The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: analysis of large sub populations.

Background: Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.

The Objective: To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer.

Methods: The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.

Gestational diabetes and risk of incident primary cancer: a large historical cohort study in Israel.

Purpose: Gestational diabetes mellitus (GDM), a state of glucose intolerance associated with pregnancy, is increasing in prevalence. Data regarding the cancer risk associated with GDM are sparse and limited to cancers of the breast and pancreas. This study was conducted to examine the risk of incident overall and site-specific malignancies associated with prior GDM in a historical cohort of women in a large health maintenance organization in Israel.

The achievement of target cholesterol level differs between coronary heart disease and diabetic patients.

Background: Guidelines recommend that LDL-C level should be <100mg/dl among diabetes mellitus (DM) and coronary heart disease (CHD) patients.

Objective: To evaluate how patients with DM and CHD differ in attaining the target level and to examine the association between goal achievement, demographic and clinical parameters.

Methods: The study was conducted in Maccabi Healthcare Services, the second largest health maintenance organization in Israel.

Statin use and the risk of age related macular degeneration in a large health organization in Israel.

Objective: To investigate the association between persistent use of statins and the risk of age-related macular degeneration (AMD).

Design: A population-based retrospective cohort among adults who began statin therapy between 1998 and 2006 in a large health organization in Israel. The organization's central computerized databases were used to collect data on incident AMD cases diagnosed by ophthalmologists.

Trends in breast cancer incidence associated with reductions in the use of hormone replacement therapy.

Background: The publication of the Women's Health Initiative Study in 2002 spurred reductions in hormone replacement therapy (HRT) use worldwide. Subsequent drops in breast cancer incidence have since been reported. We used person-level data from a large Israeli health plan to study the relationship between HRT use and breast cancer incidence.

Disparities in diabetes care: role of the patient's socio-demographic characteristics.

Background: The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients.

Persistence with statins and onset of rheumatoid arthritis: a population-based cohort study.

Background: The beneficial effects of statins in rheumatoid arthritis (RA) have been suggested previously, but it is unclear whether statins may prevent its development. The aim of this retrospective cohort study was to explore whether persistent use of statins is associated with onset of RA.

Methods And Findings: The computerized medical databases of a large health organization in Israel were used to identify diagnosed RA cases among adults who began statin therapy between 1998 and 2007.

The use of an automated patient registry to manage and monitor cardiovascular conditions and related outcomes in a large health organization.

Background: The present study describes a computerized registry of cardiovascular disease patients in a large health maintenance organization in Israel. The registry is aimed to be used by health professionals to identify cardiovascular disease patients and to follow the courses of their illnesses and risk factors.

Methods: In 1998, the registry was initiated using advanced information technology that integrated personal computerized community and hospital records, data from laboratory tests, dispensed medications, physiological signals, radiological images, and reports from investigations and procedures.

[Equity promotion in Maccabi Healthcare Services: from the Equality Report to an organizational action plan].

Maccabi Healthcare Services (MHS), the second largest HMO in Israel, has chosen to implement a multi-annual strategy to promote equality and equity in healthcare. Within the strategy's framework, MHS will maintain an ongoing process of studying the variability of its members characteristics for the purpose of adjusting service provision and improving health outcomes. MHS has recently published its first Equality Report, dedicated to defining the observed associations between its members demographic and socioeconomic characteristics and their health measures.

Database evaluation of the effects of long-term rosiglitazone treatment on cardiovascular outcomes in patients with type 2 diabetes.

Recent meta-analyses suggest an increased risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) treated with rosiglitazone. These meta-analyses have drawn considerable criticisms. Retrospective observational studies do not consistently support this association.

Diabetes and risk of incident cancer: a large population-based cohort study in Israel.

Type 2 diabetes mellitus has been associated with an increased risk of a variety of cancers in observational studies, but few have reported the relationship between diabetes and cancer risk in men and women separately. The main goal of this retrospective cohort study was to evaluate the sex-specific risk of incident overall and site-specific cancer among people with DM compared with those without, who had no reported history of cancer at the start of the follow-up in January 2000. During an average of 8 years of follow-up (SD = 2.

Persistence with statins and incident cataract: a population-based historical cohort study.

Purpose: In recent years, there is a growing body of evidence suggesting that statins may have anti-inflammatory effects; consequently, it was hypothesized that statins may have a preventive effect against cataract.

Methods: The study was carried out on a retrospective cohort of 180,291 new statin users in a large health organization in Israel. Study participants were followed between 1998 and 2007 for incident cataract or cataract extraction.

Potential impact and cost-effectiveness analysis of rotavirus vaccination of children in Israel.

Background: Rotavirus is a common cause of acute gastroenteritis in children under 5 years of age. Two effective vaccines against rotavirus gastroenteritis were recently licensed in many countries throughout the world. The study aimed to investigate the cost effectiveness of vaccinating an Israeli birth cohort of 143 500 children.

Continuation of statin treatment and all-cause mortality: a population-based cohort study.

Background: The beneficial effects of statins on cardiovascular mortality in secondary prevention have been established in several long-term, placebo-controlled trials. However, the value of statin therapy in reduction of overall mortality in patients without coronary heart disease (CHD) is questionable. This study evaluated the effect of statin therapy in subjects with no indication of cardiovascular disease (primary prevention) and patients with known CHD (secondary prevention).

Use of hormone replacement therapy, 1998-2007: sustained impact of the Women's Health Initiative findings.

Background: Trials of hormone replacement therapy (HRT) for prevention of chronic disease in postmenopausal women have suggested that the risks of treatment outweigh the benefits. The publication in 2002 of the Women's Health Initiative (WHI) study sparked a rapid decline in HRT purchases among American women.

Objective: To examine the impact of the WHI findings on patterns of HRT use in Israeli women.

Long-term persistence with statin treatment in a not-for-profit health maintenance organization: a population-based retrospective cohort study in Israel.

Background: Although discontinuing lipid-lowering treatment can cause preventable morbidity, previously published reports have indicated considerable variability in persistence with statin use. In general, such reports have been limited by short follow-up periods and modest study populations.

Objectives: The aims of this study were to assess long-term persistence with statins and to identify the sociodemographic, clinical, and pharmacotherapy-related factors associated with long-term persistence with statin treatment in first-time users in Israel.

[Redesign of community-based health services: the solution for decreasing the quality gap].

The quality gap is defined as the gap between the observed and the expected, evidence-based, quality indicators. Experts agree that significant reduction of the quality gap requires transformation of the current system of health care provision. Maccabi Healthcare Services has formulated a "change package" in order to redesign its community-based healthcare services.

[The physician manager--building a clinical leadership in community medicine--the Maccabi Healthcare Services (MHS) model].

Community medicine around the world is facing constant trends of changes. The need to overcome the huge burden of chronic diseases, the need to prioritize and adapt new technologies, and above all, the fact that all these must be done within a given, restricted budget, calls for advanced medical management. In this review we focused on the development of the role of the physician manager in Maccabi Healthcare Services (MHS) over the last 60 years.

Coping specificity: the case of women coping with infertility treatments.

Customizing the measurement of coping to a specific situation can answer some of the concerns regarding its measurement by checklist. A context-specific measure of coping with infertility was developed on the basis of theoretical principles of coping, interviews with women and providers, and existing findings. Data on the resulting Coping with Infertility questionnaire was collected from 652 Israeli women undergoing treatment and meta-strategies of coping were identified on the basis of a hierarchical structure of the coping subscales.

Women's and men's perceptions of infertility and their associations with psychological adjustment: a dyadic approach.

Objectives: Research on illness perceptions and their associations with psychological adjustment to medical conditions has mostly focused on individuals coping with chronic diseases. The objective of the current study was to expand this research to the study of couples by examining the perceptions of infertility among couples undergoing treatment and their associations with each partner's psychological adjustment.

Design: The study was cross-sectional and included two samples that differed in the stage of treatment: Sample 1 included 72 couples at their first visit to an infertility clinic and Sample 2 included 49 couples at various stages of treatment.

Deaths following influenza vaccination--background mortality or causal connection?

In October 2006, four deaths occurred in Israel shortly after influenza immunization, resulting in a temporary halt to the vaccination campaign. After an epidemiologic investigation, the Ministry of Health concluded that these deaths were not related to the vaccine itself and the campaign resumed; however, vaccine uptake was markedly reduced. Estimates of true background mortality in this high-risk population would aid in public education and quell unnecessary concerns regarding vaccine safety.

[Description of a diabetes disease register extracted from a central database].

Objectives: To describe the development of inclusion criteria for identifying diabetic patients using administrative, laboratory and pharmacy data on a large central electronic database.

Design: A descriptive study in which entry criteria were developed, validated then changed in an iterative fashion and revalidated. The final register was compared with a traditionally built diabetes register.

Evaluation of a syndromic surveillance system using the WSARE algorithm for early detection of an unusual, localized summer outbreak of influenza B: implications for bioterrorism surveillance.

Background: Syndromic surveillance systems have been developed for early detection of bioterrorist attacks, but few validation studies exist for these systems and their efficacy has been questioned.

Objectives: To assess the capabilities of a syndromic surveillance system based on community clinics in conjunction with the WSARE algorithm in identifying early signals of a localized unusual influenza outbreak.

Methods: This retrospective study used data on a documented influenza B outbreak in an elementary school in central Israel.

The use of medical informatics as a management tool for community health services during the 2006 Israel-Lebanon War.

Background: During war the health management organizations have tremendous difficulty monitoring members' needs according to geographic spread.

Objectives: To describe how an HMO used its health information technology in a way that enables its management to receive updated online information on the needs of the insured, according to their distribution throughout the country during the time of the war in Lebanon in July-August 2006.

Methods: Data were derived from the computerized medical records of Maccabi Healthcare Services--the second largest HMO in Israel, providing care to more than 1.

Re-evaluation of serum alanine aminotransferase upper normal limit and its modulating factors in a large-scale population study.

Background: The upper normal limit (ULN) of serum alanine-aminotrasferase (ALT) normal range was recently challenged, because patients diagnosed with liver diseases may have 'normal' or near-'normal' ALT levels, and because possible modulators are often ignored in determining normal range.

Aim: To estimate the ULN for serum ALT and to identify factors modulating it.

Subjects And Methods: We reviewed medical records of subjects aged 15-90, who underwent standard panels of laboratory tests, including serum ALT, over 6 months at a central laboratory.