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Klinger G.,Tel Aviv University | Levy I.,Infectious Disease Unit | Levy I.,Tel Aviv University | Sirota L.,Tel Aviv University | And 5 more authors.
Pediatrics | Year: 2010

BACKGROUND: Early-onset sepsis (EOS) is associated with significant morbidity and mortality among infants with a very low birth weight (VLBW); however, there is a sparse amount of complete data on large cohorts. OBJECTIVE: To evaluate the mortality and major morbidities among VLBW infants with EOS. METHODS: This was a population-based observational study. Data were prospectively collected by the Israel Neonatal Network on all VLBW infants born in Israel from 1995 through 2005. Univariate and multivariable analyses were performed to assess the independent association of EOS on morbidity and mortality of VLBW infants. RESULTS: The study cohort included 15 839 infants, of whom 383 (2.4%) developed EOS. EOS was associated with significantly increased odds for mortality (odds ratio [OR]: 2.57 [95% confidence interval (Cl): 1.97-3.35]), severe intraventricular hemorrhage (OR: 2.24 [95% Cl: 1.67-3.00]), severe retinopathy of prematurity (OR: 2.04 [95% Cl: 1.32-3.16]), and bronchopulmonary dysplasia (OR: 1.74 [95% Cl: 1.24-2.43]). EOS was associated with an increased risk of death and/or severe neurologic morbidity (OR: 2.92 [95% Cl: 2.27-3.80]). CONCLUSIONS: Although only 2.4% of VLBW infants had an episode of EOS, these infants were at an approximately threefold excess risk of death or major neurologic morbidities.

Ofek Shlomai N.,Hebrew University of Jerusalem | Reichman B.,Gertner Institute | Reichman B.,Tel Aviv University | Lerner-Geva L.,Gertner Institute | And 3 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2014

Aim: To assess whether the postnatal growth of preterm very-low-birthweight (VLBW) infants, as determined by measures of postnatal growth failure (PNGF), improved during the period 1995-2010 and to evaluate postnatal growth by gestational age (GA) and intrauterine growth groups. Methods: The study was based on the Israel national VLBW infant database and comprised 13 531 VLBW infants of 24-32 weeks' GA, discharged at a postmenstrual age of ≤40 weeks. Z-scores were determined for weight at birth and discharge. Severe and mild PNGF was defined as a decrease >2 and 1-2 z-scores, respectively. Three time periods were considered: 1995-2000, 2001-2005 and 2006-2010. Multinomial logistic regression was used to assess the independent effect of time period on PNGF. Results: Severe PNGF decreased from 11.7% in 1995-2000 to 7.2% in 2001-2005 and 5.2% in 2006-2010. Infants born in 2006-2010 had sixfold lower odds for severe PNGF than babies born in 1995-2000 (adjusted odds ratio 0.17, 95% confidence interval 0.14-0.21) and

Klinger G.,Neonatal Intensive Care Unit | Klinger G.,Tel Aviv University | Sokolover N.,Neonatal Intensive Care Unit | Sokolover N.,Tel Aviv University | And 7 more authors.
American Journal of Obstetrics and Gynecology | Year: 2013

Objective: We sought to assess the independent effect of perinatal factors on the risk for bronchopulmonary dysplasia (BPD) in very-low-birthweight infants. Study Design: This was a population-based observational study. Data were prospectively collected by the Israel Neonatal Network. Multivariable analyses identified independent risk factors for BPD. Results: Of 12,139 infants surviving to a postmenstrual age of 36 weeks, 1663 (13.7%) developed BPD. BPD was independently associated with young maternal age (odds ratio [OR], 1.53), maternal hypertensive disorders (OR, 1.28), antepartum hemorrhage (OR, 1.26), male gender (OR, 1.41), non-Jewish ethnicity (OR, 1.23), birth defects (OR, 1.94), small for gestational age (GA) (OR, 2.65), and delivery room resuscitation (OR, 1.86). Stratified analysis by GA groups showed that postdelivery resuscitation had a more pronounced effect with increasing maturity. Conclusion: Perinatal factors and pregnancy complications were independently associated with development of BPD in very-low-birthweight infants. Most risk factors identified were consistent within GA groups. © 2013 Mosby, Inc.

Horowitz E.,Gertner Institute | Bergman L.C.,Bar - Ilan University | Ashkenazy C.,Yehuda Abarbanel Mental Health Center | Moscona-Hurvitz I.,Teva Pharmaceutical Industries | And 2 more authors.
PLoS ONE | Year: 2014

Background: Off-label use of a drug not according to its regulatory labeling has become common in medicine, especially in the field of psychiatry. Mood stabilizers are intended to be used to attenuate mood fluctuations in bipolar disorder, but their use has spread to patients with schizophrenia, as it provides greater control of impulsivity and aggressiveness. Sodium valproate is one of the most frequently used mood stabilizers in psychiatry. This study determined the prevalence of offlabel use of sodium valproate for schizophrenia and schizoaffective disorder in Abarbanel Psychiatric Hospital and the demographic and clinical characteristics associated with its use. Methods: Retrospective study of patients hospitalized in 2011-2012 with a diagnosis of schizophrenia or schizoaffective disorder in one of three general psychiatric wards. Results: Valproate use was significantly lower in the geriatric group (11.6% vs. 20.1%, chi square = 4.7, p = .03), in patients with schizophrenia (14.1% vs. schizoaffective disorder (35.2%), chi square = 29, p<.001) and in patients receiving both atypical and typical antipsychotics (23.3% vs. 16.4%, p = .04). In multivariate logistic regression analysis, diagnosis and the combination of atypical and typical antipsychotics predicted the use of sodium valproate. The number of other medications prescribed did not predict sodium valproate use. Conclusions: Off-label use of sodium valproate in psychiatric patients with schizophrenia or schizoaffective disorder is extensive, especially in younger patients and those with schizoaffective disorder. More research is needed to determine whether it is being prescribed appropriately. © 2014 Horowitz et al.

Katriel G.,Tel Aviv University | Yaari R.,Tel Aviv University | Huppert A.,Gertner Institute | Roll U.,Tel Aviv University | Stone L.,Tel Aviv University
Journal of the Royal Society Interface | Year: 2011

This paper presents new computational and modelling tools for studying the dynamics of an epidemic in its initial stages that use both available incidence time series and data describing the population's infection network structure. The work is motivated by data collected at the beginning of the H1N1 pandemic outbreak in Israel in the summer of 2009. We formulated a new discrete-time stochastic epidemic SIR (susceptible-infected-recovered) model that explicitly takes into account the disease's specific generation-time distribution and the intrinsic demographic stochasticity inherent to the infection process. Moreover, in contrast with many other modelling approaches, the model allows direct analytical derivation of estimates for the effective reproductive number (Re) and of their credible intervals, by maximum likelihood and Bayesian methods. The basic model can be extended to include age-class structure, and a maximum likelihood methodology allows us to estimate the model's next-generation matrix by combining two types of data: (i) the incidence series of each age group, and (ii) infection network data that provide partial information of 'who-infected-who'. Unlike other approaches for estimating the next-generation matrix, the method developed here does not require making a priori assumptions about the structure of the next-generation matrix. We show, using a simulation study, that even a relatively small amount of information about the infection network greatly improves the accuracy of estimation of the next- generationmatrix. The method is applied in practice to estimate the next-generation matrix from the Israeli H1N1 pandemic data. The tools developed here should be of practical importance for future investigations of epidemics during their initial stages. However, they require the availability of data which represent a random sample of the real epidemic process. We discuss the conditions under which reporting rates may or may not influence our estimated quantities and the effects of bias. © 2011 The Royal Society.

Modern epidemiology has evolved in the last decades from the simplified " cause-effect" paradigm to a multi-factorial framework of causality. The concept of " Fetal Origin of Adult Diseases" (FOAD) is a good example: it suggests that preconception circumstances and fetal exposures as well as infancy and early childhood experiences may eventually change an individual's susceptibility to adult morbidity through fetal programming and epigenetic changes. The FOAD concept was supported, between others, by well-designed cohort studies carried out on non-Jewish World War II (WWII) survivors, exposed to hunger during the War years. However, data on late physical morbidity of Jewish WWII survivors are still scarce.The current paper presents some cohorts addressing the FOAD hypothesis in relation to the long-term impact of early exposures to hunger and their main results. It stresses the need for the establishing of a similar cohort in Israel, in order to study the long-term effects of the Holocaust on the health of Holocaust child survivors and on that of the " second" and " third" generations. A framework for such a cohort in Israel is also proposed.Establishing a cohort of this character in Israel should be a national priority and policy. First, taking special care of Holocaust survivors is a somewhat neglected national obligation. Second, if the population of Holocaust survivors and their offspring is indeed a high risk group for late chronic morbidity, higher awareness may lead to better primary prevention and to tailored secondary prevention programs. Third, the population at stack is unique and its contribution to the consolidation of the FOAD theory and its translational applications may be of foremost importance, in the global and national sense. © 2014 Keinan-Boker; licensee BioMed Central Ltd.

Peleg K.,Gertner Institute
The Journal of trauma | Year: 2010

BACKGROUND: The sudden influx of patients during mass casualty events (MCEs) may compromise the quality of care provided and possibly impact on the medical outcomes of these patients. To test this assumption, a comparison must be made between injuries sustained in MCE and non-MCE events caused by the same mechanism. The mechanism of injury selected for this study was gunshot wounds, which occur in both types of event. METHODS: A retrospective study was carried out using the Israel's National Trauma Registry data on patients hospitalized between November 1, 2000, and December 31, 2005, as a result of high-energy gunshot trauma. Descriptive statistics and bivariate analysis were used to characterize injury patterns, and multivariate analysis was used to determine factors influencing inpatient mortality. RESULTS: Of 462 patients with gunshot wounds, 120 cases (26.38%) were defined as MCE and 342 (73.62%) as non-MCE. Both populations had ∼30% of severely injured patients (Injury Severity Score 16+). MCE patients had undergone significantly fewer operational procedures. No differences between MCE and non-MCE were found in intensive care units utilization. The likelihood of death as a result of MCE was 2.75 (CI 1.09-7.02) times higher than non-MCE. Factors influencing this difference are the number of injured regions and injuries to the brain, chest, and abdomen. CONCLUSIONS: MCE patients have a significantly higher mortality than non-MCE patients, not manifesting substantial differences in the severity of injuries. The absence of difference in intensive care units utilization may be related to the effectiveness of existing protocols for dealing with MCEs.

Tartakovsky D.,Technion - Israel Institute of Technology | Tartakovsky D.,Gertner Institute | Broday D.M.,Technion - Israel Institute of Technology | Stern E.,Gertner Institute
Environmental Pollution | Year: 2013

Concentrations of particulate emissions from a quarry located in hilly terrain were calculated by two common atmospheric dispersion models, AERMOD and CALPUFF. Evaluation of these models for emissions from quarries/open pit mines that are located in complex topography is missing from the literature. Due to severe uncertainties in the input parameters, numerous scenarios were simulated and model sensitivity was studied. Model results were compared among themselves, and to measured total suspended particulate (TSP). For a wide range of meteorological and topographical conditions studied, AERMOD predictions were in a better agreement with the measurements than those obtained by CALPUFF. The use of AERMOD's "Open pit" tool seems unnecessary when accurate digital topographic data are available. Onsite meteorological data are shown to be crucial for reliable dispersion calculations in complex terrain. © 2013 Elsevier B.V.

Abadi-Korek I.,Gertner Institute
Harefuah | Year: 2011

The reformation in the marketing of non-prescription medicinal products has been launched. As of May 10th 2005, the pharmacist regulations 2004 (marketing of over-the-counter (OTC) drugs outside of pharmacies, as well as not by a pharmacist) will be in effect. This change aLlows the marketing of medicines outside of pharmacies, as has been the custom in the U.S.A., England and some of the European Union countries for many years. This reformation is incorporated in a policy that encourages self-medication by the use of non-prescription drugs. The self-medication policy originates from the point of view of the consumers who wish to be responsible for their own health and save precious time wasted on doctor visits; and the government's assumption that self-medication of OTC medicines by citizens wiLL decrease expenses for the HMOs in both doctor's billings as well as medication costs. In order to regulate the marketing terms of these medicinal products, regulations and complimentary guidelines were written and published. These documents encompass the following issues: the list of OTC medicines, marketing reguLations, packaging regulations, Licensed marketing Locations, storage regulations as well as display regulations, advertising regulations, monitoring and control. The medicinal products in this category only included medicines containing "safe" active ingredients with restrictions regarding the strength/concentration and packaging size; this category does not include medicines requiring special storage conditions (such as refrigeration or freezing), medicines containing an active ingredient that is addictive, medicines containing an active ingredient with danger of poisoning if misused, and medicines containing an active ingredient that has the potential to harm. The implementation of the regulations and guidelines will improve the consumer's ability to diagnose and treat oneself when sick with minor ailments, without consulting a doctor.

Medical resonance imaging (MRI) is a technology for imaging and diagnosis of tissues and organs which does not use ionizing radiation. It was developed in the 1960's and 1970's and has been in clinical use since the 1980's. Over the last two decades there has been a substantial increase in utilization of MRI due to: improvements in imaging technology and image processing, the development of new indications for its use, and the increase in availability and accessibility of MRI in several medical fields. However, there is also overutilization of this technology due to: the use of imaging as a substitute for regular physical examinations, repeated examinations for the same medical reason, "defensive" medicine, and due to the public's desire for sophisticated examinations. These issues are all responsible for the increased use of MRI. MRI is an expensive technology and therefore, cost-lowering medical and economic mechanisms are employed to Limit its use. Until recently there were ten MRI scanners in Israel and this review presents their utilization patterns. The number of MRI scanners will double in the coming years. This may improve accessibility in different regions of the country, shorten waiting times, and improve medical diagnosis due to implementation for new indications. An international comparison showed that the number of MRI scanners in Israel is lower than the average number of MRI scanners in OECD countries. However, the utilization of MRI scanners in Israel is high relative to other OECD countries, indicating the high level of efficiency of the Israeli healthcare system.

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