Showing papers by "Arnon D. Cohen published in 2008"
TL;DR: The findings demonstrate that Appropriate treatment of the metabolic syndrome may be an important part of the management of patients with psoriasis, and an association alone was proven and not causality.
Abstract: Background: Previous reports have shown an association between inflammatory diseases such as systemic lupus erythematosus or rheumatoid arthritis and the metabolic syndrome. Recent
280 citations
TL;DR: This work has shown an association between psoriasis and the metabolic syndrome, but there are only a few studies on the association between PsOriasis and diabetes.
Abstract: Background Previous reports have shown an association between psoriasis and the metabolic syndrome, but there are only a few studies on the association between psoriasis and diabetes.
Objectives To study the association between psoriasis and diabetes.
Methods A cross-sectional study was performed utilizing the database of Clalit Health Services (CHS). Patients who were diagnosed with psoriasis were compared with CHS enrolees without psoriasis regarding the prevalence of diabetes. Patients with diabetes were identified using the CHS chronic diseases registry. Chi-squared tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses.
Results The study included 16 851 patients with psoriasis and 74 987 subjects without psoriasis (control patients). The proportion of diabetes was significantly higher in patients above 35 years (P < 0.05). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared to the control group [odds ratio (OR), 1.38, P < 0.05] and was similar in men and women (OR, 1.32, 1.45, respectively). A multivariate logistic regression model showed that psoriasis was significantly associated with diabetes, independently of age and gender (OR, 1.58, P < 0.001).
Conclusions Our study supports previous reports of an association between psoriasis and diabetes. Dermatologists taking care of patients with psoriasis should be aware of this association and advise the patients to reduce additional risk factors such as smoking, hypertension or dyslipidemia.
157 citations
TL;DR: Infantile BP may not be as rare as commonly stated as age-related differences in regional distribution of lesions in BP were demonstrated and no major differences regarding laboratory results, treatment, and prognosis were found.
Abstract: Background Recent cases of infants with bullous pemphigoid (BP) prompted us to explore the clinical and laboratory features of childhood BP. Objectives We sought to explore the characteristics of infantile BP and compare them with childhood BP. Methods All new consecutive cases of infantile BP referred to dermatologic departments in Israel during 2004 to 2006 were retrospectively reviewed. All reported cases in the English- and foreign-language medical literature were gathered and statistical analysis of all cases was performed. Results Reports on infantile BP are rapidly increasing. Among 78 reported children with BP, 42 (53%) occurred in the first year of life. The incidence of infantile BP in Israel in the last years is 2.36:100,000/y. Predisposition for acral involvement is significantly higher in infantile BP than in childhood BP (79% vs 17%, P Limitations Statistical analyses of published cases may not be representative and could be affected by possible reporting biases. Conclusions Infantile BP may not be as rare as commonly stated. Age-related differences in regional distribution of lesions in BP were demonstrated. No major differences regarding laboratory results, treatment, and prognosis were found.
127 citations
TL;DR: This study supports previous reports of an association between psoriasis and lipid abnormalities and multivariate analysis of the "low-risk" subset of subjects without diabetes, hypertension and cardiovascular disease found triglyceride levels were higher in Psoriasis patients and high-density cholesterol levels were lower.
Abstract: Previous reports demonstrated an association between psoriasis and the metabolic syndrome. The aim of this study was to elucidate the association between psoriasis and dyslipidaemia. A cross-sectional study was performed utilizing a population-based database. Psoriasis patients were compared with enrollees without psoriasis regarding the prevalence of dyslipidaemia and lipid levels. Comparison of lipid levels was performed on a "low-risk" subset of subjects without diabetes, hypertension and cardiovascular disease. The study included 10,669 psoriasis patients and 22,996 subjects without psoriasis. The prevalence of dyslipidaemia was significantly higher in psoriasis patients (odds ratio (OR) = 1.48, 95% confidence interval (CI) 1.40-1.55). The association remained significant after controlling for confounders (OR = 1.19, 95% CI 1.12-1.26, p < 0.001). In multivariate analysis of the "low-risk" subset, triglyceride levels were higher in psoriasis patients and high-density lipoprotein cholesterol levels were lower. This study supports previous reports of an association between psoriasis and lipid abnormalities.
87 citations
TL;DR: Antipsychotic drug use was associated with diabetes mellitus in patients of different ages, and the association was stronger in younger patients, while in older adults the difference was much smaller and, in some cases, there was no association.
Abstract: BackgroundPrevious studies have reported an association between antipsychotic medications and diabetes.ObjectiveTo explore the association between antipsychotic medications and diabetes in patients of different ages.MethodsA retrospective analysis of a large health maintenance organization's drug claim database (3.7 million members) was performed. All patients treated with antipsychotic drugs during 1998–2004 were identified. Patients with diabetes were defined by a record of antidiabetic drug uso during 2004. The prevalence of diabetes in different age groups treated with antipsychotics was compared with the prevalence of diabetes among enrollees in the same age groups not treated with antipsychotics.Results:Among 82,754 patients treated with antipsychotics, the association between diabetes and consumption of antipsychotics was strongest in the younger age groups and decreased with increasing age: for patients aged 0–24 years, OR 8.9 (95% CI 7.0 to 11.3); 25–44 years, OR 4.2 (95% CI 3,8 to 4.5); 45–54 ye...
67 citations
TL;DR: Nonattendance in OB/GYN patients is independently associated with age, population sector and waiting time for an appointment, and it is suggested that various solutions should be carefully introduced regarding routine patient scheduling in OB-GYN clinics.
Abstract: Background: Nonattendance for obstetrics and gynecology (OB/GYN) appointments disrupts medical care and leads to misuse of valuable resources. We investigated factors associated wit
49 citations
TL;DR: Two studies have described factors determining non‐attendance at dermatology appointments in small sample sizes and called for further research into these factors and their impact on attendance at appointments.
Abstract: Background Previous studies have described factors determining non-attendance at dermatology appointments in small sample sizes.
Objective To perform an analysis of factors associated with non-attendance in a dermatology clinic in a larger sample.
Methods Factors determining non-attendance were examined in 52 604 consecutive first-time visits to a dermatology clinic over a period of 44 months.
Results Non-attendance proportion was 27.6%. Among children, non-attendance was associated with waiting for an appointment < 7 days [odds ratio (OR), 1.44], Bedouin sector (OR, 1.30), rural Jewish sector (OR, 0.45) and the treating physician. Among adults, non-attendance was associated with female gender (OR, 1.08), age < 55 years (OR, 1.65), waiting time for an appointment < 7 days (OR, 1.44), timing of the appointment between 1 and 4 pm (OR, 1.13), Bedouin sector (OR, 1.63), rural Jewish sector (OR, 0.46) and the treating physician.
Conclusion Non-attendance is common among Bedouins, adult female patients and young adults and is more likely as waiting times become longer. Strategies to reduce non-attendance are needed.
44 citations
TL;DR: It is concluded that in children attending allergy clinics, factors that determine non‐attendance include the ethnic origin of the patients and the season of the year.
Abstract: Non-attendance for scheduled appointments is common in many medical specialties. However, there are no published reports on non-attendance in pediatric allergy clinics. We investigated the factors for non-attendance in pediatric allergy patients. We assessed the effects of age, gender, ethnic origin, waiting time for an appointment and the timing of the appointment on non-attendance proportions. Chi-square tests were used to analyze statistically significant differences of categorical variables. Logistic regression models were used for multivariate analyses. A total of 442 visits in a 21-month period were included in the study. The overall proportion of non-attendance at the pediatric allergy clinic was 33.0%. Jewish rural patients had 19.4% non-attendance; Jewish urban patients had 35.6% non-attendance; and Bedouin patients had 57.1% non-attendance (p < 0.001). Non-attendance was higher in spring and winter (43.5% and 36.7%, respectively) than in summer and autumn (26.9% and 26.5%, respectively) (p = 0.016). Non-attendance was not significantly influenced by gender, age, hour of the appointment or waiting time for the appointment. A multivariate logistic regression model demonstrated that the ethnic origin of the patients and the season of the year were significantly associated with non-attendance. We conclude that in children attending allergy clinics, factors that determine non-attendance include the ethnic origin of the patients and the season of the year.
18 citations
Journal Article•
TL;DR: Primary care physicians report that they routinely prescribe folic Acid to women in childbearing age in order to prevent congenital anomalies, but their knowledge about folic acid supplementation is insufficient.
Abstract: Background Pre-conceptional folic acid supplementation is an effective way to reduce the incidence of neural tube defects (NTDs). Primary care providers are an important source of information to promote folic acid intake. This study aimed at evaluating primary care physicians' knowledge and attitudes regarding folic acid supplementation for childbearing women. Material/methods A questionnaire on physicians' knowledge and attitudes, mostly including multiple-choice questions, was delivered by mail to all physicians (n=370) in a large health provider organization in southern Israel in 2006. Data regarding demographics as well as type of specialty, experience, and place of work were collected. Results Eighty-seven physicians were included in the study (response rate: 24%). Seventy physicians out of 81 (94%) reported routine recommendation of folic acid for their patients. Most physicians admitted that they needed more information regarding folic acid supplementation. Knowledge about folic acid's role in preventing congenital anomalies was suboptimal, with 2% of the physicians correctly estimating the efficacy of folic acid in decreasing the risk of NTDs and 8% recognizing the association between folic acid supplementation and decreased prevalence of malformations other than NTDs. Knowledge about the correct timing (12%) and dosage (47%) of folic acid preparations for average-risk women was also lacking. Conclusions Primary care physicians report that they routinely prescribe folic acid to women in childbearing age in order to prevent congenital anomalies, but their knowledge about folic acid supplementation is insufficient.
16 citations
TL;DR: The objective of the current study was to assess the effectiveness of CDS in a series of patients with psoriasis treated for a “short-term” period of 2 weeks, using BPSS and PASI, with particular emphasis on PASi75 and PasI50 end-points.
Abstract: Climatotherapy at the Dead Sea (CDS) for patients with psoriasis induces a persistent remission in the majority of patients with psoriasis, is associated with minor side-effects and is pleasant for the patients (1–11). The published literature on CDS describes patients with moderate to severe psoriasis who spend an average period of one month (“long-term”) at the Dead Sea. There are no published data, however, on the effectiveness and characteristics of “short-term” CDS for patients with psoriasis, who spend only 2 weeks at the Dead Sea.The instruments used previously for assessment of response to CDS in psoriasis patients were not stan-dardized. In the last 10 years, the use of a 75% or 50% decrease in Psoriasis Area and Severity Index (PASI75 and PASI50, respectively; 12, 13) has become the gold standard in evaluating the efficiency of psoriasis treat-ment. In a literature review, we found no publications that used the PASI75 or PASI50 instruments to assess the response to CDS in patients with psoriasis. In a previous study we have shown the utility of the Beer Sheva Psoriasis Severity Score (BPSS) to assess pso-riasis severity and response to treatment (14). The objective of the current study was to assess the effectiveness of CDS in a series of patients with psoria-sis treated for a “short-term” period of 2 weeks, using BPSS and PASI, with particular emphasis on PASI75 and PASI50 end-points.METHODS
15 citations
TL;DR: An OLI detector is developed based on the generalized likelihood ratio test (GLRT), assuming coherent distributed sources for each lung and exhibited reliable results also when the lungs were modeled by incoherent distributed sources, which is a more accurate model for lung sources.
Abstract: Lung sounds are very common source for monitoring and diagnosis of pulmonary function. This approach can be used for detecting one lung intubation (OLI) during anesthesia or intensive care. In this paper, an algorithm for detecting OLI from lung sounds is presented. The algorithm assumes a multiple-input-multiple-output system, in which a multi-dimensional auto-regressive model relates the input (lungs) and the output (recorded sounds). An OLI detector is developed based on the generalized likelihood ratio test (GLRT), assuming coherent distributed sources for each lung. This method exhibited reliable results also when the lungs were modeled by incoherent distributed sources, which is a more accurate model for lung sources. The algorithm was tested using real breathing sounds recorded in an operating room, and it achieved an OLI detection rate of more than 95%, for each breathing cycle.
Journal Article•
TL;DR: BPSS may be used as a comprehensive tool for measuring psoriasis severity, and was demonstrated that BPSS included six factors that explained 74.0% of the variance.
Abstract: Background: The Beer Sheva Psoriasis Severity Score is a novel instrument for the assessment of psoriasis severity, designed for use in routine clinical conditions. Objective To identify the main factors of the BPSS. Methods: The sample used to study the BPSS comprised 70 patients with psoriasis vulgaris treated by climatotherapy at the Dead Sea. Psoriasis severity was assessed using BPSS and PASI (Psoriasis Area and Severity Index). Factor analysis was used to identify the main factors of BPSS. Internal consistency analysis was performed. Correlation matrices were generated to compare BPSS factors. Results: Factor analysis demonstrated that BPSS included six factors that explained 74.0% of the variance as follows: patient assessment 26.0%; physician assessment 13.2%; palms and soles involvement 11.9%; genitals, nails, and pruritus 9.0%; face involvement 7.3%; and scalp involvement 6.6%. Total scale Cronbach’s alpha was 0.76; alpha for the factors ranged between 0.39 and 0.81. Conclusions: The major factors of BPSS were identified. BPSS may be used as a comprehensive tool for measuring psoriasis severity.
TL;DR: A relatively small compulsory co-payment was not found to have a long term effect on utilization of specialists’ services.
Abstract: Prospective evaluation of the effect of a new co-payment for specialists consultations on actualization of referrals (2,432 patient), was examined. Actualization of the appointment, reasons for not actualizing, and sociodemographic characteristics were recorded. Actualization was 85.1% in community consultation clinics and 91.7% in hospital outpatient clinics. The main reasons for non actualization were: inability to reach the clinic (53.4%), the problem had resolved (15%), and co-payment (2%). In addition, 19.1% stated that they did not actualize a past consultant visit due to co-payment. Referring physicians noted that co-payment had some effect on their decision, especially with the elderly or lower income patients. A relatively small compulsory co-payment was not found to have a long term effect on utilization of specialists' services.
TL;DR: In patients with PAR, the SAC state is more prevalent compared with the healthy population, and treatment with topical nasal mupirocin reduces the Sac state but fails to clinically improve PAR, as assessed by the SS.
Abstract: Background Staphylococcus aureus (SA) colonization is frequent in patients with perennial allergic rhinitis (PAR). Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved for the eradication of SA nasal colonization. Objective To investigate the frequency of SA nasal carriage, its possible influence on AR severity, and nasal mupirocin's role on AR clinical severity. Methods Sixty patients, aged 5 to 60 years, with AR were included, and 55 healthy individuals served as a control group. Nasal smear specimens were drawn from both nares. A skin prick test to inhalational allergens and a score-graded clinical evaluation of AR were performed. Carriers of SA were treated with topical nasal mupirocin. Results The SA carrier (SAC) state was found in 23 (38%) of the patients with AR and in 8 (15%) of the healthy controls ( P = .004). Comparing SACs with AR SA noncarriers, nasal symptom scores (SSs) tended to be higher in the SAC group (mean [SD], 11.09 [2.16] vs 8.86 [1.43]; P P = .009) but did not change AR clinical severity, as assessed by the SS. Conclusions In patients with PAR, the SAC state is more prevalent compared with the healthy population. Topical nasal mupirocin reduces the SAC state but fails to clinically improve PAR, as assessed by the SS.
Journal Article•
TL;DR: A lower prevalence of dyslipidemia was found in African Bedouins, as compared with Middle-Eastern Bedouining, as well as higher total cholesterol and low-density lipoprotein levels.
Abstract: Background: Previous studies observed higher high-density lipoprotein (HDL) levels and lower triglycerides levels among people of African ancestry The goal of this study was to characterize lipid levels in Bedouins of African vs. Middle-Eastern ethnicity. Material/Methods: A cross-sectional study was conducted in a Bedouin primary care clinic in southern Israel, with 4470 listed individuals over the age of 21, of whom 402 (9%) were of African origin. A stratified random sample was included in the analysis. Associations between ethnicity, age, gender and lipid levels were assessed. Multiple linear regression and logistic regression models were used for multivariate analysis. Results: The study included 261 African Bedouins and 406 Middle-Eastern Bedouins. (median age: 37 years, 58.6% females). The average total cholesterol and low-density lipoprotein (LDL) levels were 10 mg/dl lower among African Bedouins as compared to Middle-Eastern Bedouins (total cholesterol: 168.6 vs. 179.6 mg/dl, p<0.001; LDL: 99.5 vs. 109.0 mg/dl, respectively, p<0.001). Average triglycerides levels were 36 mg/dl lower among African Bedouins as compared to Middle-Eastern Bedouins (102.8 vs. 138.9 mg/dl, respectively, p<0.001). Average HDL levels were 3 mg/dl higher among African Bedouins as compared to Middle-Eastern Bedouins (48.3 vs. 44.6 mg/dl, respectively, p<0.001). Conclusions: In conclusion, a lower prevalence of dyslipidemia was found in African Bedouins, as compared with Middle-Eastern Bedouins.
Journal Article•
TL;DR: FAs in a Bedouin community pose a special challenge for the primary care clinic, as they are more likely to be chronically ill, and utilize referrals to various services and consultations more frequently than controls.
Abstract: Background Frequent attendance affects delivery and cost of effective health services, quality of care, and burden on primary care physicians. The aim of this study was to investigate factors associated with frequent attendance, as well as types of health care utilization, in a Bedouin primary care setting. Methods A case-control study was conducted on adult frequent attenders (FAs) and controls in a primary care clinic serving a Bedouin population in southern Israel. Social, demographic and clinical data were manually extracted by reviewing the clinic's computerized medical records. The associations between these factors and frequent attendance were analyzed. Results The study included 118 cases and 121 controls (59% female, mean age: 39.6 +/- 14.9 years). FAs were more likely to use consultation referrals, prescriptions, investigative studies, laboratory tests, and emergency department referrals than controls and were prescribed more sick-leave days than controls. Controlling for age and gender, FAs were significantly more likely to have a chronic disease (OR = 4.46, 95% CI: 1.86-10.71), use chronic medications (OR = 3.31, 95% CI: 1.57-6.99), have a musculoskeletal disease (OR = 2.08, 95% CI: 1.02-7.49) and be of African Bedouin ethnicity (OR = 2.77, 95% CI: 1.02-7.49). Conclusions FAs in a Bedouin community pose a special challenge for the primary care clinic, as they are more likely to be chronically ill, and utilize referrals to various services and consultations more frequently than controls.