To assess whether asking questions about a future behavior changes this behavior (i.e., the question-behavior effect) when applied to a population-level intervention to enhance colorectal cancer ...screening.
In 2013, text-message reminders were sent to a national sample of 50 000 Israeli women and men aged 50 to 74 years following a fecal occult blood test invitation. Participants were randomized into 4 intervention groups (2 interrogative reminders, with or without reference to social context; 2 noninterrogative reminders, with or without social context) and a no-intervention control group. The outcome was fecal occult blood test uptake (n = 48 091, following attrition).
Performance of fecal occult blood test was higher in the interrogative-reminder groups than in the other 3 groups (odds ratio = 1.11; 95% confidence interval = 1.05, 1.19); the effect size was small, varying in the different group comparisons from 0.03 to 0.06.
The question-behavior effect appears to be modestly effective in colorectal cancer screening, but the absolute number of potential screenees may translate into a clinically significant health promotion change.
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CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective
To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition.
Study design
A retrospective cohort study.
Setting
Data ...based on electronic medical records of the largest Health Maintenance Organization in Israel.
Methods
Children hospitalized due to acute mastoiditis during the years 2008–2018 were identified, and their diagnosis was verified. Patients with recurrent acute mastoiditis were identified and grouped, and their characteristics were outlined and compared to those of the original group to identify risk factors for recurrence.
Results
During the 11-year period, a total of 1115 cases of children hospitalized due to acute mastoiditis were identified with a weighted incidence rate of 7.8/100,000. Of this group, 57 patients were diagnosed with recurrence following a full clinical recovery. The incidence proportion of recurrent acute mastoiditis was 5.1% (57/1115), male-to-female ratio was 27:30, 73.4% were younger than 24 months, the median period from the first episode was 3.4 months (IQR 2.0;10.0), and 82.5% of the patients (
n
= 47) had a single recurrence, whereas 18.5% (
n
= 10) had two recurrences or more. Mastoidectomy and swelling over the mastoid area during the first episode were identified as the main risk factors for recurrent mastoiditis HR = 4.7 (2.7–8.2),
p
< 0.001 and HR = 2.55 (1.4–4.8),
p
= 0.003, respectively. Mastoidectomy was the only independent significant risk factor for recurrence in a multivariate analysis.
Conclusions
Mastoidectomy and swelling over the mastoid area during the first episode of acute mastoiditis were found strongly related independent risk factor for future recurrent episodes of acute mastoiditis.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To identify potential factors associated with keratoconus.
This cross-sectional study included data from Israel's largest healthcare provider for the years 2005-2020. Keratoconus patients and ...age-matched controls were identified. Demographic factors and comorbid conditions, including smoking, diabetes mellitus, asthma, myalgia, mental retardation, Down syndrome, atopic dermatitis and allergy/allergic rhinitis, were compared between the two cohorts. The independent risk factors associated with keratoconus were determined using a multivariable conditional logistic regression model.
Overall, 145 508 subjects were reviewed of which 13 228 were keratoconus patients. A ten-fold group (n = 132 280) of age-matched control subjects served as controls for comparisons. In multivariable analysis, several factors were found to be significantly associated with keratoconus. Male gender (OR = 1.27, p < 0.001), Arab ethnicity (OR = 1.50, p < 0.001), diabetes (OR = 1.19, p < 0.001), asthma (OR = 1.50, p < 0.001), myalgia (OR = 1.09, p = 0.02), mental retardation (OR = 2.63, p < 0.001), atopic dermatitis (OR = 1.35, p < 0.001) and allergic rhinitis (OR = 1.21, p < 0.001) were significantly associated with keratoconus. Smoking was significantly protective of keratoconus (OR = 0.66, p < 0.001).
This population-based study reports male gender, Arab ethnicity, diabetes, asthma, myalgia, mental retardation/Down syndrome, atopic dermatitis and allergic rhinitis as factors associated with keratoconus while smoking demonstrates a protective effect. The results of this study could guide enhanced screening strategies and early interventions, particularly for high-risk groups.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Cancer centers are increasingly providing complementary medicine as part of an emerging discipline termed ‘integrative oncology’ (IO). The present study explored factors associated with disparities ...in referral and adherence to a freely-provided IO program.
The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0–3 sessions).
Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0–4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3–2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02–2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03–1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32–0.83, P = 0.006).
Patients’ ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aim
Condensation often occurs when providing humidified respiratory support. We examined conditions conducive to excess water formation in heated humified high‐flow nasal cannula (HHHFNC).
Methods
An ...HHHFNC device, at 35 or 37°C, was attached with a nasal cannula to a reservoir and tested in five ambient conditions and flows. For Group A, tubing and collection bottle remained at room temperature (23°C). Group B, tubing and reservoir remained inside an incubator (31°C). Group C, tubing and reservoir remained at 33°C. In Group D, the HHHFNC was set to 35°C, the reservoir remained at 33°C, and the nasal cannula and tubing remained at 23°C. Group E, same as D, with HHHFNC at 37°C.
Results
The largest amounts of collected water were in groups A and E. Both had highest temperature differences. Median (range) was 4.9°C (4.1–6.9) and 4.0°C, collecting 38.4 (26.4–50.4) and 26.4 (19.2–50.4) ml/24 h, respectively. Smallest amounts of water were seen with lower temperature differences as in groups B, C, and D with 2.7 (1.9–4.7), 1.6 (1.2–2.1), and 2.0°C with 8.4 (0.0–33.6), 2.4 (0.0–14.4), and 9.6 (4.8–16.8) ml/24 h, respectively.
Conclusion
HHHFNC devices may produce clinically significant amounts of water reaching the upper airways. This may be prevented with appropriate device set‐up.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: Factor XI (FXI) deficiency is a rare bleeding disorder, common in Ashkenazi Jews. Recently, target FXI as antithrombotic therapy became real issue as FXI antisense oligonucleotide ...appeared safe and efficient for preventing post- operative deep vein thrombosis following knee replacement (Buller et al. NEJM2015). The fact that in two models of Klebsiella pneumonia and Streptococcus pneumonia of FXI knock out (KO) mice there was an increased lethality as a result of enhanced bacterial overgrowth and dissemination along with augmented inflammatory response (Stroo et al. JTH 2017), incited us to explore whether patients with FXI deficiency harbor increased risk of pneumonia or increased pneumonia fatality in comparison to individuals with normal factor XI activity
Methods: This historical cohort study was performed by using the electronic database of the largest health care provider in Israel. All adults tested for FXI activity between 2002 and 2014 were included in the study. FXI activity was classified into three categories; normal (activity >50%), mild-moderate deficiency (activity: 20-50%), and severe deficiency (activity <20%). The cohort was followed until December 31, 2015 for incident overall pneumonia and severe pneumonia defined as pneumonia requiring hospitalization. The association was assessed using Cox proportional regression models with adjustment for age, gender, smoking status , diabetes, chronic obstructive disease ,ischemic heart disease, cirrhosis, previous stroke, malignancy, previous pneumonia, influenza vaccine, as well as pneumococcal vaccine
Results: Of the 10,193 included patients; 8,958 (87.9%) had normal FXI activity, 804 (7.9%) had mild-moderate deficiency and 431 (4.2%) had severe deficiency. A total of 579 individuals had pneumonia and 221 individuals had severe pneumonia during follow up. Compared to individuals with normal FXI activity the adjusted HR for overall pneumonia was 0.81 (95% CI, 0.60-1.10) in those with mild-moderate deficiency, and 0.97 (0.68-1.37) in those with severe factor XI deficiency. The adjusted HR for severe pneumonia was 0.86 (95% CI, 0.56-1.30) in those with mild-moderate deficiency, and 0.86 (0.51-1.40) in those with severe FXI deficiency.Of the 579 patients with pneumonia; 33 (5.7%) and 47 (8.1%) patients died within 30 days and 90 days, respectively. Compared to individuals with normal FXI activity the adjusted HRs for 30 days and 90 days mortality were 0.50 (0.15-1.7) and 0.47 (0.17-1.30), respectivelyin those with mild-moderate deficiency, and 0.81 (0.23-2.9) and 0.47 (0.14-1.60), respectively in those with severe FXI deficiency
Conclusions: FXI deficiency is not associated with increased incidence of pneumonia or with increased mortality among patients with pneumonia and as such it is suggested that FXI target therapy can be applied in adult patients without the fear of exposing them to increased risk of pneumonia
No relevant conflicts of interest to declare.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Women with the most extensive breast density, have a 4‐ to 6‐fold higher cancer risk than women with the lowest density. This cross‐sectional study evaluated associations of cumulative mammographic ...density in two distinct ethnic groups with the respective age‐specific breast cancer incidences in the population. The study compared four cohorts of 200 women each aged 35 to 49 and 50 to 74, representing Jewish and Arab ethnicity. Breast density measures were calculated from screening mammograms, using a thresholding software (Cumulus). Breast cancer specific incidence values were obtained from the National Cancer Registry. The percent mammographic density was lower for women aged 50 to 74 than 35 to 49 years, both for Jews: 11.7 vs 23.1 and for Arabs: 11.6 vs 18.3. In contrast, the cumulative density increased with age, from 37.30 to 181.24 in Jews, compared to 21.26 to 108.03 in Arabs. Similar trends in breast cancer incidence rates per 100 000 in the Israeli population were apparent, with an increase from 92.95 to 381.91 in Jews, compared to 48.6 to 244.44 in Arabs. Comparing cumulative density of the cohort with respective age‐specific breast cancer incidence in the population yielded a highly significant correlation: Jews; r = .97, P < .0001 and Arabs: r = .86, P = .007. A strong association was found between the log of cumulative density and the log of cancer incidence, as well. Our study identified correlations between cumulative mammographic density and breast cancer incidence in two distinct populations. The findings should prompt research to enhance our understanding of the pathogenesis of breast cancer, and lead to novel insights into measures of prevention.
What's new?
As a part of the International Consortium on Mammographic Density (ICMD), an Israeli Jewish and Arab biethnic study cohort, includes data screening participation, mammographic density and breast cancer incidence. Here, the authors analyzed data from the ICMD to better understand relationships between breast density and breast cancer risk. Cumulative mammographic density was found to correlate significantly with breast cancer incidence, with density values being higher among Jewish Israeli women compared to Arab Israeli women. The findings offer novel perspective on the utility of measures of breast cancer detection and warrant follow‐up investigation into a potential causal role for breast density in breast cancer development.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
In this study, the impact of a multimodal integrative oncology pre‐ and intraoperative intervention on pain and anxiety among patients undergoing gynecological oncology surgery was ...explored.
Methods
Study participants were randomized to three groups: Group A received preoperative touch/relaxation techniques, followed by intraoperative acupuncture; Group B received preoperative touch/relaxation only; and a control group (Group C) received standard care. Pain and anxiety were scored before and after surgery using the Measure Yourself Concerns and Wellbeing (MYCAW) and Quality of Recovery (QOR‐15) questionnaires, using Part B of the QOR to assess pain, anxiety, and other quality‐of‐life parameters.
Results
A total of 99 patients participated in the study: 45 in Group A, 25 in Group B, and 29 in Group C. The three groups had similar baseline demographic and surgery‐related characteristics. Postoperative QOR‐Part B scores were significantly higher in the treatment groups (A and B) when compared with controls (p = .005), including for severe pain (p = .011) and anxiety (p = .007). Between‐group improvement for severe pain was observed in Group A compared with controls (p = .011). Within‐group improvement for QOR depression subscales was observed in only the intervention groups (p <0.0001). Compared with Group B, Group A had better improvement of MYCAW‐reported concerns (p = .025).
Conclusions
A preoperative touch/relaxation intervention may significantly reduce postoperative anxiety, possibly depression, in patients undergoing gynecological oncology surgery. The addition of intraoperative acupuncture significantly reduced severe pain when compared with controls. Further research is needed to confirm these findings and better understand the impact of intraoperative acupuncture on postoperative pain.
Plain language summary
Integrative oncology programs are increasingly becoming part of supportive/palliative care, with many working within the Society for Integrative Oncology.
This study examined the impact of a multimodal integrative oncology program on pain and anxiety among 99 patients undergoing gynecological oncology surgery. Participants were randomized to three groups: preoperative touch/relaxation treatments, followed by intraoperative acupuncture; preoperative touch/relaxation without acupuncture; and a control group receiving standard care only.
The preoperative touch/relaxation intervention significantly reduced perioperative anxiety, with the addition of intraoperative acupuncture significantly reducing severe pain as well, when compared with controls. Further research is needed to confirm these findings.
Preoperative touch/relaxation reduces postoperative anxiety in patients undergoing gynecological oncology surgery, whereas intraoperative acupuncture reduces severe pain more significantly than controls. The addition of intraoperative acupuncture to preoperative touch/relaxation improves perioperative patient concerns.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
OBJECTIVE:
To evaluate maternal and neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody levels at birth after a third (booster) dose of the ...Pfizer-BioNTech messenger RNA (Pfizer) coronavirus disease 2019 (COVID-19) vaccine during the second trimester of pregnancy, and compare them with those in women who received two vaccine doses during the second trimester.
METHODS:
We conducted a prospective cohort study of women admitted to the delivery ward at a single center who received the third Pfizer COVID-19 vaccine dose (booster group) at 17–30 weeks of pregnancy and who did not have previous SARS-CoV-2 infection. Maternal and neonatal antibody levels were measured on admission for delivery and in the umbilical cord blood after birth. Antibody levels for the booster group were compared with those in a historical control group of pregnant women who received their second vaccine dose (two-dose group) within the same gestational age window.
RESULTS:
Between October 2021 and February 2022, antibody levels were measured in 121 women and 109 neonates at a mean±SD of 15.3±3.9 weeks after booster vaccination. Neonatal titers measured two times higher than maternal titers, with inverse correlation between maternal and neonatal titers at birth and time interval from third vaccination. The two-dose group included 121 women and 107 neonates, with antibody levels measured at a mean±SD of 14.6±2.6 weeks after the second dose. Median interquartile range maternal antibody titers were higher in the booster group (4,485 2,569–9,702 AU/mL) compared with the two-dose group (1,122 735–1,872 AU/mL) (
P
<.001). Furthermore, neonatal antibody titers were higher in the booster group (8,773 5,143–18,830 AU/mL) compared with the two-dose group (3,280 2,087–5,754 AU/mL) (
P
<.001).
CONCLUSION:
Maternal and neonatal SARS-CoV-2 IgG antibody titers after second-trimester maternal Pfizer COVID-19 vaccination were significantly higher after the booster dose compared with the two-dose vaccination series. Although there is uncertainty as to whether antibody levels correlate with protection, these data support the importance of booster vaccination during pregnancy to restore maternal and neonatal protection against COVID-19.
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