Arnon D. Cohen

Association between psoriasis and the metabolic syndrome. A cross-sectional study.

Background: Previous reports have shown an association between inflammatory diseases such as systemic lupus erythematosus or rheumatoid arthritis and the metabolic syndrome. Recent data demonstrate that psoriasis is an inflammatory disease, suggesting that psoriasis may be one of the components of the metabolic syndrome. Objective: To assess the association between psoriasis and the metabolic syndrome. Methods: A cross-sectional study was performed utilizing the database of the Clalit Health Services. Case patients were defined as patients with a diagnosis of psoriasis vulgaris. Controls were randomly selected from the list of Clalit Health Services enrollees. The proportions of components of the metabolic syndrome (ischemic heart disease, hypertension, diabetes, obesity and dyslipidemia) were compared between case and control patients by univariate analyses. χ2 tests were used to compare categorical parameters between the groups. Logistic and linear regression models served to measure the association between psoriasis and the metabolic syndrome. Results: The study included 16,851 patients with psoriasis and 48,681 controls. In the case group, there were 8,449 men (50.1%) and 8,402 women (49.9%), with a mean age of 42.7 years (SD = 20.3, range = 2–111). Diabetes mellitus was present in 13.8% of the patients with psoriasis as compared to 7.3% of the controls (p < 0.001). Hypertension occurred in 27.5% of the patients with psoriasis and in 14.4% of the controls (p < 0.001). Obesity was present in 8.4% of the patients with psoriasis as opposed to 3.6% of the controls (p < 0.001). Ischemic heart disease was observed in 14.2% of the patients with psoriasis as compared to 7.1% of the controls (p < 0.001). Multivariate models adjusting for age, gender and smoking status of the patients demonstrated that psoriasis was associated with the metabolic syndrome (OR = 1.3, 95% CI = 1.1–1.4), ischemic heart disease (OR = 1.1, 95% CI = 1.0–1.2), diabetes mellitus (OR = 1.2, 95% CI = 1.0–1.3), hypertension (OR = 1.3, 95% CI = 1.2–1.5) and obesity (OR = 1.7, 95% CI = 1.5–1.9). Limitations: The study is designed as a case-control study, thus an association alone was proven and not causality. Conclusion: Our findings demonstrate a possible association between psoriasis and the metabolic syndrome. Appropriate treatment of the metabolic syndrome may be an important part of the management of patients with psoriasis.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence‐based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence‐based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long‐term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.

Antipsychotics and Diabetes: An Age-Related Association

Background Previous studies have reported an association between antipsychotic medications and diabetes. Objective To explore the association between antipsychotic medications and diabetes in patients of different ages. Methods A retrospective analysis of a large health maintenance organizations drug claim database (3.7 million members) was performed. All patients treated with antipsychotic drugs during 1998–2004 were identified. Patients with diabetes were defined by a record of antidiabetic drug uso during 2004. The prevalence of diabetes in different age groups treated with antipsychotics was compared with the prevalence of diabetes among enrollees in the same age groups not treated with antipsychotics. Results: Among 82,754 patients treated with antipsychotics, the association between diabetes and consumption of antipsychotics was strongest in the younger age groups and decreased with increasing age: for patients aged 0–24 years, OR 8.9 (95% CI 7.0 to 11.3); 25–44 years, OR 4.2 (95% CI 3,8 to 4.5); 45–54 years, OR 1.9 (95% CI 1.8 to 2.1); 55–64 years, OR 1.3 (95% CI 1.2 to 1.4); and 65 years or older, OR 0.93 (95% CI 0.9 to 1.0). However, the risk associated with atypical antipsychotics was lower than the risk associated with typical antipsychotics, with ORs ranging from 0.7 in patients 0–24 years old to 0.3 in those 65 years or older. Conclusions: Antipsychotic drug use was associated with diabetes mellitus. This association was stronger in younger patients. In older adults, the difference was much smaller and, in some cases, there was no association. A lowor risk was associated with atypical agents, as compared with typical antipsychotics. Clinicians should bo aware that young adults treated with antipsychotics are at increased risk for diabetes.

Drug Exposure and Psoriasis Vulgaris: Case-Control and Case-Crossover Studies

Intake of drugs is considered a risk factor for psoriasis. The aim of this study was to investigate the association between drugs and psoriasis. A case-control study including 110 patients who were hospitalized for extensive psoriasis was performed. A control group (n = 515) was defined as patients who had undergone elective surgery. A case-crossover study included 98 patients with psoriasis. Exposure to drugs was assessed during a hazard period (3 months before hospitalization) and compared to a control period in the patients past. Data on drug sales were extracted by data mining techniques. Multivariate analyses were performed by logistic regression and conditional logistic regression. In the case-control study, psoriasis was associated with benzodiazepines (OR 6.9), organic nitrates (OR 5.0), angiotensin-converting enzyme (ACE) inhibitors (OR 4.0) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR 3.7). In the case-crossover study, psoriasis was associated with ACE inhibitors (OR 9.9), beta-blockers (OR 9.9), dipyrone (OR 4.9) and NSAIDs (OR 2.1). Extensive psoriasis may be associated with intake of ACE inhibitors, NSAIDs or beta-blockers.

Psoriasis Associated with Hepatitis C but Not with Hepatitis B

Purpose: To investigate the association between psoriasis and viral hepatitis. Methods: Psoriasis patients were compared to controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate models. The study was performed utilizing the medical database of Clalit Health Services. Results: The study included 12,502 psoriasis patients >20 years old and 24,287 age- and sex-matched controls. The prevalence of hepatitis C in patients with psoriasis was increased compared to the prevalence in controls (1.03 vs. 0.56%; p < 0.001). In a multivariate analysis, psoriasis was associated with hepatitis C. An interaction with smoking was noted (smokers: odds ratio, OR = 1.93, 95% confidence interval, CI = 1.30–2.67; nonsmokers: OR = 2.22, 95% CI = 1.63–3.04). The prevalence of hepatitis B in patients with psoriasis was higher than in the controls (0.74 vs. 0.56%; p = 0.043). However, in a multivariate analysis psoriasis was not associated with hepatitis B (OR = 1.22, 95% CI = 0.93–1.60, p = 0.15). Conclusion: Our observation supports previous reports of an association between psoriasis and hepatitis C but not with hepatitis B. Physicians who care for patients with psoriasis should be aware of this possible association and consider screening patients with psoriasis for hepatitis C.

The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments

PURPOSEnIn 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEKs use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals.nnnMETHODSnExamining the frequency of OFEKs use with its own track-log data; comparing, before and after, quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients).nnnRESULTSnOFEKs use increased by tens of percentages each year, Internal Medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests performed compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in General Surgery wards.nnnCONCLUSIONSnThe study helps evaluate the extent to which OFEKs targets were achieved and contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems.

Nonattendance in Obstetrics and Gynecology Patients

Background: Nonattendance for obstetrics and gynecology (OB/GYN) appointments disrupts medical care and leads to misuse of valuable resources. We investigated factors associated with nonattendance in an outpatient OB/GYN clinic. Methods: Nonattendance was examined for a period of 1 year in first-time visitors of an ambulatory OB/GYN clinic. The effects of age, population sector, the treating physician, waiting time, and timing of the appointment on the proportions of nonattendance were assessed. χ2 tests and logistic regression were used for simple and multiple regression models. Results: A total of 8,883 visits were included (median age 36 years). The proportion of nonattendance was 30.1%: 19.9% among rural Jewish, 30.5% in urban Jewish, and 36% in Bedouins (p < 0.001). Nonattendance increased from 26.6% among those waiting up to 1 week to 32.3% among those who waited more than 15 days (p < 0.001) and decreased with age (p < 0.001). A multiple logistic regression model demonstrated that age, population sector and waiting time for an appointment were significantly associated with nonattendance. Conclusion: Nonattendance in OB/GYN patients is independently associated with age, population sector and waiting time for an appointment. It is suggested that various solutions should be carefully introduced assessed regarding routine patient scheduling in OB/GYN clinics.

Nonattendance in a dermatology clinic – a large sample analysis

Backgroundu2003 Previous studies have described factors determining non‐attendance at dermatology appointments in small sample sizes.

Community healthcare in Israel: quality indicators 2007-2009

BackgroundThe National Program for Quality Indicators in Community Healthcare in Israel (QICH) was developed to provide policy makers and consumers with information on the quality of community healthcare in Israel. In what follows we present the most recent results of the QICH indicator set for 2009 and an examination of changes that have occurred since 2007.MethodsData for 28 quality indicators were collected from all four health plans in Israel for the years 2007-2009. The QICH indicator set examined six areas of healthcare: asthma, cancer screening, cardiovascular health, child health, diabetes and immunizations for older adults.ResultsDramatic increases in the documentation of anthropometric measures were observed over the measurement period. Documentation of BMI for adolescents and adults increased by 30 percentage points, reaching rates of 61% and 70%, respectively, in 2009. Modest increases (3%-7%) over time were observed for other primary prevention quality measures including immunizations for older adults, cancer screening, anemia screening for young children, and documentation of cardiovascular risks. Overall, rates of recommended care for chronic diseases (asthma, cardiovascular disease and diabetes) increased over time. Changes in rates of quality care for diabetes were varied over the measurement period.ConclusionsThe overall quality of community healthcare in Israel has improved over the past three years. Future research should focus on the adherence to quality indicators in population subgroups and compare the QICH data with those in other countries. In addition, one of the next steps in assessing and further improving healthcare quality in Israel is to relate these process and performance indicators to health outcomes.

Cherry angiomas associated with exposure to bromides.

Cherry angiomas are the most common vascular proliferation; however, little is known about the pathogenesis and etiology of these lesions. We present two laboratory technicians who were exposed to brominated compounds for prolonged periods and who developed multiple cherry angiomas on the trunk and extremities. We suggest that the association between exposure to bromides and cherry angiomas should be investigated by a controlled study.