1
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Gat I, Ronen M, Avraham S, Youngster M, Hourvitz A, Levtzion-Korach O. Israeli students' perceptions regarding sperm donation: dilemmas reflections with dominant demographic effect. Reprod Health 2024; 21:37. [PMID: 38500168 PMCID: PMC10946193 DOI: 10.1186/s12978-024-01767-4] [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: 08/22/2023] [Accepted: 03/02/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sperm donation has undergone significant medical and social transformations in recent decades. This study aimed to explore Israeli students' perceptions towards sperm donation and investigate the potential influence of demographic characteristics on these perceptions. DESIGN The study encompassed 254 students from Tel-Aviv University, who completed an anonymous online survey in January-February 2021. This cross-sectional quantitative online survey, comprised 35 questions categorized into three sections: demographic data, assessment of prior knowledge, and perceptions of sperm donation (general perceptions related to both positive and negative stigmas associated with sperm donation, the roles and activities of sperm banks, and considerations surrounding identity disclosure versus the anonymity of sperm donors and their offspring). RESULTS Participants exhibited a relatively low level of prior knowledge (mean 31.2 ± 19 of 100). Scores for positive and negative stigmas ranged from 1.3 to 2.2. Notably, the statement "Donors' anonymity preservation is crucial to maintain sperm donation" received a mean of 3.7. Seeking for anonymous sperm donation identity both by recipients and offspring was ranked with low means (1.5 and 1.7, respectively). However, the pursuit of half-siblings by mothers or siblings themselves received higher ratings ranging from 2.7 to 3. Women's stigma ranking were notably lower, while men emphasized the importance of donor anonymity. CONCLUSIONS Sperm Banks hold a position of medical authority rather than being perceived as being commercial entity. The preservation of donor anonymity is widely accepted as a crucial element, prioritized over the requests for identity disclosure from recipients and offspring. Demographic parameters exhibit a strong and precise effects on participants' perceptions.
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Affiliation(s)
- Itai Gat
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel
- IVF Department, Shamir Medical Center, Zrifin, Israel
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Maya Ronen
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
- Obstetrics and Gynecology Department, Shamir Medical Center, Zrifin, Israel.
| | - Sarit Avraham
- IVF Department, Shamir Medical Center, Zrifin, Israel
| | | | - Ariel Hourvitz
- IVF Department, Shamir Medical Center, Zrifin, Israel
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Levtzion-Korach
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center, Zrifin, Israel
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2
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Kagansky N, Levy Y, Awar A, Derazne E, Shilovsky A, Kagansky D, Chepelev V, Mazurez E, Stambler I, Levtzion-Korach O. Do Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Need to Be Stratified for Age and Comorbidities in COVID-19 Disease? A Subgroup Analysis of Two Distinct Cohorts over Disease Course. J Clin Med 2024; 13:605. [PMID: 38276111 PMCID: PMC10816969 DOI: 10.3390/jcm13020605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Several studies described neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as markers of COVID-19 severity. In a recently published study, age and frailty affected NLR and PLR more than disease severity. The study compared two distinct cohorts. The first comprised older frailer patients positive for SARS-CoV-2, with mild or asymptomatic disease, admitted to designated COVID-19 departments in a large geriatric medical center (GMC). The second cohort comprised COVID-19 patients admitted to a large general hospital (GH) for symptomatic disease. This was a follow-up study comparing a subgroup of patients who had NLR and PLR values measured a week after admission. Only 100 of 177 patients in the original GMC cohort had a second NLR test compared to almost all (287 of 289) patients in the general hospital (GH) cohort. The subgroup baseline characteristics did not change significantly from that of the original cohort. Disease symptoms were more prevalent in the GH cohort. In the GMC group, the median second NLR rose from 3.9 to 4.6, while in the GH cohort, the NLR value dropped from 3.5 to 2.8, enhancing the NLR differences between the groups. Smaller changes were observed in the second PLR. These results strengthen the prior results that age and frailty seem to have a stronger impact on NLR and PLR than disease severity.
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Affiliation(s)
- Nadya Kagansky
- School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Shmuel Harofe Geriatric Medical Center, Be’er Ya’akov 70350, Israel
| | - Yochai Levy
- School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Shmuel Harofe Geriatric Medical Center, Be’er Ya’akov 70350, Israel
| | - Anas Awar
- Shmuel Harofe Geriatric Medical Center, Be’er Ya’akov 70350, Israel
| | - Estela Derazne
- School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | | - Victor Chepelev
- Shmuel Harofe Geriatric Medical Center, Be’er Ya’akov 70350, Israel
| | - Evelina Mazurez
- Shmuel Harofe Geriatric Medical Center, Be’er Ya’akov 70350, Israel
| | - Ilia Stambler
- Shmuel Harofe Geriatric Medical Center, Be’er Ya’akov 70350, Israel
| | - Osnat Levtzion-Korach
- School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Shamir Medical Center, Rishon Le-Zion 70300, Israel
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3
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Parnass G, Levtzion-Korach O, Peres R, Assaf M. Estimating emergency department crowding with stochastic population models. PLoS One 2023; 18:e0295130. [PMID: 38039309 PMCID: PMC10691698 DOI: 10.1371/journal.pone.0295130] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
Environments such as shopping malls, airports, or hospital emergency-departments often experience crowding, with many people simultaneously requesting service. Crowding highly fluctuates, with sudden overcrowding "spikes". Past research has either focused on average behavior, used context-specific models with a large number of parameters, or machine-learning models that are hard to interpret. Here we show that a stochastic population model, previously applied to a broad range of natural phenomena, can aptly describe hospital emergency-department crowding. We test the model using data from five-year minute-by-minute emergency-department records. The model provides reliable forecasting of the crowding distribution. Overcrowding is highly sensitive to the patient arrival-flux and length-of-stay: a 10% increase in arrivals triples the probability of overcrowding events. Expediting patient exit-rate to shorten the typical length-of-stay by just 20 minutes (8.5%) cuts the probability of severe overcrowding events by 50%. Such forecasting is critical in prevention and mitigation of breakdown events. Our results demonstrate that despite its high volatility, crowding follows a dynamic behavior common to many systems in nature.
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Affiliation(s)
- Gil Parnass
- Racah Institute of Physics, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Renana Peres
- The Hebrew University Business school, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Assaf
- Racah Institute of Physics, Hebrew University of Jerusalem, Jerusalem, Israel
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4
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Trotzky D, Aizik U, Mosery J, Carady N, Tavori G, Cohen A, Pachys G, Avraham M, Levtzion-Korach O, Tal O. Resilience of hospital staff facing COVID-19 pandemic: Lessons from Israel. Front Public Health 2023; 11:1050261. [PMID: 37064690 PMCID: PMC10102590 DOI: 10.3389/fpubh.2023.1050261] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionThe COVID-19 pandemic has placed additional burden on already strained healthcare systems worldwide, intensifying the responsibility and burden of healthcare workers. Although most hospital staff continued working during this stressful and challenging unprecedented pandemic, differences in the characteristics and attributes were noted between sectors and hospital departments. Israeli healthcare workers are trained and experienced in coping with national emergencies, but the pandemic has exposed variations in staff reactions. Understanding the intrinsic differences between sectors and departments is a key factor in staff and hospital preparedness for unexpected events, better resource utilization for timely interventions to mitigate risk and improve staff wellbeing.ObjectiveTo identify and compare the level of resilience, secondary traumatization and burnout among hospital workers, between different sectors and hospital departments, during the COVID-19 pandemic.MethodsCross-sectional research to assess the resiliency, secondary traumatization and burnout of healthcare workers at a large general public hospital in central Israel. The sample consisted of 655 participants across various hospital units exposed to COVID-19 patients.ResultsEmergency department physicians had higher rates of resilience and lower rates of burnout and secondary traumatization than staff in other hospital departments. In contrast, staff from internal medicine departments demonstrated the highest levels of burnout (4.29). Overall, physicians demonstrated higher levels of resilience (7.26) and lower levels of burnout compared to other workers.ConclusionIdentifying resilience characteristics across hospital staff, sectors and departments can guide hospital management in education, preparation and training of healthcare workers for future large-scale health emergencies such as pandemics, natural disasters, and war.
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Affiliation(s)
- Daniel Trotzky
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Aizik
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Mosery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
| | - Natali Carady
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Tavori
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aya Cohen
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Aya Cohen
| | - Gal Pachys
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Avraham
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Nursing Administration, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
| | - Osnat Levtzion-Korach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Management, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
| | - Orna Tal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Management, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Israeli Center for Emerging Technologies, Zerifin, Israel
- Department of Management, Bar Ilan University, Ramat Gan, Israel
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5
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Barnea R, Tur-Sinai A, Levtzion-Korach O, Weiss Y, Tal O. Patient preferences and choices as a reflection of trust-A cluster analysis comparing postsurgical perceptions in a private and a public hospital. Health Expect 2022; 25:2340-2354. [PMID: 35833265 PMCID: PMC9615048 DOI: 10.1111/hex.13487] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient–physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel. Methods A cross‐sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level). Results A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient–provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital. Conclusions The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient–physician encounters. Patient or Public Contribution Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses.
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Affiliation(s)
- Royi Barnea
- Assuta Health Services Research Institute, Assuta Medical Centers, Tel-Aviv, Israel.,School of Health Systems Management, Netanya Academic College, Netanya, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel.,School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Yossi Weiss
- Assuta Health Services Research Institute, Assuta Medical Centers, Tel-Aviv, Israel.,Ariel University, Ariel, Israel
| | - Orna Tal
- Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.,Israeli Center for Emerging Technologies (ICET), Tel Aviv, Israel.,Department of Management, Bar Ilan University, Ramat Gan, Israel
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6
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Gat I, Umanski A, Kaufman S, Kedem A, Avraham S, Youngster M, Yerushalmi G, Kugel C, Hourvitz A, Levtzion-Korach O. What can we learn about posthumous sperm retrieval after extra long-term follow-up? J Assist Reprod Genet 2022; 39:1661-1665. [PMID: 35689734 DOI: 10.1007/s10815-022-02535-8] [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: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe spermatozoa extraction rate by testicular sperm extraction (TESE) for posthumous sperm retrieval (PMSR) and examine harvest time impact on sperm motility; to compare long-term sperm usage between married vs. single deceased men. METHODS This retrospective study included all PMSR cases in Shamir Medical Center during 2003-2021. We evaluated sperm cryopreservation according to latency time after death. Then, we assessed sperm usage according to Israeli PMSR regulations. RESULTS The study included 69 (35 married and 34 singles) deceased men with average age of 30.3 ± 7.8 years. Sperm was cryopreserved in 65 cases (94.2%) after maximum and average harvest time of 40 and 16.5 ± 8.1 h, respectively. Motile sperm extraction was associated with significantly shorter harvest time compared with non-motile sperm (13.8 ± 7.3 vs. 18.7 ± 8.1 h, p = 0.046). Sperm usage among married deceased was significantly higher than single (15.6% vs. 0%, p = 0.05). Disposal requests were lower among single compared to married men relatives without reaching statistical difference. Eventually, single men had significantly higher rate of non-used cryopreserved samples (93.8% vs 69.6%, p = 0.01). CONCLUSION This large long-term cohort study demonstrates high efficacy of PMSR. We found significant harvest latency time difference between motile and non-motile preserved sperm. Clinical sperm usage rate justifies the efforts for PMSR among married deceased. However, contradicting policy on the topic of single men (which implies liberal sperm preservation but rigid prevention of usage) results with high non-used sperm rate and relatives' extremely sophisticated emotional burden.
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Affiliation(s)
- Itai Gat
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel.
- IVF Department, Shamir Medical Center, Zrifin, Israel.
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Ana Umanski
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel
| | - Sarita Kaufman
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel
| | - Alon Kedem
- IVF Department, Shamir Medical Center, Zrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Department, Shamir Medical Center, Zrifin, Israel
| | | | | | - Chen Kugel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- National Institute of Forensic Medicine, Abu Kabir, Tel Aviv, Israel
| | - Ariel Hourvitz
- IVF Department, Shamir Medical Center, Zrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Levtzion-Korach
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center, Zrifin, Israel
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7
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Shapira G, Abu Hamad R, Weiner C, Rainy N, Sorek-Abramovich R, Benveniste-Levkovitz P, Rock R, Avnat E, Levtzion-Korach O, Bar Chaim A, Shomron N. Population differences in antibody response to SARS-CoV-2 infection and BNT162b2 vaccination. FASEB J 2022; 36:e22223. [PMID: 35239233 PMCID: PMC9111330 DOI: 10.1096/fj.202101492r] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
Abstract
The concentration of SARS‐CoV‐2‐specific serum antibodies, elicited by vaccination or infection, is a primary determinant of anti‐viral immunity, which correlates with protection against infection and COVID‐19. Serum samples were obtained from 25 897 participants and assayed for anti‐SARS‐CoV‐2 spike protein RBD IgG antibodies. The cohort was composed of newly vaccinated BNT162b2 recipients, in the first month or 6 months after vaccination, COVID‐19 patients and a general sample of the Israeli population. Antibody levels of BNT162b2 vaccine recipients were negatively correlated with age, with a prominent decrease in recipients over 55 years old, which was most significant in males. This trend was observable within the first month and 6 months after vaccination, while younger participants were more likely to maintain stable levels of serum antibodies. The antibody concentration of participants previously infected with SARS‐CoV‐2 was lower than the vaccinated and had a more complex, non‐linear relation to age, sex and COVID‐19 symptoms. Taken together, our data supports age and sex as primary determining factors for both the magnitude and durability of humoral response to SARS‐CoV‐2 infection and the COVID‐19 vaccine. Our results could inform vaccination policies, prioritizing the most susceptible populations for repeated vaccination.
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Affiliation(s)
- Guy Shapira
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
| | | | - Chen Weiner
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Shamir Medical Center, Be'er Yaacov, Israel
| | - Nir Rainy
- Shamir Medical Center, Be'er Yaacov, Israel
| | | | | | | | - Eden Avnat
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Noam Shomron
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
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8
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Efrati S, Catalogna M, Abu Hamed R, Hadanny A, Bar-Chaim A, Benveniste-Levkovitz P, Strugo R, Levtzion-Korach O. Early and long term antibody kinetics of asymptomatic and mild disease COVID-19 patients. Sci Rep 2021; 11:13780. [PMID: 34215811 PMCID: PMC8253728 DOI: 10.1038/s41598-021-93175-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
Most patients infected with SARS-CoV-2 are asymptomatic or mildly symptomatic. However, the early and late antibody kinetics, and the association between antibody levels, clinical symptoms, and disease phase in these patients have not yet been fully defined. Confirmed SARS-CoV-2 patients and their household contacts were evaluated over a period four months. The evaluation procedure included symptom monitoring, viral load and serology analysis every ten days. A total of 1334 serum samples were collected from 135 patients and analyzed using three assays for IgG-N, IgG-S and IgM antibodies. Of the study participants, 97% were seropositive during the study, and two distinct clusters were identified. These clusters were significantly different in their inflammatory related symptoms. Peak IgG-S was 40.0 AU/ml for the non-inflammatory cluster and 71.5 AU/ml for the inflammatory cluster (P = 0.006), whereas IgG-N peaks were 4.3 and 5.87 (P = 0.023) respectively. Finally, a decision tree model was designed to predict the disease phase based on the serological titer levels, and had an overall accuracy of 80.7%. The specific profile of seroconversion and decay of serum antibodies can be used to predict the time-course from the acute infection.
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Affiliation(s)
- Shai Efrati
- Research and Development Unit, Shamir Medical Center, Zerifin, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Merav Catalogna
- Research and Development Unit, Shamir Medical Center, Zerifin, Israel
| | - Ramzia Abu Hamed
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Chemistry Laboratory, Shamir Medical Center, Zerifin, Israel
| | - Amir Hadanny
- Research and Development Unit, Shamir Medical Center, Zerifin, Israel
| | - Adina Bar-Chaim
- Clinical Chemistry Laboratory, Shamir Medical Center, Zerifin, Israel
| | | | | | - Osnat Levtzion-Korach
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Management, Shamir Medical Center, Zerifin, Israel
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9
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Bahat H, Hasidov-Gafni A, Youngster I, Goldman M, Levtzion-Korach O. The prevalence and underreporting of needlestick injuries among hospital workers: a cross-sectional study. Int J Qual Health Care 2021; 33:6101296. [PMID: 33449085 DOI: 10.1093/intqhc/mzab009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Needlestick and sharps injuries (NSIs) are known occupational risks among health-care workers. Reporting these injuries is important for early prevention and management of blood-borne infections. We investigated the prevalence and characteristics of NSIs and underreporting among hospital workers (HWs) from different sectors. METHODS A single-center cross-sectional study, involving an anonymous survey delivered to 2205 HWs. The survey included demographic information about the worker and information about training, injuries and reporting. RESULTS Of the 844 HWs respondents (40%), NSIs occurred in 443 of them (53%); the majority were from needles (68%) and at bedside (51%). Significantly higher prevalences of injuries (P < 0.001) were noted among physicians (75%) and workers in their 40s (61%) and in the emergency and surgical departments (66% and 55%, respectively). NSIs were reported among 28% of workers who did not directly use needles. Underreporting was found in 46%, with a significant decrease in the report rate as the number of injuries increased (P < 0.001). Underreporting was significantly more common (P < 0.001) among physicians (59%), especially seniors (72%), workers without training about NSIs (59%), older age groups (56% in workers above 51 years, P = 0.003) and males (54%, P = 0.01). The highest underreporting rate was in injuries occurring in the operating room and the lowest in witnessed injuries occurring while passing a needle (82% vs. 31%, P < 0.001). CONCLUSIONS NSIs and underreporting are common among HWs from all sectors, including those who do not use needles. Improving preventive measures and reporting should be encouraged. We recommend reducing bedside procedures as possible and assigning two workers to procedures at risk for injuries, to increase the report rate.
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Affiliation(s)
- Hilla Bahat
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Adi Hasidov-Gafni
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel
| | - Ilan Youngster
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Michael Goldman
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Osnat Levtzion-Korach
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.,Medical Management, Shamir Medical Center, Zerifin 70300, Israel
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10
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Hemmo Lotem M, Tzezana R, Levtzion-Korach O. [THE IMPACT OF ARTIFICIAL INTELLIGENCE AND BIG DATA ON HEALTHCARE]. Harefuah 2021; 160:24-29. [PMID: 33474875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The fourth industrial revolution has led to a paradigm shift in the world of data; this paper reviews the implications on the medical and health services. These changes include: -The transition to big data: New layers of information such as longitudinal data, OMICS, information from social networks and the internet will be added to the conventional sources of information: anamnesis, physical examination, lab results etc. and will assist in medical decisions. -The transition to medical prediction: The information will allow not only diagnosing the current medical situation, but will also enable predicting the patient's risk level for developing certain diseases in the future. -The transition to artificial intelligence systems: This will enable analysis and generate insights into the vast amount of available information. -The decline in data production and data analysis costs: Much of the information will be collected by the patient himself and derived from his wearable devices. Information that was previously costly and exclusively owned by health officials, will be owned by others including the patient himself. These changes pose risks alongside the opportunities. The pace and quality of incorporating all this data depends on two opposing forces: technological innovation on the one hand, and system barriers on the other. Barriers include objections from users, budgetary constraints, patient privacy and regulatory barriers. The healthcare system must prepare wisely, but quickly, for the dramatic changes.
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Affiliation(s)
| | - Roey Tzezana
- Yuval Ne'eman Workshop for Science, Technology and Security, Tel Aviv University, Ramat Aviv
| | - Osnat Levtzion-Korach
- Medical Executive Offices, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv
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Topaz M, Lisby M, Morrison CRC, Levtzion-Korach O, Hockey PM, Salzberg CA, Efrati N, Lipsitz S, Bates DW, Rozenblum R. Nurses' Perspectives on Patient Satisfaction and Expectations: An International Cross-Sectional Multicenter Study With Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2016; 13:185-96. [PMID: 26840190 DOI: 10.1111/wvn.12143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Addressing patient expectations is necessary to achieve high satisfaction. However, few data are available on nurses' perceptions and performance with respect to patient expectations and satisfaction. OBJECTIVES This international multicenter study aimed to: (a) evaluate nurses' attitudes and performance with respect to patient satisfaction and expectations, and (b) identify predictors of nurses' inquiry of patients' satisfaction at the point of discharge. METHODS A questionnaire examining attitudes and performance toward patient satisfaction and expectations was developed and validated. Nurses at four academic hospitals in the United States, the United Kingdom, Israel, and Denmark were surveyed. RESULTS A total of 536 nurses participated in the study (response rate 85.3%). Nurses expressed positive attitudes toward activities related to patient satisfaction and expectations, endorsing the importance of talking with patients about their satisfaction status (91.6%) and their expectations (93.2%). More than half of the responders (51.8%) claimed to have responded to the status of patient satisfaction or dissatisfaction (Israel: 25%; United States: 54.9%; United Kingdom: 61.7%; Denmark: 69.9%; p < .001). However, only 12.1% stated that they routinely ask patients about their level of satisfaction, with nurses in the United States (18.3%) and Denmark (17.5%) more likely to ask compared to nurses in the United Kingdom (7.4%) and Israel (6.3%; p = .001). Adjusted logistic regression identified four significant predictors (p < .05) of nurses' inquiry about patients' satisfaction: "Responding to patient's satisfaction status" (OR: 3.1; 95% CI: 1.7-5.8); "Documenting patient's satisfaction status" (OR: 2.8; 95% CI: 1.6-5.1); "Asking routinely about expectations" (OR: 5.4; 95% CI: 3-9.7); and "Responded to expectations during the past month" (OR: 4.3; 95% CI: 1.9-9.4). LINKING EVIDENCE TO ACTION These findings warrant further investigation, potentially into the nurses' work environments or educational programs, to better understand why nurses' positive attitudes toward patient satisfaction and expectations do not result in actively asking patients about their satisfaction level and what should be done to improve nurses' performance. Healthcare organizations and policy makers should develop and support structured programs to address patient expectations and improve patient satisfaction during hospitalization.
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Affiliation(s)
- Maxim Topaz
- Postdoctoral Research Fellow, Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, and Postdoctoral Research Fellow, Harvard Medical School, Boston, MA
| | - Marianne Lisby
- Postdoctoral fellow, Faelles AKUT Afdeling & Center for Akutforskning, Aarhus University Hospital, Denmark
| | - Constance R C Morrison
- Project Manager, Center for Patients and Families, Brigham and Women's Hospital, Boston, MA
| | | | - Peter M Hockey
- Immunopharmacology Group, University Medicine and University Pathology, Southampton University, Southampton, UK
| | - Claudia A Salzberg
- Research Fellow, Division General Internal Medicine, Johns Hopkins Bloomberg School of Medicine, Baltimore, MD
| | - Nechama Efrati
- End of Life Care Coordinator, Unit of Palliative Care, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Stuart Lipsitz
- Director, Biostatistical Services, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - David W Bates
- Senior Vice President and Chief Innovation Officer, Brigham and Women's Hospital; Chief, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; and Professor of Medicine, Harvard Medical School, Boston, MA
| | - Ronen Rozenblum
- Director, Unit for Innovative Healthcare Practice & Technology, Division of General Internal Medicine, Brigham and Women's Hospital and, Harvard Medical School, Boston, MA
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Rozenblum R, Lisby M, Hockey PM, Levtzion-Korach O, Salzberg CA, Efrati N, Lipsitz S, Bates DW. The patient satisfaction chasm: the gap between hospital management and frontline clinicians. BMJ Qual Saf 2012. [PMID: 23178858 DOI: 10.1136/bmjqs-2012-001045] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process. METHOD We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA. RESULTS We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries (p<0.0001). Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction. CONCLUSIONS This portrait of clinicians' attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
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Affiliation(s)
- Ronen Rozenblum
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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Levtzion-Korach O, Frankel A, Alcalai H, Keohane C, Orav J, Graydon-Baker E, Barnes J, Gordon K, Puopulo AL, Tomov EI, Sato L, Bates DW. Integrating incident data from five reporting systems to assess patient safety: making sense of the elephant. Jt Comm J Qual Patient Saf 2010; 36:402-10. [PMID: 20873673 DOI: 10.1016/s1553-7250(10)36059-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A study was conducted to examine and compare information gleaned from five different reporting systems within one institution: incident reporting, patient complaints, risk management, medical malpractice claims, and executive walk rounds. These data sources vary in the timing of the reporting (retrospective or prospective), severity of the events, and profession of the reporters. METHODS A common methodology was developed for classifying incidents. Data specific to each incident were abstracted from each system and then categorized using the same framework into one of 23 categories. RESULTS Overall, there was little overlap, although each reporting system identified important safety issues. Communication problems were common among patient complaints and malpractice claims; malpractice claims' leading category was clinical judgement. Walk rounds identified issues with equipment and supplies. Adverse event reporting systems highlighted identification issues, especially mislabelled specimens. The frequency of contributions of reports by provider group varied substantially by system. Physicians accounted for 50% of risk management reports, but in adverse event reporting, where nurses were the main reporters, physicians accounted for only 2.5% of reports. Complaints and malpractice claims come primarily from patients. CONCLUSIONS The five reporting systems each identified different yet complementary patient safety issues. To obtain a comprehensive picture of their patient safety problems and to develop priorities for improving safety, hospitals should use a broad portfolio of approaches and then synthesize the messages from all individual approaches into a collated and cohesive whole.
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Levtzion-Korach O, Murphy KG, Madden S, Dempsey C. For urgent and emergent cases, which one goes to the OR first? OR Manager 2010; 26:1-13. [PMID: 20672452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, Moniz T, Rothschild JM, Kachalia AB, Hayes J, Churchill WW, Lipsitz S, Whittemore AD, Bates DW, Gandhi TK. Effect of bar-code technology on the safety of medication administration. N Engl J Med 2010; 362:1698-707. [PMID: 20445181 DOI: 10.1056/nejmsa0907115] [Citation(s) in RCA: 322] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). METHODS We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. RESULTS We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. CONCLUSIONS Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)
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Affiliation(s)
- Eric G Poon
- Division of General Medicine Primary Care, Brigham and Women's Hospital, 3/F, 1620 Tremont St., Boston, MA 02120, USA.
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Siegrist RB, Gutkin M, Levtzion-Korach O, Madden S. Improving patient flow in the cath lab. Healthc Financ Manage 2009; 63:92-98. [PMID: 19391570] [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: 05/27/2023]
Abstract
Key steps that led to Kennestone Hospital's success in improving patient flow in the cath lab included: Developing an urgency classification system for patients. Creating a more accurate scheduling system to increase throughput and efficiency. Establishing a project team. Developing a time line. Recognizing ongoing challenges
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Levtzion-Korach O, Israeli A. [The British Star rating system--review and its implication for the Israeli health system]. Harefuah 2005; 144:865-9, 909. [PMID: 16400788] [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: 05/06/2023]
Abstract
The British NHS system is undergoing a process of reform and renewal. In addition to allocating resources, the NHS developed the star rating system, a system developed to evaluate and increase performances of the medical institutes. The rating of zero to three stars of the general hospitals (acute trusts) is based on the level of achievements of the 9 key targets and 36 indicators composing 3 focus areas: clinical, patient and logistic aspects. The key targets and performance indicators are determined every year based on the accomplishments of the previous year and actual problems. The 2004 key targets included shortening waiting times in the emergency room and waiting lists for elective admission and ambulatory clinics, hospital finance management and hospital cleanliness. We examined the evaluation system in relation to the goals set, after a three-year period. There is impressive progress in the quality and level of medical care given in the areas examined. Besides the improvement, criticism arose in respect of different aspects: the hospital rating does not necessarily reflect the quality of care given in the individual departments, the publicity of the hospital ratings had a deleterious effect on the patient trust in the medical staff and their relationship, the hospitals requested to be involved in the process of choosing the indicators etc. The method for evaluating hospitals is one of the top issues on the agenda of the leaders of the Israeli health system. It is known that the evaluation process itself leads to improvement but it might also have a harmful effect. The application of the British Star system to the Israeli system requires core adjustments: defining relevant indicators based upon current problems, securing the quality of the data, defining the correct case-mix of patients and working in full cooperation with the hospital managers and the professional authorities. The publicity aspect is a delicate issue considering the current restrictions on patient's freedom of choice.
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Gesundheit B, Grisaru-Soen G, Greenberg D, Levtzion-Korach O, Malkin D, Petric M, Koren G, Tendler MD, Ben-Zeev B, Vardi A, Dagan R, Engelhard D. Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition. Pediatrics 2004; 114:e259-63. [PMID: 15286266 DOI: 10.1542/peds.114.2.e259] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Genital neonatal herpes simplex virus type 1 (HSV-1) infection was observed in a series of neonates after traditional Jewish ritual circumcision. The objective of this study was to describe neonate genital HSV-1 infection after ritual circumcision and investigate the association between genital HSV-1 after circumcision and the practice of the traditional circumcision. METHODS Eight neonates with genital HSV-1 infection after ritual circumcision were identified. RESULTS The average interval from circumcision to clinical manifestations was 7.25 +/- 2.5 days. In all cases, the traditional circumciser (the mohel) had performed the ancient custom of orally suctioning the blood after cutting the foreskin (oral metzitzah), which is currently practiced by only a minority of mohels. Six infants received intravenous acyclovir therapy. Four infants had recurrent episodes of genital HSV infection, and 1 developed HSV encephalitis with neurologic sequelae. All four mohels tested for HSV antibodies were seropositive. CONCLUSION Ritual Jewish circumcision that includes metzitzah with direct oral-genital contact carries a serious risk for transmission of HSV from mohels to neonates, which can be complicated by protracted or severe infection. Oral metzitzah after ritual circumcision may be hazardous to the neonate.
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Affiliation(s)
- Benjamin Gesundheit
- Pediatric Hematology/Oncology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
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Abstract
OBJECTIVES The purpose of this study was to assess the characteristic motor developmental pattern in blind children in Israel. METHODOLOGY The study compared the developmental data concerning 10 motor skills of 40 blind children to a control group of sighted children and to the motor developmental milestones of the Bayley Developmental Scale and the Revised Denver Developmental Screening Test. RESULTS The motor development of blind children was delayed, the delay being significant in all 10 motor skills that were examined. This delay emphasizes the major importance of vision as a sensory input modality for the process of sensory- motor development. CONCLUSION An adequate stimulating environment and proper parental handling could potentially shorten the motor developmental delay but probably not eliminate it entirely.
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Affiliation(s)
- O Levtzion-Korach
- Jerusalem Institute for Child Development, Israeli Ministry of Health, Bney-Zion Medical Center, Haifa, Israel
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