Reducing infantile anemia: insight on patterns of process and outcome indicators by ethnicity and socioeconomic class during a 10-year intervention program and 5 years after

Background In 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019). Methods The CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy. Results At study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended. Conclusions The 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions.

PREVALENCE OF GROUP B STREPTOCOCCUS AND LEVEL OF RELIGIOSITY OF JEWISH MOTHERS IN NORTHERN ISRAEL - IS THERE A CONNECTION?

Group B streptococcus (GBS) during pregnancy is associated with increased risk of preterm delivery and is a leading cause of invasive infections in newborns. Rates of vaginal GBS prevalence in pregnant women vary among ethnic groups and geographical regions, with a range of 0.5-38%. The aim is to assess the prevalence rate of GBS bacteria among Jewish pregnant mothers in northern Israel, according to their level of religiosity. A cross-sectional study was pursued in 303 Jewish mothers at Ziv Medical Center, Safed of whom 89 (29.4%) were secular, 59 (19.5%) traditional, 60 (19.8%) Orthodox and 95 (31.3%) ultra-Orthodox, from December 2019-July 2020. All participants were tested for GBS from pregnancy week 35 as part of the routine medical care at their Health Maintenance Organization (HMO) and submitted the GBS test result upon arrival at the hospital delivery room. The overall prevalence of GBS was 33.7%: 16.9% of the secular mothers, 25.4% of the traditional women and 46.5% of the Orthodox and ultra-Orthodox group (p<0.001). In a univariate regression model the risk of GBS carriage in Orthodox mothers was 2.5 times higher and 6 times higher in ultra-Orthodox mothers than in secular mothers (p for trend <0.001). The prevalence of GBS was directly and significantly associated with the level of the birthing mother's religiosity. This study shows the need for systematic GBS screening of all pregnant women, particularly of Orthodox and ultra-Orthodox women, prior to their arrival in the delivery room.

Call Me Back: Examining Provider Biases Through Callback Rates and Responsiveness

We conducted a phone-based field experiment to investigate the callback rate of psychologists. Providers ( N = 903) in Los Angeles, California who were selected from a health maintenance organization insurance panel list were left voicemails by actors simulating patients of various backgrounds (i.e., race, gender, clinical diagnosis, and ethnic distinctiveness of name). Findings indicated that 71.5% of providers did not return calls to prospective patients. There were no main effects of race and ethnicity on callback. However, ethnic distinctiveness of name moderated the effects of diagnosis. Providers were more responsive to depressed patients with ethnic names, but less responsive to patients with ethnic names and personality or substance abuse disorders. These findings are important because unresponsive providers and insurance companies that do not provide up-to-date panel listings can act as barriers to care, which can have deleterious consequences for help-seekers. Advocacy recommendations and the importance of cultural competency are highlighted.

Patterns and Predictors of First-Line Taxane Use in Patients with Metastatic Triple-Negative Breast Cancer in US Clinical Practice

We investigated first-line (1L) treatment patterns and predictors of taxane use to better understand the evolving metastatic triple-negative breast cancer (mTNBC) treatment landscape. This retrospective analysis of the Truven Health MarketScan® (Somers, NY, USA) Database included women with mTNBC who received 1L therapy within six months of diagnosis (January 2005–June 2015). Multivariate logistic regression models identified predictors of taxane use, adjusting for prognostic factors. A total of 2,271 women with newly diagnosed mTNBC received 1L treatment during the study period. Half received a 1L taxane (53%), more often in combination than as monotherapy (58% versus 42%), though this varied by specific taxane. Nab-Paclitaxel monotherapy increased substantially after 2010. More recent treatment year (odds ratio, 2.16 (95% CI 1.69–2.76]) and number of metastases (≥3 versus 1: 1.73 (1.25–2.40)) predicted taxane monotherapy versus combination. Having a health maintenance organization versus a preferred provider organization plan predicted less nab-paclitaxel versus paclitaxel (0.32 (0.13–0.80)) or docetaxel (0.30 (0.10–0.89)) use. More recent index year (2011–2015 vs 2005–2010) was the only predictor favoring nab-paclitaxel versus paclitaxel (2.01 (1.26–3.21)) or docetaxel (3.63 (2.11–6.26)). Taxane-containing regimens remained the most common 1L mTNBC treatments. Paclitaxel and nab-paclitaxel use changed substantially over time, with nab-paclitaxel use associated with insurance coverage.

Resuscitation in Community Healthcare Facilities in Israel

Background: Out-of-hospital cardiac-arrest (OHCA) is a major public health challenge. Community health care providers (CHP) may play an important role through early identification, basic life support and defibrillation. Few studies have evaluated the incidence and characteristics of OHCAs initially cared for by CHP, most finding improved survival. This study combined CHP treated OHCA case analysis, with assessment of provider resuscitation preparedness. Methods: An analysis of all CHP initiated resuscitations in a large Health Maintenance Organization (HMO) reported over 42 months, coupled with an online survey assessing CHP resuscitation knowledge, experience, training and self-confidence. Results: 22 resuscitations met inclusion criteria. In 21 CHP initiated chest-compressions but in only 8 cases they utilized the clinic’s automated external defibrillator (AED) prior to emergency medical services (EMS) arrival. There were 275 providers surveyed. Of the surveyed providers, 89.4% reported previous basic life support (BLS)/advanced cardiovascular life support (ALS) training, 67.9% within the last three years. Previous resuscitation experience was reported by 72.7%. The lowest scoring knowledge question was on indications for AED application −56.3%. Additionally, 44.4% reported low confidence in their resuscitation skills. CHP with previous cardiopulmonary resuscitation (CPR) experience reported higher confidence. Longer time since last CPR training lowered self-confidence. Conclusions: Early AED application is crucial for patients with OHCA. All clinics in our study were equipped with AED’s and most CHP received training in their use, but remained insecure regarding their use, often failing to do so.

BNT162b2 vaccine effectiveness in preventing asymptomatic infection with SARS-CoV-2 virus: a nationwide historical cohort study

Background There is strong evidence regarding the efficacy and effectiveness of BNT162b2 vaccine in preventing symptomatic infection with SARS-CoV-2 virus. There is a relative paucity of data regarding effectiveness in prevention of asymptomatic infection. Methods In this real-world observational study, we identified a sub-population of individuals in a large health maintenance organization who were repeatedly tested for SARS-CoV-2 infection by PCR. We included these individuals in the study cohort, and compared those who were vaccinated with BNT162b2 mRNA vaccine to the unvaccinated ones. A positive SARS-CoV-2 PCR test result was used as the outcome. Follow-up period was from January 1,2021 until February 11, 2021. Findings 6,286 individuals were included in the cohort. Seven days following the second vaccine dose, a rate of six positive PCR tests per 10,000 person-days was recorded, compared with a rate of 53 positive tests per 10,000 person-days for the unvaccinated group. The estimated vaccine effectiveness against infection with SARS-CoV-2 virus after two vaccine doses was 89% (95% confidence interval 82%-94%). The estimated effectiveness two weeks following the first vaccine dose was 61% (95% confidence interval 49%-71%). Interpretation In this study, vaccination with BNT162b2 reduced infection rates among individuals who underwent screening by frequent SARS-CoV-2 PCR testing. Using a cohort of frequently tested individuals reduced the indication bias for the PCR testing, which enabled estimation of infection rates. Funding This study received no funding.