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Golan S.,Tel Aviv Medical Center | Golan S.,Tel Aviv University | Shalev V.,Maccabi Health Care Services | Shalev V.,Tel Aviv University | And 5 more authors.
Eye | Year: 2011

Purpose: Recent evidence has suggested a correlation between reduced vitamin D levels and delayed angiogenesis and reduced inflammatory response, which are known to have a major role in the development and progression of age-related macular degeneration (AMD). Design: Cross-sectional study. Participants: Members of the Maccabi Healthcare Services (MHS, one of the four largest Israeli Health Maintenance Organization) aged ≥ 60 years, whose vitamin D levels were taken as part of routine examinations between 2000 and 2008. Methods: All data for this study were obtained from MHS databases that include medical information on 1.8 million subscribers. Main outcome measures: Serum 25-OH vitamin D levels. Results: The total study population comprised of 1045 members diagnosed as having AMD, and 8124 as non-AMD, for whom there was information on vitamin D levels. The mean ± SD level of 25-OH vitamin D was 24.1±9.41 ng/ml (range 0.8-120) for the AMD patients and 24.13±9.50 ng/ml (range 0.0-120) for the controls (P=ns). One-third (33.6%) of the AMD patients and 32.86% of the controls had a 25-OH vitamin D level <16 ng/ml, and the proportions of tests in which the 25-OH vitamin D level was >74 ng/ml were 0.19 and 0.14%, respectively (P=ns)ConclusionsNo association was detected between vitamin D levels and the presence of AMD in this cross-sectional study. These results raise some doubt about an association between reduced vitamin D levels and the prevalence of AMD. © 2011 Macmillan Publishers Limited All rights reserved.


Endevelt R.,Maccabi Health Care Services | Endevelt R.,Haifa University | Elkayam O.,Maccabi Healthcare Services | Cohen R.,Maccabi Healthcare Services | And 7 more authors.
Journal of the American Board of Family Medicine | Year: 2014

Background: Childhood and adolescent obesity constitute a significant public health concern. Family health care settings with multidisciplinary teams provide an opportunity for weight loss treatment. The objective of this study was to examine the effect of intensive treatment designed to reduce weight using a parent-child lifestyle modification intervention in a family health care clinic for obese and overweight children who had failed previous treatment attempts. Methods: This was a practice-based 6-month intervention at Maccabi Health Care Services, an Israeli health maintenance organization, consisting of parental education, individual child consultation, and physical activity classes. We included in the intervention 100 obese or overweight children aged 5 to 14 years and their parents and 943 comparison children and their parents. Changes in body mass index z-scores, adjusted for socioeconomic status, were analyzed, with a follow-up at 14 months and a delayed follow-up at an average of 46.7 months. Results: The mean z-score after the intervention was lower in the intervention group compared to the comparison group (1.74 and 1.95, respectively; P = .019). The intervention group sustained the reduction in z-score after an average of 46.7 months (P < .001). Of the overweight or obese children, 13% became normal weight after the intervention, compared with 4% of the comparison children. Conclusion: This multidisciplinary team treatment of children and their parents in family health care clinics positively affected measures of childhood obesity. Additional randomized trials are required to verify these findings.


Ber A.,Maccabi Health Care Services | Seidman D.S.,Chaim Sheba Medical Center | Seidman D.S.,Tel Aviv University
Contraception | Year: 2012

Background: The management of a malpositioned levonorgestrel (LNG)-releasing intrauterine system (IUS) can present a clinical challenge, complicated by the high cost of replacing it with a new device. We tried to challenge the guidelines and common practice that usually suggest prompt removal of any malpositioned IUS and replacement with a new one. Study Design: We present our experience with 18 patients in whom the LNG-releasing IUS was found during a routine sonographic evaluation to be displaced towards the cervical canal 2 to 36 months postinsertion. Using an alligator forceps, the device was repositioned in the uterine cavity. Results: The procedure was deemed successful in 17 (94.4%) of 18 cases. In 3 (17.6%) of the 17 successful procedures, the LNG-releasing IUS was found again to be malpositioned within 2 months. No complications were noted, and no postprocedural infection occurred. Conclusion: Repositioning of a malpositioned LNG-releasing IUS should be considered, as it is an easy and simple manipulation that can be done in the office with a high success rate and minimal risk of complications. © 2012 Elsevier Inc. All rights reserved.


Hazan-Molina H.,Technion - Israel Institute of Technology | Reznick A.Z.,Technion - Israel Institute of Technology | Kaufman H.,Maccabi Health Care Services | Aizenbud D.,Technion - Israel Institute of Technology
Archives of Oral Biology | Year: 2013

Objective: This study aimed to investigate PDL's cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy in a rat model. Materials and methods: An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The expression and concentration of IL-1β and VEGF were evaluated by ELISA assay. On day 3 all rats were sacrificed and histologic and immunohistochemical assays were applied. Results: IL-1β concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. No statistically significant difference was detected between the groups on day 3. The number/area of TRAP positive cells was higher in the non shockwave group than in the treated group. The percentage of cells expressing VEGF displayed the opposite trend. The findings regarding the immunohistochemical assay for IL-1β corresponded with those of the ELISA assay on day 3. Conclusion: The application of shockwaves during orthodontic tooth movement influences the expression of IL-1β and VEGF and may alternate the periodontal remodelling expected rate. © 2012 Elsevier Ltd. All rights reserved.


Ziv T.,Tel Aviv University | Heymann A.D.,Tel Aviv University | Heymann A.D.,Maccabi Health Care Services | Azuri J.,Tel Aviv University | And 3 more authors.
Epidemiology and Infection | Year: 2011

We determined the extent by which mandatory reporting on isolates of Shigella and Salmonella underestimates the burden of diarrhoeal diseases in individuals aged <17 years in Israel and examined paediatricians' knowledge, attitudes and practices related to patient visits with diarrhoeal diseases. Sources of data were a nationwide population-based telephone survey for presence of diarrhoeal diseases, Maccabi Healthcare Services databases and a mail survey among its paediatricians. Monte Carlo simulation and rate estimates for all stages, from visit to physician to reporting on a culture-confirmed case of shigellosis or salmonellosis, were used to determine the underestimation factor. Of 1492 children, 5·7% reported a diarrhoeal episode during the 2 weeks prior to interview. The rate of visiting a physician with and without fever was 86% and 16%, respectively. A stool culture was performed for around 20% of patients and the isolation rates were 7·1% for Shigella and 2·1% for Salmonella. Paediatricians (n=214) ranked very young age of patient and the complaint 'bloody diarrhoea' as the most important determinants. We estimated that one reported isolate of Shigella or Salmonella represented 152 diarrhoeal episodes of all aetiologies. This estimate is important for further assessments of the true burden of diarrhoeal diseases. © Copyright Cambridge University Press 2010.


Bezalel T.,Maccabi Health Care Services | Kalichman L.,Ben - Gurion University of the Negev
Journal of Bodywork and Movement Therapies | Year: 2015

Background: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar spine. Few case reports have demonstrated the effectiveness of Schroth therapy in improving the thoracic angle curve in Scheuermann's patients; however, additional verification is needed. Case description: A 14-year-old female patient presented with Scheuermann's disease. On X-ray, thoracic kyphosis was 55° and lumbar lordosis 55°. The self-rated cosmetic disturbance was graded 10/10 on a verbal numeric scale. The patient received a course of seven weekly Schroth therapy sessions, in addition to daily home exercises tailored specifically for the patient's posture. Five months later, follow-up X-rays revealed thoracic kyphosis of 27° and lumbar lordosis 35°. The patient graded the degree of her cosmetic disturbance as 3/10. Conclusions: Schroth therapy seems to be able to decrease the thoracic curve angle of Scheuermann's patients; however, efficacy and effectiveness of this method should be investigated in future prospective controlled clinical trials. © 2014 Elsevier Ltd.


Endevelt R.,Haifa University | Endevelt R.,Maccabi Health Care Services | Ben-Assuli O.,Ono Academic College | Klain E.,Maccabi Health Care Services | And 2 more authors.
Surgery for Obesity and Related Diseases | Year: 2013

Background: A growing number of patients have been undergoing bariatric surgery in recent years. The role of adherence with regular dietician follow-up in successful long-term weight reduction has yet to be determined, and there are no studies characterizing the utilization of nutritional services after bariatric surgery. The objective of this study was to determine whether dietary counseling by a dietician can contribute to weight reduction after surgery in a follow-up of morbidly obese adult patients who underwent bariatric surgery. Methods: Inclusion criteria were age 20-70 at the time of the bariatric surgery and available body mass index (BMI) measurements before and at least 1 month after the surgery. Medical history and blood test results (triglycerides, cholesterol, and glucose) were recorded. Furthermore, data were collected on the utilization of healthcare services. Results: The final study sample consisted of 1680 patients. Only 681 (40.54%) patients in the cohort attended dietician counseling in Maccabi, and only 471 (28%) patients received such counseling at least twice. Patients attending significant diet counseling had significantly higher proportions of at least 5% reduction in BMI. Two or more visits to dietician counseling were significantly and independently associated (odds ratio = 1.56, 1.02-2.38, 95% CI, P =.04) with a BMI reduction of at least 5%, adjusting for age, gender, number of expert counseling sessions, additional surgery, type of operation, and the interval between BMI measurements. Conclusion: Structured nutritional counseling after bariatric surgery can help in achieving clinically significant weight reduction. © 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.


Weintraub Y.,Edmond and Lily Safra Childrens Hospital | Weintraub Y.,Tel Aviv University | Singer S.,Maccabi Health Care Services | Alexander D.,Maccabi Health Care Services | And 7 more authors.
International Journal of Obesity | Year: 2013

Objective:Obstructive sleep apnea (OSA), attention deficit/hyperactivity disorder (ADHD), type 2 diabetes mellitus and psychopathological problems co-occur at increased rates among both obese and enuretic children. We hypothesized that the prevalence of enuresis will be increased in obese children and adolescents.Design:A cross-sectional study.Subjects:281 children and adolescents aged 7-18 years, who completed a questionnaire regarding enuresis, medical conditions and sociodemographic parameters; 158 were normal weight, 37 overweight (85th≤BMI (body mass index)<95th percentiles) and 86 obese (BMI≥95th percentile).Main outcome measure(s):Occurrence of enuresis among obese children and adolescents.Results:Enuresis was reported in 14 (8.8%) normal weight, 6 (16%) overweight and 26 (30%) obese youth. Odds ratio (OR)=6.5, 95% confidence interval (CI)=2.67-15.78 for enuresis among obese compared with normal weight (P<0.0001). Each increment of one BMI-Z score unit was associated with an increased risk of enuresis, OR of 2.14, 95% CI (1.46-3.12), P=0.00008. Male gender (OR 2.84, 95% CI (1.10-5.58), P=0.028), first-degree relative with current/past enuresis (OR 4.24, 95% CI (1.62-11.08), P=0.003), voiding dysfunction symptoms (OR 3.067, 95% CI (1.05-9.00), P=0.041) and ADHD (OR 2.31, 95% CI (0.99-5.34), P=0.051) increased the risk of enuresis. OSA-related symptoms, academic achievements in school, sharing a bedroom, family size relative to number of rooms in home, parental education, family status and religious observance were not found to increase the risk for enuresis.Conclusions:Obese children are at increased risk for enuresis. Enuresis should be clarified during the primary workup of every obese child and adolescent. © 2013 Macmillan Publishers Limited. All rights reserved.


PubMed | Tel Aviv University, Central LaboratoryMaccabi Healthcare Services, Institute of EndocrinologyRabin Medical Center Beilinson Hospital and Maccabi Health Care Services
Type: Journal Article | Journal: European journal of endocrinology | Year: 2016

To investigate the incidence of Cushings syndrome (CS) in patients with significant hypercortisoluria and the performance of urinary free cortisol (UFC) screening.Retrospective file review.The computerized database of a publicly funded health maintenance organization (HMO) in Israel was searched for all patients who underwent 24-h UFC testing in 2005-2014 with a result of more than twice the upper limit of normal (ULN). The patients medical files were reviewed for a subsequent diagnosis of CS by an expert endocrinologist. Findings were evaluated for patterns in CS diagnosis and UFC testing over time.Of 41183 individuals tested, 510 (1.2%) had UFC >2 ULN (214 >3 ULN). Eighty-five (16.7%) individuals were diagnosed with CS (63 female and mean age 47.215.1 years), mainly Cushings disease (55.3%) or adrenal Cushings syndrome (37.6%). The number of UFC tests increased steadily, from 1804 in 2005 to 6464 in 2014; yet, the resultant detection rate of CS remained generally stable. The calculated incidence of CS in the general HMO-insured population based only on the patients identified in the present cohort was 4.5 new cases/million/year (median 4.9/million/year, range 1.7-5.9/million/year), which was also relatively stable. The most common reason for referral for UFC screening was obesity. Of the 148 patients before bariatric surgery with UFC >2 ULN, 2 were diagnosed with CS.The incidence of CS is higher than previously suggested. The consistently increasing number of UFC tests being performed has not been accompanied by a similar increase in CS detection rate. The expected yield of routine UFC testing before bariatric surgery is low.


PubMed | Maccabi Health Care Services, Tel Aviv University, Wolfson Medical Center, Ministry of Health and Public Health Services
Type: | Journal: The Journal of pediatrics | Year: 2016

Israel is a relatively rapidly growing country with a high fertility rate and a young population. These data emphasize the importance of an efficient and appropriate pediatric service for its population. Although the pediatric service in Israel has attained several achievements, such as a relatively low infant mortality, high vaccination rates, and a primary care service that is mainly based on licensed pediatricians, several challenges, such as overcoming inequalities in health care and health indices between different regions and different populations within the country and the provision of a more organized mental and dental health care service to children, need to be addressed.

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