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Background and objective: Over the past decade, researchers have been seeking to understand the consequences of adult attention-deficit/hyperactivity disorder (ADHD) for different types of everyday behaviors. In this study, we investigated the associations between ADHD and political participation and attitudes, as ADHD may impede their active participation in the polity. Methods: This observational study used data from an online panel studying the adult Jewish population in Israel, collected prior the national elections of April 2019 (N = 1369). ADHD symptoms were assessed using the 6-item Adult ADHD Self-Report (ASRS-6). Political participation (traditional and digital), news consumption habits, and attitudinal measures were assessed using structured questionnaires. Multivariate linear regression analyses were conducted to analyze the association between ADHD symptoms (ASRS score <17) and reported political participation and attitudes. Results: 200 respondents (14.6%) screened positive for ADHD based on the ASRS-6. Our findings show that individuals with ADHD are more likely to participate in politics than individuals without ADHD symptoms (B = 0.303, SE = 0.10, p =.003). However, participants with ADHD are more likely to be passive consumers of news, waiting for current political news to reach them instead of actively searching for it (B = 0.172, SE = 0.60, p =.004). They are also more prone to support the idea of silencing other opinions (B = 0.226, SE = 0.10, p =.029). The findings hold when controlling for age, sex, level of education, income, political orientation, religiosity, and stimulant therapy for ADHD symptoms. Conclusions: Overall, we find evidence that individuals with ADHD display a unique pattern of political activity, including greater participation and less tolerance of others' views, but not necessarily showing greater active interest in politics. Our findings add to a growing body of literature that examines the impact of ADHD on different types of everyday behaviors. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is taking a staggering toll on healthcare systems worldwide, with the bulk of the expenditures invested in the late stages of the disease. Considering the rising life expectancy and the increasing prevalence of PD across the globe, a clear understanding of the early signs and treatment options available for advanced PD (APD), will facilitate tailoring management programs and support services. This task is complicated by the lack of both global consensus in defining APD and standardized care guidelines. This perspective prepared by a panel of movement disorder specialists, proposes to extend and optimize currently accepted PD coding to better reflect the diverse disease manifestations, with emphasis on non-motor features. The panel seeks to promote timely diagnosis by adjustment of evaluation tools for use by community neurologists and suggests modification of eligibility criteria for advanced therapy. Moreover, it advocatesmultidisciplinary assessments of APD patients to drive personalized, patient-centered and holistic management. Overall, earlier and more targeted intervention is expected to markedly improve patient quality of life. [ABSTRACT FROM AUTHOR]

Background/Aim This article explores the development of a unique, culturally sensitive, designated academic occupational therapy programme for the Ultra- Orthodox ( Haredi) minority in Israel. This normative university environment did not provide the opportunity for Haredi participation due to the lack of consideration of the strong commitment to a modest way of life of this community. This prevented their participation in academia and resultant employment that are necessary for economic advancement of the community. Method A follow-up survey that tracked the programme's graduates' participation in the workforce was used to determine the success of the initial goal of the establishment of the designated programme. Results Slightly above 97% of the respondents worked as occupational therapists during the first year after completing their bachelor's degree. The employment data obtained from the graduates showed that the central goal of the Council of Higher Education has been achieved. The designated culturally adapted occupational therapy programme has provided varied employment opportunities for its graduates in diverse professional environments. Conclusion With the implementation of this programme, the occupational therapy department of the University of Haifa has created greater accessibility of the profession to both the occupational therapy providers and the recipients of occupational therapy intervention as well as serve as a model for other communities. [ABSTRACT FROM AUTHOR]

Sensory processing abilities involve the registration and modulation of sensory information and the internal organization of sensory input. These abilities are necessary for executing successful responses to the environmental demands and thus for meaningful engagement in daily activities. Sensory processing disabilities are defined as inability to process sensory stimuli in a graded manner and to execute behaviors that are suitable to the degree, nature or intensity of the sensory stimuli. As such, sensory processing disabilities may affect function, behavior and quality of life in a negative manner. At present, the sensory profile of children with generalized epilepsy has not been fully elucidated. The purpose of the study was to assess possible sensory processing disabilities within all sensory modalities in children with generalized epilepsy. Forty-eight children at the age of 6-10.9 yr participated including 22 patients with generalized epilepsy compared with 26 age and gender matched controls. A standardized Short Sensory Profile questionnaire including 38 items was given to caregivers to report, measured tactile and taste/ smell sensitivities, movement sensitivity; under-responsive/seeks sensation, auditory filtering, low energy/weak sensation and visual/auditory sensitivity. We have found that children with generalized epilepsy had significantly higher sensory processing disabilities in all sensory modalities compared with controls and even showed extreme patterns of under-responsive/sensation seeking. These results are preliminary given a rather small group of patients in each tests group and should be verified in large groups. The present study further delineates the growing bulk of data recognizing generalized epilepsy among children as a multi-faceted neurological disorder with diverse functional disabilities also including sensory processing dysfunction. [ABSTRACT FROM AUTHOR]

This study examined the links between parental divorce, quality of maternal parenting, spousal relationships and middle adolescent romantic competence in 80 mother-adolescent daughter pairs (40 divorced). Mothers were asked to describe their attitudes and behaviors with regard to their daughters' romantic behavior. In addition, mothers were interviewed about their own romantic experiences when they were at the age of their daughters. Adolescent girls (mean age = 16.98 years; range 16-18) were administered a comprehensive interview about romantic competence. Findings indicated that adolescent girls from divorced families showed lower levels of romantic competence, which were expressed in their behavior, attitudes toward relationships and skill in handling those relationships. Divorce was found to have had an adverse effect on girls' romantic competence, whereas continued adaptive parenting and spousal relationships alleviated the effect of divorce. Mothers' coherent representation of their own adolescent romantic experiences also alleviated the effect of divorce on daughters' romantic behavior. Results show the important role of family relationships in fostering romantic competence among adolescent girls. [ABSTRACT FROM AUTHOR]

Objective: To investigate pregnancy outcome of patients following splenectomy. Methods: A retrospective study comparing pregnancies of women who have and have not undergone splenectomy was performed. The study investigated a select population representing the south of Israel. Women lacking antenatal care as well as those having multiple gestations were excluded from the analysis. Stratified analysis, using a multiple logistic regression model, was performed to control for confounders. Results: During the study period, there were 219,656 deliveries, of which 150 occurred in women who underwent splenectomy. Postsplenectomy women tended to be older, were more likely to be Jewish, and had a lower number of deliveries and an earlier gestational age at delivery. Higher rates of fertility treatment, previous cesarean delivery, and severe preeclampsia were found among postsplenectomy women. In addition, splenectomy was significantly associated with pregnancy and labor complications, such as cesarean delivery, pneumonia during pregnancy, and complications of anesthesia and sedation during labor. Using a multivariate analysis with backward elimination, the following conditions were independently associated with splenectomy: previous cesarean delivery (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.3, p=0.039), fertility treatment (OR 2.6, 95% CI 1.3-5.4, p=0.008), preterm delivery (OR 1.9, 95% CI 1.3-3.1, p=0.003), and maternal age (OR 1.04, 95% CI 1.015-1.07, p=0.002). After controlling for possible confounders by using another multivariate analysis with preterm delivery as the outcome variable, splenectomy was found to be an independent risk factor for preterm delivery (OR 2.1, 95% CI 1.4-3.3, p=0.001). Conclusion: Splenectomy is an independent risk factor for preterm delivery. [ABSTRACT FROM AUTHOR]

Background: The problem of unexploded ordnance (UXO) is global and is usually associated with active or former war zones. Civilian injuries due to UXO in military training areas are not common. Methods: This is a retrospective case series study based on prospectively collected data on patients who sustained injuries from UXO explosions and were admitted to the Soroka University Trauma Center during a five-year period. Results: Twelve patients were included in this series. All patients were Bedouin and the distribution of injuries was concentrated around the head and upper and lower extremities, with sparing of the torso. Conclusion: Awareness and implementation of preventive measures are expected to reduce the incidence of this type of injury. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) and fibromyalgia (FM) are two relatively common disorders that are considered distinct diagnoses. The aim of this study was to investigate the epidemiological characteristics of patients with both PD and FM, as well as their comorbidities and medication use. We performed a population-based retrospective cohort study in Israel from 2000 to 2015. We identified patients with PD according to a refined medication tracer algorithm and patients with FM according to their medical records. Using the algorithm, we identified 2606 patients diagnosed with PD, 60 of them (2.3%) were also diagnosed with FM. Most of the patients were females (88.3%) and the mean age of FM diagnosis was 63.95 ± 12.27 years. These patients had a higher prevalence of depression, anxiety, and dementia. Of the patients diagnosed with PD + FM, 46 (76.7%) were diagnosed with FM after the diagnosis of PD. Patients with PD + FM used analgesics of distinct kinds in higher rates, as well as more anti-PD medications. We suggest that patients with PD + FM represent a distinct subgroup with a fibromyalgia-like syndrome associated with Parkinson's disease (FLISPAD). Their PD is more treatment resistant, and they take more medications, both analgesics and anti-PD. [ABSTRACT FROM AUTHOR]

Background: Headache is a common condition, and a common complaint leading patients to emergency departments (ED). There have been a number of studies of the effect of environmental factors on headache, such as weather and air pollutants.Methods: This retrospective cohort study included data on daily ED visits with a chief complaint of headache in Soroka University Medical Center (SUMC) during 2002-2012. Data on weather and air pollutants were obtained from monitor station in Be'er-Sheva. To estimate the short-term effects of air pollution and temperature on number of daily headache ED visits, we applied generalized linear mixed models (GLMM).Results: A total of 22,021 ED visits were included in the analysis. An increase in 5℃ in temperature was associated with an increase in ED visits, relative risk (RR) = 1.042, (95% CI 1.009; 1.076). RR for headache was associated with an increase in 10 units of nitrogen dioxide (NO2), RR = 1.110 (95% CI 1.057; 1.167), with a higher effect for older patients.Discussion: The current findings give evidence of an association between air pollution, weather and ED visits for headache, especially for NO2. Short-term increases in air pollution exposure may trigger headache by increasing pulmonary and systemic inflammation, increasing blood coagulability or altering endothelial function. [ABSTRACT FROM AUTHOR]

The risk of aspiration during general anesthesia for cesarean delivery has long been thought to be increased due to factors such as increased intra-abdominal pressures and delayed gastric emptying in pregnant patients. However, recent studies have reported normal gastric emptying in pregnant patients, suggesting that the risk of aspiration may not be as high as previously believed. We conducted a retrospective study of 48,609 cesarean deliveries, of which 22,690 (46.7%) were performed under general anesthesia at two large tertiary medical centers in Israel. The study aimed to examine the incidence of potentially severe aspiration during cesarean delivery, both under general and neuraxial anesthesia. Among the patients included in the study, three were admitted to the intensive care unit due to suspected pulmonary aspiration. Two of these cases occurred during induction of general anesthesia for emergency cesarean delivery associated with difficult intubation and one under deep sedation during spinal anesthesia. The incidence of aspiration during cesarean delivery during general anesthesia in our study was 1 in 11,345 patients, and the incidence of aspiration during neuraxial anesthesia was 1 in 25,929 patients. No deaths due to aspiration were reported during the study period. Our findings provide another contemporary analysis of aspiration rates in obstetric patients, highlighting increased risks during the management of difficult airways during general anesthesia and deep sedation associated with neuraxial anesthesia. [ABSTRACT FROM AUTHOR]

[This corrects the article DOI: 10.1155/2021/6633210.]. [ABSTRACT FROM AUTHOR]

During a 12-month surveillance period, haemodialysis (HD) patients in southern Israel were categorised according to the type of vascular access site (VAS), i.e., arteriovenous (AV) fistula, synthetic AV graft, and cuffed or non-cuffed vascular catheters. Endpoints, expressed as cases/100 patient-months, were: incidence of hospital admission; antibiotic therapy; bloodstream infection (BSI); and VAS infection. These were compared to Centers for Disease Control (CDC) surveillance data, overall and by VAS type. In total, 2568 patient-months were analysed. The VAS distribution differed significantly from CDC data for fistulas (72% vs. 31%), grafts (12% vs. 41%), cuffed catheters (11% vs. 25%) and non-cuffed catheters (5% vs. 3%) (p < 0.0001 in all cases). Of 151 admissions, 32% resulted from infection, for which 112 antibiotic courses (22% vancomycin) were given. There were 16 BSIs, three involving resistant strains. The incidences of admission, antibiotic therapy, BSI and VAS infection were significantly lower overall, compared to CDC rates, as were most VAS-specific endpoints. These differences may be explained by VAS type distribution, although other factors may also be involved. Reporting regional or national surveillance data may allow a standardised comparison of the incidence of HD-associated infections. [ABSTRACT FROM AUTHOR]

Background: Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries., Objectives: To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic., Methods: We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications., Results: We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001)., Conclusions: We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.

Purpose: Dynamic changes in urine output and neurological status are the recognized clinical signs of hemodynamically significant hemorrhage. In the present study, we analyzed the dynamic minute-to-minute changes in the UFR and also the changes in its minute-to-minute variability in a group of critically ill multiple trauma patients whose blood pressures were normal on admission to the ICU but who subsequently developed hypotension within the first few hours of their ICU admission., Patients and Methods: The study was retrospective and observational. Demographic and clinical data were extracted from the computerized register information systems initially; the clinical and laboratory data of 100 critically ill patients with multiple trauma who were admitted to the ICU during the study period were analyzed. Of this group, ten patients were eventually included in the study on the basis of the inclusion criteria., Results: The minute-to-minute urine flow rate (UFR) and urine flow rate variability (UFRV) both decreased significantly during the periods of hypotension (p values 0.001 and 0.006, respectively). Notably, the decrease in UFRV preceded by at least 30 min a corresponding decline in the systolic and mean arterial blood pressures, which manifested as a flattening of UFRV amplitude which was observed prior to the occurrence of the lowest recorded systolic and mean arterial blood pressures. Statistical analysis by the Pearson method demonstrated a strong direct correlation between the decrease in UFRV and the decrease in the MAP (R = 0.9, p = 0.001), and SBP (R = 0.86, p = 0.001) and the decreasing urine output per hour (R = 0.88, p < 0.001)., Conclusion: We found that changes in UFRV correlate strongly with systolic and mean arterial blood pressures. We feel that this parameter could potentially serve as an early signal of hemodynamic deterioration due to occult bleeding in critically ill trauma patients, and might also be able to identify the optimal end-point of hemodynamic resuscitative measures in these patients.

Background: Optimal oxygen supply is the cornerstone of the management of critically ill patients after extubation, especially in patients at high risk for extubation failure. In recent years, high flow oxygen system devices have offered an appropriate alternative to standard oxygen therapy devices such as conventional face masks and nasal prongs., Objectives: To assess the clinical effects of high flow nasal cannula (HFNC) compared with standard oxygen face masks in Intensive Care Unit (ICU) patients after extubation., Methods: We retrospectively analyzed 67 consecutive ventilated critical care patients in the ICU over a period of 1 year. The patients were allocated to two treatment groups: HFNC (34 patients, group 1) and non-rebreathing oxygen face mask (NRB) (33 patients, group 2). Vital respiratory and hemodynamic parameters were assessed prior to extubation and 6 hours after extubation. The primary clinical outcomes measured were improvement in oxygenation, ventilation-free days, re-intubation, ICU length of stay, and mortality., Results: The two groups demonstrated similar hemodynamic patterns before and after extubation. The respiratory rate was slightly elevated in both groups after extubation with no differences observed between groups. There were no statistically significant clinical differences in PaCO2. However, the use of HFNC resulted in improved PaO2/FiO2 post-extubation (P < 0.05). There were more ventilator-free days in the HFNC group (P< 0.05) and fewer patients required reintubation (1 vs. 6). There were no differences in ICU length of stay or mortality., Conclusion: This study demonstrated better oxygenation for patients treated with HFNC compared with NRB after extubation. HFNC may be more effective than standard oxygen supply devices for oxygenation in the post-extubation period.

Background: Traumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients., Methods: Twenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory., Results: Mean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 - 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading., Conclusions: CFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment.

Objective: The study was aimed to define trends, risk factors and perinatal outcome associated with shoulder dystocia (SD)., Methods: A population-based study comparing all singleton deliveries with and without SD was conducted. Statistical analysis was performed using multiple logistic regression analysis., Results: Shoulder dystocia complicated 0.2% (n = 451) of all deliveries included in the study (n = 240,189). The rate of SD declined from 0.4% in 1988 to 0.13% in 2009. Independent risk factors for SD in a multivariable analysis were fetal macrosomia (birth-weight ≥ 4 kg; OR = 16.1; 95% CI 13.2-19.6, P < 0.001), failure of labor to progress during the second stage (OR = 2.4; 95% CI 1.5-3.7, P < 0.001), diabetes mellitus (OR = 1.8; 95% CI 1.4-2.3, P < 0.001) and advanced maternal age (years, OR = 1.02; 95% CI 1.001-1.03, P = 0.029). Perinatal mortality was significantly higher after SD as compared to the comparison group (6.2 vs. 1.4%, P <0.001). Another multivariable analysis, with perinatal mortality as the outcome variable, controlling for confounders such as maternal age, gestational age, diabetes mellitus, etc. was constructed; SD was noted as an independent risk factor for perinatal mortality (adjusted OR = 11.1; 95% CI 7.2-17.1, P < 0.001)., Conclusions: Shoulder dystocia, associated with macrosomia, labor dystocia, diabetes mellitus, and advanced maternal age, is an independent risk factor for perinatal mortality. In an era of increased rate of cesarean deliveries, and perhaps increased accuracy of birth weight estimation, the rate of shoulder dystocia gradually declines.

Objective: This study aimed at determining trends, risk factors and pregnancy outcome in women with uterine rupture., Methods: A population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 2009 was conducted. Statistical analysis was performed using a multiple logistic regression analysis., Results: Uterine rupture occurred in 0.06% (n = 138) of all deliveries included in the study (n = 240,189); 59% in women with a previous cesarean delivery (CD). A gradual increase in the rate of uterine rupture from 1988 (0.01%) to 2009 (0.05%) was noted. Independent risk factors for uterine rupture in a multivariable analysis were: previous CD (OR = 7.4, 95% CI 5.2-10.6), preterm delivery (<37 weeks, OR = 2.5, 95% CI 1.5-4.1), malpresentation (OR = 3.0, 95% CI 1.9-4.5), parity (OR = 1.2, 95% CI 1.1-1.3 for each birth), and dystocia during the first and second stages of labor (OR = 4.1, 95% CI 2.3-7.4 and OR = 11.2, 95% CI 6.7-18.7, respectively). Uterine rupture led to significant maternal morbidity and perinatal mortality. In another multivariable analysis, with perinatal mortality as the outcome variable uterine rupture was noted as an independent risk factor for perinatal mortality (adjusted OR = 17.7; 95% CI 10.0-31.4, P < .01)., Conclusions: Uterine rupture, associated with previous cesarean delivery, malpresentation, and labor dystocia, is an independent risk factor for perinatal mortality.

Objective: The objective of the study was to assess the factors affecting the latency period in woman with preterm premature rupture of membranes (PPROM) and evaluate morbidity associated with prolonged latency., Study Design: A population-based retrospective study including all women with PPROM (prior to 37 weeks' gestation) during the years 1998-2008 was conducted. Comparison of the latency period was conducted by the Mann-Whitney U test since the latency period was not normally distributed (most delivered in 24 h). Multivariable logistic regression model was constructed to find independent factors associated with prolonged latency period (>72 h)., Results: During the study period, there were 1,399 singleton deliveries of patients with PPROM; 24.6% (345) occurred prior to 34 weeks' gestation. The duration of the latency period was significantly longer among woman with PPROM before 34 weeks as compared to PPROM after 34 weeks' gestation (5.78 vs. 2.02 days; p < 0.001). Other factors associated with longer latency period were multiparity (more than one previous delivery) and maternal age >35. Using a multivariable analysis, the following factors were significantly associated with latency period >72 h: lower gestational age (weeks, OR = 0.8, 95% CI 0.77-0.84; p < 0.001) and multiparity (OR = 1.7, 95% CI 1.3-2.2; p < 0.001). Prolonged latency period (>72 h) was significantly associated with chorioamnionitis (OR = 2.095, 95% CI 1.44-3.04; p < 0.001) and oligohydramnios (OR = 3.041, 95% CI 1.43-6.45; p = 0.004) but not with placental abruption (OR = 0.854, 95% CI 0.41-1.78; p = 0.674) or perinatal mortality (OR = 1.2, 95% CI 0.6-2.2; p = 0.556)., Conclusion: The duration of the latency period is inversely associated with gestational age. Nulliparity is associated with lower latency period. Prolonged latency is a significant risk factor for chorioamnionitis.

Objective: To investigate pregnancy and labour outcomes in grand and great grand multiparous women., Study Design: A retrospective population-based study was conducted between the years 1988 and 2007. Parturients were classified into three groups: multiparous; 2-5 deliveries, grand multiparous; 6-9 deliveries, and great grand multiparous; 10+ deliveries. Stratified analyses included multiple logistic regression models., Results: A significant linear association was found between parity and adverse maternal and perinatal outcomes such as malpresentation, labour dystocia, caesarean delivery, postpartum haemorrhage, maternal anaemia (HB<10), congenital malformations and perinatal mortality. Using multivariable logistic regression models, grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=1.5, P<0.001), and perinatal mortality (OR=2.0, P<0.001). Great grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=2.6, P<0.001), labour dystocia, second stage (OR=2.1, P<0.001), and perinatal mortality (OR=2.5, P<0.001)., Conclusion: Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is higher for great grand multiparous women compared to grand multiparous women. Grand and great grand multiparity are independent risk factors for labour dystocia and perinatal mortality.