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Sencer S.F.,Childrens Hospitals and Clinics of Minnesota | Zhou T.,California State University, Long Beach | Zhou T.,Childrens Oncology Group | Freedman L.S.,Gertner Institute for Epidemiology and Public Health Policy | And 9 more authors.
Bone Marrow Transplantation | Year: 2012

Mucositis can be a serious complication of hematopoietic SCT (HSCT). A previous phase II trial in 32 children undergoing HSCT reported a beneficial effect of the homeopathic remedy Traumeel S. The Children's Oncology Group sought to replicate the results in a multi-institutional trial. The study was an international multi-center, double-blind, randomized trial comparing Traumeel with placebo in patients aged 325 years undergoing myeloablative HSCT. Traumeel/placebo was started on Day 1 as a five-time daily mouth rinse. Efficacy of the treatment was assessed using the modified Walsh scale for mucositis, scored daily from Day 1 to 20 days after HCST. The main outcome was the sum of Walsh scale scores (area-under-the-curve (AUC)) over this period. Other outcomes included narcotic use, days of total parenteral feeding, days of nasogastric feeding and adverse events. In 181 evaluable patients, there was no statistical difference in mucositis (AUC) in the Traumeel group (76.7) compared with placebo (67.3) (P0.13). There was a trend towards less narcotic usage in the Traumeel patients. No statistically beneficial effect from Traumeel was demonstrated for mucositis. We could not confirm that Traumeel is an effective treatment for mucositis in children undergoing HSCT. © 2012 Macmillan Publishers Limited All rights reserved.


PubMed | Chaim Sheba Medical Center, Ben - Gurion University of the Negev, Tel Aviv University, Wolfson Medical Center and Gertner Institute for Epidemiology and Public Health Policy
Type: | Journal: Israel journal of health policy research | Year: 2015

In recent years, an increasing number of care procedures previously under the physicians authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics.A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work.Nurses reported positive attitudes toward the expansion of nurses authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses authority.In the Israeli reality of a nurses shortage, we are witnessing professional transitions toward expansion of the scope of nurses accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.


Subar A.F.,U.S. National Cancer Institute | Midthune D.,U.S. National Cancer Institute | Tasevska N.,U.S. National Cancer Institute | Kipnis V.,U.S. National Cancer Institute | Freedman L.S.,Gertner Institute for Epidemiology and Public Health Policy
European Journal of Clinical Nutrition | Year: 2013

Background/Objectives:The orally administered para-Amino benzoic acid (PABA) is known to have near 100% excretion in urine and is used as a measure of 24-h urine collection completeness (referred to as PABAcheck). The purpose was to examine the effect of including urine collections deemed incomplete based on PABAcheck in a dietary measurement error study.Subjects/Methods:The Observing Protein and Energy Nutrition (OPEN) study was conducted in 1999-2000 and included 484 men and women aged 40-69 years. A food frequency questionnaire and 24-h dietary recalls were evaluated using recovery biomarkers that included urinary nitrogen and potassium from two 24-h urine collections. Statistical modeling determined the measurement error properties of dietary assessment instruments. In the original analyses, PABAcheck was used as a measure of complete urine collection; incomplete collections were either excluded or adjusted to acceptable levels. The OPEN data were reanalyzed including all urine collections and by using criteria based on self-reported missing voids to assess the differences.Results:Means and coefficients of variation for biomarker-based protein and potassium intakes, and measurement error model-based correlations and attenuation factors were similar regardless of whether PABAcheck or missed voids were considered.Conclusion:PABAcheck may not be required in large population-based biomarker studies. However, until there are more analyses evaluating the necessity of a PABAcheck, it is recommended that PABA be given to all participants, but not necessarily analyzed. Then, PABAcheck could be used selectively as a marker of completeness among the collections in which low levels of biomarker are detected or for which noncompliance is suspected. © 2013 Macmillan Publishers Limited. All rights reserved.


Leitner-Dagan Y.,Weizmann Institute of Science | Sevilya Z.,Weizmann Institute of Science | Pinchev M.,Weizmann Institute of Science | Kramer R.,Rambam Health Care Campus | And 8 more authors.
Journal of the National Cancer Institute | Year: 2012

Only a minority of smokers develop lung cancer, possibly due to genetic predisposition, including DNA repair deficiencies. To examine whether inter-individual variations in DNA repair activity of N-methylpurine DNA glycosylase (MPG) are associated with lung cancer, we conducted a blinded, population-based, case-control study with 100 lung cancer case patients and 100 matched control subjects and analyzed the data with conditional logistic regression. All statistical tests were two-sided. MPG enzyme activity in peripheral blood mononuclear cells from case patients was higher than in control subjects, results opposite that of 8-oxoguanine DNA glycosylase (OGG1) DNA repair enzyme activity. For lung cancer associated with one standard deviation increase in MPG activity, the adjusted odds ratio was 1.8 (95% confidence interval [CI] 1.2 to 2.6; P . 006). A combined MPG and OGG1 activities score was more strongly associated with lung cancer risk than either activity alone, with an odds ratio of 2.3 (95% CI 1.4 to 3.6; P <. 001). These results form a basis for a future panel of risk biomarkers for lung cancer risk assessment and prevention. © 2012 The Author.


Tiruneh A.,Gertner Institute for Epidemiology and Public Health Policy | Siman-Tov M.,Gertner Institute for Epidemiology and Public Health Policy | Radomislensky I.,Gertner Institute for Epidemiology and Public Health Policy | Peleg K.,Gertner Institute for Epidemiology and Public Health Policy | Peleg K.,Tel Aviv University
Ethnicity and Health | Year: 2016

Objective. To examine whether characteristics and circumstances of injuries are related to ethnicity. Design. The study was based on the Israeli National Trauma Registry data for patients hospitalized between 2008 and 2011. Data included demographics, injury, hospital resource utilization characteristics and outcome at discharge. Univariate analysis followed by logistic regression models were undertaken to examine the relationship between injury and ethnicity. Results. The study included 116,946 subjects; 1% were Ethiopian Born Israelis (EBI), 11% Israelis born in the Former Soviet Union (FSUBI) and 88% the remaining Israelis (RI). EBI were injured more on street or at work place and had higher rates of penetrating and severe injuries. However, FSUBI were mostly injured at home, and had higher rates of fall injuries and hip fracture. Adjusted analysis showed that EBI and FSUBI were more likely to be hospitalized because of violence-related injuries compared with RI but less likely because of road traffic injuries. Undergoing surgery and referral for rehabilitation were greater among FSUBI, while admission to intensive care unit was greater among EBI. Conclusion. Targeted intervention programmes need to be developed for immigrants of different countries of origin in accordance with the identified characteristics. © 2016 Informa UK Limited, trading as Taylor & Francis Group


Siman-Tov M.,Gertner Institute for Epidemiology and Public Health Policy | Jaffe D.H.,Gertner Institute for Epidemiology and Public Health Policy | Peleg K.,Gertner Institute for Epidemiology and Public Health Policy | Peleg K.,Tel Aviv University
Accident Analysis and Prevention | Year: 2012

Bicycle riding is a popular form of recreation with positive health and environmental effects. These road users are vulnerable to serious injuries, especially when motor vehicles are involved. The goal of this study was to characterize cyclist-related injuries according to motor vehicle involvement for adults versus children. A retrospective study was carried out using data from 11 trauma centers in the Israeli National Trauma Registry (2001-2007). Injuries were classified according to whether a motor vehicle was involved, and differences in injury characteristics were assessed for adults (18+ years) versus children (1-17 years). A total of 5529 patients were hospitalized for bicycle injuries, of whom 1765 were adults and 3764 were children. Thirty percent (n = 1662) of all bicycle injuries involved motor vehicles, although the rate of injuries resulting in hospitalization was 37% among adults and 27% among children. Injury characteristics and hospital resource utilization differed substantially by age group. Cyclists struck by a motor vehicle presented with more severe injuries requiring more hospital resources and resulting in poorer outcomes than those not involved with motor vehicles. The interaction effect between motor vehicle involvement and age was significant for torso injuries and need for medical imaging. We found that injury characteristics, hospital resource utilization and health-related outcomes for bicycle injuries are highly dependent on patient's age and mechanism of injury. Effect modification of motor vehicle involvement by age may in part reflect physicians' attitudes toward pediatric imaging. The risks identified in this study should be used for preparedness and management of trauma hospitalizations from bicycle injuries. © 2010 Elsevier Ltd. All rights reserved.


Abdel-Rahman N.,Gertner Institute for Epidemiology and Public Health Policy | Siman-Tov M.,Gertner Institute for Epidemiology and Public Health Policy | Peleg K.,Gertner Institute for Epidemiology and Public Health Policy | Peleg K.,Tel Aviv University
Ethnicity and Health | Year: 2013

Objective. To examine the differences and characteristics of road traffic injuries (RTIs) among Jewish and Arab children, ages 0-17 years, in Israel. Design. A retrospective study based on data from the Israeli National Trauma Registry between 2001 and 2010. This study relates specifically to traffic-related hospitalizations among children ages 0-17 years. Data include demographic, injury, and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences of RTIs between the two ethnic groups. Results. A total of 18,884 children were included, of which Arab children comprised 38.2% of the total and 44.1% of the severely injured. Among Arab children 41.8% were pedestrians compared to 33.4% among Jewish children (p<0.0001). Arab children were younger, had more severe injuries and more traumatic brain injury (TBI) compared to Jewish children. Adjusted logistic regression analysis shows that the probability of an Arab child, relative to a Jewish child, to undergo surgical procedures was 1.2 (p<0.0001), to be hospitalized in intensive care units (ICUs) was 0.8 (p=0.003), and to be transferred to rehabilitation was 0.5 (p<0.0001). There was no significant difference in inpatient mortality between the two ethnic groups. Conclusions. Arab children in Israel are more likely to be hospitalized due to road accidents in comparison to Jewish children. Intervention programs should focus on Arab children and their unique characteristics. © 2013 Taylor and Francis Group, LLC.


PubMed | The Edmond and Lily Safra Childrens Hospital, Chaim Sheba Medical Center and Gertner Institute for Epidemiology and Public Health Policy
Type: Journal Article | Journal: Journal of paediatrics and child health | Year: 2016

The aim of the study is to examine whether baseline serum Mg concentration has an impact on short-term and long-term outcomes in preterm infants exposed antenatally to MgSO4.Participants included all infants admitted to the neonatal intensive care unit at <32weeks of gestational age. Infant serum Mg concentration (iMgC) was examined immediately after birth in those exposed to maternal MgSO4. Data for short-term outcomes were collected from the infants computerised charts. Neurodevelopmental outcomes at 6-12 months corrected age were assessed using the Griffiths Mental Developmental Scales.Of 197 eligible infants, 145 were exposed to MgSO4. Baseline iMgC was available for 88 infants. Mean iMgC was 3.50.88mg/dL (1.6-5.7mg/dL). Baseline iMgC was not associated with an increased risk for neither early morbidities nor adverse long-term outcome. However, iMgC above the mean (>3.5mg/dL) was associated with significantly lower scores on locomotor (P=0.016) and personal-social (0.041) scales in the first year of life.In a cohort of preterm infants antenatally exposed to MgSO4, elevated baseline iMgC (>3.5mg/dL) was associated with lower locomotor scores. Further research is needed in order to study the relationship between supra-physiologic iMgC and its effect on the developing brain.


PubMed | Gertner Institute for Epidemiology and Public Health Policy
Type: Journal Article | Journal: Traffic injury prevention | Year: 2015

According to the World Health Organization, over one million people die annually from traffic crashes, in which over half are pedestrians, bicycle riders and two-wheel motor vehicles. In Israel, during the last decade, mortality from traffic crashes has decreased from 636 in 1998 to 288 in 2011. Professionals attribute the decrease in mortality to enforcement, improved infrastructure and roads and behavioral changes among road users, while no credit is given to the trauma system. Trauma systems which care for severe and critical casualties improve the injury outcomes and reduce mortality among road casualties.1) To evaluate the contribution of the Israeli Health System, especially the trauma system, on the reduction in mortality among traffic casualties. 2) To evaluate the chance of survival among hospitalized traffic casualties, according to age, gender, injury severity and type of road user.A retrospective study based on the National Trauma Registry, 1998-2011, including hospitalization data from eight hospitals.During the study period, the Trauma Registry included 262,947 hospitalized trauma patients, of which 25.3% were due to a road accident. During the study period, a 25% reduction in traffic related mortality was reported, from 3.6% in 1998 to 2.7% in 2011. Among severe and critical (ISS 16+) casualties the reduction in mortality rates was even more significant, 41%; from 18.6% in 1998 to 11.0% in 2011. Among severe and critical pedestrian injuries, a 44% decrease was reported (from 29.1% in 1998 to 16.2% in 2011) and a 65% reduction among bicycle injuries. During the study period, the risk of mortality decreased by over 50% from 1998 to 2011 (OR 0.44 95% 0.33-0.59. In addition, a simulation was conducted to determine the impact of the trauma system on mortality of hospitalized road casualties. Presuming that the mortality rate remained constant at 18.6% and without any improvement in the trauma system, in 2011 there would have been 182 in-hospital deaths compared to the actual 108 traffic related deaths. A 41% difference was noted between the actual number of deaths and the expected number.This study clearly shows that without any improvement in the health system, specifically the trauma system, the number of traffic deaths would be considerably greater. Although the health system has a significant contribution on reducing mortality, it does not receive the appropriate acknowledgment or resources for its proportion in the fight against traffic accidents.


PubMed | Gertner Institute for Epidemiology and Public Health Policy
Type: Journal Article | Journal: Ethnicity & health | Year: 2016

To examine whether characteristics and circumstances of injuries are related to ethnicity.The study was based on the Israeli National Trauma Registry data for patients hospitalized between 2008 and 2011. Data included demographics, injury, hospital resource utilization characteristics and outcome at discharge. Univariate analysis followed by logistic regression models were undertaken to examine the relationship between injury and ethnicity.The study included 116,946 subjects; 1% were Ethiopian Born Israelis (EBI), 11% Israelis born in the Former Soviet Union (FSUBI) and 88% the remaining Israelis (RI). EBI were injured more on street or at work place and had higher rates of penetrating and severe injuries. However, FSUBI were mostly injured at home, and had higher rates of fall injuries and hip fracture. Adjusted analysis showed that EBI and FSUBI were more likely to be hospitalized because of violence-related injuries compared with RI but less likely because of road traffic injuries. Undergoing surgery and referral for rehabilitation were greater among FSUBI, while admission to intensive care unit was greater among EBI.Targeted intervention programmes need to be developed for immigrants of different countries of origin in accordance with the identified characteristics.

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