Varda Shalev

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (112)407.29 Total impact

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    ABSTRACT: Bisphosphonates are a first-line treatment for osteoporosis but require adequate renal function. We estimated the prevalence of renal impairment among osteoporotic women in Israeli. Approximately 2.3 % of women had renal impairment at a level that makes them inappropriate for bisphosphonate use, demonstrating the need for alternative therapies for osteoporosis treatment. The purpose of this study is to estimate the prevalence of renal impairment among postmenopausal osteoporotic women within a large Israeli health plan. This was a retrospective analysis of Maccabi electronic medical records, including Israeli women aged ≥55 with either an osteoporosis diagnosis or osteoporosis-related fracture between January 1, 2007, and December 31, 2011. The estimated glomerular filtration rate (eGFR), which was calculated from the lowest serum creatinine levels reported during the study period, was used to classify stage 1-5 renal impairment: normal ≥90, mild 60-89, moderate 30-59, severe 15-29, and failure <15 mL/min/1.73 m(2), respectively. Outcomes were distributions of renal impairment across the study population and stratified by age and osteoporosis-defining event. A total of 15,608 patients met all eligibility criteria. Patients with stage 1-5 renal function accounted for 25.2, 54.9, 18.5, 1.2, and 0.3 %, respectively, of all patients. Of osteoporotic patients, 2.3 % had eGFR levels (<35 mL/min/1.73 m(2)) that make them inappropriate for bisphosphonate use. This rate was 1.6 % among patients with an osteoporosis diagnosis and 3.8 % among patients with osteoporosis-related fracture. Within the group of renally impaired patients, older patients were overrepresented. Of the fracture group, patients with hip fractures had a higher prevalence of renal dysfunction (9.3 %) than those having vertebral fractures (3.2 %) or other fractures (2.0 %). Among postmenopausal women with osteoporosis, 2.3 % had renal impairment which makes them inappropriate for bisphosphonate use in Israel.
    Archives of Osteoporosis 12/2015; 10(1):210. DOI:10.1007/s11657-015-0210-y
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    ABSTRACT: Statins were shown to down-regulate immune mechanisms activated in psoriasis. However, previous studies on their potential role in preventing psoriasis yielded conflicting results. To assess the relationship between adherence with statins and the risk of psoriasis. This retrospective cohort study included 205,820 health plan enrollees in Israel (mean age 55 years; 54.1% female) who initiated statin treatment from 1/1998 through 9/2009. Adherence with statins, measured by proportion of days covered (PDC) throughout the entire follow-up period (mean= 6.2 years). Diagnosis codes of psoriasis were given by a dermatologist or rheumatologist or at discharge from hospitalization RESULTS: During 1.28 million person-years (PY) of follow-up (median=5.74 years per person; IQR=3.78-8.36), a total of 5,615 psoriasis cases (incidence density= 4.4 per 1,000PY) were recorded. Compared with non-adherent patients (PDC<20%), patients covered with statins for 40%-59% of the time had a significantly (P<0.05) lower risk of psoriasis with hazard ratios (HRs) of 0.84 and 0.74 among males and females, respectively. Among more adherent patients (PDC≥80%), HRs were 0.88 (95%CI: 0.79-0.98) and 1.00 (0.90-1.11), respectively. The results of the current study suggest that high and long-term adherence with statins is not associated with a meaningful reduction in the risk of psoriasis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 04/2015; DOI:10.1111/bjd.13850 · 4.10 Impact Factor
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    ABSTRACT: Elevated serum uric-acid levels reflect and also cause both oxidative stress and insulin resistance and are frequently observed in patients with the metabolic syndrome. A strong association exists between the metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). Therefore, we aimed to test the association between uric-acid and elevated alanine aminotransferase (ALT), as a surrogate for NAFLD, using real-world data. A cross-sectional study using data from Maccabi Healthcare System, a 2-million member health maintenance organization in Israel. The population consisted of individuals aged 20-60 years who underwent blood tests for ALT and uric-acid between 1997 and 2012. Individuals with secondary liver disease, celiac and inflammatory bowel-disease were excluded. Subgroup analysis was performed in subjects who were given the diagnosis of fatty liver in their medical records (n=2,628). The study population included 82,608 people (32.5% men, mean age 43.91±10.15 years). There was a significant positive dose-response association between serum uric-acid levels and the rate of elevated serum ALT (P for trend<0.001). In multivariable model, controlling for potential confounders, the association between uric-acid and elevated ALT persisted (OR=2.10, 95%CI 1.93-2.29, for the fourth quartile vs. the first). This association was maintained in all categories of gender and BMI. Similar results were observed among patients diagnosed with fatty liver (OR= 1.77, 1.22-2.57). Serum uric-acid is independently associated with elevated ALT, as a surrogate for NAFLD, and thus may serve as a serum marker for liver damage and should be further investigated as a risk factor for NAFLD. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 04/2015; DOI:10.1111/liv.12842 · 4.41 Impact Factor
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    ABSTRACT: Aim: To describe the drug management of T2DM patients in a real life cohort with suboptimal HbA1c after treatment with metformin monotherapy. Methods: we performed a retrospective cohort analysis of computerized medical records after measuring an HbA1c >7% for the first time following at least 90 days on metformin therapy. Results: Among 7705 eligible patients, 56% (n = 4336) changed treatment within 1-year, by increasing metformin dose (36%), adding drugs (60%), or switching to other medications (4%). Strongest predictors of change were higher HbA1c, younger age and higher socioeconomic status (SES). Conclusion: In this cohort, the extent of inertia appears to be smaller than that reported in previous studies. Nonetheless, disease management programs aimed at improving guideline adherence and reducing inertia are still warranted. Summary points Background ● The importance of proactive diabetes treatment has been reinforced by recent diabetes guidelines. Understanding the magnitude of clinical inertia in a real world cohort of patients with Type 2 diabetes mellitus, and understanding the factors affecting intensity of care may improve diabetes care. Results ● Overall, 7705 patients were identified in a large computerized database of an Israeli HMO, in whom HbA1c >7% was measured for the first time following at least 90 days on metformin therapy. Of these, 56% (n = 4336) changed treatment within 1-year, by increasing metformin dose (36%), adding drugs (60%), or switching to other medications (4%). ● Strongest predictors of change were higher HbA1c, younger age and higher socioeconomic status (SES). Conclusion ● In this cohort, the extent of inertia appears to be smaller than that reported in previous studies. The may be due to intensive implementation of guidelines.
    01/2015; 5(1):17-24. DOI:10.2217/DMT.14.45
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    ABSTRACT: To assess the proportion of male versus female offspring of women diagnosed with SLE or RA, disorders in which female predominance is well known and PsA a disease in which female dominance is less established. The study population encompassed all females aged 16-46, who were members of the Maccabi Health Services (MHS) throughout the period of 2000-2011 and had at least one pregnancy. Data were retrieved from the computerized database of MHS, a 2-million enrollee health maintenance organization operating in Israel. The database was also used to collect data on patients with RA, SLE, and PsA. A total of 182,073 women had at least one indication of pregnancy during the study period. Among them, 546, 270, and 170 were diagnosed with RA, SLE, and PsA, respectively. The proportion of live-born males in 380,472 offspring of women free of these diseases was 51.5 % (95 % CI 51.4-51.7 %). The proportion (95 % CIs) of male offspring born to mothers diagnosed with of RA, SLE, and PsA were 46.3 % (42.3-50.3 %), 51.8 % (46.6-57.0 %), and 50.6 % (42.8-58.5 %), respectively. Our findings support the primary contribution of the hormonal phenotype rather than the genetic phenotype on autoimmunity. Neither patients with SLE or RA differ from the general population by the sex of their offspring.
    Annals of the Rheumatic Diseases 11/2014; 73(Suppl 2). DOI:10.1007/s12026-014-8603-3 · 9.27 Impact Factor
  • The Israel Medical Association journal: IMAJ 10/2014; 16(10):625-6. · 0.90 Impact Factor
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    ABSTRACT: The incidence of skin cancer, both melanoma and keratinocyte cancers (KC) is rising throughout the world, specifically squamous cell carcinomas(SCC) and basal cell carcinoma(BCC), being the most common of all cancers.
    British Journal of Dermatology 06/2014; 172(1). DOI:10.1111/bjd.13213 · 4.10 Impact Factor
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    ABSTRACT: Previous assessments of the prevalence of resistant hypertension (RH) in uncontrolled blood pressure (BP) have ranged from 3% to 30%. Using real-world data, our aim was to estimate the prevalence of RH in patients belonging to the Maccabi Healthcare Services, a 2-million-member health organization in Israel. From 2010 to 2011, all hypertensive patients with ≥2 recorded BP measurements during a minimum period of 6 months were identified. Patients were considered uncontrolled if their most recent BP during the study period and their mean systolic BP or diastolic BP during a preceding period of ≥6months were systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg in chronic kidney disease or diabetes mellitus. Uncontrolled patients taking diuretics and ≥2 antihypertensive therapy classes at their maximal recommended dose were regarded as resistant hypertensives. A total of 172 432 patients were eligible for the study. Uncontrolled BP was found in 35.9% (n=65 710). Overall, 2.2% of the uncontrolled patients (n=1487) were resistant hypertensives. Patients with RH were characterized by a significantly (P<0.01) older age, higher body mass index, and multicomorbidity (including dyslipidemia, diabetes mellitus, and impaired renal function) compared with patients with controlled hypertension receiving equivalent treatment. The results of this large population-based study indicate a substantially lower prevalence of RH than previously reported. Most patients with uncontrolled BP took less than the maximal recommended antihypertensive treatment.
    Hypertension 06/2014; 64(3). DOI:10.1161/HYPERTENSIONAHA.114.03718 · 7.63 Impact Factor
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    ABSTRACT: Background: The dramatic increase in autism spectrum disorder (ASD) prevalence has been attributed to the broadening of diagnostic criteria, greater awareness, improved case finding methods, and the development of services for children with ASD. Diagnostic substitution has also been suggested as a reason for this increase, with several studies pointing to an increase in the diagnosis of ASD and a decrease in the diagnoses of intellectual disabilities, and other language and developmental disorders. However, to our knowledge, no studies have examined whether shifts in psychiatric diagnoses could contribute to the rise in ASD prevalence. Objectives: To describe the changes in diagnoses of autism and mental health disorders in children in Israel between 2003 and 2012, using data from psychiatrists in Maccabi Healthcare Services (MHS), a large healthcare organization in Israel. Methods: A search of the MHS computerized databases was conducted for all diagnoses given to children (up to the age of 18) by psychiatrists from 2003 to 2012. Diagnoses were grouped by year and divided into ten broad categories, such as ASD, anxiety, and phobia. If a child received a diagnosis that fell into multiple categories, the diagnosis was listed in all relevant categories. However, if a child received the same type of diagnosis twice or more in a single year, the diagnosis was listed only once. The relative percentage change was calculated and chi square analysis was performed. Results: The total number of children diagnosed by psychiatrists in MHS increased from 1499 children in 2003 to 7327 in 2012. ASD accounted for 6.1% of all diagnoses in 2003, compared to 10.4% in 2012, representing a relative percentage increase of 69.2% (p<0.001). Statistically significant (p<0.01) relative increases between 2003 and 2012 were also found for behavior problems (60.7%), anxiety (58.6%) and ADHD (38.4%). A significant (p<0.001) decrease in the relative percentage between the same years was found for psychosis (58.5%), schizophrenia (40.8%) and depression (35.4%). Non-significant changes were found for phobia, obsessive compulsive disorder and bipolar diagnoses. Conclusions: Results indicate a substantial shift in psychiatric case mix among children (up to the age of 18) between 2003 and 2012 in one of Israel’s largest healthcare organizations. ASD accounts for a growing proportion of all cases diagnosed by psychiatrists. While there was a relative increase also in behavior problems, anxiety and ADHD, there was a relative decrease in psychosis, schizophrenia, and depression. This shift may reflect psychiatric diagnosis substitution over time with an increasing number of children receiving an ASD diagnosis instead of other psychiatric diagnoses. Possible explanations for the shift in psychiatric case mix include increased awareness as well as a significant increase in services provided to children and adolescents with ASD.
    2014 International Meeting for Autism Research; 05/2014
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    ABSTRACT: To investigate the prevalence and incidence of glaucoma in a large health maintenance organization (HMO) in Israel. A population-based retrospective cohort study, conducted using electronic medical database. Collected data included personal and medical characteristics. Maccabi Healthcare Services, the second largest HMO in Israel insuring 2 million members and serving 25% of the population with a nationwide distribution. Maccabi members from January 2003 to December 2010. Prevalence and incidence of glaucoma according to the International Classification of Diseases, 9th revision, Clinical Modification diagnostic codes. A total of 15,708 prevalent glaucoma patients were identified among active members of Maccabi in December 2010. A total of 15,332(97.6%) were 40 years or older, with a point prevalence of 2.2%. Prevalence of glaucoma was strongly associated with age, ranging from 0.28%at age 40-50 to 9.2% among elderly aged 80 or above. The 5 most prevalent diagnoses were open angle glaucoma (1.61%), exfoliation glaucoma (0.20%), unspecified glaucoma (0.17%), angle closure (0.11%), and normal tension glaucoma (0.06%). We identified 6,674 incident glaucoma patients diagnosed between 2003 and 2010. The observed incidence density rate among 40+ year old members was 1.84 (1.79-1.88) new cases per 1000 person years. Median age at diagnosis was 64 years old. The risk of glaucoma was similar between sexes up to age 70 years, and was significantly (P<0.01) higher in men in older ages. Glaucoma affects nearly 10% of the elderly population in Maccabi with the highest risk of diagnoses at age 70 to 74. Since glaucoma leads to irreversible vision loss, the present estimates of morbidity should be of significant concern.
    American Journal of Ophthalmology 05/2014; DOI:10.1016/j.ajo.2014.04.026 · 4.02 Impact Factor
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    ABSTRACT: Background/Aims: A worldwide decline in the age at menarche (AAM) has been reported in recent decades. This trend has been also clinically observed among Israeli women and was reported in our previous study. Methods: We reviewed the literature reporting the mean AAM in Israel during the past century. Studies were excluded if participants had been investigated due to illness or any condition which could affect sexual maturation. Mean AAM was analyzed using a simple linear regression weighted for number of participants in each birth cohort and stratified to birth cohorts before and after 1970, based on the outcome of our previous study. Results: AAM varied little among women born between 1875 and 1970, but there was a clear downwards trend from 13.4 in 1970 to 12.8 two decades later. In a stratified analysis we found a significant negative association between birth year and AAM in the birth cohort after 1970 (standardized β coefficient = -0.94 per year, R(2) = 0.87; p < 0.001). Conclusion: These results suggest a significant decline in mean AAM in Israeli women born in 1970 or later. © 2014 S. Karger AG, Basel.
    Hormone Research in Paediatrics 02/2014; 81(4). DOI:10.1159/000357444 · 1.71 Impact Factor
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    ABSTRACT: The aim of this population-based study is to describe trends in the characteristics and treatment patterns of statin initiators over the first decade of the 21st century. New statin use was studied retrospectively using the database of Maccabi Healthcare Services (MHS), a large Israeli health maintenance organization. Statin initiators were defined as MHS members aged ≥30 years who first purchased statins between 2000 and 2010. The starting dose was calculated in simvastatin equivalents based on the World Health Organization's daily defined dose index. Persistence was calculated as the percentage of days covered (PDC) with statins during the first year of therapy. Statin initiation peaked in 2005 and decreased from 38.6 to 18.6 per 1,000 in the period 2005-2010. The average age at therapy initiation decreased from 58.9 (±12.0) to 54.5 (±11.7) years, and the average (SD) baseline low-density lipoprotein cholesterol (LDL-C) decreased from 4.2 (±1.1) to 4.0 (±0.9) mmol/l during the study period. Women were on average 3 years older than men at treatment initiation, with a higher baseline LDL-C. Among statin initiators, the prevalence of ischemic heart disease (IHD) decreased from 17.8 to 6.7 %, and diabetes prevalence increased from 8.6 to 15.7 %, peaking in 2008 (18.0 %). The PDC with statins ranged between 52.9 and 57.7 %. Simvastatin use at initiation increased from 27.5 % in 2000 to >90 % since 2002. Starting dose increased from 18.5 (±8.9) to 24.3 (±13.7) mg simvastatin equivalent. Among the study population, statin initiators were increasingly characterized by a lower cardiovascular risk-namely, younger individuals without IHD and with a lower baseline LDL-C. These trends underscore the important shift towards statin initiation for primary prevention, as well as the need to balance between benefits and the potential side effect of statins.
    European Journal of Clinical Pharmacology 01/2014; DOI:10.1007/s00228-013-1637-y · 2.70 Impact Factor
  • Epidemiology (Cambridge, Mass.) 01/2014; 25(1):152-3. DOI:10.1097/EDE.0000000000000014 · 6.18 Impact Factor
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    ABSTRACT: To validate the use of drug dispensing data as a measure of drug exposure and to quantify the association between persistence with statin therapy and low-density lipoprotein cholesterol (LDL) levels using real-life community data. Retrospective, population-based cohort study. Maccabi Healthcare Services (MHS) database, which contains linked prescription drug information, hospitalization records, and laboratory test results of 2 million members of the second largest health organization in Israel. A total of 87,219 primary prevention patients and 15,139 secondary prevention patients who were MHS members and who started statin therapy between 1998 and 2008. Baseline and follow-up LDL levels were documented from 3 months before the date of first dispensed statin (index date) to 6 months afterward. Persistence was assessed by proportion of days covered (PDC) with statins during the follow-up period. Over the follow-up period, significant (p<0.001) reductions in LDL levels of 54, 33, and 13 mg/dl were noted among highly persistent (PDC ≥ 80%), moderately persistent (34% ≤ PDC < 79%), and poorly persistent statins users (PDC ≤ 33%), respectively. The reduction was observed as early as 2-3 weeks after therapy initiation. In a multivariable model controlling for baseline LDL level and traditional coronary heart disease risk factors (diabetes mellitus, hypertension), high persistence with statin therapy was associated with a 27% and 25% decrement in LDL level among the primary and secondary prevention cohorts, respectively. Similarly, a higher proportion of the persistent statins users reached their target LDL level within the study follow-up period: 80% and 58% among primary and secondary prevention cohorts, respectively, compared with only 28% and 17%, respectively, among poorly persistent patients. In this observational population-based study, calculated PDC with statins during study follow-up was strongly associated with drug effect of LDL level reduction. The results agree with previous estimates of statin efficacy from randomized clinical trials, supporting the validity of using PDC methods as a measure of drug exposure.
    Pharmacotherapy 01/2014; 34(1). DOI:10.1002/phar.1326 · 2.20 Impact Factor
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    ABSTRACT: Red blood cell distribution width (RDW) has been shown to predict cardiovascular mortality in various populations, but studies were less conclusive regarding cardiovascular morbidity. We aimed at evaluating the prognostic effect of RDW on cardiovascular morbidity and all-cause mortality in the largest community cohort to date.We utilised the computerised database of a large community based healthcare maintenance organization (HMO) in Israel to identify a cohort of 225,006 eligible patients aged 40 or above who performed a blood count during 2006. We evaluated the relationship between 1% increments of RDW values and major cardiovascular events and all-cause mortality over a period of five years. A total of 21,939 incident cases of a major cardiovascular event and 4,287 deaths were documented during a total of six years of follow up, respectively. In comparison with patients with RDW level <13%, the hazard ratio for total mortality gradually increased to 4.57 (95% confidence interval [CI]: 3.35-6.24, p<0.001) among male patients and to 3.26 (95% CI: 2.49-4.28, p<0.001) among female patients with a RDW of 17% or above. Similar results were evident in anaemic and non-anaemic populations. RDW above 17% was also associated with a modest increased risk of major cardiovascular events in females 1.26 (95% CI: 1.03-1.52, p=0.021), while in men it was not significant, 1.08 (95% CI: 0.82-1.41, p=NS). In conclusion, increasing RDW levels significantly increased risk of cardiovascular morbidity and all-cause mortality. Our observation is evident in both anaemic and non-anaemic patients.
    Thrombosis and Haemostasis 10/2013; 111(2). DOI:10.1160/TH13-07-0567 · 5.76 Impact Factor
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    ABSTRACT: Anemia on admission and during hospitalization is associated with poor short and long term prognosis among patients with acute coronary syndrome (ACS). Our objective was to examine the prognostic implications of longitudinal hemoglobin (Hb) levels following a first acute myocardial infarction (AMI). We utilized data obtained from the computerized database of a large community based health care maintenance organization to identify patients who survived for at least 6months following a first AMI, during the years 2003-2010. Hazard ratios were calculated using Cox proportional regression models with various Hb measurements as dependent variables, and net reclassification improvement (NRI) was applied to evaluate the prognostic usefulness of these Hb measurements. Last Hb measurement during a 6-24month follow-up period was found to have the highest prognostic power. In males, Hb levels below 13g/dL were gradually associated with a higher risk of events, reaching a HR of 4.13 at Hb levels <11g/dL. In females, only Hb levels lower than 11g/dL were significantly associated with a higher event rate (HR=2.42, p=0.003). Hb decrease was significantly associated with an increased risk in both genders, even among non-anemic patients at baseline. Anemia and Hb decrement following a first AMI are associated with worse prognosis and elevated risk of combined all cause mortality and recurrent cardiac events.
    International journal of cardiology 10/2013; 169(5). DOI:10.1016/j.ijcard.2013.09.004 · 6.18 Impact Factor
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    ABSTRACT: Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor-patient-computer communication (DPCC). 36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training. Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction. We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills. Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.
    Patient Education and Counseling 08/2013; 93(3). DOI:10.1016/j.pec.2013.08.007 · 2.60 Impact Factor
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    ABSTRACT: To assess the incidence of Herpes Zoster (HZ) and its complications in the Israeli general population and specifically in immune-compromised individuals, and to identify risk factors for developing HZ and post-herpetic neuralgia (PHN). A retrospective database search for newly diagnosed cases of HZ and of PHN during 2006-2010 was conducted using the comprehensive longitudinal database of Maccabi Health Services. Cox proportional hazards models were used to assess associations between risk factors and HZ and PHN. During 2006-2010 there were 28,977 newly diagnosed cases of HZ and 1,508 newly diagnosed cases of PHN. Incidence density rate of HZ was 3.46 per 1,000 person-years in the total population and 12.8 per 1,000 person-years in immune-compromised patients. HZ and PHN incidence increased sharply with age. 12.4% and 3.1% of elderly HZ patients (≥65 years) developed PHN or ophthalmic complications, respectively. In multivariable analyses, HZ and PHN were associated with female sex, higher socio-economic status, diabetes mellitus, cancer history, and HIV treatment. Extrapolating to the entire Israeli population, we estimate over 24,000 new cases of HZ and 1,250 new cases of PHN each year. Cost-effectiveness analysis should be performed to determine the threshold age for vaccination against HZ.
    The Journal of infection 07/2013; DOI:10.1016/j.jinf.2013.06.016 · 4.02 Impact Factor
  • Value in Health 05/2013; 16(3):A176. DOI:10.1016/j.jval.2013.03.882 · 2.89 Impact Factor
  • Value in Health 05/2013; 16(3):A199. DOI:10.1016/j.jval.2013.03.1003 · 2.89 Impact Factor

Publication Stats

1k Citations
407.29 Total Impact Points


  • 2003–2015
    • Tel Aviv University
      • Department of Internal Medicine
      Tell Afif, Tel Aviv, Israel
  • 2011–2013
    • Tel Aviv Sourasky Medical Center
      • Department of Cardiology
      Tell Afif, Tel Aviv, Israel
  • 2010
    • Hadassah Medical Center
      Yerushalayim, Jerusalem District, Israel
  • 2009
    • Meir Medical Center
      Kafr Saba, Central District, Israel