Joelle Singer

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (29)58.19 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This study assessed the safety and efficacy of a new beverage on suppressing hunger and improving feelings of satiety in healthy volunteers. In the safety study, participants (n = 269) received either i) a control beverage (group C, comprising coffee alone); ii) the study beverage (group S, comprising coffee, whey protein, inulin and dextrin); or iii) an inulin-enriched beverage (I group, comprising coffee, whey protein and inulin). The study was held over a 7-day period during which participants were required to consume 2 cups of coffee a day. There were no significant differences between the groups in any reported adverse effects apart from more abdominal pain after the first cup in group I versus S (p <0.05) and after the second cup in group I compared with either groups S or C (p=0.0008). Regarding the separate efficacy study (n = 36), no significant differences were found between the 3 groups regarding hunger or satiety levels at the first meeting 1 week after commencement of the study. At the second meeting 1 week later, group S showed a significant decrease in feelings of hunger over the 200 minute study period compared to group I and group C (p<0.0001) and a significant increase in the feeling of satiety when compared to group C (p<0.0001). While leptin, ghrelin and glucagon-like peptide-1 levels assessed 2 hours after ingestion were not significantly different between the groups, leptin levels were significantly lower 2 hours after ingestion when compared to the values obtained after one night of semi-starvation. This study showed that a coffee beverage enriched with inulin, dextrin and whey is safe and has possible benefits regarding feelings of hunger and satiety two hours after ingestion.
    No preview · Article · Jan 2016
  • Pierre Singer · Joelle Singer
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    ABSTRACT: Critically ill patients often require nutrition support, but accurately determining energy needs in these patients is difficult. Energy expenditure is affected by patient characteristics such as weight, height, age, and sex but is also influenced by factors such as body temperature, nutrition support, sepsis, sedation, and therapies. Using predictive equations to estimate energy needs is known to be inaccurate. Therefore, indirect calorimetry measurement is considered the gold standard to evaluate energy needs in clinical practice. This review defines the indications, limitations, and pitfalls of this technique and gives practice suggestions in various clinical situations.
    No preview · Article · Dec 2015 · Nutrition in Clinical Practice
  • M. Theilla · I. Kagan · S. Lev · J. Singer · P. Singer

    No preview · Article · Sep 2014
  • J. Singer · M. Grinev · V. Silva · P. Singer

    No preview · Article · Sep 2014
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    ABSTRACT: Objectives: To understand the impact of nocturnal and daytime non-severe hypoglycemic events on healthcare systems, work productivity and quality of life in people with type 1 or type 2 diabetes. Methods: People with diabetes who experienced a non-severe hypoglycemic event in the 4 weeks prior to the survey were eligible to participate in a nocturnal and/or daytime hypoglycemia survey. Surveys were conducted in Argentina, Australia, Brazil, Israel, Mexico and South Africa. Results: In total, 300 respondents were included in nocturnal/daytime hypoglycemia surveys (50/participating country/survey). All respondents with type 1 diabetes and 68%/62% (nocturnal/daytime) with type 2 diabetes were on insulin treatment. After an event, 25%/30% (nocturnal/daytime) of respondents decreased their insulin dose and 39%/36% (nocturnal/daytime) contacted a healthcare professional. In the week after an event, respondents performed an average of 5.6/6.4 (nocturnal/daytime) additional blood glucose tests. Almost half of the respondents (44%) reported that the event had a high impact on the quality of their sleep. Among nocturnal survey respondents working for pay, 29% went to work late, 16% left work early and 12% reported missing one or more full work days due to the surveyed event. In addition, 50%/39% (nocturnal/daytime) indicated that the event had a high impact on their fear of future hypoglycemia. Conclusions: The findings suggest that nocturnal and daytime non-severe hypoglycemic events have a large financial and psychosocial impact. Diabetes management that minimizes hypoglycemia while maintaining good glycemic control may positively impact upon the psychological wellbeing of people with diabetes, as well as reducing healthcare costs and increasing work productivity.
    Full-text · Article · Jul 2014 · Journal of Medical Economics
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    ABSTRACT: Background: It has been previously shown that platelets of patients with diabetes are more reactive and less responsive to anti-platelet drugs compared with platelets from subjects without diabetes. Studies examining the effect of glycemic control on platelet reactivity have yielded conflicting data. Thus, in this study, we sought to explore the effect of tight glycemic control on platelet reactivity in patients with long standing uncontrolled diabetes. Methods: The study included 30 patients with long-standing treated diabetes and a baseline HbA1c level of ≥ 8.5%. All patients were treated with aspirin and statins. Patients were tested at baseline and after 3 months of intensive glycemic and metabolic control. The treatment goal was to achieve a HbA1c level of ≤ 7%. Platelet reactivity was assessed by light transmission aggregation in response to 5 and 10 μM ADP and to 0.5mg/ml arachidonic acid (AA). Additonally, platelet activation was assessed by plasma levels of soluble P-selectin using an enzyme-linked immunosorbent assay. Results: The mean duration of diabetes from the time of diagnosis was 20.46 ± 9.31 years. Baseline HbA1c was 9.4 ± 0.8%. Following the intensive glycemic control period, the HbA1C level decreased to 8.1 ± 0.8% (P < 0.0001). Other laboratory parameters did not change significantly except for triglyceride levels, which decreased. None of the platelet aggregation studies nor P-selectin levels differed between baseline and after 3 months of intensive glycemic control. Conclusions: Intensive glycemic control in patients with longstanding uncontrolled diabetes does not seem to result in a reduction in platelet reactivity.
    No preview · Article · May 2014 · Thrombosis Research
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    ABSTRACT: Introduction: Altered levels of adipokines, which may be influenced by energy availability, have been demonstrated in critically ill patients. These patients frequently undergo fasting and underfeeding. This study investigated the effect of continuous nutritional support on adipokine levels in critically ill patients. Materials and Methods: Patients admitted to the intensive care unit were randomized to receive nutritional support with an energy target determined either by (i) repeated indirect calorimetry measurements (study group), or (ii) a weight-based formula (25 Kcal/kg/day; control group). Adipokine levels (serum leptin, resistin, ghrelin, and adiponectin) were measured on days 1 and 7. Both cumulative energy balance (energy balance at discharge from intensive care unit or after 7 days) and maximal negative energy balance (most negative energy balance observed during the study) were assessed. Results: The daily energy balance (p=0.001), cumulative energy balance (p=0.01), and maximal negative energy balance (p=0.01) were significantly positive for the study group and negative for the control group. There were no significant between-group differences in adipokine levels on day 1 or day 7. In the control group, serum ghrelin increased significantly over time (p<0.05) and a trend for an increase in resistin (p<0.065) was noted. For the whole group, a more positive cumulative energy balance and a lower maximal negative energy balance were associated with a significantly smaller increase in serum ghrelin levels (p=0.008 and p=0.035, respectively) and a smaller increase in resistin levels (p=0.061 and p=0.027, respectively). Conclusions: A positive cumulative energy balance in critically ill patients appears to influence the levels of ghrelin and, to a lesser extent, resistin. The clinical significance of this finding requires further investigation.
    Full-text · Article · Apr 2014 · Nutritional Therapy and Metabolism
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    ABSTRACT: Background It has been previously shown that platelets of patients with diabetes are more reactive and less responsive to anti-platelet drugs compared with platelets from subjects without diabetes. Studies examining the effect of glycemic control on platelet reactivity have yielded conflicting data. Thus, in this study, we sought to explore the effect of tight glycemic control on platelet reactivity in patients with long standing uncontrolled diabetes. Methods The study included 30 patients with long-standing treated diabetes and a baseline HbA1c level of ≥ 8.5%. All patients were treated with aspirin and statins. Patients were tested at baseline and after 3 months of intensive glycemic and metabolic control. The treatment goal was to achieve a HbA1c level of ≤ 7%. Platelet reactivity was assessed by light transmission aggregation in response to 5 and 10 μM ADP and to 0.5 mg/ml arachidonic acid (AA). Additonally, platelet activation was assessed by plasma levels of soluble P-selectin using an enzyme-linked immunosorbent assay. Results The mean duration of diabetes from the time of diagnosis was 20.46±9.31years. Baseline HbA1c was 9.4±0.8%. Following the intensive glycemic control period, the HbA1C level decreased to 8.1±0.8% (P<0.0001). Other laboratory parameters did not change significantly except for triglyceride levels, which decreased. None of the platelet aggregation studies nor P-selectin levels differed between baseline and after 3 months of intensive glycemic control. Conclusions Intensive glycemic control in patients with longstanding uncontrolled diabetes does not seem to result in a reduction in platelet reactivity.
    No preview · Article · Jan 2014 · Thrombosis Research
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    ABSTRACT: The aim of this preliminary study was to compare the effectiveness of domperidone and acupuncture for the management of diabetic gastroparesis. This was a preliminary, prospective non-randomised, unblinded case-crossover study conducted in patients with longstanding, uncontrolled diabetes mellitus and gastroparesis. All patients received domperidone (20 mg four times a day) for 12 weeks, followed by a 2-3 week washout period, and then biweekly acupuncture treatments for 8 weeks. Gastric emptying rate, glucose and glycated haemoglobin (HbA1C) levels were measured at start and end of each treatment period. At each of these timepoints patients completed the Gastroparesis Cardinal Symptom Index (GCSI), the Satisfaction with Life Scale (SWLS), and the Short-Form 36 Health Survey Update (SF-36). The trial was curtailed after only eight participants could be recruited in 3 years. The mean age of patients was 57.1±9.9 years, the male:female ratio was 1:7 and mean body mass index (kg/m(2)) was 25.2±1.2. There was no change in any of the outcome parameters after treatment with domperidone. Acupuncture was associated with a decrease in scores for almost all cardinal symptoms of the GCSI, as well as in increased total score on the SWLS (p=0.002) and the social functioning domain of the SF-36 (p=0.054). Acupuncture did not lead to an improvement in gastric emptying, or glucose control from baseline. Acupuncture treatment may lead to symptomatic improvement in patients with diabetic gastroparesis. Within the limitations of this preliminary, non-randomised and unblinded study, it appears that this effect may be due to non-specific mechanisms.
    No preview · Article · Dec 2013 · Acupuncture in Medicine

  • No preview · Article · Sep 2012 · Clinical Nutrition Supplements
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    ABSTRACT: Objective: To test the effects of implementing computer-assisted Monitoring of Individual Needs in Diabetes (MIND) in routine diabetes care on psychological status and glycemic control, identify predictors of poor psychological outcomes, and evaluate care providers' experiences. Research design and methods: The MIND procedure was implemented as part of the annual review in diabetes clinics across eight countries in a prospective observational study with a 1-year follow-up. MIND encompasses well-being (World Health Organization Five Well-Being Index [WHO-5]), diabetes-related distress (Problem Areas in Diabetes [PAID]), a Life Event Inventory, and the patient's agenda for their consultation. Medical data and agreed case-management actions were retrieved from the charts. Results: Of the total 1,567 patients, 891 patients (57%) were monitored at a 1-year follow-up. Twenty-eight percent of the patients screened positive for depression and/or diabetes distress at baseline and considered cases, 17% of whom were receiving psychological care. Cases were significantly more often female and had type 2 diabetes and worse glycemic control compared with noncases. Clinically relevant improvements in WHO-5 and PAID were observed over time in cases, irrespective of referral (effects sizes 0.59 and 0.48, respectively; P < 0.0001). Glycemic control did not change. Female sex, life events, and concomitant chronic diseases were predictors of poor psychological outcomes. MIND was well received by patients and staff. Conclusions: MIND appears suitable for screening and discussion of emotional distress as part of the annual review. Broader dissemination in diabetes care is recommendable, but sustainability will depend on reimbursement and availability of support services.
    Full-text · Article · Jul 2012 · Diabetes care
  • P. Singer · J. Singer
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    ABSTRACT: La calorimétrie indirecte est la méthode de référence pour mesurer la dépense énergétique au repos. En réanimation, le calcul des besoins caloriques est réalisé à l’aide des formules plutôt qu’avec la calorimétrie indirecte. Les formules sont peu précises, mais d’un autre côté, la calorimétrie indirecte présente des limitations techniques et financières. Mal évaluer la demande énergétique d’un patient et ne pas lui administrer la compensation calorique requise peut aboutir à des conséquences délétères. Un déficit énergétique augmente la morbidité, le risque d’infection, la dénutrition et le délai de cicatrisation. Un excès calorique prolonge la ventilation mécanique, augmente les risques d’infection, surtout si la nutrition parentérale est utilisée. C’est pourquoi il est recommandé de réaliser la calorimétrie indirecte quand l’état clinique du patient le permet.
    No preview · Article · Jul 2012 · Réanimation
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    ABSTRACT: Thyroglobulin is an excellent biological marker of persistent or recurrent thyroid cancer during long-term follow-up. Most studies investigated its diagnostic value but not its prognostic value over time. We aim to study the prognostic value of thyroglobulin levels early after total thyroidectomy, before iodine ablation. The study was based on the Rabin Medical Center registry of patients with non-medullary thyroid carcinoma. Data were collected on the clinical, laboratory, and outcome characteristics of 420 consecutive patients followed at our institution for whom early post-operative pre-ablation thyroglobulin values (baseline thyroglobulin) were available. Patients were classified into 4 groups by baseline thyroglobulin level: 0-2, 2-10, 10-100, and >100 ng/ml. Higher levels were associated with a shift toward male gender (p=0.01), larger tumor size (p=0.02), and a more extensive disease (p<0.0001). They were also related to disease persistence and evidence of disease at last follow-up (p<0.0001). The 10 ng/ml cut-off level identified patients with persistent disease with a sensitivity and specificity of 73%, positive predictive value of 43%, and negative predictive value of 89%. On multivariate analysis, the following variables were predictive of persistent disease: baseline thyroglobulin level, male gender, lymph-node involvement, distant metastases, higher tumor invasiveness, and larger tumor size. However, the predictive power of baseline thyroglobulin level was relatively weak (odds ratio 1.002, 95% confidence interval 1.00-1.04). In patients with well-differentiated thyroid cancer, a post-thyroidectomy thyroglobulin level <10 ng/ml is associated with a low probability of having persistent disease and can be used combined with other disease characteristics for decisions regarding treatment and follow-up.
    No preview · Article · May 2011 · Journal of endocrinological investigation
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    ABSTRACT: To test the feasibility and impact of implementing the computer-assisted Monitoring of Individual Needs in Diabetes (MIND) procedure, which is aimed at improving recognition and management of the psychological needs of diabetic patients in routine care. The MIND study was implemented in diabetes clinics across eight countries as part of the annual review. The computerized assessment covered emotional well-being (World Health Organization 5 Well-Being Index), diabetes-related distress (Problem Areas in Diabetes), life events, and the patient's agenda. Medical data were retrieved from the charts, and agreed-upon actions were recorded. Of 1,567 patients monitored using the MIND, 24.9% had either likely depression or high diabetes-related distress; 5.4% had both. Over 80% of these patients were newly identified cases, and 41% of patients with depression were referred to a mental health professional. Monitoring of well-being and diabetes-related distress as part of routine diabetes care is feasible and helps to identify and discuss unmet psychosocial needs.
    Full-text · Article · Feb 2011 · Diabetes care
  • L. Lupinski · J. Singer · R. Hirsh · M. Grunev · S. Lev · P. Singer

    No preview · Article · Dec 2010 · Clinical Nutrition Supplements
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    ABSTRACT: Papillary thyroid cancer (PTC) commonly affects women of child-bearing age. During normal pregnancy, several factors may have a stimulatory effect on normal and nodular thyroid growth. The aim of the study was to determine whether pregnancy in thyroid-cancer survivors poses a risk of progression or recurrence of the disease. The files of 63 consecutive women who were followed at the Endocrine Institute for PTC in 1992-2009 and had given birth at least once after receiving treatment were reviewed for clinical, biochemical, and imaging data. Thyroglobulin levels and neck ultrasound findings were compared before and after pregnancy. Demographic and disease-related characteristics and levels of thyroid-stimulating hormone (TSH) during pregnancy were correlated with disease persistence before conception and disease progression during pregnancy using Pearson's analysis. Mean time to the first delivery after completion of thyroid-cancer treatment was 5.08 ± 4.39 years; mean duration of follow up after the first delivery was 4.84 ± 3.80 years. Twenty-three women had more than one pregnancy, for a total of 90 births. Six women had evidence of thyroid cancer progression during the first pregnancy; one of them also showed disease progression during a second pregnancy. Another two patients had evidence of disease progression only during their second pregnancy. Mean TSH level during pregnancy was 2.65 ± 4.14 mIU/L. There was no correlation of disease progression during pregnancy with pathological staging, interval from diagnosis to pregnancy, TSH level during pregnancy, or thyroglobulin level before conception. There was a positive correlation of cancer progression with persistence of thyroid cancer before pregnancy and before total I-131 dose was administered. Pregnancy does not cause thyroid cancer recurrence in PTC survivors who have no structural or biochemical evidence of disease persistence at the time of conception. However, in the presence of such evidence, disease progression may occur during pregnancy, yet not necessarily as a consequence of pregnancy. The finding that a nonsuppressed TSH level during pregnancy does not stimulate disease progression suggests that it may be an acceptable therapeutic goal in this setting.
    Full-text · Article · Oct 2010 · Thyroid: official journal of the American Thyroid Association
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    ABSTRACT: Familial nonmedullary thyroid cancer (FNMTC) is a disease defined by clustering of thyroid cancers of follicular cell origin, and it is estimated to account for 5% of all thyroid cancers. Several studies found FNMTC to be more aggressive than sporadic disease, whereas others found them to have a similar course and outcome. The purpose of this study was to determine whether FNMTC is more aggressive than sporadic thyroid cancer. A retrospective controlled study of FNMTC versus sporadic nonmedullary thyroid cancers was conducted using a registry of patients with thyroid cancer. Data on disease severity at presentation, treatment modalities, and outcome were collected. Sixty-seven patients with FNMTC and 375 controls with sporadic disease were included. Follow-up period was 8.6 ± 10 years for patients with FNMTC and 8.4 ± 9.1 years for sporadic cases. Patients with FNMTC had comparable disease severity at diagnosis as sporadic patients, underwent similar surgical and radioiodine treatments, and had similar long-term disease-free survival. Long-term outcome in families with three or more affected relatives was similar to families with only two affected relatives. Our results suggest that FNMTC is not more aggressive than sporadic thyroid cancer within our studied population. After a similar therapeutic strategy, FNMTC and sporadic cases had comparable prognosis, including in families with three or more affected members.
    No preview · Article · Oct 2010 · Thyroid: official journal of the American Thyroid Association
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    ABSTRACT: Acute lung injury (ALI) and the more severe acute respiratory distress syndrome (ARDS) are forms of pulmonary edema that result from robust local and systemic inflammatory states, such as sepsis. The morbidity and mortality associated with ALI and ARDS are significant and the treatment of these conditions presents a formidable challenge. Controlling hyperglycemia with insulin is a core component of patient management in the critically ill. Insulin treatment also exerts beneficial metabolic effects beyond glucose control, as well as non-metabolic effects, in insulin-resistant states. For instance, insulin inhibits NF-kappaB--dependent synthesis of pro-inflammatory factors and attenuates production of ROS. Indeed, intravenous administration of insulin ameliorates pulmonary injury and dysfunction in the LPS model of ALI. Most recently, an inhalable insulin formulation was shown to effectively reduce glucose concentrations with minimal impact on long-term pulmonary function. We propose that administering inhalable insulin to hyperglycemic ALI/ARDS patients could directly reduce alveolar inflammation while reducing circulating glucose levels.
    No preview · Article · Feb 2010 · Inflammation

  • No preview · Article · Dec 2009 · Clinical Nutrition Supplements
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    ABSTRACT: Patients with differentiated thyroid cancer (DTC) usually have a good prognosis but may experience a decline in quality of life (QOL). The way patients perceive their illness may have a major impact on their QOL. Our hypothesis was that patients with DTC frequently perceive their illness as much more severe than its objective clinical characteristics indicate. The aim of the study was to investigate how patients with DTC perceive their illness and to correlate these findings to various demographic parameters as well as objective indices of disease severity. The self-administered Illness Perception Questionnaire-Revised (IPQ-R) was completed by consecutive patients with DTC during routine follow-up at the endocrine clinic. The questionnaire consists of three parts that measure different aspects of illness perception. The patients' medical records were reviewed for data on demographic parameters (sex, age) and indices of disease severity (duration of DTC, disease stage at diagnosis, number of operations, number of radioactive iodine treatments, and evidence of disease persistence/recurrence). The patients were also asked for additional data on family status, level of education, and employment status. Pearson and Spearman correlations and analysis of variance were used for statistical analysis. The study group included 110 patients (91 women) of mean age 53.5 years. Level of education was the only demographic factor found to affect the patients' perception of their illness. There was no correlation of patient illness perception and cancer stage. Among the disease-severity parameters, time since last treatment, evidence of disease persistence, and number of iodine treatments were significantly associated with a negative disease perception. Number of iodine treatments was the most broadly affecting factor. There was a high correlation of scores among the various illness perception subscales. Patients with DTC perceive their illness on a subjective, emotional basis unrelated to its actual severity. To improve patients' illness representations and, consequently, their QOL, a trained psychologist should be included in the multidisciplinary team that manages patients with DTC. Attention should be particularly directed to less-educated patients and patients who require repeated iodine treatments.
    No preview · Article · Jun 2009 · Thyroid: official journal of the American Thyroid Association

Publication Stats

302 Citations
58.19 Total Impact Points

Institutions

  • 2007-2016
    • Tel Aviv University
      • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2009-2014
    • Rabin Medical Center
      Tell Afif, Tel Aviv, Israel
  • 2008
    • Institute of Endocrinology
      Praha, Praha, Czech Republic