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Revel-Vilk S, Shalev V, Gill A, Paltiel O, Manor O, Tenenbaum A, Azani L, Chodick G. Assessing the diagnostic utility of the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system using real-world data. Orphanet J Rare Dis 2024; 19:71. [PMID: 38365689 PMCID: PMC10873939 DOI: 10.1186/s13023-024-03042-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Gaucher disease (GD) is a rare autosomal recessive condition associated with clinical features such as splenomegaly, hepatomegaly, anemia, thrombocytopenia, and bone abnormalities. Three clinical forms of GD have been defined based on the absence (type 1, GD1) or presence (types 2 and 3) of neurological signs. Early diagnosis can reduce the likelihood of severe, often irreversible complications. The aim of this study was to validate the ability of factors from the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system to discriminate between patients with GD1 and controls using real-world data from electronic patient medical records from Maccabi Healthcare Services, Israel's second-largest state-mandated healthcare provider. METHODS We applied the GED-C scoring system to 265 confirmed cases of GD and 3445 non-GD controls matched for year of birth, sex, and socioeconomic status identified from 1998 to 2022. The analyses were based on two databases: (1) all available data and (2) all data except free-text notes. Features from the GED-C scoring system applicable to GD1 were extracted for each individual. Patients and controls were compared for the proportion of the specific features and overall GED-C scores. Decision tree and random forest models were trained to identify the main features distinguishing GD from non-GD controls. RESULTS The GED-C scoring distinguished individuals with GD from controls using both databases. Decision tree models for the databases showed good accuracy (0.96 [95% CI 0.95-0.97] for Database 1; 0.95 [95% CI 0.94-0.96] for Database 2), high specificity (0.99 [95% CI 0.99-1]) for Database 1; 1.0 [95% CI 0.99-1] for Database 2), but relatively low sensitivity (0.53 [95% CI 0.46-0.59] for Database 1; 0.32 [95% CI 0.25-0.38]) for Database 2). The clinical features of splenomegaly, thrombocytopenia (< 50 × 109/L), and hyperferritinemia (300-1000 ng/mL) were found to be the three most accurate classifiers of GD in both databases. CONCLUSION In this analysis of real-world patient data, certain individual features of the GED-C score discriminate more successfully between patients with GD and controls than the overall score. An enhanced diagnostic model may lead to earlier, reliable diagnoses of Gaucher disease, aiming to minimize the severe complications associated with this disease.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel.
| | - Varda Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aidan Gill
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Ora Paltiel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
- Department of Hematology , Hadassah Medical Organization, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | | | - Liat Azani
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv, Israel
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Revel-Vilk S, Zimran A, Istaiti M, Azani L, Shalev V, Chodick G, Manor O, Paltiel O. Cancer Risk in Patients with Gaucher Disease Using Real-World Data. J Clin Med 2023; 12:7707. [PMID: 38137776 PMCID: PMC10744109 DOI: 10.3390/jcm12247707] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The association between GD and cancer has been uncertain due to ascertainment bias in previously published studies. We analyzed cancer incidence using the Maccabi Healthcare Service (MHS) electronic health records among 264 patients with GD compared to 3440 matched controls. We ascertained cancers diagnosed before and after the index date (i.e., the first documentation of GD in cases and the corresponding date for controls). Before the index date, cancers were diagnosed in 18 individuals, with 11 (4.2%) in the GD group and 7 (0.2%) in the control group. After the index date, cancers were diagnosed in 57 individuals, with 20 (7.9%) in the GD group and 37 (1.1%) in the control group, with a median follow-up of almost 13 years in both groups. The most common cancers diagnosed in GD were non-melanoma skin cancer (NMSC) and hematological malignancies, with a clustering of diagnoses around the time of GD diagnosis. The incidence of cancers (excluding MNSC) was 4.1 (95% CI 2.2-7.1) and 0.7 (95% CI 0.4-0.9) per 1000 patient-years in the GD and control groups, respectively, with an incidence rate ratio of 6.37 (95% CI 3-12.7). Patients with GD underwent more cancer screening tests than their counterparts in the control group. While our study revealed an increased occurrence of cancers in patients with GD, this finding might be partly attributed to the more rigorous surveillance procedures employed in this patient population.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (A.Z.); (M.I.)
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel;
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Ari Zimran
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (A.Z.); (M.I.)
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel;
| | - Majdolen Istaiti
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (A.Z.); (M.I.)
| | - Liat Azani
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv 6772168, Israel
| | - Varda Shalev
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (G.C.)
| | - Gabriel Chodick
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (G.C.)
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Ora Paltiel
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel;
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel;
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Levinsky Y, Azani L, Shkalim Zemer V, Chodick G, Tal R, Harel L, Amarilyo G. Adherence to colchicine prophylaxis among patients with familial Mediterranean fever treated with interleukin-1 inhibitors. Semin Arthritis Rheum 2023; 61:152211. [PMID: 37201215 DOI: 10.1016/j.semarthrit.2023.152211] [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: 12/24/2022] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Interleukin-1 (IL-1) inhibitors are approved for treating familial Mediterranean fever (FMF) that is resistant to colchicine. However, continued concomitant treatment with colchicine is imperative, as it is the only drug proven to prevent secondary amyloidosis. We aimed to compare the adherence to colchicine between patients with colchicine-resistant FMF (crFMF) who were treated with IL-1 inhibitors and patients with colchicine-sensitive FMF (csFMF) who were treated only with colchicine. METHODS The databases of Maccabi Health Services, a 2.6-million-member state-mandated health provider in Israel were searched for patients with FMF diagnosis. The medication possession ratio (MPR), calculated from the day of the first colchicine purchase (index date) until the last colchicine purchase was the main outcome measure. Patients with crFMF were matched in a 1:4 ratio to patients with csFMF. RESULTS The final cohort included 4526 patients. Of them, 108 (2.4%) were with crFMF, and were matched to 432 with csFMF. The total mean MPR in each of the matched groups was similar (78.9 ± 41.4 and 82.5 ± 80.6, respectively, P = 0.5). Statistically significant differences in MPR were not found between the groups according to age or duration of colchicine use. However, adherence to colchicine was insufficient (MPR<80%) among more than 50% of the patients in both groups. CONCLUSION In contrast to initial concerns, adherence to colchicine was similar between patients with crFMF and csFMF. However, in both groups, adherence to colchicine was poor. Education of both caregivers and patients is essential to increase adherence.
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Affiliation(s)
- Yoel Levinsky
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Liat Azani
- Kahn-Sagol-Maccabi Research & Innovation Institute, Maccabi Healthcare
| | - Vered Shkalim Zemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dan-Petach Tikva District, Clalit Health Services, Israel
| | - Gabriel Chodick
- Kahn-Sagol-Maccabi Research & Innovation Institute, Maccabi Healthcare
| | - Rotem Tal
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Harel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Amarilyo
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Feferkorn I, Azani L, Dr EP, Hizkiyahu R, Shrem G, Salmon-Divon M, Dahan MH. GEOGRAPHIC VARIATION IN SEMEN PARAMETERS FROM DATA USED FOR THE WORLD HEALTH ORGANIZATION SEMEN ANALYSIS REFERENCE RANGES. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.09.058] [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: 11/04/2022]
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Feferkorn I, Azani L, Kadour-Peero E, Hizkiyahu R, Shrem G, Salmon-Divon M, Dahan MH. Geographic variation in semen parameters from data used for the World Health Organization semen analysis reference ranges. Fertil Steril 2022; 118:475-482. [PMID: 35750517 DOI: 10.1016/j.fertnstert.2022.05.037] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To study geographic variations in sperm parameters using data from the trials that defined the reference ranges of the World Health Organization 2021 manual. DESIGN Retrospective evaluation of the data used to define the World Health Organization reference ranges. SETTING Not applicable. PATIENT(S) Data from 11 studies, including 3,484 participants across 5 continents. INTERVENTION(S) The data were divided according to geographic locations. MAIN OUTCOME MEASURE(S) Differences in sperm parameters. RESULT(S) The semen volume was significantly lower in samples from Asia and Africa than in other regions. The sperm concentration was the lowest in Africa and highest in Australia. The total motile sperm count (TMSC) and total motile progressive sperm count (TMPS) were significantly lower in Africa than in other regions. The TMSC and TMPS in Asia and the United States were significantly lower than in Europe and Australia. The 5th percentile of the sperm concentration was lowest in the United States (12.5 × 106/mL). The 5th percentile for the normal sperm morphology was lowest in the United States (3%) and highest in Asia (5%). The 5th percentile for the TMSC and TMPS were lowest in Africa (TMSC, 15.08 million; TMPS, 12.06 million) and the United States (TMSC, 18.05 million; TMPS, 16.86 million) and highest in Australia (TMSC, 29.61 million; TMPS, 25.80 million). CONCLUSION(S) Significant geographic differences in sperm parameters exist, and regional fertility societies should consider adding their own reference ranges on the basis of local experience and treatment outcomes.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada.
| | - Liat Azani
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada
| | - Ranit Hizkiyahu
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada
| | - Guy Shrem
- IVF Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, Ariel, Israel; Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada
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Feferkorn I, Azani L, Kadour-Peero E, Hizkiyahu R, Shrem G, Salmon-Divon M, Dahan MH. An evaluation of changes over time in the semen parameters data used for the World Health Organization semen analysis reference ranges. Andrology 2021; 10:660-668. [PMID: 34964554 DOI: 10.1111/andr.13150] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous meta-analyses concluded that there is a decline in sperm parameters over time. This conclusion might be incorrect due to inherent biases or focusing only on a single parameter - sperm concentration. OBJECTIVE To study trends in sperm parameters over the past twenty years using data from the trials that defined the reference ranges of the World Health Organization manual. MATERIALS AND METHODS Retrospective evaluation of the data used to define the World Health Organization reference ranges. The data from 11 studies, including 3589 participants between 1996-2016, were divided into three period groups based on the decade of study. Differences in semen parameters' distribution were presented in boxplot. P-values were calculated by the Kruskal Wallis rank-sum test followed by Dunn post-hoc test. Analyses were conducted using the R programming language. RESULTS A small decrease was noted in mean sperm concentrations (88.1 million/ml, 87.6 million/ml and 77.2 million/ml for the first second and third decades respectively) (p<0.01). However, the 5th percentile of sperm concentration for the third decade was higher than the first or second decades (18 million/ml vs. 14.9 million/ml and 15 million/ml respectively). No significant differences were noted in progressive motility over the years (p = 0.32). The percent of morphologically normal sperm decreased between the first (24.2%) and the second (12.6%) periods of the study (p<0.001) and then increased in the third decade (14.2%) (p<0.01). While TMC declined between the second and third decades (189 million and 153.9 million respectively, p<0.001), at levels unlikely to decrease fertility. However, the 5th percentile of the TMC remained stable at 24.9, 20.8 and 20.6 million, for the first, second and third decades respectively (p = 0.36). DISCUSSION AND CONCLUSION AND RELEVANCE Trends in sperm parameters over the last three decades do not seem to be clinically significant. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Liat Azani
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Ranit Hizkiyahu
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Guy Shrem
- IVF unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, 1 Derech Pasternak, Rehovot, Israel
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel.,Adelson School of Medicine, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
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Feferkorn I, Shrem G, Azani L, Son WY, Nehushtan T, Salmon-Divon M, Dahan MH. Hope for male fecundity: clinically insignificant changes in semen parameters over 10 years at a single clinic while assessing an infertility population. J Assist Reprod Genet 2021; 38:2995-3002. [PMID: 34386934 PMCID: PMC8609088 DOI: 10.1007/s10815-021-02298-8] [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: 06/13/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE What is the trend in sperm parameters in a group of men attending a single reproductive center, over a 10-year period? METHODS A retrospective study was conducted on 12,188 semen samples obtained from unique individuals who attended a university reproductive clinic from 2009 to 2018, inclusively. Semen analysis was done using computer-assisted sperm analysis and verified by an andrologist. Analysis was done after dividing the dataset into two groups: above WHO 2010 lower reference limits (ARL) (N = 6325) and below the reference limits (BRL) (N = 5521). RESULTS Volume increased slightly (ARL, p = 0.049) before returning to baseline or was stable (BRL, p = 0.59). Sperm concentration and total count of the BRL and ARL group declined initially and then recovered slightly (p < 0.0001, in all cases). Although these changes were statistically significant, this was due to the large study population; clinically, these changes were quite mild and would not have been significant for fertility. Sperm total motility and progressive motility of both the BRL group and the ARL group increased slightly from 2009 until 2015 and then decreased back to baseline (p < 0.0001). This change offset the decrease in count seen in those years. A spurious change was observed with sperm morphology that declined after the first 2 years and remained stable thereafter (p < 0.0001, in both groups). However, this change was attributed to a contemporaneous change in the method of analyzing strict morphology which happened when the change occurred. CONCLUSION While statistically significant changes were found, clinically, these changes were quite mild and would not have been significant for fertility.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada.
| | - Guy Shrem
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
- IVF Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, 1 Derech Pasternak, Rehovot, Israel
| | - Liat Azani
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Weon-Young Son
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Tamar Nehushtan
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
- Adelson School of Medicine, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Michael Haim Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
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Feferkorn I, Shrem G, Son WY, Salmon-Divon M, Dahan MH, Azani L. HOPE FOR MALE FECUNDITY – CLINICALLY INSIGNIFICANT CHANGES IN SEMEN PARAMETERS OVER 10 YEARS AT A SINGLE CLINIC WHILE ASSESSING AN INFERTILITY POPULATION. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.266] [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: 10/20/2022]
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Shiyovich A, Chodick G, Azani L, Tirosh M, Shuvy M, Pereg D, Katz A, Minha S. Sex-specific contemporary trends in incidence, prevalence and survival of patients with non-valvular atrial fibrillation: A long-term real-world data analysis. PLoS One 2021; 16:e0247097. [PMID: 33600504 PMCID: PMC7891766 DOI: 10.1371/journal.pone.0247097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is a major increasing public health problem worldwide, with clinical and epidemiological differences between men and women. However, contemporary population-level data on incidence and survival are scarce. Aim To evaluate sex-specific contemporary trends in the incidence, prevalence, and long-term survival of non-valvular AF in a real-world setting Methods AF patients diagnosed between 2007–2015, insured by a large, state-mandated health organization in Israel (Maccabi Healthcare Services) were included. AF was diagnosed based on registered diagnoses. Patients with valvular disease, active malignancy, cardiac surgery ≤ 6 months, or recent pregnancy, were excluded. Annual incidence rate, period prevalence, and 5-year survival for each calendar year during the study period, were calculated. Results A total of 15,409 eligible patients (8,288 males, 7,121 females) were identified. Males were more likely to be younger, have higher rates of underlying diseases (ischemic heart disease, heart failure, and chronic obstructive pulmonary disease), but with lower rates of hypertension and chronic kidney diseases as compared to female patients. During the study period, age-adjusted incidence decreased both in men: (-0.020/1,000-person year, p-for trend = 0.033) and, women (-0.025/1,000 person-year p = 0.009). The five-year survival rate was significantly higher among men vs. women (77.1% vs. 71.5%, respectively, p<0.001). Age-adjusted prevalence increased significantly among men (+0.102 per year, p-for trend<0.001) yet decreased among women (-0.082 per year, p-for trend = 0.005). A significant trend toward improved long-term survival was observed in women and not in men. Conclusions The current study shows significant sex-related disparities in the incidence, prevalence, and survival of AF patients between 2007–2015; while the adjusted incidence of both has decreased over-time, prevalence and mortality decreased significantly only in women.
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Affiliation(s)
- Arthur Shiyovich
- Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liat Azani
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Mony Shuvy
- Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Pereg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Meir Medical Center, Kfar-Saba, Israel
| | - Amos Katz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sa’ar Minha
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel
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Friedler S, Glasser S, Azani L, Freedman LS, Raziel A, Strassburger D, Ron-El R, Lerner-Geva L. The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer. Fertil Steril 2011; 95:2127-30. [PMID: 21211796 DOI: 10.1016/j.fertnstert.2010.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 11/17/2022]
Abstract
This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, 1.36-5.24). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation.
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Affiliation(s)
- Shevach Friedler
- Infertility and IVF unit, Assaf Harofeh Medical Center, Zrifin, Israel.
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