The Pfizer BNT162b2 vaccine showed a reassuring safety profile in clinical trials, but real-world data are scarce. Bell's palsy, herpes zoster, Guillain–Barré syndrome (GBS) and other neurological ...complaints in proximity to vaccination have received special public attention. We compared their rates among vaccinated and unvaccinated individuals.
Individuals ≥16 years vaccinated with at least one dose of BNT162b2 were eligible for this historical cohort study in a health maintenance organization insuring 1.2 million citizens. Each vaccinee was matched to a non-vaccinated control by sex, age, population sector (general Jewish, Arab, ultra-orthodox Jewish) and comorbidities. Diagnosis of Covid-19 before or after vaccination was an exclusion criterion. The outcome was a diagnosis of Bell's palsy, GBS, herpes zoster or symptoms of numbness or tingling, coded in the visit diagnosis field using ICD-9 codes. Diagnoses of Bell's palsy and GBS were verified by individual file review.
Of 406 148 individuals vaccinated during the study period, 394 609 (97.2%) were eligible (11 539 excluded). A total of 233 159 (59.1%) were matched with unvaccinated controls. Mean follow was 43 ± 15.14 days. In vaccinated and unvaccinated individuals there were 23 versus 24 cases of Bell's palsy (RR 0.96, CI 0.54–1.70), one versus zero cases of GBS, 151 versus 141 cases of herpes zoster (RR 1.07, CI 0.85–1.35) and 605 versus 497 cases of numbness or tingling (RR 1.22, CI 1.08–1.37), respectively.
No association was found between vaccination, Bell's palsy, herpes zoster or GBS. Symptoms of numbness or tingling were more common among vaccinees. This study adds reassuring data regarding the safety of the BNT162b2 vaccine.
Background:
Teriparatide (TPTD) should be followed by an antiresorptive to maximize bone mineral density gain and anti-fracture protection. Infrequent zoledronic acid (ZOL) administration has ...demonstrated effectiveness. The duration of ZOL effect following TPTD is unknown.
Objective:
To evaluate the effect of ZOL on bone resorption marker in a post-TPTD versus ZOL-alone scenario in osteoporotic patients.
Design:
Retrospective cohort study.
Methods:
Patients treated with TPTD followed by ZOL (TPTD–ZOL) or with a single ZOL infusion were identified in the database of a tertiary referral center. Clinical and laboratory data, including C-terminal telopeptide of type I collagen (CTX) following ZOL treatment, were compared.
Results:
Twenty-six patients (93% women) treated with TPTD–ZOL and 41 with ZOL were comparable in age (median 70.1 versus 69.6 years, p = 0.6) and sex. Timing of CTX measurement post-ZOL was the same, median 1.0 year. CTX was lower following TPTD–ZOL (median 142.1 versus 184.2 pg/mL, p = 0.005). In a multivariable regression model (controlled for baseline characteristics), pretreatment with TPTD strongly predicted CTX <150 pg/mL, 1 year following ZOL (odds ratio = 7.5, 95% CI 1.3–58.1, p = 0.03). In a subgroup with sequential CTX measurements following one ZOL, significantly lower levels persisted in the TPTD–ZOL group for a median of 4.4 years follow-up.
Conclusion:
ZOL-administered sequential to TPTD yielded deeper and more prolonged bone resorption suppression than ZOL alone. Prospective data are needed to confirm whether in a sequential treatment scenario, subsequent ZOL dosing interval should be less frequent.
The proportion of the population vaccinated in Israel against COVID-19 in 2021 was significantly higher than that of the annual uptake rates of the influenza vaccine over time. Understanding the ...reasons behind the high vaccination rate may facilitate maintaining these rates if annual COVID-19 vaccination is required. Using a mixed-methods design, we characterized the individuals who were vaccinated and studied their attitudes toward vaccines and motivators for the COVID-19 vaccine. The first part was a cross-sectional study of adults aged 65 and over who were vaccinated against COVID-19. We stratified them according to their annual influenza vaccination patterns, and compared variables such as age, gender, health status, and timing of COVID-19 vaccination. The second part consisted of a questionnaire administered to a subsample of the above population, inquiring about vaccine hesitancy, motivators for vaccination, and intention to be vaccinated in the future. We found that motivating factors for COVID-19 vaccination are similar between those who regularly vaccinate against influenza and those who don't. Internal motivators such as perceived vaccine effectiveness and the desire to protect others were stronger than external rewards or sanctions. High adherence to annual influenza vaccine recommendations was associated with earlier COVID-19 vaccine uptake. Respondents with lower adherence to influenza vaccines were more likely to demonstrate higher levels of vaccine hesitancy. These factors should be addressed in future vaccination campaigns.
Since the outbreak of COVID-19, billions of people have gone into lockdown, facing pandemic related challenges that engender weight gain, especially in the obese. We report the results of an online ...survey, conducted during Israel's first quarantine, of 279 adults treated in hospital-based obesity clinics with counseling, medications, surgery, endoscopic procedures, or any combination of these for weight loss. In this study, we assessed the association between changes in dietary and lifestyle habits and body weight, and the benefits of receiving weight management care remotely through telemedicine during lockdown. Compared to patients not receiving obesity care via telemedicine, patients receiving this care were more likely to lose weight (OR, 2.79;
= 0.042) and also to increase participation in exercise (OR, 2.4;
= 0.022). While 40% of respondents reported consuming more sweet or salty processed snacks and 33% reported less vegetables and fruits, 65% reported more homemade foods. At the same time, 40% of respondents reported a reduction in exercise and 52% reported a decline in mood. Alterations in these eating patterns, as well as in exercise habits and mood, were significantly associated with weight changes. This study highlights that lockdown affects health behaviors associated with weight change, and advocates for the use of telemedicine to provide ongoing obesity care during future quarantines in order to promote weight loss and prevent weight gain.
The skin-gut axis, characterized by bidirectional communication between the skin and gut, plays a crucial role in the pathogenesis of psoriasis and inflammatory bowel diseases (IBD).
We aimed to ...explore the association between psoriasis and IBD and identify predictors associated with IBD development among patients with psoriasis.
Retrospective cohort study.
A retrospective study which utilized an electronic database from the Meuhedet Health Maintenance Organization (MHMO) in Israel. Psoriasis was categorized as severe if any systemic agent or phototherapy was administered. Univariate and multivariate logistic regressions were used to identify specific predictors for IBD, with adjustments made for potential confounders. The study received approval from the Ethical Committee of the MHMO.
In total, 61,003 adult patients who were diagnosed with psoriasis between 2000 and 2022 were included. Among them, 1495/61,003 patients (2.4%) were diagnosed with IBD, as compared to 3834/244,012 patients (1.6%) in the non-psoriasis group adjusted odds ratio (OR): 1.47; 95% confidence interval (CI): 1.37-1.56;
< 0.001. Increased age (OR: 1.01; 95% CI: 1.01-1.02;
< 0.001), male gender (OR: 1.22; 95% CI: 1.03-1.45;
= 0.024), and Jewish ethnicity (OR: 2.5; 95% CI: 1.2-4.1;
< 0.001) were identified as significant risk factors for IBD. Spondyloarthropathies, including psoriatic arthritis (OR: 2.27; 95% CI: 1.86-2.77;
< 0.001) and ankylosing spondylitis (OR: 2.82; 95% CI: 1.5-5.32;
< 0.05), were associated with a higher prevalence of IBD. Furthermore, severe psoriasis was significantly associated with a higher likelihood of IBD, compared to mild psoriasis (OR: 16.03; 95% CI: 11.02-23.34;
< 0.001).
A significant association between psoriasis and IBD was demonstrated, including its subtypes: Crohn's disease and ulcerative colitis. Moreover, such association may depend on psoriasis severity as determined by the treatment used. This association warrants further investigation and implies a potential need for closer monitoring of patients with severe psoriasis.
Abstract
Background
The COVID-19 pandemic had a major impact on primary care and primary care physicians (PCPs) in Israel and around the world. There is paucity of information regarding treatment of ...patients with COVID-19 in the community, since most research was performed in hospitals. The aim of this study was to describe the Israeli PCPs’ experience.
Methods
This study is a part of an international cross-sectional study, the PRICOV-19. A translated version of the questionnaire was distributed among Israeli PCPs from December 2020 to July 2021. In this study, we describe the Israeli results and compare them to the international results.
Results
5,961 respondents from 29 countries answered the questionnaire, 94 from Israel, with an Israeli response rate of 16%. Israeli PCPs reported an increase in use of telemedicine from 11 to 49% during the COVID epidemic. PCPs also reported a decline in their wellbeing; absence of secured time slots for keeping updated; perception that the Ministry of Health guidelines were a threat to the staff wellbeing and organization of practice and delays in the examination of non-COVID urgent cases.
Conclusions
The findings of this study raise concerns regarding the PCPs experience and may form the basis for an improved process of care. Guidelines for proper usage of telemedicine, substitutes for the physical examination and procedures for minimizing delayed patient examination for urgent conditions should be developed. Government directives and clinical guidelines should be communicated in a timely manner, with secured timeslots for physicians’ self-learning or updating. Ensuring physicians’ well-being in general should be an organization priority.
Behavioral treatments can augment the success of pharmacotherapy in smoking cessation. The aim of this study was to compare smoking quit rates between patients receiving individual counseling with ...their general practitioner during office visits or intensive counselling with behavioral support, both augmented by varenicline.
A nationwide retrospective cohort study conducted in a large Healthcare Maintenance Organization in Israel. We selected randomly patients who filled a prescription for varenicline and received either individual consulting by their general practitioner or intensive counselling with behavioural support, and asked them to answer a questionnaire. The outcome variables were smoking cessation 26-52 weeks following the beginning of treatment and satisfaction with the process.
870 patients were contacted and 604 agreed to participate (a response rate of 69%); 301 patients in the general practitioner group, 300 in the intensive counselling group and 3 were excluded due to missing date. The quit rate was 36.5% in the general practitioner group and 42.3% in the intensive counselling group (P = 0.147). In a logistic regression analysis, controlling for age, gender, socioeconomic status, ischemic heart disease, chronic obstructive pulmonary disease, pack years and duration of varenicline consumption, the adjusted OR for quitting in the general practitioner group was 0.79 (95% CI 0.56,1.13). The adjusted OR was higher in the group with the highest socioeconomic status at 2.06 (1.39,3.07) and a longer period of varenicline consumption at 1.30 (1.15,1.47). Age, gender and cigarette pack-years were not associated with quit rate. In the general practitioner group 68% were satisfied with the process, while 19% were not. In the intensive counselling group 64% were satisfied and 14% were not (P = 0.007).
We did not detect a statistically significant difference in smoking quit rates, though there was a trend towards higher quit rates with intensive counselling.
Introduction
Drug prior authorization (PA) imposes a bureaucratic and economic burden on healthcare service providers and payers. A novel automated PA system may improve these drawbacks.
Methods
An ...historical cohort study from a large health maintenance organization in Israel, comparing manual versus automated PA mechanisms for diabetes mellitus (DM) drugs: sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogs (GLP1-A). We compared patients with DM, whose first drug applications were approved using the automated system, with similar patients whose first drug applications were approved by manual PA. The primary endpoint was the time elapsed from application approval to prescription filling (accessibility time). Secondary endpoints included the prescription filling rate at 7 and 30 days.
Results
In total, 1371 automated approved prescriptions and 1240 manually approved prescriptions were included in the analysis. Median accessibility time was one day (interquartile range (IQR) 0–5) with automated PA for both GLP1-A and SGLT2i, compared with four days (IQR 1–9) and three days (IQR 1–8), respectively, with the manual PA (p < 0.001). Eighty-four percent of GLP1-A automated PA approvals were filled within seven days compared with 70% with manual PA (p < 0.001). Similar results were seen with SGLT2i (80% vs. 72%, p < 0.008). No differences were observed at 30 days post-approval. Using logistic regression, odds for GLP1-A and SGLT2i prescription filling within seven days were 2.36 and 1.53 folds higher (respectively) with automated PA (p < 0.01).
Conclusions
Automated PA system improved access time to SGLT2i/GLP1-A seven days post-approval compared to manual PA.
Smoking is the leading preventable cause of death and illness globally. There is conflicting evidence regarding the association between quitting rates and partners' smoking status. It is thought that ...spouses influence one another's health habits, including smoking. This study aims to evaluate this association in patients who made a smoking cessation attempt with pharmacotherapy.
For this Israeli nationwide retrospective cohort study, we randomly selected patients who filled a prescription for varenicline as part of their smoking cessation process and were partnered. The participants were asked to complete a questionnaire 26-52 weeks after the first varenicline purchase. The independent variables were the partner's smoking status at the beginning of the smoking cessation process and while answering the questionnaire. The outcome was a success in the quitting process.
In all, 226 (50%) participants had partners who smoked at the beginning of the quitting process, and 230 (50%) had non-smoking partners; 178 (39%) participants reported successful smoking cessation. There was a significant difference in success rates depending on partners' smoking status at the end of the process, with success rates of 39% with a non-smoking partner, 76% with a partner who also stopped smoking, and 31% with a partner who continued smoking (p<0.001). Multivariate analysis showed that having a partner who stopped smoking during the quitting process was associated with higher odds of quitting compared with having a non-smoking partner (OR=4.73; 95% CI: 1.86-12.05).
This study showed that both partners quitting was associated with increased odds of successful quitting. Health providers should make efforts to engage both partners in smoking cessation.
The treatment of systemic sclerosis (SSc) presents a clinical challenge because of the progressive nature of the disease, relatively poor prognosis, and lack of a proven treatment. In the last 10 ...years, several studies demonstrated the importance of interleukin 6 (IL6) as a pivotal cytokine in the development of fibrosis and angiopathy, especially in SSc. Tocilizumab, an IL6 receptor antibody, has shown promising results for patients with SSc.
A total of 16 patients with SSc were treated with tocilizumab; 14 were female and 2 were male, with a median age of 45.5 years and median disease duration of 31.5 months. Ten patients had anti-SCl-70, none had anticentromere, and two had antipolymerase. Tocilizumab treatment was provided as long as the patient's condition improved.
Total treatment duration was 30.33 patient-years. Median treatment duration was 18.5 months, and 3 patients were treated for a period of 4 years and longer. Ten patients were treated with tocilizumab to the date of data collection. All were feeling good and maintained the achieved improvement throughout the treatment period. Improvement was recorded in 12 patients (75%). Mean reduction in modified Rodnan skin score was 11 points (p < 0.001), musculoskeletal and joint involvement improved in 75% and 80% of patients, respectively, and improvement in lung function was recorded in 46%. Patients with early SSc responded better to tocilizumab (p = 0.01).
This is the largest reported case series of tocilizumab treatment in patients with SSc. The treatment was without significant side-effects and was beneficial for most patients, especially in early disease. The present study reinforces previous findings regarding the efficacy of tocilizumab in treating SSc.
PDF
