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Brill J, Zacay G, Raviv G, Tsamir J, Heymann AD. Continuity of care after attempted suicide: the primary care physicians' role. Fam Pract 2023; 40:776-781. [PMID: 37053085 DOI: 10.1093/fampra/cmad045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Suicide prevention is an important public health concern, and primary care physicians (PCPs) often serve as the first point of contact for individuals at risk. Few interventions in the primary care setting have been linked to reduced suicide attempt (SA) rates. The Continuity of Care (COC) protocol was developed to improve the primary care treatment of high-risk suicidal patients. OBJECTIVES This study examined PCPs' awareness of the COC protocol, its perceived effectiveness, and PCPs' attitudes towards post-SA-discharge visits. METHODS A survey was administered to 64 PCPs who had a recent office visit with a patient who had attempted suicide. Data were collected between May and July 2021 and analyzed anonymously. RESULTS Thirty of the 64 PCPs answered the questionnaires, giving a response rate of 47%. Most were unaware of the COC protocol. Seventeen physicians (57%) felt that the visit strengthened their physician-patient relationship, and while nearly half of the physicians (47%, n = 14) agreed they had the knowledge and tools to manage a post-SA-discharge visit, 43% of them (n = 13) preferred that the visit would have been handled by a mental health professional rather than a PCP. Analysis of open-ended questions uncovered three themes: knowledge gap, system limitation, and the PCP's role in maintaining the COC. CONCLUSION The findings of this study highlighted the important role PCPs can play to prevent future SAs, as well as exposed gaps in the knowledge and system constraints that impede them from carrying out this role as effectively as possible.
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Affiliation(s)
- Jonathan Brill
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Raviv
- Directorate of Mental Health, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Judith Tsamir
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Valinsky D, Heymann AD, Albukrek D, Tsamir J, Zacay G. The critical factors for COVID-19 vaccination uptake are perceived vaccine effectiveness and the desire to protect others. Hum Vaccin Immunother 2023; 19:2265170. [PMID: 37846842 PMCID: PMC10583610 DOI: 10.1080/21645515.2023.2265170] [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: 06/07/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023] Open
Abstract
The proportion of the population vaccinated in Israel against COVID-19 in 2021 was significantly higher than that of the annual uptake rates of the influenza vaccine over time. Understanding the reasons behind the high vaccination rate may facilitate maintaining these rates if annual COVID-19 vaccination is required. Using a mixed-methods design, we characterized the individuals who were vaccinated and studied their attitudes toward vaccines and motivators for the COVID-19 vaccine. The first part was a cross-sectional study of adults aged 65 and over who were vaccinated against COVID-19. We stratified them according to their annual influenza vaccination patterns, and compared variables such as age, gender, health status, and timing of COVID-19 vaccination. The second part consisted of a questionnaire administered to a subsample of the above population, inquiring about vaccine hesitancy, motivators for vaccination, and intention to be vaccinated in the future. We found that motivating factors for COVID-19 vaccination are similar between those who regularly vaccinate against influenza and those who don't. Internal motivators such as perceived vaccine effectiveness and the desire to protect others were stronger than external rewards or sanctions. High adherence to annual influenza vaccine recommendations was associated with earlier COVID-19 vaccine uptake. Respondents with lower adherence to influenza vaccines were more likely to demonstrate higher levels of vaccine hesitancy. These factors should be addressed in future vaccination campaigns.
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Affiliation(s)
- Danna Valinsky
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anthony D. Heymann
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meuhedet Health Services, Tel Aviv, Israel
| | | | | | - Galia Zacay
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meuhedet Health Services, Tel Aviv, Israel
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3
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Kagan I, Tsamir J, Engelchin Nissan E. Public views on healthcare workers' burnout before and during COVID-19: A comparative study. J Nurs Scholarsh 2023; 55:1036-1043. [PMID: 36938840 DOI: 10.1111/jnu.12878] [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: 08/26/2022] [Revised: 01/02/2023] [Accepted: 01/20/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Understanding burnout among nurses and physicians may mobilize public support for increasing budgets, personnel, and trust in both routine and pandemic times. The study aimed to examine public views of nurse and physician burnout both before and 1 year after the COVID-19 outbreak. DESIGN This study was conducted in two phases in a pre-post design. METHODS The general public (a random sample) responded to a structured questionnaire with 1-2 open-ended questions: (a) before the COVID-19 pandemic, in 2019 during routine life (n = 504) and (b) 1 year after the COVID-19 outbreak, in 2021 (n = 500). Quantitative and qualitative data on public perceptions of nurse and physician burnout, its sources and consequences, were collected. RESULTS The public view was that hospital physicians and even more so hospital nurses suffer from higher burnout than those working in the community, and that this worsened during the pandemic. Three themes related to caregiver burnout were identified: (a) work overload, (b) lack of sensitivity, empathy, and motivation, and (c) impaired ability to provide quality care. CONCLUSIONS The public is aware of the experiences of caregivers both in times of routine and in emergency. Healthcare management must influence public opinion in order to receive support for organizational steps. CLINICAL RELEVANCE Healthcare leaders should leverage public support in order to receive backing for organizational moves aimed at improving work conditions and, in turn, the quality of care and patient outcomes.
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Affiliation(s)
- Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
| | - Judith Tsamir
- The Israel Academic College in Ramat Gan, Ramat Gan, Israel
| | - Esti Engelchin Nissan
- Head, The Bachelor's Degree Program in Economics, The Israel Academic College in Ramat Gan, Ramat Gan, Israel
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Shasha D, Bareket R, Sikron FH, Gertel O, Tsamir J, Dvir D, Mossinson D, Heymann AD, Zacay G. Real-world safety data for the Pfizer BNT162b2 SARS-CoV-2 vaccine: historical cohort study. Clin Microbiol Infect 2022; 28:130-134. [PMID: 34592420 PMCID: PMC8479307 DOI: 10.1016/j.cmi.2021.09.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The Pfizer BNT162b2 vaccine showed a reassuring safety profile in clinical trials, but real-world data are scarce. Bell's palsy, herpes zoster, Guillain-Barré syndrome (GBS) and other neurological complaints in proximity to vaccination have received special public attention. We compared their rates among vaccinated and unvaccinated individuals. METHODS Individuals ≥16 years vaccinated with at least one dose of BNT162b2 were eligible for this historical cohort study in a health maintenance organization insuring 1.2 million citizens. Each vaccinee was matched to a non-vaccinated control by sex, age, population sector (general Jewish, Arab, ultra-orthodox Jewish) and comorbidities. Diagnosis of Covid-19 before or after vaccination was an exclusion criterion. The outcome was a diagnosis of Bell's palsy, GBS, herpes zoster or symptoms of numbness or tingling, coded in the visit diagnosis field using ICD-9 codes. Diagnoses of Bell's palsy and GBS were verified by individual file review. RESULTS Of 406 148 individuals vaccinated during the study period, 394 609 (97.2%) were eligible (11 539 excluded). A total of 233 159 (59.1%) were matched with unvaccinated controls. Mean follow was 43 ± 15.14 days. In vaccinated and unvaccinated individuals there were 23 versus 24 cases of Bell's palsy (RR 0.96, CI 0.54-1.70), one versus zero cases of GBS, 151 versus 141 cases of herpes zoster (RR 1.07, CI 0.85-1.35) and 605 versus 497 cases of numbness or tingling (RR 1.22, CI 1.08-1.37), respectively. DISCUSSION No association was found between vaccination, Bell's palsy, herpes zoster or GBS. Symptoms of numbness or tingling were more common among vaccinees. This study adds reassuring data regarding the safety of the BNT162b2 vaccine.
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Affiliation(s)
- David Shasha
- Meuhedet Health Maintenance Organization, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Ronen Bareket
- Meuhedet Health Maintenance Organization, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Omer Gertel
- Meuhedet Health Maintenance Organization, Israel
| | | | - David Dvir
- Meuhedet Health Maintenance Organization, Israel
| | | | - Anthony D Heymann
- Meuhedet Health Maintenance Organization, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Zacay
- Meuhedet Health Maintenance Organization, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sharir T, Hollander I, Hemo B, Tsamir J, Yefremov N, Bojko A, Prokhorov V, Pinskiy M, Slomka P, Amos K. Survival benefit of coronary revascularization after myocardial perfusion SPECT: The role of ischemia. J Nucl Cardiol 2021; 28:1676-1687. [PMID: 31823328 DOI: 10.1007/s12350-019-01932-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/26/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Survival benefit of revascularization over medical therapy (MT) in patients with stable ischemic heart disease (SIHD) is uncertain. We evaluated the prognostic effects of revascularization in patients with SIHD undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). METHODS Of 47,894 patients, 7973 had ischemia ≥ 5% of the left ventricle. Of these, 1837 underwent early revascularization (≤ 60 days after SPECT-MPI). The rest were MT subgroup. Follow-up period was 4.04 ± 1.86 years. Statin therapy intensity and adherence were assessed. Outcomes were all-cause mortality, death + non-fatal myocardial infarction (MI), and MACE [major adverse cardiac event = death + MI + late revascularization (> 60 days after SPECT-MPI)]. RESULTS Among patients with moderate-severe ischemia (≥ 10%), death rate was lower in early revascularization compared to MT subgroup (1.42%/year vs 3.12%/year, adjusted hazard ratio (HR) 0.67 (95% CI 0.50-0.90, P = .008). Death + MI and MACE rates were also lower, adjusted HR 0.69 (0.55-0.88, P = .003) and 0.80 (0.69-0.92, P = .003). Revascularization was beneficial in optimal statin therapy subgroup (death rate 1.04%/year vs 2.36%/year, adjusted HR 0.51 (0.30-0.86, P = .012). In mild ischemia (5%-9%), revascularization did not improve survival or MI-free survival, and was associated with higher MACE rate (8.86%/year vs 7.67%/year, adjusted HR 1.30 (1.12-1.52, P < .001). CONCLUSION Compared to MT, revascularization was associated with reduced risk of death, death + MI, and MACE in patients with moderate-severe ischemia, incremental over optimal statin therapy. In mild ischemia, revascularization was associated with higher risk of MACE, driven by late revascularization, with no impact on death and death + MI.
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Affiliation(s)
- Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, Building C, 67891, Tel Aviv, Israel.
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Idan Hollander
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, Building C, 67891, Tel Aviv, Israel
| | | | | | - Nikolay Yefremov
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, Building C, 67891, Tel Aviv, Israel
| | - Andrzej Bojko
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, Building C, 67891, Tel Aviv, Israel
| | - Vitaly Prokhorov
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, Building C, 67891, Tel Aviv, Israel
| | - Marina Pinskiy
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, Building C, 67891, Tel Aviv, Israel
| | - Piotr Slomka
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Katz Amos
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Zacay G, Shasha D, Bareket R, Kadim I, Hershkowitz Sikron F, Tsamir J, Mossinson D, Heymann AD. BNT162b2 Vaccine Effectiveness in Preventing Asymptomatic Infection With SARS-CoV-2 Virus: A Nationwide Historical Cohort Study. Open Forum Infect Dis 2021; 8:ofab262. [PMID: 34189176 PMCID: PMC8231369 DOI: 10.1093/ofid/ofab262] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 04/02/2021] [Accepted: 05/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background There is strong evidence regarding the efficacy and effectiveness of the BNT162b2 vaccine in preventing symptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a relative paucity of data regarding its effectiveness in the prevention of asymptomatic infection. Methods In this real-world observational study, we identified a subpopulation of individuals in a large health maintenance organization who were repeatedly tested for SARS-CoV-2 infection by polymerase chain reaction (PCR). We included these individuals in the study cohort and compared those who were vaccinated with BNT162b2 mRNA vaccine to unvaccinated individuals. A positive SARS-CoV-2 PCR test result was used as the outcome. The follow-up period was from January 1, 2021, until February 11, 2021. Results A total of 6286 individuals were included in the cohort. Seven days after the second vaccine dose, a rate of 6 positive PCR tests per 10 000 person-days was recorded, compared with a rate of 53 positive tests per 10 000 person-days for the unvaccinated group. The estimated vaccine effectiveness against infection with SARS-CoV-2 virus after 2 vaccine doses was 89% (95% CI, 82%-94%). The estimated effectiveness 2 weeks after the first vaccine dose was 61% (95% CI, 49%-71%). Conclusions In this study, vaccination with BNT162b2 reduced infection rates among individuals who underwent screening by frequent SARS-CoV-2 PCR testing. Using a cohort of frequently tested individuals reduced the indication bias for the PCR testing, which enabled estimation of infection rates.
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Affiliation(s)
- Galia Zacay
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Shasha
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronen Bareket
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Kadim
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | | | - Judith Tsamir
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | | | - Anthony D Heymann
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Na'amnih W, Ben Tov A, Bdair-Amsha A, Cohen S, Tsamir J, Chodick G, Muhsen K. Physicians' adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study. Isr J Health Policy Res 2020; 9:28. [PMID: 32527326 PMCID: PMC7291643 DOI: 10.1186/s13584-020-00389-y] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) play a pivotal role in the management of illnesses of the digestive tract. The study aim was to assess the adherence of PCPs to the guidelines on the management of Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) in adults. METHODS We conducted a cross-sectional study during March-July 2017 using the survey platform of Maccabi Healthcare Services in Israel. The study questionnaire assessed adherence to the Maastricht/Florence guidelines on H. pylori infection and the American College of Gastroenterology guidelines on the management of GERD. We sent the study questionnaires to a random sample of 610 PCPs via electronic mails. We contacted those who did not respond by telephone; eventually 180 physicians completed the survey. RESULTS Ninety (50%) and 60 (36%) of the responders reported using professional guidelines for the diagnosis and management of H. pylori infection and GERD, respectively. Of the 180 participants, 153 (85%) reported referring patients with suspected peptic ulcer disease to H. pylori testing, 109 (61%) reported referring patients with unexplained iron deficiency anemia and 83 (46%) refer relatives of gastric cancer patients. In caring for young patients who have dyspepsia without alarm symptoms, 127 (74%) reported referral to a urea breath test for the diagnosis of H. pylori infection, and 136 (81%) referral to a specialist in gastroenterology if alarm symptoms present. Triple therapy with proton pump inhibitors/clarithromycin/amoxicillin or metronidazole was reported as first-line therapy by 141 (83%) participants. For GERD, 94-98% of the participants followed the appropriate recommendations. CONCLUSIONS We identified gaps between the practices of PCPs and the guidelines on H. pylori infection management, while guidelines on GERD management are well adopted. Simplification of the guidelines and exploring barriers towards their implementation by PCPs is warranted.
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Affiliation(s)
- Wasef Na'amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Amir Ben Tov
- Maccabi Healthcare Services, Tel Aviv, Israel.,Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amna Bdair-Amsha
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Gabriel Chodick
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Maccabi Healthcare Services, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
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Adler L, Tsamir J, Katz R, Koren G, Yehoshua I. Associations of sociodemographic and clinical factors with perinatal depression among Israeli women: a cross-sectional study. BMC Psychiatry 2019; 19:331. [PMID: 31675947 PMCID: PMC6824132 DOI: 10.1186/s12888-019-2311-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Perinatal depression is a common problem that affects about 18% of women worldwide, though the heterogeneity between countries is great. The aims of this study were to assess the prevalence of perinatal depressive symptoms in a national sample of women in Israel, and to investigate associations of these symptoms with demographic, medical and lifestyle factors. METHODS The study included all members of Maccabi Health Services, the second largest health maintenance organization in Israel, who filled the Edinburgh Postnatal Depression Scale (EPDS) during 2015-2016. Crude odds ratios (ORs) and adjusted ORs (aORs) are presented for associations of sociodemographic, medical and lifestyle factors with perinatal depressive symptoms, according to a score ≥ 10 on the EPDS. RESULTS Of 27,520 women who filled the EPDS, 1346 (4.9%) met the criteria for perinatal depression. In a logistic regression analysis we found the following factors associated with perinatal depression: the use of antidepressant medications (aOR = 2.34, 95% CI 1.94-2.82, P < 0.001 and aOR = 3.44; 95% CI 2.99-3.97, P < 0.001 for ≤3 months and > 3 months respectively), a diagnosis of chronic diabetes mellitus (aOR = 2.04; 95% CI 1.22-3.43, P = 0.007), Arab background (aOR = 2.28; 95% CI 1.82-2.86, P < 0.001), current and past smoking (aOR = 1.62; 95% CI 1.35-1.94, P < 0.001 and aOR = 1.36; 95% CI 1.05-1.76, P = 0.021, respectively), and anaemia (aOR = 1.17; 95% CI 1.04-1.32, P = 0.011). Orthodox Jewish affiliation and residence in the periphery of the country were associated with lower perinatal depression (aOR = 0.48; 95% CI 0.36-0.63, P < 0.001 and aOR = 0.72; 95% CI 0.57-0.92, P = 0.007, respectively). CONCLUSIONS The prevalence of perinatal depression in this study was 4.9%. Perinatal depression was associated with a number of demographic, medical and lifestyle factors, including the use of antidepressant medication, chronic diabetes mellitus, Arab background, current or past smoking, and anaemia. These risk factors may help identify women at risk of perinatal depression.
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Affiliation(s)
- Limor Adler
- Family Medicine - Southern region, Maccabi Health Services, Tel Aviv University, Tel Aviv, Israel.
| | - Judith Tsamir
- grid.425380.8Maccabi Healthcare Services, Tel Aviv, Israel
| | - Rachel Katz
- grid.425380.8Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gideon Koren
- 0000 0000 9824 6981grid.411434.7Kahn - Maccabi Institute of Research and Innovation, Ariel University, Ari’el, Israel
| | - Ilan Yehoshua
- 0000 0004 1937 0546grid.12136.37Family Medicine - Southern region, Maccabi Health Services, Tel Aviv University, Tel Aviv, Israel ,0000 0004 1937 0511grid.7489.2Ben Gurion University, Be’er Sheva, Israel
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Peretz C, Rozani V, Giladi N, El-Ad B, Tsamir J, Hemo B, Gurevich T. The Modifying Effect of Age on Survival in Parkinson’s Disease: A Population-Based Cohort Study. Neuroepidemiology 2019; 53:13-19. [DOI: 10.1159/000492672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022] Open
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Rozani V, Giladi N, Gurevich T, El-Ad B, Tsamir J, Hemo B, Peretz C. Anemia in men and increased Parkinson's disease risk: A population-based large scale cohort study. Parkinsonism Relat Disord 2019; 64:90-96. [PMID: 30922776 DOI: 10.1016/j.parkreldis.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/05/2018] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the association between anemia and Parkinson's disease risk (PD) in men and women. METHODS A population-based cohort of 474,129 individuals (aged 40-79 years at date of first Hb test, 47.4% men) with repeated Hb levels was derived from a large Healthcare Maintenance Organization that serves 2 million citizens in Israel (study-period 1.1.1999-31.12.2012). An annual anemia indicator [Hb levels (g/dL) for men <13; for women <12.0] was assessed for each individual and they were followed from first Hb test until the date of PD incidence, death or end of the study. Cox-proportional hazards models, stratified by sex and age, with time-dependent anemia covariate were used to estimate adjusted Hazard Ratio with 95% of confidence intervals (HR, 95%CI) for PD. RESULTS During a mean follow up of 8.8 ± 3.9 years (7.0 ± 3.6 for men and 7.9 ± 4.1 for women), 2427 incident PD cases were detected. Cumulative PD incidence at ages over 65 years was 3.3%. The mean levels of Hb at baseline was 14.8 ± 1.1 g/dL among men; 12.8 ± 1.1 g/dL among women. Anemia was associated with significant PD risk among men, age-pooled HR = 1.19 (95%CI: 1.04-1.37), with the highest risk between ages 60-64 years [HR = 1.41 (95%CI: 1.03-1.93)]. Anemia was not associated with PD risk among women across all age-groups. The age-pooled HR for women was 1.02 (95%CI 0.95-1.09). CONCLUSIONS The finding that anemia was associated with PD risk in men, especially in middle age, warrants further investigations on common pathophysiologic processes between Hb abnormalities and brain dysfunction.
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Affiliation(s)
- Violetta Rozani
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Tanya Gurevich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Chava Peretz
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hochhauser M, Avoros O, Perman V, Simcha N, Tsamir J, Fremder A. Survey of family doctors' attitudes towards statin treatment in patients with type 2 diabetes. Diabetes Res Clin Pract 2019; 148:81-92. [PMID: 30583035 DOI: 10.1016/j.diabres.2018.12.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 10/16/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
Abstract
AIMS Clinical guidelines advocate that cardiovascular benefits of statin treatment overweigh the risk of impairment of glucose metabolism. The aim of the study was to examine the attitudes of family doctors towards statin treatment in patients with type 2 diabetes. METHODS We disseminated a questionnaire examining doctors' attitudes to existing clinical guidelines and the factors leading to a doctor's decision to prescribe statins to diabetic patients. RESULTS Clinical policy and guidelines were defined by doctors as having the greatest influence on the decision to prescribe statins for diabetic patients particularly by salaried doctors in comparison to self-employed doctors (χ2 = 9.138, df = 3, p ≤ 0.01). When considering the ways healthcare services can assist cholesterol control, monetary compensation yielded higher importance by young doctors compared to mature doctors (χ2 = 8.15, df = 2, p ≤ 0.01), while nursing services in the clinic yielded higher importance by mature doctors in comparison to younger doctors(χ2 = 13.7, df = 2, p ≤ 0.01). CONCLUSIONS Doctors defined a list of priorities for organizational support mechanisms that are likely to lead to the formation of an intervention plan for increasing the percentage of balanced cholesterol levels in patients with diabetes.
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Affiliation(s)
- Michal Hochhauser
- Department of Health Management Systems, Faculty of Health Sciences, Ariel University, 65 Ramat Hagolan, Ariel 407000, Israel.
| | - Olga Avoros
- Maccabi Healthcare Services, Hanadiv 3, Herzelia 4648503, Israel.
| | - Victoria Perman
- Maccabi Healthcare Services, Hanadiv 3, Herzelia 4648503, Israel
| | - Nava Simcha
- Maccabi Healthcare Services, Hanadiv 3, Herzelia 4648503, Israel.
| | - Judith Tsamir
- Maccabi Healthcare Services, Hanadiv 3, Herzelia 4648503, Israel.
| | - Ariela Fremder
- Maccabi Healthcare Services, Hanadiv 3, Herzelia 4648503, Israel.
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Rozani V, Gurevich T, Giladi N, El-Ad B, Tsamir J, Hemo B, Peretz C. Higher serum cholesterol and decreased Parkinson's disease risk: A statin-free cohort study. Mov Disord 2018; 33:1298-1305. [DOI: 10.1002/mds.27413] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Violetta Rozani
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Tanya Gurevich
- Neurological Institute; Tel Aviv Medical Center; Tel Aviv Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Nir Giladi
- Neurological Institute; Tel Aviv Medical Center; Tel Aviv Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | | | | | | | - Chava Peretz
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Rozani V, Giladi N, El-Ad B, Gurevich T, Tsamir J, Hemo B, Peretz C. Statin adherence and the risk of Parkinson's disease: A population-based cohort study. PLoS One 2017; 12:e0175054. [PMID: 28388626 PMCID: PMC5384675 DOI: 10.1371/journal.pone.0175054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/20/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND While experimental data provided some compelling evidence on the benefits of statins on dopaminergic neurons, observational studies reported conflicting results regarding the potential of statins to effect the risk of Parkinson's disease (PD). OBJECTIVES To evaluate the association between changes in statin adherence over time and PD risk. METHODS A population-based cohort of new statin users (ages 40-79, years 1999-2012) was derived from a large Israeli healthcare services organization. Data included history of statin purchases and low density lipoprotein cholesterol (LDL-C) levels. Personal statin adherence was measured annually by the proportion of days covered (PDC). PD was detected employing a drug-tracer approach. Stratified (by sex, LDL-C levels at baseline and age) Cox proportional hazards models with time-dependent covariates were used to compute adjusted Hazard Ratio (HR) with 95%CI. RESULTS The cohort included 232,877 individuals, 49.3% men. Mean age at first statin purchase was 56.5 (±9.8) years for men and 58.7 (±9.2) years for women. PDC distribution for the whole follow up period differed between men and women: medians 58.3% and 54.1% respectively. During a mean follow up of 7.6 (±3.4) years, 2,550 (1.1%) PD cases were identified. In a 1-year lagged analysis, we found no association between annual statin adherence and PD risk in all age-groups regardless of statin type and potency. Age-pooled HR (95%CI) for men and women with LDL-C levels at baseline ≤160mg/dL were: 0.99 (0.99-1.01), 1.01 (1.00-1.02); and for men and women with LDL-C >160mg/dL levels: 0.99 (0.98-1.01), 0.97 (0.98-1.01). CONCLUSIONS Our findings suggest that statin adherence over time does not affect PD risk. Future studies should use large-scale cohorts and refining assessments of long-term profiles in statin adherence.
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Affiliation(s)
- Violetta Rozani
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tanya Gurevich
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Chava Peretz
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peretz C, Gurel R, Rozani V, Gurevich T, El-Ad B, Tsamir J, Giladi N. Cancer incidence among Parkinson's disease patients in a 10-yrs time-window around disease onset: A large-scale cohort study. Parkinsonism Relat Disord 2016; 28:68-72. [DOI: 10.1016/j.parkreldis.2016.04.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/19/2016] [Accepted: 04/23/2016] [Indexed: 01/07/2023]
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Rozenfeld V, Ribak J, Danziger J, Tsamir J, Carmeli E. Prevalence, risk factors and preventive strategies in work-related musculoskeletal disorders among Israeli physical therapists. Physiother Res Int 2010; 15:176-84. [DOI: 10.1002/pri.440] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hemo B, Shamir-Shtein NH, Silverman BG, Tsamir J, Heymann AD, Tsehori S, Friedman NL. Can a nationwide media campaign affect antibiotic use? Am J Manag Care 2009; 15:529-534. [PMID: 19670956] [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
OBJECTIVE To evaluate the effectiveness of a nationwide media campaign to reduce antibiotic overuse among children. STUDY DESIGN Prospective observational study of the pediatric population of a health maintenance organization (HMO) comparing antibiotic use during the baseline (November 2004-February 2005) and study (November 2005-February 2006) periods. METHODS During January 2006 the HMO conducted a media campaign to increase public awareness of the risks of misusing antibiotics, particularly for influenza-like diseases. Antibiotic purchasing rates during specific periods in the study winter were compared with those during corresponding periods in the baseline winter among children diagnosed with upper respiratory infection (URI), otitis media (OM), or pharyngitis. After the intervention, a random subset of the study population was surveyed by telephone to estimate the level of exposure to the campaign and attitudes toward antibiotic use. RESULTS The study population consisted of 101,401 children in the baseline winter and 84,979 in the study winter. We noted reductions in antibiotic purchasing for URI, OM, and pharyngitis during the postintervention period compared with the preintervention period (URI odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.69, 0.81; OM OR = 0.65, 95% CI = 0.59, 0.72; pharyngitis OR = 0.93, 95% CI = 0.89, 0.97). Parents of children with URI exposed to the media campaign were more likely to agree with standards of appropriate antibiotic use than parents not exposed (F(1) = 4.18, P = .04). CONCLUSIONS A media campaign aimed at changing patient behavior can contribute to reducing the rate of inappropriate antibiotic use.
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