Introduction
Missed appointments (MAs) at child development centres (ChDCs) cause multiple problems: they preclude timely diagnosis and treatment of both the invited child and children whose ...appointment was delayed due to overbooking, as well as disrupting efficient organisational management. The aim of this study was to assess the rate and describe the reasons for missed appointments at Israeli ChDCs, and to evaluate the association of socio‐demographic, clinical, and administrative variables with MA rates.
Methods
This nested case‐control study included all children scheduled for initial appointments (N = 1143) at three centres during 1 year. Parents of children who missed their appointment and a sample of those who attended were interviewed by telephone.
Results
The rate of missed appointments was 26.6%, and the most frequent reasons were unexpected events (26.0%) and lack of insurance coverage (23.4%). Variables associated with lower MA rates were: having had ≥3 types of rehabilitative interventions (odds ratios (OR) = 0.26; 95% confidence interval CI 0.16–0.44), detailed referral letter (OR = 0.48; 95%CI 0.30–0.75), telephone reminder (OR = 0.37; 95%CI 0.24–0.57) and health maintenance organisations or private insurance coverage (OR = 0.12; 95%CI 0.06–0.17 and OR = 0.56; 95% CI 0.38–0.89, respectively).
Conclusion
Encouraging physician's referral letters and personal‐contact reminders can reduce missed appointments. Understanding the family's and the child's personal characteristics, and the organisational/administrative aspects of missed appointments may guide efforts to ensure timely care for every child.
Highlights
The missed appointment (MA) rate at Child Development Centres (ChDCs) was 26.6%
The most frequent reasons was unexpected personal events, for example, child's illness
Children who had received previous rehabilitative therapy had lower MA rates
Organisational factors, for example, insurance, reminders, were associated with MA rates
COVID-19 infection imposes a risk for pregnant individuals and may lead to adverse maternal and obstetric outcomes. This is a retrospective cohort study of all women giving birth between March and ...July 2021 at a single tertiary center. Obstetric and neonatal outcomes were compared between vaccinated and non-vaccinated pregnant women with singleton pregnancies. Women with prior COVID-19 infection, multiple gestations and stillbirth were excluded from the study. Of 4708 women who delivered during the study period, 3700 met the eligibility criteria, of whom 3240 were vaccinated during pregnancy. Compared with the non-vaccinated group, the vaccinated group was characterized by a lower rate of smoking (3.70% vs. 6.67%,
= 0.0028), whereasother maternal characteristics were not significantly different. Multivariable analysis demonstrated that COVID-19 mRNA vaccination was not significantly associated with increased risk of preterm birth as well as other adverse obstetric outcomes including hypertensive diseases of pregnancy, cesarean delivery and small for gestational age. However, a significantly lower risk for meconium-stained amniotic fluid was observed among the vaccinated group (adjusted odds ratio 0.63; 95% confidence interval, 0.46-0.86,
= 0.0039). Moreover, the vaccine was not significantly associated with increased risk of neonatal adverse outcomes including respiratory complications and NICU hospitalization. In conclusion, BNT162b2 messenger RNA vaccination during pregnancy was not associated with an increased rate of adverse obstetric and neonatal outcomes. Therefore, in view of its safety on one hand, and the risk associated with COVID-19 disease in pregnancy on the other hand, BNT 162b2 COVID-19 vaccine should be recommended for pregnant women.
To evaluate the long-term survival of ovarian cancer (OvC) patients in total and by BRCA1/2 mutation status.
In a nationwide case-control study on OvC conducted in Israel between 1994 and 1999, 779 ...Jewish women with epithelial invasive OvC were tested for the three Ashkenazi Jewish founder mutations in BRCA1 (185delAG; 5382insC) and BRCA2 (6174delT) genes and followed for survival up to 2003. Of the 605 women of Ashkenazi origin, 213 (35.2%) carried a mutation in the BRCA1/2 genes. Clinical characteristics were abstracted from the patients' medical records. The Kaplan-Meier method, log-rank tests, and stepwise Cox regression model were used for survival analyses.
The 5-year survival rate for the entire group was 39%. Median survival for carriers was significantly longer than for noncarriers (53.7 v 37.9 months, respectively; P = .002). This differential survival was pronounced among women diagnosed at stages III to IV (5-year survival rates of 38.1% and 24.5% for carriers and noncarriers, respectively; P < .001) and for women with poor grade (45.4% v 31.5%, for carriers and noncarriers, respectively; P < .001). These results remained significant after controlling for age at diagnosis, grade, and morphology. This benefit in prognosis was seen for both BRCA1 and BRCA2 carriers compared with noncarriers. During the study period (median follow-up, 6.2 years), being a BRCA1/2 mutation carrier decreased the mortality rate by 28%.
This study confirms that, among Ashkenazi OvC patients, BRCA1/2 mutations are associated with improved long-term survival. This may be due to distinct clinical behavior and/or to a better response to chemotherapy.
Objective:
This study aimed to describe Israeli maternity departments’ policies regarding cesarean delivery on maternal request, and factors associated with obstetricians’ support for cesarean ...delivery on maternal request in specific scenarios.
Methods:
This multicenter cross-sectional study included 22 maternity department directors and 222 obstetricians from the majority of Israeli hospitals. Directors were interviewed and completed a questionnaire about their department’s cesarean delivery on maternal request policy, and obstetricians responded to a survey presenting case scenarios in which women requested cesarean delivery on maternal request. The scenarios represented profiles referring to the following factors: maternal age, poor obstetric history, pregnancy complications, and psychological problems. The survey also included the obstetricians’ socio-demographic information and questions about other issues associated with cesarean delivery on maternal request. The main outcome measures were department policies regarding cesarean delivery on maternal request and obstetricians’ support for cesarean delivery on maternal request in specific cases.
Results:
Policies were divided between allowing and prohibiting cesarean delivery on maternal request (n = 10 and 12, respectively), and varied regarding issues such as informed consent and pre-surgery consultation. Most of the obstetricians (96.5%) did not support cesarean delivery on maternal request in the “reference scenario” describing a young woman with no obstetric complications. Additional factors increased the rate of support. Support was greater among obstetricians aged > 45 (odds ratio = 2.11; 95% confidence intervals 1.33–3.36) and lower among females (odds ratio = 0.58; 95% confidence intervals 0.39–0.86). Obstetricians whose department policy was less likely to allow cesarean delivery on maternal request reported lower rates of support for cesarean delivery on maternal request in most cases.
Conclusion:
Policies and obstetricians’ support for cesarean delivery on maternal request vary broadly depending on clinical profiles and physician characteristics. Department policy has an impact on obstetricians’ support for cesarean delivery on maternal request. Health policy will benefit from a framework in which the organizations, physicians, and patients are consulted.
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Background: The SARS-CoV-2 pandemic outbreak declared by the World Health Organization in March 2020 challenged health systems in affected countries and raised concerns for its ...potential direct and indirect impact on cancer patients. Cancer patients are at high risk for COVID-19 infections and complications due to factors related to their underlying condition and treatments. We aimed to evaluate the impact of COVID-19 on clinical activity of the oncology departments in Israel, and to assess the implementation of measures aimed at containment of COVID-19 diffusion, while allowing continuation of quality cancer care. Methods: A national survey among 18 of 19 oncology departments in Israel was conducted on April 2020 focusing on the institute's preparedness for treatment of their cancer patients during the COVID-19 pandemic. Results: Prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying at the departments. most participants reported employing a quick triage of patients and caregivers, prior to their entrance to the oncology units. Most departments limited the entrance of caregivers; one third not allowing entrance of any caregivers and more than half allowing entrance of only one caregiver. Some differences between large and small/medium sized medical centers were observed, with less strict measures taken by the smaller hospitals. Most departments implemented steps aimed at reducing unnecessary visits to the clinic. These included a shift to telephone interactions or telemedicine (78%) and switching to oral therapies, rather than intravenous ones, when possible. This approach was taken mostly by the medium/small hospitals compared to large hospitals (60% vs. 92%, p = 0.1). Conclusions: Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity. However, some differences between large and small hospitals were noted. These findings call for either better allocation of resources in case of an epidemic.
RAD51 colocalizes with both BRCA1 and BRCA2, and genetic variants in RAD51 would be candidate BRCA1/2 modifiers. We searched for RAD51 polymorphisms by sequencing 20 individuals. We compared the ...polymorphism allele frequencies between female BRCA1/2 mutation carriers with and without breast or ovarian cancer and between population-based ovarian cancer cases with BRCA1/2 mutations to cases and controls without mutations. We discovered two single nucleotide polymorphisms (SNPs) at positions
135 g→c and 172 g→t of the 5′ untranslated region. In an initial group of BRCA1/2 mutation carriers, 14 (21%) of 67 breast cancer cases carried a “c” allele at RAD51 :135 g→c, whereas 8 (7%) of 119 women without breast cancer carried this allele. In a second set of 466 mutation carriers
from three centers, the association of RAD51 :135 g→c with breast cancer risk was not confirmed. Analyses restricted to the 216 BRCA2 mutation carriers, however, showed a statistically significant association of the 135 “c” allele with the risk of breast
cancer (adjusted odds ratio, 3.2; 95% confidence limit, 1.4–40). BRCA1/2 mutation carriers with ovarian cancer were only about one half as likely to carry the RAD51 :135 g→c SNP. Analysis of the RAD51 :135 g→c SNP in 738 subjects from an Israeli ovarian cancer case-control study was consistent with a lower risk of ovarian
cancer among BRCA1/2 mutation carriers with the “c” allele. We have identified a RAD51 5′ untranslated region SNP that may be associated with an increased risk of breast cancer and a lower risk of ovarian cancer
among BRCA2 mutation carriers. The biochemical basis of this risk modifier is currently unknown.
To describe development of a methodology for an outcome study of children born following
fertilization or spontaneously-conceived, as a model for defining normal and below-normal development of ...school-age children for research purposes.
The main issues addressed were defining the major health and developmental domains to be investigated, selection of age-appropriate validated instruments, considering time constraints to maximize compliance, and budgetary limitations. The final protocol included a half-hour structured telephone interview with mothers of all 759 children and a 2-h developmental assessment of 294 of them. Each of the instruments and recruiting methods are described in terms of the abovementioned considerations.
Almost all of the mothers who agreed to be interviewed completed it within the half-hour allotted; however only about half of those who agreed to bring the child for the developmental assessment actually did so. The entire examination battery, assessing cognitive ability, executive functions, attention, and learning skills, was completed by almost all 294 children. There was a significant degree of agreement between the maternal report of the child's reading, writing and arithmetic skills and the in-person examination, as well as regarding the child's weight and height measurements.
The findings lend support for a low-budget study, relying on telephone interviews. However, limitations such as the validity of maternal report and recall bias must be taken into consideration.
Concern has been raised regarding the possible effects of mobile phone use on health, especially by children and adolescents. Thus, it is important to evaluate factors affecting their patterns of ...use. This study aimed to identify determinants of heavy mobile phone use among Israeli adolescents. Data were collected using a self-report questionnaire regarding mobile phone usage, leisure activity, sociodemographics, and opinion regarding mobile phone use. "Heavy use" was defined as >1 hour of daily duration of voice calls, or >50 daily text messages. The survey included 1,688 seventh and ninth graders in eight middle schools. The vast majority (96.1 percent) used the mobile phone for voice calls daily. Girls were heavier users than boys, and ninth graders were heavier users than seventh graders. Among students attending religious schools, the rate of heavy users was lower than among those attending secular schools. About half of the students did not use hands-free devices at least half of the time. Leisure activities were significantly associated with mobile phone use. This study demonstrates that several variables, including sociodemographics and leisure activities, may predict heavy mobile phone use among teenagers. This information can be useful for exposure assessment and for designing intervention programs for reducing radio frequency (RF) radiation exposure.
Objective:
The purpose of this study was to assess major neurodevelopmental aspects of children conceived by assisted reproductive treatments compared to spontaneously conceived children during the ...early school years.
Material & Methods:
In this follow-up study, mothers of 358 children born following assisted reproductive treatments and 401 spontaneously-conceived children were interviewed by telephone regarding their children’s health and development, when the children were 7-8 years old. The main outcomes were maternal responses to 4 questionnaires: Developmental Coordination Disorder Questionnaire, Short Sensory Profile, Autism Spectrum Screening Questionnaire, and the Attention-deficit hyperactive disorder (ADHD) Child Symptom Inventory-4 subscale. Mothers reported diagnoses of ADHD and autism spectrum disorder.
Results:
No significant differences were found between the groups in Developmental Coordination Disorder Questionnaire or Short Sensory Profile scores upon univariate or multivariable analyses. There was a slightly higher but nonsignificant rate of diagnosed ADHD among children in the assisted reproductive treatment group (9.6% vs 5.5%; P = .18); on multivariable analysis, a nonsignificant increase in ADHD was also found for assisted reproductive treatment children (hazard ratio 1.45, 95% confidence interval 0.81-2.61). Regarding the Child Symptom Inventory-4 criteria for ADHD among the children who had never been diagnosed, there was also a slightly higher but nonsignificant rate among the assisted reproductive treatments compared to spontaneously-conceived children on univariate (2.4% vs 1.8%; P = .50) and multivariable analysis (odds ratio 0.88, 95% confidence interval 0.27-2.86). Autism spectrum disorder diagnosis or Autism Spectrum Screening Questionnaire scores were not significantly different; however, 5 of the 6 children with autism spectrum disorder diagnoses were in the assisted reproductive treatment group.
Conclusions:
Neurodevelopmental measures were similar in both groups, although nonconclusive regarding ADHD and autism spectrum disorder risk. These findings contribute to the knowledge regarding long-term assisted reproductive treatment outcomes.
While assisted reproductive technology is increasingly prevalent, there is concern amid conflicting findings reported regarding the long-term outcomes of children born following these treatments. The ...aim of this research was to investigate aspects of cognitive development in early school-age Israeli children born following assisted reproductive technology (ART) treatments, compared to those spontaneously conceived (SC).
This prospective follow-up study was based on an Israeli cohort recruited from June 2006 to December 2008, that included 561 women whose pregnancies were achieved by ART treatments and 600 women whose pregnancies were SC. When the children were 7–8 years old, 759 of their mothers were interviewed by telephone, and 294 were came for developmental assessment. The examination included: Kaufman Brief Intelligence Test; Kaufman Assessment Battery for Children (arithmetic only); Test of Everyday Attention for Children; Beery-Buktenica Developmental Test of Visual-Motor Integration and Supplemental Test for Visual Perception; Rey-Osterrieth Complex Figure Test; Aleph-ad-Tav Hebrew reading and writing; Tavor Picture Naming Expressive Vocabulary Test. Multivariable analyses were adjusted for maternal years of education (≤12, 13+) at child's birth and child's sex.
Cognitive function, visual-motor ability, attention, and verbal skills of children born after ART treatments were similar to those of SC children, upon both univariate and multivariable analysis.
No significant differences were found between the ART and SC groups on any of the measures examined. This finding offers couples seeking ART treatments improved information regarding child development during the important and formative school years.
Increasing rates of ART treatments arouse concern about long-term outcomes for offspring, and conflicting findings have been reported with respect to the skills necessary to their academic success. This prospective follow-up study compared school-age children born following ART with spontaneously-conceived children. Children were examined by developmental psychologists, and cognitive function, visual-motor, attention, verbal, and performance skills were similar in both groups.
•Assisted reproductive treatments arouse concern for offspring's long-term outcomes.•Conflicting findings have been reported regarding their academic success.•School-age children born following ART and those spontaneously-conceived were compared.•Developmental psychologists examined children in both groups.•Cognitive, visual-motor, attention and verbal skills were similar in both groups.
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