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Background and Aims: Disorders of gut-brain interaction (DGBI) are a group of chronic illnesses that are crucial to public health because they are widespread, influence patients‘ quality of life and functional level, and exert a major socioeconomic impact. We assessed the national prevalence of all 22 DGBI, the percentage of respondents satisfying diagnostic criteria for at least one DGBI, and the impact on the disease burden in Romania using data from the Rome Foundation Global Epidemiology Study. Methods: Data were collected through an anonymous, nationwide, and secure online survey, which evaluated the prevalence of any DGBI as well as over 22 different DGBI. The Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire were included in the survey, which was completed through the Internet with numerous built-in quality-assurance measures. Results: The survey was completed by 2,049 participants (mean age 42.29±13.11 years) with a representative national distribution. Diagnostic criteria for any DGBI were met in 40.1% of the subjects, while 28.6% met criteria for only one DGBI (no overlap), and 11.5% met criteria for DGBIs in two, three, or four overlapping gastrointestinal anatomical regions. Females had a substantially higher predominance of DGBI than males. Psychosocial characteristics (such as quality of life, somatization, and concern about digestive problems) and healthcare utilization (such as physician visits and medication use) were associated with having any DGBI. Conclusions: We provide the first comprehensive evaluation of the prevalence and burden of DGBI in Romania using the Rome IV criteria. The burden of DGBI in Romania is substantial, with 40.1% of the 2,049 participants meeting diagnostic criteria for any DGBI. These findings demonstrate the importance of patient care, and the need for training and future research.

Rivka Milman,1 Evgeniya Zikrin,2,3 David Shacham,2,3 Tamar Freud,4 Yan Press2– 6 1Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel; 2Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel; 3Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel; 4Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel; 5Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 6Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, IsraelCorrespondence: Yan Press, Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Tel +972-8-6477433 ; +972-50-6263903, Fax +972-8-6407795, Email yanp@bgu.ac.ilPurpose: It is important to identify factors associated with the outcome of rehabilitation after hip fracture as an aid to planning the rehabilitation framework and the future discharge of patients. Previous studies have shown that handgrip strength (HGS) is one of the factors associated with the success of rehabilitation.Materials and Methods: A retrospective study among patients 65 years of age and above who underwent surgical repair of a hip fracture followed by rehabilitation in the Geriatrics ward between September 2019 and December 2021. Successful rehabilitation was determined as Montebello Rehabilitation Factor Score Revised (MRFS-R) ≥ 50%. Associations were assessed between various sociodemographic and clinical variables, including HGS, and rehabilitation success. HGS was tested as a continuous and dichotomous variable, in accordance with various definitions of low muscle strength.Results: Data were collected for 173 patients. The mean age was 81.2 ± 7.2 years and 68.2% were women. In a logistic regression model only HGS, as a continuous variable, was independently associated with rehabilitation success, with each increase of 1 kg increasing the chance for successful rehabilitation by 6.8%.Conclusion: HGS is a simple tool for the planning of the rehabilitation process among patients with hip fracture.Keywords: hip fracture, rehabilitation, handgrip strength, a Montebello Rehabilitation Factor Score Revised, geriatric

The main objective of the study is to investigate the prevalence of anxiety in patients with neovascular age-related macular degeneration (nAMD).A retrospective cross-sectional study of 3 304 nAMD patients and 16 515 age- and gender-matched controls. The proportions of patients with anxiety were compared between the groups using univariate analyses and a multivariate logistic regression model. Proportion of anxiety in patients with nAMD was compared with the proportion of anxiety in controls, matched for age and gender. Data was obtained from the largest health maintenance organization in Israel (Clalit Health Services) with 4 200 000 members.The mean age of patients was 79.7 years; 54.8% were females; Anxiety was more common in patients with nAMD (13.2%) compared to the control group (10.2%) (OR 1.3; 95%CI 1.2-1.5). Multivariate logistic regression analysis revealed a significant association between anxiety and nAMD (OR 1.3; 95% CI: 1.2-1.5), adjusted for age, gender, and socio-economic status.Our study demonstrated that anxiety is more common in patients with nAMD compared to a control group. Physicians treating patients with nAMD should be aware of this association, in order to provide appropriate care for the anxiety associated with nAMD.

BACKGROUND AND AIMS: Conditions such as irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation are among the prevalent gastrointestinal (GI) disorders classified as disorders of gut-brain interaction (DGBI), which can adversely affect the lives of sufferers. This study aimed to assess the degree and consequences of overlapping DGBI in a large population-based global scale. METHODS: Internet survey data from 54,127 adults (49.1% women) in 26 countries were analyzed by 4 GI anatomic regions (esophageal, gastroduodenal, bowel, and anorectal). The number of DGBI-affected GI regions was assessed, including associations with sex, age, disease severity, quality of life, psychosocial variables, and health care utilization. RESULTS: A total of 40.3% of surveyed individuals met Rome IV criteria for a DGBI. The percentages with 1-4 DGBI-affected GI regions were 68.3%, 22.3%, 7.1%, and 2.3%, respectively. The IBS symptom severity score increased significantly from 1 (207.6) to 4 (291.6) regions, as did non-GI symptom reporting (somatization), anxiety and depression, concerns and embarrassment about bowel function, doctor visits, medications, and abdominal surgeries (all P < .0001). Quality of life decreased with increasing number of DGBI regions (P < .0001). In a logistic mixed model, non-GI symptoms (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.08-1.10), being very vs not concerned (OR, 2.55; 95% CI, 2.27-2.90), being very vs not embarrassed about bowel function (OR, 1.20; 95% CI, 1.08-1.33), and mean number of doctor visits (OR, 1.23; 95% CI, 1.115-1.32) were most strongly associated with number of DGBI regions. CONCLUSIONS: DGBI in multiple anatomic GI regions is associated with increased psychological comorbidity, health care utilization, and IBS severity. Physician awareness of overlap could improve quality of care, prevent unnecessary interventions, and yield more positive health outcomes. ispartof: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY vol:20 issue:5 pages:E945-E956 ispartof: location:United States status: published

To characterize and compare occupational injuries among population sectors in southern Israel and to evaluate their use of healthcare services and analgesic drugs.Retrospective cross-sectional study.There were 100,000 occupational injuries among 70,037 insured individuals over the study period from January 1, 2009 to December 31, 2016. There was a large increase in occupational traffic injuries over this period. Compared to the veteran Jewish population, Bedouin Arabs, new immigrants and foreign workers had significantly lower rates of use of ambulatory services and imaging tests ( P0.001). Arabs had significantly higher odds for recurrent occupational injuries (OR = 1.29, P0.001), and being a new immigrant protected against recurrent injuries (OR = 0.70, P0.001).Medical staffs should invest greater effort into explaining the spectrum of diagnostic and treatment options for vulnerable groups as well as workers' rights.

Ageism is an important phenomenon that affects individuals and how society relates to older adults. It is important to evaluate ageism in the medical staff because of its potential effect on treatment for older adults. A cross-sectional study to assess the negative attitudes of doctors and nurses toward older adults was conducted using the Fraboni Scale of Ageism (FSA), a method for evaluating attitudes toward ageism in medical teams. Additional variables associated with ageism such as aging anxiety, and death and dying anxiety were also assessed. The study population included doctors and nurses working in a large university hospital or in community clinics in southern Israel. In all, 431 questionnaires were collected, 203 from the hospital (47.5%) and 224 from the community (52.5%). Of these, 216 (50.1%) were from doctors and 215 (49.9%) from nurses. The mean ageism score in the FSA was 2.8. In a linear regression model, doctors were less ageist than nurses; ageism was directly associated with aging anxiety, and dying anxiety, and was inversely associated with death anxiety. Among doctors, prominent ageist attitudes were directly associated with aging and dying anxiety, inversely associated with graduation from medical school in Israel, and death anxiety. Among nurses, prominent ageism attitudes were directly associated with dying anxiety and inversely associated with work in the hospital. Ageist attitudes were found among doctors and nurses in both the hospital and community clinics. The results emphasize the need to raise awareness of ageism in medical teams and to include this subject in professional training programs designed to reduce its prevalence.

Background: Given that common pathophysiological factors play a role in atopic dermatitis (AD) and infertility, we assumed that the 2 conditions might demonstrate an epidemiological association. Large-scale epidemiological data on this topic are lacking. Objectives: The aim of this work was to evaluate the potential association between AD and infertility in a broad community-based population. Methods: A nationwide retrospective cohort study was conducted, analyzing the association between AD and infertility. We compared AD patients diagnosed by a dermatologist between 2002 and 2018 and a matched control group. The study population was subdivided according to age into adults (age ≥18 years) and children (age Results: The study included 127,150 patients with AD and 127,071 comparison enrollees. AD was associated with a higher prevalence of infertility than that of the control group (1.4 and 1.1%, respectively). The prevalence of infertility, per 1,000 patient-years, was increased in patients with AD compared to that of the control group (2.17 and 1.7, respectively). Multivariate analysis for infertility demonstrated that AD was a key risk factor for infertility in both males and females with mild AD and moderate-to-severe AD. Conclusion: A significant association between AD and infertility was observed. This association suggests that infertility may be an additional manifestation of AD. Further studies are warranted to evaluate the impact of AD management in the setting of infertility and vice versa.

Social workers’ exposure to their clients' trauma can lead to secondary traumatisation stress (STS). In light of cognitive theories suggesting the tendency for repetitive thought (RT) as being pred...

Dementia is a terminal illness and in an advanced stage it is suitable for palliative care.To examine the results of a pilot program of home hospice for the elder patients with advanced dementia.Patients aged 65 years and over who met the criteria for advanced dementia and palliative care were treated as part of the geriatric team-based home hospice program. The program included home visits by a multidisciplinary team that was available 24/7. During the program, special questionnaires are used to assess the patients' condition, the caregivers' burden and the caregivers' satisfaction with the treatment.Between August 2017 and July 2020, 44 patients were treated in hospice, the mean age was 86.1 ± 6.2 years and 26 (59%) of the patients were women. The average length of stay in the hospice was 129.4 ± 155.5 days (median 68 days) and most patients (36) died at home. The home hospice program leads to statistically significant improvement in the intensity of the behavioral and psychological effects of dementia, the severity of the pain and the intensity of the patients' suffering. In addition, there was a statistically significant decrease in the level of distress and the intensity of anxiety and depression of the family members. Almost all family members noted high satisfaction with end-of-life care.A home hospice program for patients with advanced dementia, based on a multidisciplinary geriatric team and the use of dedicated tools to evaluate the effectiveness of the intervention makes it possible to prevent the suffering of patients and their families and enable them to die in their preferred place.Home hospice is a worthy treatment alternative for terminally ill patients with advanced dementia who want to end their lives at home The home hospice care alleviates the patient's suffering, allows him/her to die in his/her preferred place and alleviates the distress of the family members, who express satisfaction from the treatment.

Two populations with different socio-demographic characteristics reside in southern Israel: the traditional Muslim Bedouin population and the Jewish population that leads a western lifestyle. The aim of the study was to assess the rate, pattern, and dynamics of the use of contraception in these two ethnic populations from 2006 to 2016 and to identify factors associated with the practice of effective and safe contraception. A retrospective study based on a computerized medical database. We recorded actual purchases of different forms of contraception by women of childbearing age (15–49 years) from the two populations in the southern Negev region of Israel. Contraceptives were purchased by 7588 Bedouin women and 30,482 Jewish women. The rate of purchase ranged from 5.2 to 9.7% in the Bedouin sector and from 12.9 to 28.2% in the Jewish sector. Oral contraceptives were the most common type. In the Jewish sector, their use remained relatively stable over the years. In the Bedouin sector, in contrast, the rate increased. The only factor that was associated with the use of intrauterine devices was age (OR = 1.063, P

Aims: Pregnancies complicated with gestational diabetes mellitus (GDM) or preeclampsia should be considered risk factors for subsequent morbidity later in a women’s life. Appropriate screening test...

Data for Israel from the Rome Foundation Global Epidemiology Study on the disorders of gut-brain interaction (DGBI) were used to assess the national prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in Israel.The survey was conducted through the Internet with multiple built-in quality-assurance techniques and included the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire.2012 Israeli participants completed the survey nationwide: mean age 44.6 ± 16.4 years, 50% females. The national distribution was very close to the latest Israeli census. 36.4% (95% CI 34.3, 38.4) met diagnostic criteria for at least one DGBI, with 4.4% for any esophageal disorder, 6.5% for any gastroduodenal disorder, 30.8% for any bowel disorder, and 5.3% for any anorectal disorder. The rates were higher for women. Having any DGBI was associated negatively with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and healthcare utilization (including doctor visits, use of medications, and abdominal surgeries).The results of this study provide the first in-depth assessment of the prevalence and burden of Rome IV DGBI in Israel and facilitate comparisons with other countries. As 36.4% of the 2,012 participants met diagnostic criteria for at least one DGBI, and 23.5% of those met criteria for more than one DGBI, the burden of DGBI in Israel is high, indicating a need to focus on research and training for patient care.

Both atopic dermatitis and celiac disease are often accompanied by other immune-mediated disorders. The objective of this study was to evaluate the potential association between atopic dermatitis and celiac disease in a broad community-based population. A cross-sectional observational design was used. Demographic and clinical data were collected for patients enrolled in a large health management organization who were diagnosed with atopic dermatitis by a dermatologist in 2002–17. The presence of celiac disease/celiac disease-related morbidities was recorded for the whole group, for adults (age > 18 years), and for adults with moderate-to-severe atopic dermatitis. Findings were compared with a matched control group without atopic dermatitis. The study group included 116,816 patients of whom 45,157 were adults; 1909 adult patients had moderate-to-severe atopic dermatitis. Compared to the respective control subjects, the prevalence rate of celiac disease in the whole group was 0.6% vs. 0.4%; in the adults, 0.6% vs. 0.3%; and in the adults with moderate-to-severe atopic dermatitis, 0.8% vs. 0.3% (p

Widespread use of cannabis as a drug and passage of legislation on its use should lead to an increase in the number of scientific publications on cannabis. The aim of this study was to compare trends in scientific publication for papers on medical cannabis, papers on cannabis in general, and all papers between the years 2000 and 2017. A search of PubMed and Web of Science was conducted. The overall number of scientific publications in PubMed increased 2.5-fold. In contrast, the number of publications on cannabis increased 4.5-fold and the number of publications on medical cannabis increased almost 9-fold. The number of publications on medical cannabis in Web of science increased even more (10-fold). The most significant number of publications was in the field of psychiatry. In the fields of neurology and cancer treatment there was a significant increase in the years 2011-2013. There was a rise in the number of publications on children and the elderly after 2013. The specific indications with the largest number of publications were HIV (261), chronic pain (179), multiple sclerosis (118), nausea and vomiting (102), and epilepsy (88). More than half of the publications on medical cannabis originated from the United States, followed by Canada. More than 66% of the publications were original studies. The spike in the number of scientific publications on medical cannabis since 2013 is encouraging. In light of this trend the authors expect an even greater increase in the number of publications in this area in coming years.

Atrial fibrillation and hip fractures are common problems in elderly patients. Delay in the timing of surgical repair can lead to increased complications and anti-coagulation could be a reason for delay.To assess morbidity and mortality in patients 65 years and older with atrial fibrillation (AF) and hip fracture in relation to the type of anti-coagulation.A retrospective cross-sectional study of patients with AF and hip fracture aged 65 and older was conducted in a tertiary hospital. Data collected included co-morbidity, medical history, medications, the timing of surgery, thromboembolic events, estimated risk for stroke by CHADS2 score, for significant bleeding by HAS-BLED score and mortality rate for the six-month period following surgery.During the period 2014-2016, 186 patients 65 years and older with atrial fibrillation underwent surgical repair of a hip fracture, 113 (60.7%) women. The mean age was 81.9±7.1 years. Eighty-nine (47.8%) did not receive any anti-coagulation, 60 (32.3%) received new oral anticoagulants (NOAC), and 37 (19.9%) warfarin. There were no differences between these groups on pre-and post-operation burden of co-morbidity, timing of surgery, surgical delay, complication rate, or mortality rate during the six months following surgery.Anti-coagulation for patients 65 years and older with atrial fibrillation and hip fracture did not affect the timing of surgery or the rate of complications and mortality. Based on these results the concern over emergency surgery and its complications in patients with AF is not justified.

The Bedouin community in southern Israel is an authentic Muslim population that lives in close proximity to the Jewish population and is covered by the same healthcare services. The main aim of the study was to assess the attitudes, knowledge and practice of contraception among Bedouin women of childbearing age in southern Israel. Additional aims were to compare the attitudes and knowledge among women who did and did not use contraceptives and between younger and older women. A questionnaire-based cross-sectional study was carried out. The study population was comprised of women who visit a primary care clinic in the Bedouin village for any reason. It numbered 270 women with a mean age of 33.2 ± 6.6 years. The mean number of children was 5.0 ± 2.7, 27% were in polygamous marriages and 69% were married to relatives. The most recognized methods of contraception were pills and intrauterine devices (37.7%, each). Fourteen per cent of the women practiced the withdrawal method and 9% used breastfeeding for that purpose. The most common sources of knowledge on contraception were family (62% among uses and 69% among non-users), the media (58% and 50%, respectively) and healthcare providers (25% and 34%, respectively). The most common reasons for not practicing contraception were a desire to become pregnant (59%), fear of adverse effects (44%) and husband's opposition (28%). The desire to become pregnant is the main reason for not practicing contraception among women in the Bedouin community in the Negev. Participation of the husband in counselling, involvement of religious leaders can improve family planning. Education on the low rate of adverse effects and on the many health benefits of contraception can also improve adherence to the practice of contraception.

In the present study we assessed the rate of implementation of recommendations given following geriatric assessment for home-ridden patients; a retrospective review of medical records to evaluate the implementation of geriatric recommendations given to patients in the Home Geriatric Service (HGS) between 2015 and 2016. The patients were categorized into two groups: the HGS-clinic (HGS-C) group, in which the primary care physician was responsible for implementation of the recommendations, and the HGS-home care (HGS-H) group, in which the responsibility for implementation of the recommendations was on the geriatrician. The results were compared with the implementation of recommendations in other ambulatory models for mobile patients-Clinic-Based Geriatric Assessment Services (CBGAS). The study included 865 patients. The highest rate of implementation was in the HGS-H group (85.7%), compared with 66.6% in the HGS-C group and 52.7% in the CBGAS group (

Data regarding the association between psoriasis and dementia are inconclusive. The aim of this study was to evaluate this association in the database of Clalit Health Services, Israel. A comparative analysis for the association between psoriasis, dementia and its risk factors was performed for the entire study population and in the subgroup of patients with moderate-to-severe psoriasis. The study included 121,801 patients with psoriasis, of whom 16,947 were diagnosed with moderate-to-severe psoriasis, and 121,802 controls. Psoriasis was associated with a lower prevalence of dementia relative to control subjects (1.6% vs 1.8%; odds ratio (OR) 0.85; 95% confidence interval (95% CI) 0.80-0.91; p < 0.001). Multivariate analysis adjusting for demographic variables, cardiovascular-related risk factors, and healthcare utilization demonstrated a significant inverse association between psoriasis and dementia in the entire study population (adjusted OR 0.86; 95% CI 0.76-0.96; p = 0.009), but not in the subgroup of patients with moderate-to-severe psoriasis (adjusted OR 0.91; 95% CI 0.81-1.02; p = 0.113). In conclusion, these data support the hypothesis that psoriasis is inversely associated with dementia.

Two populations with different socio-demographic characteristics reside in southern Israel: the traditional Muslim Bedouin population and the Jewish population that leads a western lifestyle. The aim of the study was to assess the rate, pattern, and dynamics of the use of contraception in these two ethnic populations from 2006 to 2016 and to identify factors associated with the practice of effective and safe contraception.A retrospective study based on a computerized medical database. We recorded actual purchases of different forms of contraception by women of childbearing age (15-49 years) from the two populations in the southern Negev region of Israel.Contraceptives were purchased by 7588 Bedouin women and 30,482 Jewish women. The rate of purchase ranged from 5.2 to 9.7% in the Bedouin sector and from 12.9 to 28.2% in the Jewish sector. Oral contraceptives were the most common type. In the Jewish sector, their use remained relatively stable over the years. In the Bedouin sector, in contrast, the rate increased. The only factor that was associated with the use of intrauterine devices was age (OR = 1.063, P 0.001). Among women who used combined hormonal contraception, Jewish ethnicity (OR = 5.835, P 0.001), age (OR = 0.926, P 0.001), and comorbidity (OR = 0.87, P = 0.001) were associated with the use of newer, low-dose estrogen drugs.Our findings, such as the lower rate of contraception practice in the Bedouin sector in general and the use of the new and safer hormonal contraceptives in particular, can help focus the efforts of medical teams in programs for women's health promotion.

Background: The use of feeding tubes (FTs) in patients with advanced dementia does not yield positive health outcomes and can have a negative effect. Methods: A cross-sectional study assessed the knowledge and attitudes of physicians on the use of FTs for patients with advanced dementia. Results: 201 of 240 doctors (83.8%) participated in the study; 61.7% of the doctors claimed that FTs prevent aspiration, 51.7% that they prevent pneumonia, and 38.8% that they prevent weight gain. Almost one-third (32.3%) said that the decision to use FTs could be taken by a hospitalist or a primary physician (28.9%). Conclusion: We found large gaps in knowledge among doctors about the use of FTs and consequences in patients with advanced dementia.

Orly Liberman,1 Tamar Freud,2 Roni Peleg,2,3 Ariela Keren,1 Yan Press2,4,5 1Nursing Department, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 2Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 3Pain Clinic, Clalit Health Services, Beer-Sheva, Israel; 4Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel; 5Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel Background: In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatric syndromes (GS) including chronic pain. Purpose: To assess the prevalence of chronic pain among individuals aged ≥65 years in the Southern District of Israel and to evaluate associations between chronic pain and other GS. Methods: A telephone interview was conducted on a sample of older adults who live in the community. The interview included the Brief Pain Inventory and a questionnaire on common geriatric problems. Results: Of 419 elderly individuals who agreed to be interviewed 232 (55.2%) suffered from chronic pain. Of those who reported chronic pain, 136 participants (68.6%) noted that they had very severe or unbearable pain. There were statistically significant associations between the pain itself and decline in patient’s functional status, increased falls, reduced mood, and cognitive decline. Conclusion: The results of this study show that chronic pain is very common in older adults and that it is associated with other GS. There is a need to increase awareness of chronic pain in older adults and to emphasize the important role that it plays in their care. Keywords: pain, impact of pain, older adults, geriatric syndromes, community dwelling

Aim Orthostatic hypotension is a common problem in individuals aged ≥65 years. Its association with mortality is not clear. The aim of the present study was to evaluate associations between orthostatic hypotension and overall mortality in a sample of individuals aged ≥65 years who were seen at the Outpatient Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel. Methods Individuals who were evaluated in the Outpatient Comprehensive Geriatric Assessment Unit between January 2005 and December 2015, and who had data on orthostatic hypotension were included in the study. The database included sociodemographic characteristics, body mass index, functional and cognitive state, geriatric syndromes reached over the course of the assessment, and comorbidity. Data on mortality were also collected. Results The study sample included 1050 people, of whom 626 underwent comprehensive geriatric assessment and 424 underwent geriatric consultation. The mean age was 77.3 ± 5.4 years and 35.7% were men. Orthostatic hypotension was diagnosed in 294 patients (28.0%). In univariate analysis, orthostatic hypotension was associated with overall mortality only in patients aged 65-75 years (HR 1.5, 95% CI 1.07-2.2), but in the multivariate model this association disappeared. Conclusions In older frail patients, orthostatic hypotension was not an independent risk factor for overall mortality. Geriatr Gerontol Int 2018; 18: 1009-1017.

Most previous studies showed an association between sleep impairment in the elderly and symptoms of depression and anxiety. Majority of these studies were conducted in “strong”, community-dwelling elderly. To assess the association between subjective sleep impairment and its affective disturbances among frail elderly patients. The retrospective study included patients 65 years old and above. Data included socio-demographic characteristics, the mini-mental state examination, the short anxiety screening test, the 15-item Geriatric Depression Scale, and the Patient Health Questionnaire. The patients were asked about sleep complaints. The study population consisted of 496 patients. The mean age was 83.7 ± 6.2 years, and only 7 (1.4%) did not report any sleep disturbance. After adjustment, depression symptoms were associated only with decreased overall sleep satisfaction (OR 2.62, 95% CI 1.18–5.81), while anxiety symptoms were associated with decreased overall sleep satisfaction (OR 3.17, 96% CI 1.71–5.88), difficulty falling asleep (OR 3.58, 95% CI 1.96–6.52), waking up during the night (OR 3.16, 95% CI 1.63–6.1), morning weakness (OR 2.68, 95% CI 1.44–5.0) and daytime drowsiness (OR 2.39, 95% CI 1.21–4.69). Sleep impairment is very prevalent among frail elderly and associated much more with anxiety than with depression. The findings of the present study provide further evidence for the importance in taking a detailed history of sleep habits during the course of the geriatric assessment in frail elderly patients.

The aim of the present study was to compare implementation rates by primary care physicians of geriatric assessment recommendations given in various assessment settings. We compared Model "OCGAU," an outpatient comprehensive geriatric assessment unit where there was no direct contact between the geriatrician and the primary care physician with three "Clinic" models of in-clinic geriatric assessment: Model "Clinic A-2007" in which the primary care physician participated in the assessment, Model "Clinic A-2013" where there was no contact with the primary care physician, and Model "Clinics B-2013" where the primary care physician participated in a staff meeting with the geriatrician in the clinic. Subgroups of "OCGAU" model were composed of patients referred to the geriatric unit by primary care physicians of patients included in three "Clinic" models. Model "OCGAU" included 240 patients, Model "Clinic A-2007" 107, Model "Clinic A-2013" 127, and Model "Clinics B-2013" 133. The patients in Model "OCGAU" were older (mean age 83.2 ± 6.2 years) than in "Clinic" models where the mean age was 79.7 ± 6.5, 81.5 ± 6.1, and 80.7 ± 6.5, p 0.001. More recommendations were given per patient (6.4) in the Model OCGAU than in the "Clinic" models (range 1.9-3.9, p 0.05), but the implementation of recommendations by primary care physicians was lower in Model OCGAU (48.9%) than in "Clinic" models (range 56.9%-71.8%, p 0.005). Although more recommendations were made in the geriatric unit, the implementation rate was lower. This indicates the need for organizational changes, in particular, improving communication between the geriatric staff and primary care physicians.

Olga N Tkacheva,1 Nadezda K Runikhina,1 Arkadiy L Vertkin,2 Irina V Voronina,1 Natalia V Sharashkina,1 Elen A Mkhitaryan,1 Valentina S Ostapenko,1 Elena A Prokhorovich,2 Tamar Freud,3 Yan Press3–5 1Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation, 2Moscow State University of Medicine and Dentistry named after AI Evdokimov, Moscow, Russia; 3Department of Family Medicine, Faculty of Health Sciences, Sial Family Medicine and Primary Care Research Center, Ben-Gurion University of the Negev, 4Comprehensive Geriatric Assessment Unit, Clalit Health Care Services, Yassky Clinic, 5Community-Based Geriatric Unit, Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel Background: Delirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65years. The secondary aim was to identify the risk factors for delirium. Methods: A prospective study was conducted in an acute-care hospital in Moscow, Russia. Six doctors underwent a short training course on delirium. Data collected included assessment by the confusion assessment method for the intensive care units, sociodemographic data, functional state before hospitalization, comorbidity, and hospitalization indices (indication for hospitalization, stay in intensive care unit, results of laboratory tests, length of hospitalization, and in-hospital mortality). Results: Delirium was diagnosed in 13 of 181 patients (7.2%) who underwent assessment. Cognitive impairment was diagnosed more among patients with delirium (30.0% vs 6.1%, P=0.029); Charlson comorbidity index was higher (3.6±2.4 vs 2.3±1.8, P=0.013); and Barthel index was lower (43.5±34.5 vs 94.1±17.0, P=0.000). The length of hospitalization was longer for patients with delirium at 13.9±7.3 vs 8.8±4.6days (P=0.0001), and two of the 13 patients with delirium died during hospitalization compared with none of the 168 patients without delirium (P=0.0001). Conclusion: Although the rate of delirium was relatively low compared with studies from the West, this study proves that an educational intervention among doctors can bring about a significant change in the diagnosis of the condition. Keywords: delirium, elderly, inpatients, Russia

BACKGROUND Drug survival rates in patients with psoriasis had been described extensively. Different survival rates of TNF-α inhibitors (TNFIs), ustekinumab and secukinumab were reported. OBJECTIVES To investigate drug survival rates of TNFIs, ustekinumab and secukinumab, with particular emphasis on the difference between ustekinumab and secukinumab. METHODS Survival analysis was performed in patients with moderate-to-severe psoriasis who received adalimumab, infliximab, etanercept, ustekinumab and secukinumab treatment in 2002-2018, using the Clalit Health Services database. Stratified analysis was performed according to biologic treatment lines. Multivariate analysis was performed adjusting for demographic variables, calendar year, metabolic syndrome, psoriatic arthritis, biologic treatment line, biologic naivety, co-administration of oral treatments and previous oral systemic treatment exposure. RESULTS Among 1459 patients treated with 3070 biologic medication courses, ustekinumab had a significantly higher crude survival as compared with TNFIs and secukinumab. The mean drug survival of ustekinumab, adalimumab, etanercept, infliximab and secukinumab was 43.5 (CI: 39.7-47.2), 38.2 (CI: 34.8-41), 33.9 (CI: 30.8-37.1), 28.2 (CI: 22.5-33.8) and 17.1 (CI: 15.6-18.6) months, respectively, with significant statistical differences for all comparisons (P

To assess the rate of orthostatic hypotension and factors associated with it among elderly patients who underwent a comprehensive, ambulatory geriatric assessment.The study included patients 65 years and older who were assessed in the outpatient comprehensive geriatric assessment unit. Data were collected from the computerized medical record including sociodemographic data, lifestyle, falls, blood pressure, BMI, functional and cognitive status, medications, and comorbidity.The study population consisted of 571 patients who underwent assessment over a nine-year period. The mean age was 83.7 ± 6.1, 35.9% were men, and 183 (32.1%) were diagnosed with orthostatic hypotension. Multiple drugs, in general, and multiple drugs with the potential to cause orthostatic hypotension in particular increased the risk for orthostatic hypotension after adjustment for age, sex, chronic comorbidity, and supine systolic blood pressure ≥150 mmHg [odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.03-1.14 and OR = 1.22, 95% CI: 1.08-1.37, respectively]. In addition, α-blockers and calcium channel blockers increased the risk for orthostatic hypotension after similar adjustments (OR = 1.82, 95% CI: 1.01-3.16 and OR = 1.66, 95% CI: 1.11-2.48, respectively). Similarly, two additional drug types increased the risk for orthostatic hypotension: selective serotonin reuptake inhibitors (OR = 2.09, 95% CI: 1.33-3.19) and tricyclic antidepressants (OR = 4.36, 95% CI: 1.85-10.06). There were no specific associations between age, cognitive and functional state, morbidity (as measured by the Charlson Comorbidity Index), and specific diseases, and orthostatic hypotension.The results of the present study reinforce evidence of an association between drug therapy and orthostatic hypotension.

OBJECTIVES: The global prevalence of IBS is difficult to ascertain, particularly in light of the heterogeneity of published epidemiological studies. The aim was to conduct a literature review, by experts from around the world, of community-based studies on IBS prevalence. DESIGN: Searches were conducted using predetermined search terms and eligibility criteria, including papers in all languages. Pooled prevalence rates were calculated by combining separate population survey prevalence estimates to generate an overall combined meta-prevalence estimate. The heterogeneity of studies was assessed. RESULTS: 1451 papers were returned and 83, including 288 103 participants in 41 countries, met inclusion criteria. The mean prevalence among individual countries ranged from 1.1% in France and Iran to 35.5% in Mexico. There was significant variance in pooled regional prevalence rates ranging from 17.5% (95% CI 16.9% to 18.2%) in Latin America, 9.6% (9.5% to 9.8%) in Asia, 7.1% (8.0% to 8.3%) in North America/Europe/Australia/New Zealand, to 5.8% (5.6% to 6.0%) in the Middle East and Africa. There was a significant degree of heterogeneity with the percentage of residual variation due to heterogeneity at 99.9%. CONCLUSIONS: The main finding is the extent of methodological variance in the studies reviewed and the degree of heterogeneity among them. Based on this, we concluded that publication of a single pooled global prevalence rate, which is easily calculated, would not be appropriate or contributory. Furthermore, we believe that future studies should focus on regional and cross-cultural differences that are more likely to shed light on pathophysiology.

Studies of the effect of aromatherapy on patients with behavioral and psychological symptoms of dementia (BPSD) have yielded contradictory results. One possible explanation for this lack of consistent results is the site of application of the oil. The aim of the study was to evaluate the effect of lavender oil on the rate of BPSD when applied close to and away from the olfactory system. A crossover placebo-controlled study was conducted in the two psychogeriatric long term care departments. Patients in Department A received lavender oil on their face during the first month and on their foot in the second month, sunflower seed oil on their foot in the third month and on their face in the fourth month. Patients in Department B received sunflower seed oil on their face during the first month and on their foot in the second month, and lavender oil on their foot in the third month and on their face in the fourth month. Forty-two patients completed the study. Their mean age was 76.1 ± 11.2 years. After 4 months of treatment, the mean Neuropsychiatric Inventory score in Department A dropped from 13.1 ± 8.3 (median 12.0) to 3.5 ± 3.8 (median 2.0

Atopic dermatitis (AD) is a common, chronic, inflammatory, pruritic skin disorder that affects up to 20% of the children in Western countries. Attention-Deficit/Hyperactivity disorder (ADHD) has been reported to be more frequent in children with AD. The purpose of this study was to explore the risk for ADHD in our population of patients with AD. A population-based case-control study, using the medical database of Clalit Health Services (CHS), the largest healthcare provider organization in Israel. The study included 840 patients with AD between the age of 0-18 years and 900 age and gender frequency-matched patients without AD. The proportion of ADHD in patients with AD was 7.1% as compared to 4.1% in controls. ADHD was more frequent in boys with AD (9.6% vs. 5.2%, odds ratio (OR) 1.9, 95% confidence interval (CI) 1.1-3.2) but not in girls with AD (4.6% vs. 2.9% OR 1.5). In multivariate analyses, AD was associated with ADHD (OR 2.1, 95% CI 1.3-3.4). The current study demonstrated an association between AD and ADHD. This report and earlier observations emphasize the need for detection and treatment of ADHD in atopic patients.

Orthostatic hypotension is a common problem in individuals aged ≥65 years. Its association with mortality is not clear. The aim of the present study was to evaluate associations between orthostatic hypotension and overall mortality in a sample of individuals aged ≥65 years who were seen at the Outpatient Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel.Individuals who were evaluated in the Outpatient Comprehensive Geriatric Assessment Unit between January 2005 and December 2015, and who had data on orthostatic hypotension were included in the study. The database included sociodemographic characteristics, body mass index, functional and cognitive state, geriatric syndromes reached over the course of the assessment, and comorbidity. Data on mortality were also collected.The study sample included 1050 people, of whom 626 underwent comprehensive geriatric assessment and 424 underwent geriatric consultation. The mean age was 77.3 ± 5.4 years and 35.7% were men. Orthostatic hypotension was diagnosed in 294 patients (28.0%). In univariate analysis, orthostatic hypotension was associated with overall mortality only in patients aged 65-75 years (HR 1.5, 95% CI 1.07-2.2), but in the multivariate model this association disappeared.In older frail patients, orthostatic hypotension was not an independent risk factor for overall mortality. Geriatr Gerontol Int 2018; 18: 1009-1017.

We developed an algorithm to assess recorded cough episodes and differentiate them from similar, non-cough sounds.To measure cough episodes in healthy young adults, cigarette smokers and non-smokers over a 24-hour recording period, during the course of normal activity.The study subjects were students, aged 20-40 years old. 24-hour sound recordings were conducted by a portable recorder. Analysis used an algorithm that was developed and tested in the study.Seventy students were recruited. Recordings included 2628 cough episodes in 1704 h of recording. The cough detection algorithm successfully detected 88.5% of recorded cough episodes and 95.6% of non-cough sounds. There was a clear tendency for more coughs among smokers. Autumn was the season with the highest mean cough episodes per day (58.65), while summer had the lowest (14.19). There was a strong correlation between self-reported cough episodes and recorded coughs. Cough episodes were significantly more frequent between noon and midnight (p 0.0001).There is a very large range in daily coughs among healthy young adults. During sleeping hours there are less cough episodes. In autumn and spring there are more cough episodes compared to summer and winter, probably secondary to environmental factors. In smokers, the coughing rate is relatively high. If the cough detection device will be able to discriminate between cough variants (i.e., healthy versus patient), and stringent validation will confirm sensitivity and specificity, valuable data from this device may ease the decision regarding medications, or any other changes in order to improve outcome.

Background Data on the health care utilization of patients with hidradenitis suppurativa (HS) in primary care settings are scarce. Objective To investigate the health care service utilization of patients with HS. Methods In a cross-sectional study, patients with HS were compared with 2 age- and sex-matched control groups—general population enrollees of Clalit Health Services and a group of patients with psoriasis. Health care services data included inpatient and outpatient community clinic visits and pharmacy claims for topical and systemic treatments. Multivariate analysis of the data for patients with HS and controls was performed. Results The study included 4417 patients with HS, 22,085 general population enrollees, and 4417 patients with psoriasis. On the basis of multivariate analyses, patients with HS had more annual dermatology clinic visits compared with the general population enrollees (odds ratio [OR], 6.49; 95% confidence interval [CI], 7.06-5.97) and patients with psoriasis (OR, 1.32; 95% CI, 1.44-1.21), more annual surgical clinic visits (OR, 3.78; 95% CI 3.28-4.36 and OR, 1.65; 95% CI, 1.42-1.91, respectively), and more hospitalizations (OR, 2.21; 95% CI, 1.89-2.56 and OR, 1.51; 95% CI, 1.28-1.78, respectively). Limitations Underestimation of HS frequency was possible. Conclusions The burden on health care systems due to patients with HS is greater than that due to patients with psoriasis and the general population.