Objectives To examine over‐screening of older Israelis for colon and breast cancer. Design Cross sectional. Setting Clalit Health Services ( CHS ), Israel's largest health maintenance organization ( HMO ), provides care for more than half of the country's population and operates a national age‐based programs for cancer screening. Participants All community‐dwelling members aged 65 to 79 in 2014 (N = 370,876). Measurements We used CHS data warehouse to evaluate cancer screening during 2014. Life expectancy ( LE ) was estimated using the validated Schonberg index. Results Almost one‐quarter (23.1%; 15.6% of adults aged 65–74, 42.7% of adults aged 75–79) of the study population had an estimated LE of less than 10 years. Annual fecal occult blood test and biannual mammography rates among adults aged 65 to 74 with a LE of 10 years or longer were 37.1% and 70.0%, respectively. Rates dropped after age 75 (4.0%, 19.5%) and to a lesser extent with a LE of less than 10 years (31.6%, 56.4%). Prostate‐specific antigen testing is not part of the national screening program, and the proportion of people tested (42.6%), did not vary similarly with age of 75 and older (43.2%) or LE of less than 10 years (38.1%). Conclusion The cancer screening inclusion criteria of the national referral system have a strong effect on receipt of screening; LE considerations are less influential. Some method of estimating LE could be incorporated into algorithms to improve individualized cancer screening to reduce over‐ and underscreening of older adults.
Background: Although much has been written about the potential power of the association between physicians’ personal health practices and those of their patients, we found few objective studies of this relationship. We therefore investigated this association using objectively measured health care indicators. Aim of the study: The aim of the study was to show the association between physicians’ own screening/immunization practices and their patients screening/immunization practices. Material and methods: We assessed 8 indicators of quality of health care (screening and vaccination practices) for primary care physicians (n=1488) and their adult patients (n = 1 886 791) in Israel’s largest health maintenance organization. The physicians were also patients in this health care system Results: For all 8 indicators, patients whose physicians were compliant with the preventive practices were more likely (p < 0.05) to also have undergone these preventive measures than patients with noncompliant physicians. We also found that more similar preventive practices showed somewhat stronger relations. For example, among patients whose physician had received the influenza vaccine, 49.1% of eligible patients received influenza vaccines compared to 43.2% of patients whose physicians did not receive the vaccine (5.9% absolute difference, 13.7% relative difference). This is twice the relative difference (7.2%) shown for pneumococcal vaccine—eligible patients of influenza-vaccinated versus non vaccinated physicians (60.9 vs 56.8%).When we examined the rates of un-related practices, we found that, for example,mammography rates were identical for patients whose physicians did and did not receive the influenza vaccine Conclusions: We found a consistent, positive relation between physicians’ and patients’preventive health practices. Objectively establishing this healthy doctor—healthy patient relationship should encourage preventionoriented health care systems to better support and evaluate the effects on patients of improving the physical health of medical students and physicians.
The preceding paper (10) showed that the growth of Escherichia coli is slowed, without killing, at 40 to 45 C, and that in the several strains tested the cause is a decrease in the activity of homoserine trans-succinylase. These temperatures are now shown to inhibit the enzyme directly, in crude extracts and after partial purification. The effect is rapid and is immediately reversible, unlike the progressive and slowly reversible changes of conventional denaturation.
S ummary . Factor VII was purified from a lyophilized powder of PTC complex (Hemoplex, Cutter Laboratories) and an antiserum was prepared in rabbits to the partially‐purified fraction. The antiserum was found to inhibit specifically factor VII of normal plasma and the activity of the purified factor‐VII preparation. Inactive factor‐VII‐like material was detected in the plasma of one out of nine patients with factor‐VII deficiency and the Dubin‐Johnson syndrome (DJS), as well as in the plasma of patients on short‐term Coumadin therapy. No inactive factor VII could be detected in the plasma of patients on prolonged Coumadin therapy or in the plasma of two patients with hereditary factor‐VII deficiency. The methodological problems are discussed.
Understanding of the epidemiology and healthcare service utilization related to atopic dermatitis is necessary to inform the use of new treatments. This cross-sectional study was based on a group of patients with atopic dermatitis and a matched control group comprised of age- and sex- matched enrolees without atopic dermatitis from a large medical database. Healthcare service utilization usage data were extracted and compared between groups. The study included 116,816 patients with atopic dermatitis and 116,812 controls. Atopic dermatitis was associated with an increased burden of healthcare utilization across the entire spectrum of healthcare services compared with controls. For patients severely affected by atopic dermatitis, the increased burden correlated with disease severity: a high-er frequency of emergency room visits (odd ratio (OR) 1.7; 95% confidence interval (CI) 1.6-1.9), dermatology wards hospitalizations (OR 315; 95% CI 0-7,342), and overall hospitalizations (OR 3.6; 95% CI 3.3-3.9). In conclusion, this study demonstrates an increased burden of healthcare utilization in atopic dermatitis.
Comparison of published data and health indices from different countries with different health systems is subject to many pitfalls. Comparison of national expenditure for health care based on purchasing power of the currency may be misleading if the purchasing power of the health services is ignored. Comparisons may also be misleading if they ignore national geographic and demographic structures. Government and health authorities often quote different sets of data and use different terminology and definitions. This article stresses the disparity in the definition of medical manpower and points out differences relating to ratios of manpower to population and to per capita spending. Also addressed is the importance of the qualitative and value aspects of health systems not usually involved in comparison of international health indices. In conclusion, safety measures and precautions such as choosing the right index for the right purpose, adjustment of indices to the purchasing power parity of health, demographics, etc., should be used when conducting health care analyses.
A large vaccination campaign was initiated worldwide in December 2020 in order to prevent infection with SARS-CoV-2 and severe Covid-19 disease. However, long-term adverse effects of vaccination remain unclear. Therefore, our objective was to examine the association between vaccination and the incidence of autoimmune diagnoses in the first year after vaccine uptake.
Methods
This retrospective cohort study based on Clalit Health Services (CHS) comprehensive database compared the rates of immune-mediated diagnoses among BNT162b2 vaccinated versus unvaccinated individuals. As a reference, a secondary cohort compared individuals infected with Sars-CoV-2 versus uninfected individuals. The minimum follow-up period was 4 months. The cohorts were divided into 4 age groups (12-17, 18-44, 45-64, 65 years or older). Multivariate Cox proportional hazard regression models were applied, followed by a correction for multiple comparisons using the False Discovery Rate (FDR) method, hence accounting for the investigation of multiple clinical outcomes.
Results
Increased risk for immune-mediated diagnoses following vaccination with BNT162b2 was observed for psoriasis in all age groups (HR 1.41-1.69), colitis among patients younger than 65 years (HR 1.38-1.93), vitiligo in patients aged 45-64 (HR 2.82, 95%CI: 1.57-5.08) and for polymyalgia-rheumatica in patients aged 65 years or older (HR 2.12, 95% CI: 1.3-3.47). In the reference cohort, patients who were infected by Covid-19 were at increased risk for fibromyalgia (HR 1.72, 95% CI: 1.36-2.19 in individuals aged 18-44; HR 1.71, 95% CI: 1.31-2.22 in individuals aged 45-64), and hypothyroidism (HR 1.54, 95% CI: 1.15-2.07 in individuals aged 65 years or older).
Conclusions
The BNT162b2 vaccine was associated with increased risk (though rare) for psoriasis, colitis and polymyalgia rheumatica. These findings should be considered as a part of the risk-benefit assessment when planning future vaccination programs for various population groups.
