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Dive into the research topics where Nili Stein is active.

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Featured researches published by Nili Stein.


Blood | 2017

Factor XI deficiency is associated with decreased risk for cardiovascular and venous thromboembolism events

Meir Preis; Julianna Hirsch; Antonio Kotler; Ahmad Zoabi; Nili Stein; Gad Rennert; Walid Saliba

Factor XI deficiency is one of the rare inherited coagulation factor deficiencies. However, its incidence is high within the Ashkenazi Jewish community. Because factor XI displays both procoagulant and antifibrinolytic activities, it has been postulated that an underlying cardiovascular benefit may exist with factor XI deficiency. This historical cohort study was performed using the electronic database of Clalit Health Services, the largest health care provider in Israel. All adults tested for factor XI activity between 2002 and 2014 were included in the study. Factor XI activity was classified into 3 categories: normal (activity >50%), mild deficiency (activity = 30%-50%), and moderate-severe deficiency (activity ≤30%). The cohort was followed until 31 December 2015 for incidence of cardiovascular events (composite of myocardial infarction, stroke, and transient ischemic attack) and venous thromboembolism (VTE). Of the 10 193 included patients, 8958 (88.9%) had normal factor XI activity, 690 (6.8%) had mild deficiency, and 542 (5.3%) had moderate-severe deficiency. Compared with individuals with normal activity, the adjusted hazard ratio (HR) for cardiovascular events was 0.52 (95% confidence interval [CI], 0.31-0.87) in those with mild deficiency, and 0.57 (95% CI, 0.35-0.93) in those with moderate-severe factor XI deficiency. The incidence of VTE was lower in those with factor XI deficiency (activity <50%) compared with those with normal activity; adjusted HR = 0.26 (95% CI, 0.08-0.84). In summary, factor XI deficiency is associated with decreased incidence of cardiovascular events and VTE.


European Journal of Internal Medicine | 2012

The longitudinal variability of serum 25(OH)D levels

Walid Saliba; Ofra Barnett; Nili Stein; Anne Kershenbaum; Gad Rennert

BACKGROUND The extent to which a single serum 25(OH)D measurement represents long-term vitamin D status remains unclear. This study aims to assess the variability of serum 25(OH)D between tests taken at different time intervals. METHODS Using the computerized database of the largest healthcare provider in Israel, we identified subjects in whom a serum 25(OH)D test was performed on at least two different occasions between January 2008 and September 2011 (n = 188,771). For these subjects we selected the first and the last dated tests, then we identified those who were not treated with supplements during the last 6 months before the first and before the last test (n = 94,418). Of these we analyzed subjects in whom the first and the last tests were performed in the same month of the year (n = 8881). RESULTS The mean serum 25(OH)D level at the first test was 51.7 ± 24.0 nmol/L and was 56.7 ± 24.7 at the last test (P<0.001); the overall correlation was 0.63 (P < 0.001). For vitamin D status in two categories (<50 versus ≥ 50 nmol/L), the percentage of agreement between the first and last tests was 74.4%, and was 50.8% for vitamin D status in four categories (<30, 30-49.9, 50-74.9, and ≥ 75 nmol/L). The correlation decreased with increasing time between the tests ranging from 0.83 for tests done at the same year to 0.55 after 3 years. The more the first levels were higher or lower, the more likely subjects remain in their first category (≥ 50 versus <50 nmol/L). CONCLUSIONS Long-term month specific serum 25(OH)D levels are relatively stable.


Chronobiology International | 2011

Unraveling Seasonality in Population Averages: An Examination of Seasonal Variation in Glucose Levels in Diabetes Patients Using a Large Population-based Data Set

Anne Kershenbaum; Arik Kershenbaum; Jalal Tarabeia; Nili Stein; Idit Lavi; Gad Rennert

It has been shown that the population average blood glucose level of diabetes patients shows seasonal variation, with higher levels in the winter than summer. However, seasonality in the population averages could be due to a tendency in the individual to seasonal variation, or alternatively due to occasional high winter readings (spiking), with different individuals showing this increase in different winters. A method was developed to rule out spiking as the dominant pattern underlying the seasonal variation in the population averages. Three years of data from three community-serving laboratories in Israel were retrieved. Diabetes patients (N = 3243) with a blood glucose result every winter and summer over the study period were selected. For each individual, the following were calculated: seasonal average glucose for all winters and summers over the period of study (2006–2009), winter-summer difference for each adjacent winter-summer pair, and average of these five differences, an index of the degree of spikiness in the pattern of the six seasonal levels, and number of times out of five that each winter-summer difference was positive. Seasonal population averages were examined. The distribution of the individuals differences between adjacent seasons (winter minus summer) was examined and compared between subgroups. Seasonal population averages were reexamined in groups divided according to the index of the degree of spikiness in the individuals glucose pattern over the series of seasons. Seasonal population averages showed higher winter than summer levels. The overall median winter-summer difference on the individual level was 8 mg/dL (0.4 mmol/L). In 16.9% (95% confidence interval [CI]: 15.6–18.2%) of the population, all five winter-summer differences were positive versus 3.6% (95% CI: 3.0–4.2%) where all five winter-summer differences were negative. Seasonal variation in the population averages was not attenuated in the group having the lowest spikiness index; comparison of the distributions of the winter-summer differences in the high-, medium-, and low-spikiness groups showed no significant difference (p = .213). Therefore, seasonality in the population average blood glucose in diabetes patients is not just the result of occasional high measurements in different individuals in different winters, but presumably reflects a general periodic tendency in individuals for winter glucose levels to be higher than summer levels. (Author correspondence: [email protected])


American Journal of Public Health | 2016

Harnessing the Question–Behavior Effect to Enhance Colorectal Cancer Screening in an mHealth Experiment

Lea Hagoel; Efrat Neter; Nili Stein; Gad Rennert

OBJECTIVES To assess whether asking questions about a future behavior changes this behavior (i.e., the question-behavior effect) when applied to a population-level intervention to enhance colorectal cancer screening. METHODS In 2013, text-message reminders were sent to a national sample of 50 000 Israeli women and men aged 50 to 74 years following a fecal occult blood test invitation. Participants were randomized into 4 intervention groups (2 interrogative reminders, with or without reference to social context; 2 noninterrogative reminders, with or without social context) and a no-intervention control group. The outcome was fecal occult blood test uptake (n = 48 091, following attrition). RESULTS Performance of fecal occult blood test was higher in the interrogative-reminder groups than in the other 3 groups (odds ratio = 1.11; 95% confidence interval = 1.05, 1.19); the effect size was small, varying in the different group comparisons from 0.03 to 0.06. CONCLUSIONS The question-behavior effect appears to be modestly effective in colorectal cancer screening, but the absolute number of potential screenees may translate into a clinically significant health promotion change.


Clinical Transplantation | 2012

The impact of fluoroquinolone resistance of Gram-negative bacteria in respiratory secretions on the outcome of lung transplant (non-cystic fibrosis) recipients

Michal Shteinberg; Yael Raviv; Jihad Bishara; Nili Stein; Dror Rosengarten; Ilana Bakal; Mordechai R. Kramer

Bacterial airway colonization is frequent among lung transplant recipients. These patients are often treated with antibiotics, which may lead to selection of resistant bacteria. The purpose of this study was to assess whether antibiotic treatment causes acquisition of quinolone‐resistant Gram‐negative bacteria (QR‐GNB), and the effect of such colonization on mortality and on lung rejection. We retrospectively examined data from non‐cystic fibrosis, non‐bronchiectases lung transplant recipients for antibiotic treatment, GNB in respiratory secretions, bronchiolitis obliterans syndrome (BOS), and mortality. Of 126 patients included, 86 patients had QR‐GNB, 22 had quinolone‐sensitive bacteria (QS‐GNB), and 17 had no growth. Median antibiotic exposure, defined as the fraction of days with antibiotic treatment, was 2.8% in patients without growth, 11.1% in patients with QS‐GNB (p = 0.012), and 26% in patients with QR‐GNB (p < 0.0001). Age‐adjusted mortality hazard ratio was 9.2 (95% CI 1.272–78.9) for patients with QR‐GNB compared with QS‐GNB. Age‐adjusted hazard ratios for BOS was 3.7 (95% CI 1.33–10.3) for QR‐GNB compared with QS‐GNB. We found a positive correlation between antibiotic treatment and emergence of QR‐GNB. Airway colonization with QR‐GNB was significantly associated with mortality and with BOS. Further research is needed to determine whether a change in antibiotic subscription policy is required.


ERJ Open Research | 2017

Lung function and disease severity in cystic fibrosis patients heterozygous for p.Arg117His

Michal Shteinberg; D.G. Downey; Diane Beattie; J. McCaughan; A. Reid; Nili Stein; J. Stuart Elborn

Expression of p.Arg117His cystic fibrosis (CF) transmembrane conductance regulator is influenced by a polythymidine (poly-T) tract and a thymidine–guanine (TG) repeat on intron 9, which vary in length and affect exon 10 skipping. We compared clinical characteristics and the rate of progression of lung disease of CF patients carrying the p.Arg117His mutation with different intron 9 varying sequences (poly-T) and mutation classes in trans. Data were collected from patients in Northern Ireland, UK, including diagnostic features, sweat chloride, nutritional status, sputum microbiology, CF-related complications and lung function. Poly-T and TG repeats were determined by PCR. Forced expiratory volume in 1 s (FEV1) decline was determined from linear regression of FEV1 measurements of patients over time. We identified 62 patients with p.Arg117His, 55 with a class I/II mutation in trans and six with p.Arg117His/p.Gly551Asp. 42 patients had 5T and 13 had 7T. All patients had 12 TG repeats. Patients with p.Arg117His-5T had greater lung function decline, sweat chloride concentrations, pancreatic insufficiency and prevalence of Pseudomonas aeruginosa infection compared with patients with p.Arg117His-7T. Lung function decline and disease severity in p.Arg117His is determined by the poly-T tract length and identity of the mutation in trans. Patients with p.Arg117His-5T and a second class I/II mutation have a severity similar to p.Phe508del homozygous patients, although lung function decline is delayed to an older age. There may be linkage disequilibrium between p.Arg117His and 12 TG repeats. p.Arg117His CFTR with 5T repeats is associated with accelerated lung function decline compared with p.Arg117His-7T http://ow.ly/yAdS308q3dn


European Journal of Cancer Prevention | 2016

Self-rated health is prospectively associated with uptake of screening for the early detection of colorectal cancer, not vice versa.

Efrat Neter; Nili Stein; Gad Rennert; Lea Hagoel

Self-rated health (SRH) is a consistent predictor of mortality and other health outcomes. One of the mechanisms hypothesized to explain its validity as a predictor is that SRH affects the adoption of health behaviors. The present study examined the prospective association between SRH and performance of a recommended colorectal cancer (CRC) screening test. One thousand four hundred and seventy-six men and women aged 50–74 years, eligible for CRC screening, who had undergone the test a year before were interviewed 1–2 weeks (long interview, before testing) or 2 months (short interview, after testing) following the mailing of a test kit. Test performance was ascertained using an HMO’s computerized data set. Respondents in the long interview group who rated their health as ‘higher than others’ performed the screening test 2 months following the invitation more than those who rated their health as similar to or lower than that of others (65.4, 61.6, and 49.1%, respectively, &khgr;2=8.02, P=0.018). At the same time, these respondents perceived the risk of CRC as significantly lower than that of those who rated their health as comparable with or lower than that of others. In a multivariate logistic regression of CRC screening behavior that included demographic and perceptual variables, age, intentions, and SRH were found to be significant predictors. Among respondents in the short interview, who tested before the interview, there was no significant association between SRH and behavior. SRH prospectively predicts uptake of CRC screening better than other perceptual variables, after accounting for demographic variables.


Thrombosis Research | 2018

Association of factor V activity with risk of venous thromboembolism and atherothrombotic cardiovascular events: A retrospective population-based cohort study

Walid Saliba; Amir Warwar; Antonio Kotler; Shai Cohen; Nili Stein; Gad Rennert; Deborah L. Ornstein; Meir Preis

INTRODUCTION Factor V (FV) deficiency is a rare inherited coagulation disorder associated with bleeding tendency. As a result, it has been postulated that decreased FV activity may confer protection against venous thromboembolism and atherothrombotic cardiovascular events. MATERIALS AND METHODS Using the electronic database of the largest health care provider in Israel, we identified all adult individuals who were tested for FV activity between January 2004 and June 2017. Subjects with liver cirrhosis or FV Leiden mutation were excluded. FV activity was classified into three predefined categories; FV activity >50%, FV activity 30-50%, and FV activity ≤30%. Patients were followed from January 2004 to June 2017 for new atherothrombotic cardiovascular events (composite of myocardial infarction, stroke, and TIA) and venous thromboembolism (VTE). RESULTS Overall 2021 individuals were included; 83.2% had FV activity >50%, 9.6% FV activity 30-50%, and 7.2% had FV activity ≤30%. Compared to individuals with FV activity >50% the adjusted HR for atherothrombotic cardiovascular events was 1.10 (95% CI, 0.63-1.90) in those with FV activity 30-50%, and 0.95 (0.49-1.8) in those with FV activity ≤30%. None of the patients with FV activity 30-50% had VTE during follow-up; therefore those with FV activity ≤50% were classified into one group. VTE incidence was lower in those with FV activity ≤50% compared to those with FV >50% activity; adjusted HR = 0.28 (0.09-0.91). CONCLUSION This study suggests that decreased FV activity might be associated with decreased incidence of VTE. No significant association appears to exist between FV activity and atherothrombotic cardiovascular events.


European Respiratory Journal | 2018

Prevalence, risk factors and prognosis of nontuberculous mycobacterial infection among people with bronchiectasis: a population survey

Michal Shteinberg; Nili Stein; Yochai Adir; Shifra Ken-Dror; David Shitrit; Danielle Bendayan; Leonardo Fuks; Walid Saliba

The incidence of nontuberculous mycobacteria (NTM) infection among people with bronchiectasis varies between different geographical areas and accordingly between different series [1, 2]. Studies are largely based on bronchiectasis referral centres, which routinely screen for NTM in respiratory secretions. Therefore, the reported estimates of NTM prevalence in bronchiectasis may be exaggerated. Studies from bronchiectasis centres show conflicting results regarding risk factors for NTM: older age was found to increase risk in some but not other centres [1–4]. Due to the small numbers of patients in these studies, it is usually not possible to determine the effect of NTM infection on prognosis. Culture of NTM from people with bronchiectasis is negatively associated with smoking and low socioeconomic status http://ow.ly/E3jR30j553X


ERJ Open Research | 2018

Upper airway involvement in bronchiectasis is marked by early onset and allergic features

Michal Shteinberg; Najwan Nassrallah; Jenny Jrbashyan; Nechama Uri; Nili Stein; Yochai Adir

The association of bronchiectasis with chronic rhinosinusitis (CRS) has been reported. However, apart from primary ciliary dyskinesia (PCD) and cystic fibrosis (CF), predisposing conditions have not been established. We aimed to define clinical and laboratory features that differentiate patients with bronchiectasis with upper airway symptoms (UASs) and without PCD from patients without UASs. We reviewed charts of adults with bronchiectasis, excluding CF and PCD. UASs were defined as nasal discharge most days of the year, sinusitis or nasal polyps. Laboratory data included IgG, total IgE, blood eosinophils, sputum bacteriology and lung function. A radiologist blinded to UAS presence scored bronchiectasis (Reiff score) and sino-nasal pathology (Lund–Mackay score). Of 197 patients, for the 70 (35%) with UASs, symptoms started earlier (34±25 versus 46±24 years; p=0.001), disease duration was longer (median 24 versus 12 years; p=0.027), exacerbations were more frequent (median 3 versus 2 per year; p=0.14), and peripheral blood eosinophil (median 230 versus 200 μL−1; p=0.015) and total IgE (median 100 versus 42 IU·mL−1; p=0.085) levels were higher. The sinus computed tomography score was independently associated with exacerbations, with 1 point on the Lund–Mackay score associated with a 1.03-fold increase in the number of exacerbations per year (95% CI 1.0–1.05; p=0.004). These findings may implicate a higher disease burden in patients with UASs. We hypothesise that UASs precede and may in some cases lead to the development of bronchiectasis. Involvement of the upper airway in patients with bronchiectasis is associated with an early age of onset and allergic features http://ow.ly/1BuK30gWDrN

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Michal Shteinberg

Technion – Israel Institute of Technology

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Gad Rennert

Technion – Israel Institute of Technology

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Walid Saliba

Technion – Israel Institute of Technology

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Yochai Adir

Technion – Israel Institute of Technology

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D.G. Downey

Queen's University Belfast

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Efrat Neter

Ruppin Academic Center

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Lea Hagoel

Technion – Israel Institute of Technology

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Meir Preis

Rappaport Faculty of Medicine

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J. Stuart Elborn

Queen's University Belfast

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Andrew P. Levy

Technion – Israel Institute of Technology

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