Arnon D. Cohen

Bio: Arnon D. Cohen is an academic researcher from Clalit Health Services. The author has contributed to research in topics: Population & Odds ratio. The author has an hindex of 41, co-authored 374 publications receiving 7913 citations. Previous affiliations of Arnon D. Cohen include University of Milan & University of Connecticut.

Reducing Health Disparities: Strategy Planning and Implementation in Israel's Largest Health Care Organization

Abstract: The role of health care organizations in reducing inequalities in health has recently drawn considerable interest from researchers and policy makers (McKee 2002; Smedley, Stith, and Nelson 2003;). It is clearly acknowledged that disparities in health are a result of interrelated factors external to the health care realm, such as socioeconomic status (SES), ethnicity, geography, and education (Chin et al. 2007; Starfield and Birn 2007; Benyamini et al. 2008; Riva et al. 2009;), yet health care organizations have an important role in reducing health disparities caused by these social factors, as well as by unequal access to quality medical care (Aaron and Clancy 2003). To address this need, the National Health Plan Collaborative was formed in 2004, aimed at reducing racial and ethnic disparities and improving the overall quality of care in the U.S. health care system. Early reports indicate that the plans have made significant headway in achieving coordination of disparities activities across the organization (Lurie et al. 2008). Yet data on programs' structures and the processes put in place, as well as achievements in disparity reduction, have not been reported to date. The means by which health care organizations can effectively achieve disparity reductions are yet to be unveiled (Fiscella 2007). Israeli society has a diverse demographic profile in terms of its ethnic, religious, immigrant, and socioeconomic makeup. Recent reports show widening inequalities in economic status, as attested by the higher Gini coefficient (a marker of income variance) in Israel than in all OECD countries (Shmueli and Gross 2001). Recent studies report considerable differences in the health status of the Israeli population (Epstein and Horev 2007): differences in life expectancy according to geographical areas, minority status (mainly between the largest minority of Arab Muslims and the general Israeli Jewish population), and level of education (Shuval 1990; Chernichovsky and Anson 2005; Israeli Bureau of Statistics 2009;); large differences in infant mortality rates according to geographical area and minority status (Tarabeia et al. 2004); and disparities in the prevalence of chronic diseases according to minority status and education level in a variety of conditions, including osteoporosis (Nitzan-Kaluski et al. 2003), obesity (Keinan-Boker et al. 2005), and coronary artery disease (Salameh et al. 2008). In Israel, all citizens, by law, are members of one of four health funds that serve as insurers and health care providers. Clalit Health Services is the largest health fund with over 3.8 million enrollees (53 percent market share), with <4 percent annual shifts between health funds, mainly of younger more affluent urban populations. Clalit has a significant overrepresentation of the underprivileged: low-socioeconomic groups, minorities, new immigrant (mainly overrepresentation of persons who immigrated from Ethiopia), residents of rural areas, the elderly, and people with disabilities (Horev and Kop 2008). Over the years, Clalit has gained experience in many sporadic efforts directed at improving the health status of these disadvantaged populations, including improving access to care, health education, health promotion, and cultural competency initiatives (Nirel, Pilpel, and Rosen 2000; Maislos, Weisman, and Sherf 2002;). In recent years, Clalit has developed advanced quality measurement and quality improvement initiatives for better quality of care for its patient population (Goldfracht and Porath 2000; Peleg et al. 2008;). To further address the needs of diverse population groups, Clalit, with a network of over 1,500 primary and secondary care clinics, and 14 hospitals, unfolded in 2008 its first organization-wide strategic plan to reduce inequalities in health and health care. Jones, Trivedi, and Ayanian (2010) recently report on organizational factors that contribute to success in disparity reduction: organizational commitment, population health focus, use of data to inform solutions, and a comprehensive approach to quality improvement. These factors are in fact an integral part of the Clalit initiative, with strong leadership support (by the director general and all top management staff), and an integrative approach, which comprises many of the medical home attributes (Carrier, Gourevitch, and Shah 2009), including a unique data warehouse that contains detailed “cradle to crib” data (demographic, health indicators, and health care services utilization data); a large primary care—public-health-oriented workforce in the local communities; and an extensive set of quality measurement tools, based on data from a universal system of electronic medical records. Additionally, this new disparity-reduction strategy builds on Clalit's primary care orientation as a major force for driving disparity reduction (Shi et al. 2002). The two main components of the strategy are (1) a top-down approach of disparity-reduction goal setting, continuous monitoring, and provision of incentives; and (2) use of tailored interventions to reduce disparities by a bottom-up approach in which each district and locality is empowered to plan interventions, policy changes, and shifts in workforce. Findings on the initial implementation efforts and their results are presented.

A study on the association with hepatitis B and hepatitis C in 1557 patients with lichen planus.

Abstract: Background Previous reports have demonstrated contradicting results on the association between lichen planus and hepatitis. Objectives The aim of this study was to investigate the association between lichen planus and viral hepatitis. Methods Patients with lichen planus were compared with controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate regression models. The study was performed utilizing the medical database of Clalit Health Services. Results The study included 1557 lichen planus patients over the age of 20 years and 3115 age- and gender-matched controls. The prevalence of hepatitis C in patients with lichen planus was higher than that in the control group (1.9%, 0.4% respectively, P < 0.001). In a multivariate analysis, lichen planus was associated with hepatitis C (OR 4.19, 95% CI 2.21; 7.93). The prevalence of hepatitis B in patients with lichen planus was similar to that in the control group (0.9%, 0.5% respectively, P = 0.12). A multivariate analysis revealed that lichen planus was not associated with hepatitis B (OR 1.69, 95% CI 0.82; 3.47). Conclusion Lichen planus is associated with hepatitis C but not with hepatitis B. Physicians who care for patients with lichen planus should consider screening patients with lichen planus for hepatitis C.

Prevalence and risk factors for tinea pedis in Israeli soldiers.

Abstract: Background Tinea pedis is a common infection in soldiers. However, prevalence and risk factors for tinea pedis in soldiers were investigated in only a few studies. Objectives To investigate the prevalence and risk factors for tinea pedis in Israeli soldiers. Methods A cross-sectional study including interviews, clinical skin examination and mycological tests was performed in Israeli soldiers. The presence of tinea pedis was assessed using the Athlete's Foot Severity Index (AFSI), a scoring system that was developed in order to evaluate the presence and severity of tinea pedis. In soldiers with clinical evidence of tinea pedis (AFSI > 1), scrapings were taken for direct microscopic examination (20% KOH preparation) and fungal culture. Statistical analyses were performed using chi-square or Fisher's exact test for dichotomous variables (as needed), or t-tests for continuous variables. Logistic regression was used for multivariate analyses of dichotomous variables. Results Two hundred and twenty-three soldiers were included in the study: 205 men (91.9%) and 18 women (8.1%). Mean age was 19.6 years (SD 1.0 year). Clinical point prevalence was 60.1%. Mycological point prevalence was 27.3%. Further analyses were performed using the clinical point prevalence. Univariate analyses demonstrated that the prevalence of tinea pedis varied with the setting of military training (basic training: 70.3%, advanced infantry training: 81.5%, armor commander training: 56.4% and armor officer training: 34.8%) and was associated with male gender, frequency of sock changes and the length of military service. A multivariate analysis demonstrated that tinea pedis was associated with the setting of the military training (OR 1.6, 95% CI 1.2–2.1) and male gender (OR 4.3, 95% CI 1.4–13.8); however, there was no association with hygiene measures (e.g. frequency of changing socks or sleeping with socks) or the length of military service. Conclusion Tinea pedis is highly prevalent in Israeli soldiers. Association of tinea pedis with the setting of military training suggests that contagious spread may be an important risk factor. We suggest that environmental interventions should be planned to in order to decrease the morbidity of tinea pedis among soldiers.

Aortic aneurysm association with SLE – a case–control study

Abstract: ObjectivesAortic aneurysm is a life threatening cardiovascular complication in patients with systemic lupus erythematosus (SLE).The purpose of this study was to investigate the association between SLE and occurrence of aortic aneurysms.MethodsPatients with SLE were compared with age- and sex-matched controls regarding the proportion of aortic aneurysm in a case–control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services.ResultsThe study included 5018 patients with SLE and 25,090 age- and sex-matched controls. The proportion of aortic aneurysm in patients with SLE was increased compared with the proportion in controls (0.6% and 0.1%, respectively, p < 0.001). In a multivariate analysis SLE was associated with the coexistence of aortic aneurysms (odds ratio 2.06, 95% confidence interval 1.21–3.51).ConclusionsPatients with SLE have a higher proportio...

Harrison's Principles of Internal Medicine

Abstract: The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

The Self-Organizing Map

Abstract: An overview of the self-organizing map algorithm, on which the papers in this issue are based, is presented in this article.

The Geometry of Algorithms with Orthogonality Constraints

Abstract: In this paper we develop new Newton and conjugate gradient algorithms on the Grassmann and Stiefel manifolds. These manifolds represent the constraints that arise in such areas as the symmetric eigenvalue problem, nonlinear eigenvalue problems, electronic structures computations, and signal processing. In addition to the new algorithms, we show how the geometrical framework gives penetrating new insights allowing us to create, understand, and compare algorithms. The theory proposed here provides a taxonomy for numerical linear algebra algorithms that provide a top level mathematical view of previously unrelated algorithms. It is our hope that developers of new algorithms and perturbation theories will benefit from the theory, methods, and examples in this paper.

Sarcoidosis

Abstract: 结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Type 2 diabetes mellitus.

Abstract: Type 2 diabetes mellitus (T2DM) is an expanding global health problem, closely linked to the epidemic of obesity. Individuals with T2DM are at high risk for both microvascular complications (including retinopathy, nephropathy and neuropathy) and macrovascular complications (such as cardiovascular comorbidities), owing to hyperglycaemia and individual components of the insulin resistance (metabolic) syndrome. Environmental factors (for example, obesity, an unhealthy diet and physical inactivity) and genetic factors contribute to the multiple pathophysiological disturbances that are responsible for impaired glucose homeostasis in T2DM. Insulin resistance and impaired insulin secretion remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. The multiple pathogenetic disturbances present in T2DM dictate that multiple antidiabetic agents, used in combination, will be required to maintain normoglycaemia. The treatment must not only be effective and safe but also improve the quality of life. Several novel medications are in development, but the greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications. For an illustrated summary of this Primer, visit: http://go.nature.com/V2eGfN.