
- * Sexual Medicine Centre, Sheba Medical Centre , Tel-Hashomer , Israel
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Uziel N, Bronner G, Elran E, Eli I. Sexual correlates of gagging and dental anxiety. Community Dent Health 2012; 29:243-247. [PMID: 23038943] [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: 06/01/2023]
Abstract
OBJECTIVE Both oro-related behavioural and sexual dysfunctions are non-life-threatening conditions which can have an impact on individual well-being. Possible common features include intra-body penetration, giving control to another person, and experiencing encounters that can sometimes be subjectively experienced as aggressive and/or abusive. The present study examined possible sexual correlates of dental anxiety and gagging. BASIC RESEARCH DESIGN A total of 448 individuals, who applied for sex therapy at the Sexual Medicine Center, Sheba Medical Center, Tel-Hashomer, Israel, completed the following sexual and dental functioning questionnaires: International Index of Erectile Function (men only), Female Sexual Function Index and difficulties with sexual penetration (women only), dental anxiety, gagging reflex and dentist preference (entire population). RESULTS Higher gagging reflex was associated with problems in sexual penetration and history of sexual abuse in women (especially one that included vaginal penetration). It was also associated with dental anxiety and higher preference for dentist of the same gender for both genders. CONCLUSIONS The study shows that gagging reflex can bear sexual connotations, especially in women.
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Affiliation(s)
- N Uziel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
Female sexual functioning is a complex process involving physiological, psychosocial and interpersonal factors. Sexual dysfunction (SD) is frequent (40-74%) among women with multiple sclerosis (MS), reflecting neurological dysfunction, psychological factors, depression, side effects of medications and physical manifestations of the disease, such as fatigue and muscle weakness. A conceptual model for sexual problems in MS characterizes three levels. Primary SD includes impaired libido, lubrication, and orgasm. Secondary SD is composed of limiting sexual expressions due to physical manifestations. Tertiary SD results from psychological, emotional, social, and cultural aspects. Sexual problems cause distress and may affect the family bond. Practical suggestions on initiation of discussion of sexual issues for MS patients are included in this review. Assessment and treatment of sexual problems should combine medical and psychosexual approaches and begin early after MS diagnosis. Intervention can be done by recognizing sexual needs, educating and providing information, by letting patients express their difficulties and referring them to specialists and other information resources.
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Affiliation(s)
- Gila Bronner
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel Hashomer, Israel.
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Yagil Y, Elran E, Tarchitzky O, Levy Y, Ashkenazi I. [Unplanned pregnancies among women soldiers in the IDF--an overview]. Harefuah 2005; 144:530-3, 600. [PMID: 16146146] [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: 05/04/2023]
Abstract
UNLABELLED According to the Security Service Law in Israel, a pregnant soldier serving her compulsory military service, who decides to continue with the pregnancy, is discharged from military service. If she wishes to terminate the pregnancy (TOP) and continue serving in the army, she is referred to a civilian pregnancy termination committee. OBJECTIVE This article aims to examine the incidence of pregnancies amongst soldiers during their compulsory military service (ages 18-20 years) and characterize the populations at risk. METHODS Data reflecting yearly incidence of pregnancies, number of TOPs, discharges from military duty as a result of continuation of pregnancy and missed abortions amongst soldiers during their compulsory military duty were derived from the military social services records for the period 1997-2003. Socio-demographic variables, number of prior pregnancies, age of pregnancy, means of TOP, relationship with the other parent and his involvement regarding the pregnancy, were obtained from military records between the years 2002-2003. RESULTS The reported yearly incidence of pregnancies in 1997 was 18.6 per 1000 soldiers during their compulsory military service. In 2003, the incidence rose to 21.5 per 1000. The incidence of continuation of pregnancy, TOPs and missed abortions remained unchanged. Number-wise, the pregnancies occurred most often in Israeli-born, high-school educated young women. When stratifying by country of birth, however, the percentage of pregnancies within subgroups varied significantly. Half of the pregnancies were terminated by pharmaceutical means. In the majority of cases, the pregnancy resulted from a relationship lasting over half a year with a male partner, who was aware of the pregnancy and involved with the decisions regarding its outcome. CONCLUSION In recent years there has been a rise in the reported yearly incidence of pregnancies among soldiers aged 18-20 years serving their compulsory military service. These findings reiterate the need to increase the efforts in implementing sex education programs amongst educators and the responsible military authorities.
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Affiliation(s)
- Yael Yagil
- Medical Services and Supply Center, Medical Corps, Israel Defense Forces, Beer Sheva, Israel
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Elran E, Alesker M, Baum M, Hendler I, Kreiser D, Sivan E, Schiff E, Dennery P, Stevenson D, Rosenthal T, Peleg E, Seidman D. 325 Aspirin administration during pregnancy enhances placental heme oxygenase-1 expression in spontaneously hypertensive rats. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80356-2] [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: 10/24/2022]
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Weissmann A, Elran E, Givoni S, Poles L, Tadmor B. [Organophosphate poisoning in inexperienced workers]. Harefuah 2001; 140:818-21, 896, 895. [PMID: 11579729] [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: 02/21/2023]
Abstract
Organophosphates are frequently used as insecticides in agricultural areas, therefore they may pose a risk for accidental exposure by dermal contact or through inhalation. We present the cases of eight young men, who worked unprotected and inexperienced with organophosphates. They were exposed dermally and developed mainly gastrointestinal symptoms and also diaphoresis, hypersalivation, blurred vision and miosis. One patient developed severe weakness, fasciculations, disorientation and sleepiness. All had low levels of plasma acetylcholinesterase. All were admitted to the hospital and received antidotal treatment of atropine and toxogonin. They were released after 48 hours in good physical condition. The hospital staff rapidly diagnosed the organophosphate intoxication; additional doctors and nurses were called to the emergency department. The patients were decontaminated in showers within the hospital. This case emphasizes the need for workers handling pesticides, to be supervised by an experienced person and the advantages of hospital drills in rapid diagnosis and preparedness to provide treatment to many patients.
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Affiliation(s)
- A Weissmann
- Obstetrics and Gynecology Department, Sheba Medical Center
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Magee LA, Elran E, Bull SB, Logan A, Koren G. Risks and benefits of beta-receptor blockers for pregnancy hypertension: overview of the randomized trials. Eur J Obstet Gynecol Reprod Biol 2000; 88:15-26. [PMID: 10659912 DOI: 10.1016/s0301-2115(99)00113-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [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: 11/21/2022]
Abstract
OBJECTIVE Examine the benefits/risks of beta-blockers for pregnancy hypertension. STUDY DESIGN Meta-analysis of relevant trials identified by comprehensive literature review (1966-97). RESULTS Included were 30 trials for pregnancy hypertension, and four others for perinatal outcomes only. For mild chronic hypertension treated throughout pregnancy (n=2 trials), oral beta-blockers (compared with no therapy) were associated with an inconsistent increase in small for gestational age (SGA) infants (OR 2.46 [1.02, 5.92]). For mild-moderate 'late-onset' pregnancy hypertension (i.e. either chronic treated only late in pregnancy, or pregnancy-induced) (n=8 trials), oral beta-blockers (compared with no therapy) were associated with a decrease in severe hypertension (OR 0.27 [0.16, 0.451), borderline decrease in development of proteinuria (OR 0.69 [0.48, 1.02]), decrease in RDS (OR 0.33 [0.13, 0.85]), but a borderline increase in SGA infants (OR 1.47 [0.96, 2.26]). Beta-blockers were equivalent to other agents (n=15 trials). For severe 'late-onset' pregnancy hypertension (n=5 trials), i.v. labetalol produced less maternal hypotension (OR 0.13 [0.03, 0.71]) and fewer cesareans (OR 0.23 [0.13, 0.63]) than i.v. hydralazine/diazoxide. CONCLUSIONS It is not clear that the benefits outweigh the risks when beta-blockers are used to treat mild to moderate chronic or pregnancy-induced hypertension, given the unknown overall effect on perinatal outcomes. For severe 'late-onset' pregnancy hypertension, i.v. labetalol is safer than i.v. hydralazine or diazoxide.
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Affiliation(s)
- L A Magee
- Division of Clinical Pharmacology/Toxicology, The Hospital for Sick Children, Toronto, Ont., Canada.
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Gotlieb WH, Feldman B, Feldman-Moran O, Zmira N, Kreizer D, Segal Y, Elran E, Ben-Baruch G. Intraperitoneal pressures and clinical parameters of total paracentesis for palliation of symptomatic ascites in ovarian cancer. Gynecol Oncol 1998; 71:381-5. [PMID: 9887235 DOI: 10.1006/gyno.1998.5215] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [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: 11/22/2022]
Abstract
OBJECTIVE The present study was designed to prospectively evaluate the intraperitoneal pressure, as well as clinical and hemodynamic effects of total paracentesis, as palliation of symptomatic ascites in ovarian cancer patients. METHODS Prospective study of 35 sequential total paracenteses was performed using a Veres cannula on patients with advanced recurrent ovarian cancer with symptomatic tense ascites. Relevant clinical symptoms and patient well-being were evaluated. Vital signs, abdominal parameters, and hydrostatic intraperitoneal pressure were recorded before, during, and after the procedure. RESULTS Intraperitoneal pressure dropped from 30 +/- 7 cmH2O before paracentesis to 13 +/- 6 cmH2O after the procedure (P < 0.0001). Marked symptomatic improvement was observed in all patients (89% complete relief, 11% partial relief), while all the patients tolerated the procedure well without any complications. The mean volume of ascitic fluid removed was 4800 ml. Mean respiratory rate and mean heart rate were both significantly decreased following the procedure (29.3 to 21.4 respirations per min and 101.5 to 93.6 beats per min, respectively). Mean systolic blood pressure mildly decreased (6.6 mmHg), while the mean diastolic blood pressure did not significantly change. None of the patients presented signs or symptoms of hypovolemia during or after the total paracentesis. CONCLUSIONS Measurement of intraperitoneal pressures during total paracentesis for tense ascites in ovarian cancer patients indicated that the severity of symptoms correlated with the intraperitoneal pressure prior to paracentesis, but not with the volume of ascites. Intraperitoneal pressures measured following total paracentesis in patients with ovarian cancer were similar to the baseline intraperitoneal pressure measured in patients undergoing peritoneal dialysis.
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Affiliation(s)
- W H Gotlieb
- Department of Obstetrics and Gynecology, Tel-Aviv University, Tel-Hashomer, Israel
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