Soroka University Medical Center Research Articles

Cervical insufficiency a prologue for future pelvic organ prolapse?

Preliminary evidence suggests that women with cervical oss insufficiency may have an increased risk to develop pelvic organ prolapse later in life, suggesting a common underlying collagen-oriented mechanism. The objective of this study was to determine the association between cervical oss insufficiency and the subsequent development of pelvic organ prolapse. A matched, case-control study, including women who delivered at the Soroka University Medical Center. Cases were women diagnosed or treated with pelvic organ prolapse (n = 1463), and controls were a representative sample of women of the same age group without pelvic organ prolapse (n = 5637). The association between pelvic organ prolapse and prior preterm birth was tested. Univariate analysis was performed using a conditional logistic regression to assess the association between preterm labor and pelvic organ prolapse. Statistically and clinically significant variables in the univariate analysis were included in the multivariable regression. The rate of spontaneous preterm birth did not differ between the study groups [pelvic organ prolapse - 4.0% (59/1463) vs. non- pelvic organ prolapse - 4.9% (276/5637), p = 0.16]. The median number of preterm births was higher among women without pelvic organ prolapse (controls) than in those with pelvic organ prolapse (cases) (p = 0.004). Among those who delivered preterm, the individual proportion of preterm deliveries was higher among the controls' group (p = 0.03). Similarly, the rate of cesarean deliveries was also higher among the controls group (p = 0.003). The rate of small for gestational age neonates was higher in the controls group (p = 0.0007), while that of large for gestational age neonates was higher in the case group (p = 0.02). In the univariate analysis, birthweight, vaginal delivery, and prior surgery were associated with subsequent development of pelvic organ prolapse. The multivariable analysis exhibited the same association- having birthweight, vaginal delivery, and all types of prior surgery independently associated with subsequent development of pelvic organ prolapse. Obstetrics characteristics associated with pelvic organ prolapse included vaginal delivery and birthweight along with non-obstetrical factors such as prior surgery. There was no association between preterm birth and subsequent development of pelvic organ prolapse. Our findings suggest that the effort during labor at term required for the delivery of appropriate for gestational age or large for gestational age newborns affects the pelvic floor and is a major contributor for the subsequent development of pelvic organ prolapse.

Balance recovery stepping responses during walking were not affected by a concurrent cognitive task among older adults

BackgroundMost of older adults’ falls are related to inefficient balance recovery after an unexpected loss of balance, i.e., postural perturbation. Effective balance recovery responses are crucial to prevent falls. Due to the considerable consequences of lateral falls and the high incidence of falls when walking, this study aimed to examine the effect of a concurrent cognitive task on older adults’ balance recovery stepping abilities from unannounced lateral perturbations while walking. We also aimed to explore whether cognitive performance accuracy is affected by perturbed walking and between task trade-offs.MethodsIn a laboratory-based study, 20 older adults (> 70 years old) performed the following test conditions: (1) cognitive task while sitting; (2) perturbed walking; and (3) perturbed walking with a concurrent cognitive task. The cognitive task was serial numbers subtraction by seven. Single-step and multiple-step thresholds, highest perturbation achieved, 3D kinematic analysis of the first recovery step, and cognitive task performance accuracy were compared between single-task and dual-task conditions. Between task trade-offs were examined using dual-task cost (DTC).ResultsSingle-step and multiple-step thresholds, number of recovery step trials, number of foot collision, multiple-step events and kinematic recovery step parameters were all similar in single-task and dual-task conditions. Cognitive performance was not significantly affected by dual-task conditions, however, different possible trade-offs between cognitive and postural performances were identified using DTC.ConclusionsIn situations where postural threat is substantial, such as unexpected balance loss during walking, balance recovery reactions were unaffected by concurrent cognitive load in older adults (i.e., posture first strategy).The study was approved by the Helsinki Ethics Committee of Soroka University Medical Center in Beer-Sheva, Israel (ClinicalTrials.gov Registration number NCT04455607, ID Numbers: Sor 396–16 CTIL; 02/07/2020).

The association between striae gravidarum and perineal lacerations during labor.

ObjectiveStriae gravidarum (SG) and perineal lacerations are common occurrences during late pregnancy and labor. It has been hypothesized that both conditions may share a common pathophysiological pathway through changes in the connective tissue. We aimed to investigate a possible association between these two conditions and whether the presence of SG may predict perineal lacerations.MethodsWe conducted a prospective cohort study that included women who gave birth at the Soroka University Medical Center (SUMC), Beer-Sheva, Israel. Those who provided informed consent were examined for the presence of SG using the Davey scoring system to determine the severity of abdominal SG. Clinical and obstetrical characteristics and the presence and degree of perineal tears were retrieved from the computerized patients’ records. Univariate analysis was carried using appropriate statistical tests.ResultsA total of 187 women were recruited. Of those, 81 (43.3%) did not have SG, 24 (12.8%) 43 (23%) and 39 (20.9%) had mild, moderate and severe SG, respectively. Women with SG were significantly older and had a higher body mass index (p<0.01 for both). Delivery characteristics, mode of delivery, and gestational age were comparable between the groups; however, women with SG gave birth to significantly larger neonates (p<0.01). Seventy-one (31%) women had suffered from 1st or 2nd-degree perineal tears, and none had 3rd or 4th-degree perineal tears. No significant differences were found in rates of perineal tears between women with and without SG (p = 0.91), regardless of SG severity (p = 0.38).ConclusionsIn our study, SG was not associated with perineal tears. This information may be used as reassurance when giving antepartum consultation to women with SG, even in severe cases.

Modified Shock Index as a Predictor for Mortality and Hospitalization Among Patients With Dementia

BackgroundOne in four older adults in the Emergency Department (ED) suffers from severe cognitive impairment, creating great difficulty for the emergency physicians who determine the urgency of their patients’ condition, which informs decisions regarding discharge or hospitalization. ObjectiveOur objective was to determine whether modified shock index (MSI) can be a clinical mortality and hospitalization predictor when applied to older patients with dementia in the ED. MethodsIncluded in the research were all patients with dementia, > 65 years old, who arrived at the Soroka University Medical Center ED during 2014–2017. The population was divided into three groups according to their MSI score, calculated as heart rate/mean arterial pressure: MSI < 0.7; 0.7 > MSI < 1.3; and MSI > 1.3. We performed multivariable logistic regression as a predictor of death within 30 days, Cox analysis for number of days to death, and a negative binominal regression for predicting the number of admission days. ResultsIncluded were 1437 patients diagnosed with dementia. Patients with an MSI > 1.3 vs. those with MSI < 0.7 had an odds ratio of 8.23 (95% confidence interval [CI] 4.64–4.54) for mortality within 30 days, increased mortality risk within 180 days (hazard ratio 4.42; 95% CI 2.64–7.41), and longer hospitalization duration (incidence rate ratio 1.8; 95% CI 1.32–2.45). ConclusionsHigh MSI scores were associated with high mortality rates and longer hospitalization duration for patients diagnosed with dementia who were > 65 years old. We suggest performing prospective studies utilizing the MSI score as an indicator in ED triage settings to classify patients with dementia by their severity of risk, to determine if this benefits health, minimizes expenses, and prevents unnecessary hospitalizations.

A novel artificial intelligence-based system provides global longitudinal strain automatically behind the scenes

Abstract Funding Acknowledgements Type of funding sources: None. Background Global longitudinal strain (GLS) evaluation is an essential part of echocardiography studies and is indicated in many clinical situations. It is most frequently undertaken using software available on an ultrasound (US) device or on a dedicated workstation. Evaluating GLS is time-consuming because it requires selection of 3 apical views with sufficient image quality. In addition, the software for strain evaluation varies between vendors and may provide different results. LVivo Seamless (DiA Imaging Analysis) is a novel artificial intelligence (AI) based vendor neutral solution that performs automated evaluation of US exams in DICOM format on the server without user involvement. The system selects the optimal views, performs the evaluation, and sends the results to the PACS, providing a novel workflow (Fig.1). Purpose To evaluate the ability of LVivo Seamless to automatically identify 4 chamber (4CH), 2 chamber (2CH) and 3 chamber (3CH) views and to compare the automated GLS results based on these 3 views, to GLS results calculated by the routinely used method. Methods 100 full echo examinations for which GLS was previously calculated by Automated Functional Imaging (AFI, GE Healthcare) were retrospectively collected from Soroka University Medical center. The examinations were processed by LVivo Seamless. The 4CH, 2CH and 3CH views were automatically recognised by the system and the optimal views for evaluation were selected according to quality and depth criteria. A GLS result was only possible if all three views were selected by the system. The automatically calculated GLS values were compared to those reported by AFI. Results LV function was impaired in 48% (21% severe, 14% moderate, 13% mild). Moderate or severe valvular heart disease was found in 17%. 13% of the studies included patients receiving chemotherapy. 28% of the patients had normal GLS (GLS&amp;lt;-18%). LVivo Seamless successfully identified the 3 apical views in 95% of the studies. In 2 cases the identified views did not pass the system’s criteria. Of 93 cases available for analysis, fully automated GLS calculation was possible in 87 cases. Excellent correlation was found between GLS by AFI and GLS by LVivo Seamless with r = 0.88 [95% CI: 0.82-0.91]. The average difference and limits of agreements were -1.4 ± 3.9%. The specificity and sensitivity using a normal\abnormal threshold of -18% were 0.9 and 0.83 respectively (Fig.2). Conclusions The results provided by the AI based LVivo Seamless solution showed excellent capability to automatically identify 4CH, 2CH and 3CH views, along with excellent GLS results compared to AFI. LVivo Seamless has the potential to improve echocardiography workflow by making the results available to the cardiologist when starting the study review and in the future may become the standard method for strain evaluation. Abstract Figure. Fig.1 Seamless Workflow Abstract Figure. Fig.2 GLS by LVivo Seamless vs AFI

Serratus Anterior Block for Long-Term Post-Thoracoscopy Pain Management.

PurposeNeuropathic, chronic pain is a common and severe complication following thoracic surgery, known as post-thoracotomy pain syndrome (PTPS). Here we evaluated the efficacy of an ultrasound-guided serratus anterior plane block (SAPB) on pain control compared to traditional pain management with intravenous opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) six months after thoracic surgery.Patients and MethodsIn this retrospective observational study, we analyzed data from a questionnaire survey. We interviewed all patients who underwent elective video-assisted thoracoscopy surgery (VATS) at Soroka University Medical Center between December 2016 and January 2018. The responses of ninety-one patients were included.ResultsParticipants reported PTPS in both groups, 43% of patients in the SAPB group and 57% of patients in the standard group, which failed to reach significance. However, we demonstrated that the percentage of pain occurrence trended lower in the SAPB group. There was significantly less burning/stitching or shooting, shocking, pressure-like, and aching pain in SAPB patients compared to the standard protocol group. Patients in the SAPB group had significantly less pain located in the upper and lower posterior thorax anatomical regions compared to the standard protocol group. Moreover, we found a significant difference in occurrence of PTPS depending on the type of thoracic surgery. From both study groups, 69% of patients who underwent lobectomy reported pain, compared with 41.9% of those in the segmental (wedge resection) procedure, and 42.1% of patients in other procedures.ConclusionWhile the present study did not demonstrate a statistically significant reduction of PTPS after SAPB concerning postoperative pain control, there was a trend of a decrease. We also found significance in the type of pain and location of pain after thoracic surgery between the two groups, as well as a significant difference between pain occurrence in types of thoracic surgeries from both groups.

Prenatal maternal COVID-19 vaccination and pregnancy outcomes

BackgroundPrenatal maternal physiological changes may cause severe COVID-19 among pregnant women. The Pfizer-BioNTech COVID-19 vaccine (BNT162b2 mRNA) has been shown to be highly effective and it is recommended for individuals aged ≥16 years, including pregnant women, although the vaccine has not been tested on the latter. ObjectiveTo study the association between prenatal Pfizer-BioNTech COVID-19 vaccination, pregnancy course and outcomes. Study designA retrospective cohort study was performed, including all women who delivered between January and June 2021 at Soroka University Medical Center, the largest birth center in Israel. Excluded were women diagnosed with COVID-19 in the past, multiple gestations or unknown vaccination status. Pregnancy, delivery and newborn complications were compared between women who received 1 or 2-dose vaccines during pregnancy and unvaccinated women. Multivariable models were used to adjust for background characteristics. ResultsA total of 4,399 women participated in this study, 913 (20.8%) of which were vaccinated during pregnancy. All vaccinations occurred during second or third trimesters. As compared to the unvaccinated women, vaccinated women were older, more likely to conceive following fertility treatments, to have sufficient prenatal care, and of higher socioeconomic position. In both crude and multivariable analyses, no differences were found between the groups in pregnancy, delivery and newborn complications, including gestational age at delivery, incidence of small for gestational age and newborn respiratory complications. ConclusionsPrenatal maternal COVID-19 vaccine has no adverse effects on pregnancy course and outcomes. These findings may help pregnant women and health care providers to make informed decision regarding vaccination.

Audio source separation to reduce sleeping partner sounds: a simulation study

Objective. When recording a subject in an at-home environment for sleep evaluation or for other breathing disorder diagnoses using non-contact microphones, the breathing recordings (audio signals) can be distorted by sounds such as TV, outside noise, or air-conditioners. If two people are sleeping together, both may produce breathing/snoring sounds that need to be separated. In this study, we present signal processing and source separation algorithms for the enhancement of individual breathing/snoring audio signals in a simulated environment. Approach. We developed a computer simulation of mixed signals derived from genuine nocturnal recordings of 110 subjects. Two main source separation approaches were tested: (1) changing the basis vectors for the mixtures in the time domain (principal and independent component analysis, PCA/ICA) and (2) converting the mixtures to their time-frequency representations (degenerate un-mixing estimation technique, DUET). In addition to these source separation techniques, a beamforming approach was tested. Main results. The separation results with a reverberation time of 0.15 s and zero SNR between signals showed good performance (mean source to interference ratio (SIR): DUET = 12.831 dB, ICA = 3.388 dB, PCA = 4.452 dB), and for beamforming (SIR = −0.304 dB). To evaluate our source separation results, we propose two new measures: an evaluation measure based on a spectral similarity score (mel-SID) between the target source and its estimation (after separation) and a breathing energy ratio measure (BER). The results with the new proposed measures yielded comparable conclusions (mel-SID: DUET = 1.320, ICA = 2.732, PCA = 1.927, and beamforming = 2.590, BER: DUET = 10.241 dB, ICA = 0.270 dB, PCA = −2.847 dB, and beamforming = −1.151 dB), but better differentiated the differences between the performance of the algorithms. The DUET is superior on all measures. Its main advantage is that it only uses two microphones for separation. Significance. The separated audio signal can thus contribute to a more informed diagnosis of sleep-related and non-sleep-related diseases. The Institutional Review Committee of Soroka University Medical Center approved this study protocol (protocol number 10141) and all methods were performed in accordance with the relevant guidelines and regulations.

Hospitalizations Among Chernobyl-Exposed Immigrants to the Negev of Israel, 1992-2017: A Historical Follow-Up Study.

On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.

Condensation: A Retrospective Cohort Study to Investigate the Association Between Maternal Pre-pregnancy Obesity and Childhood Respiratory Disease.

We sought to explore whether maternal pre-pregnancy obesity is an independent risk factor for offspring respiratory morbidity during childhood. A population-based retrospective cohort analysis comparing childhood respiratory morbidity incidence in offspring to mothers with pre-pregnancy obesity (BMI≥ 30kg/m2) and those who had lower BMI was conducted. Respiratory diagnoses were pre-defined based on ICD-9 codes. The study population comprises of all deliveries that took place at the Soroka University Medical Center (SUMC), the sole tertiary hospital in the Negev (Southern Israel), between the years 1991-2014. A Kaplan-Meier survival curve was used for cumulative respiratory morbidity incidences over time and a Cox proportional hazards model was constructed to control for confounders. During the study period, 242,342 infants met the inclusion criteria; out of which 3290 were born to mothers with a diagnosis of pre-pregnancy obesity. Offspring to mothers with pre-pregnancy obesity had a significant higher risk for obstructive sleep apnea (OR 1.43, 95% CI 1.002-2.046) as well as a higher total risk for hospitalizations due to childhood respiratory morbidity (OR 1.21, 95% CI 1.041-1.398). The cumulative respiratory morbidity incidence over time was significantly higher in the maternal pre-pregnancy obesity group (p = 0.044). Controlling for maternal age, gestational diabetes mellitus, hypertensive disorders and gestational age, pre-pregnancy obesity remained an independent risk factor for offspring respiratory morbidity (adjusted HR = 1.175, 95% CI 1.018-1.357). Maternal pre-pregnancy obesity may create an environment leading to an increased risk for long-term offspring respiratory morbidity, and specifically obstructive sleep apnea.

SARS-CoV-2 universal screening upon adult hospital admission in Southern Israel

As the prevalence of coronavirus disease 2019 (COVID-19) increased in the local community, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) universal screening was initiated for all adult patients admitted through the emergency departments (EDs) at Soroka University Medical Centre. Of 8518 patients screened, 288 (3.38%) tested positive. One hundred and thirty-three (46%) positive cases were asymptomatic and would have been admitted without necessary precautions. Patients with symptoms that may be attributable to COVID-19 were significantly older and were admitted through the medical ED. Patients of Bedouin Arab ethnicity accounted for half of those who tested positive, which was double their prevalence in the general population. These findings indicate that universal SARS-CoV-2 screening on adult hospital admission is crucial in areas with a high prevalence of COVID-19.

Case series: Point-of-Care Ultrasound Conducted by Medical Students During their First Clinical Rotation Changes Patients’ Primary Diagnosis and Management

Background: As point-of-care ultrasound (POCUS) becomes a standard of care procedure, medical schools around the world have started to seek the integration of POCUS courses into their curricula. This puts medical students in a unique position as they are trained in an area in which many physicians lack knowledge. This case series provides a glimpse into the capabilities of POCUS even when used by medical students.&#x0D; Methods: Fourth-year medical students at Ben-Gurion University of the Negev performed numerous POCUS exams during their first clinical rotation at Soroka University Medical Center in Israel. All students completed a course in basic POCUS training and were evaluated in a brief practical exam before entering their first clinical rotation. Four of the cases in which the students took part are presented in this case series.&#x0D; Results: The POCUS exam in the first case discovered pulmonary embolism in addition to the diagnosis of Cushing disease. In the second case, endocarditis could have been diagnosed three days earlier had a POCUS exam been performed. Case 3 demonstrates the additional contribution of POCUS to the decision-making process carried out by physicians and its superiority in quantifying and diagnosing pleural effusion compared to chest X-Ray. Case 4 indicated that POCUS is preferable over chest X-ray and auscultation for the diagnosis of pulmonary edema.&#x0D; Conclusion: This case series may emphasize the capabilities POCUS has when utilized in the standard physical examination and the importance of incorporating POCUS instruction in medical schools for new physicians to acquire this skill.

Adhesion barriers and topical hemostatic agents are risk factors for post-cesarean section infections

BackgroundCesarean sections are the most common surgery worldwide, and post-cesarean section infections and hemorrhage are a major cause for morbidity and mortality. In recent years, many surgeons use adhesion barriers as well as hemostatic agents during primary and repeated cesarean section. The data regarding the safety of these agents is relatively limited. The objective of this study was to investigate whether the use of adhesion barriers and topical hemostatic agents pose a risk for post-cesarean section infections. MethodA case-control study composed of women who were admitted to the Soroka University Medical Center between the years 2012 and 2016 was conducted. The study group was composed of women admitted owing to post-cesarean section infections (cases) and those who underwent cesarean sections without post-cesarean section infection (control subjects). Matching was done according to date and surgery setting (elective versus emergency). A univariate analysis was followed by a multiple regression model in order to examine the association between adhesion barriers/hemostatic agents and post-cesarean section infections. ResultsDuring the study period, 113 patients developed postoperative infection (cases); 71.7% were diagnosed with surgical site infection, 7.1% with endometritis, and 21.2% with other infections. These were compared with 226 control subjects. In the univariate analysis, the use of adhesion barriers/hemostatic agents were found to be associated with post-cesarean section infection. Using a multivariable analysis controlling for previous cesarean section, skin closer technique, preterm delivery, and duration of surgery >60 minutes, the use of adhesion barriers as well as hemostatic agents was found to be independently associated with post-cesarean section infection (adjusted odds ratio = 2.11, 95% confidence interval = 1.17–3.84; adjusted odds ratio = 2.29, 95% confidence interval = 1.37–3.8, respectively) ConclusionAdhesion barriers and hemostatic agents were found to be independently associated with post-cesarean section infections. Further larger studies are needed to reinforce our findings. The use of these materials should be carefully considered, and their cost-effectiveness re-examined.

Sick of news? Television news exposure, collective stressful events and headache related emergency department visits.

Stress is a well-known trigger for primary headache yet its impact is difficult to demonstrate in large epidemiological studies. Israeli national TV news is often referred to as the "tribal fire", as many Israelis watch national news coverage following terror attacks or military operations. We examined the association between exposure to television news and their content with headache related Emergency Department visits. This retrospective cohort study included data on daily Emergency Department visits with a chief complaint of headache in Soroka University Medical Center, during 2002-2012. Data on daily television news viewership ratings were obtained from the Israeli Audience Research Board and its content from Channel 2 headlines, the highest rated TV news program. To estimate the short-term effects of news rating during the evening news on the number of daily headache visits, we applied generalized linear mixed models. 16,693 Emergency Department visits were included in the analysis. An increase in five units of daily rating percentages was associated with increase in Emergency Department visits the following day, relative risk (RR) = 1.032, (95% CI 1.014-1.050). This association increased with the age of the patients; RR = 1.119, (95% CI 1.075-1.65) for older than 60-year-old, RR = 1.044 (95% CI 1.010-1.078) for ages 40-60 and RR = 1.000 (95% CI 0.977-1.023) for younger than 40-year-old. We did not find a specific content associated with ED visit for headache. Higher television news ratings were associated with increased incidence of Emergency Department headache related visits. We assume that especially among older persons, news viewership ratings provide an indirect estimate of collective stress, which acts as a headache trigger for susceptible subjects.

Prenatal particulate matter exposure and Intrauterine Fetal Death.

Intrauterine Fetal Death (IUFD) is a rare and tragic pregnancy complication. The main causes for IUFD are largely unknown. Particulate Matter (PM)2.5 exposure has been suggested as an IUFD risk factor. To study the association between maternal PM2.5 levels and IUFD risk, to address ethnicity as a possible effect modifier, and to identify a prenatal period during which PM2.5 is most harmful regarding IUFD risk. This is a retrospective cohort study, which included pregnant women at the Soroka University Medical Center between the years 2003-2017. Estimated PM2.5 levels were calculated per residence, using a hybrid model incorporating daily satellite remote sensing data at a 1km spatial resolution. Multiple gestations, fetuses with congenital malformations or chromosomal abnormalities were excluded. Mean PM2.5 level was calculated per trimester, the entire pregnancy and the last gestational week. Analyses were also performed separately for the two ethnic groups in the study: Jews and Bedouin-Arabs. Multivariable analysis were applied to study the association between PM2.5 exposure at the different periods and IUFD risk. The study included 87,887 pregnancies, 444 (0.5%) ended with IUFD. Mean PM2.5 levels ranged between 18.18 and 22.32μm. First trimester and entire pregnancy PM2.5 levels were significantly associated with increased IUFD risk among Jewish women only. In a multivariable model, for every 10 μg/m3 unit increase in PM2.5 the risk for IUFD increases by 2.98 (95%CI 1.50-5.90) and by 3.61 (95%CI 1.32-9.85) during first trimester and the entire pregnancy, respectively, while adjusting for maternal age, smoking, socioeconomic score and season. In this retrospective cohort an association was found between PM2.5 levels and IUFD among Jewish women only. These results strengthen the importance of addressing this effect modifier when studying air pollution effects on human health.

Association between ambient temperature, particulate air pollution and emergency room visits for conjunctivitis

BackgroundNumerous studies have confirmed the association of ambient temperature and air pollution with a higher risk of morbidities, yet few have addressed their effect on the ocular system. The purpose of this study was to assess the association between temperature, air pollution, and emergency room visits for conjunctivitis.MethodsIn this case-crossover study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Daily exposure to fine and coarse particulate matter and temperature were determined by a hybrid model involving satellite sensors. Mean relative humidity was obtained from the Ministry of Environmental Protection meteorological monitoring station located in Beer-Sheva.ResultsSix hundred one patients were diagnosed with conjunctivitis in the SUMC emergency room. We discovered a positive association between temperature increments and incidence of conjunctivitis. The strongest effect was found during summer and autumn, with an immediate (lag0) incidence increase of 8.1% for each 1 °C increase in temperature (OR = 1.088, 95%CI: 1.046–1.132) between 24 and 28 °C in the summer and 7.2% for each 1 °C increase in temperature (OR = 1.072, 95%CI: 1.036–1.108) between 13 and 23 °C in the autumn. There was no statistically significant association between fine and coarse particulate matter and conjunctivitis incidence.ConclusionTemperature increases during summer and autumn are significantly associated with an increased risk of conjunctivitis. Conjunctivitis is not associated with non-anthropogenic air pollution. These findings may help community clinics and hospital emergency rooms better predict conjunctivitis cases and will hopefully lead to improved prevention efforts that will lower the financial burden on both the individual and the public.

Possible association between in vitro fertilization technologies and offspring neoplasm

To study the association among fertility treatments, treatment protocol, and offspring neoplasm risk up to the age of 18 years. A population-based retrospective cohort. Soroka University Medical Center (SUMC), the single tertiary medical center and invitro fertilization (IVF) unit in southern Israel. All offspring born at the SUMC between the years 1995 and 2018 after IVF treatment (the exposed group) and offspring conceived spontaneously (the unexposed group). The study was performed at the SUMC, the single tertiary medical center and IVF unit in southern Israel. The exposed and unexposed were matched with a ratio of 1:4, based on maternal age and calendar month of delivery. Data collection included a summary of the couple's medical records, delivery data, and offspring neoplasm diagnoses. Offspring neoplasm of any kind and time to diagnosis in each of the groups. A total of 1,583 exposed and 5,874 offspring were included in the study. The incidences of offspring benign neoplasm were 14 (0.9%) versus 21 (0.4%), and the incidences of malignancies were 17 (1.1%) versus 29 (0.5%) among offspring of the IVF and spontaneous groups, respectively. The association between mode of conception and offspring neoplasm risk remained significant after adjustingfor confounders, including mode of delivery and pregnancy complications such as hypertensive disorder, gestational diabetes mellitus, and preterm delivery compared with spontaneously conceived offspring. Among the IVF group, the increased risk for neoplasm was found among offspring who were transferred as fresh embryos, at an earlier stage of development (cleavage stage), or after three or more aspirated oocytes. IVF treatment is associated with offspring neoplasm risk; specifically, the risk was greater among offspring who were returned as fresh embryos, at an earlier embryotic stage (cleavage stage), or after three or more aspirated oocytes.

#metoo? The association between sexual violence history and parturients' gynecological health and mental well-being.

Sexual violence is a global health problem. We aimed to evaluate the association between self-reported history of sexual violence and parturients' health behaviors, focusing on routine gynecological care, and mental well-being. This was a retrospective questionnaire-based study, including mothers of newborns delivered at the "Soroka" University Medical Center (SUMC). Participants were asked to complete three validated questionnaires, including: screening for sexual violence history (SES), post-traumatic stress disorder (PDS) and post-partum depression (EPDS). Additionally, a demographic, pregnancy and gynecological history data questionnaire was completed, and medical record summarized. Multiple analyses were performed, comparing background and outcome variables across the different SES severity levels. Multivariable regression models were constructed, while adjusting for confounding variables. The study included 210 women. Of them, 26.3% (n = 57) reported unwanted sexual encounter, 23% (n = 50) reported coercion, 1.8% (n = 4) assault and attempted rape, and 1.4% (n = 3) reported rape. A significant association was found between sexual violence history and neglected gynecological care, positive EPDS screening, and reporting experiencing sexual trauma. Several multivariable regression models were constructed, to assess independent associations between sexual violence history and gynecological health-care characteristics, as well as EPDS score. Sexual violence history was found to be independently and significantly associated with a negative relationship with the gynecologist, avoidance of gynecological care, sub-optimal routine gynecological follow-up, and seeking a gynecologist for acute symptoms (adjusted OR = 0.356; 95% CI 0.169-0.749, adjusted OR = 0.369; 95% CI 0.170-0.804, adjusted OR = 2.255; 95% CI 1.187-4.283, and adjusted OR = 2.113; 95% CI 1.085-4.111, respectively), as well as with the risk of post-partum depression (adjusted OR = 4.46; 95% CI 2.03-9.81). All models adjusted for maternal age and ethnicity. Sexual violence history is extremely common among post-partum women. It is independently associated with post-partum depression, neglected gynecological care, a negative relationship with the gynecologist, and with reporting of experiencing sexual trauma. Identifying populations at risk and taking active measures, may reduce distress and improve emotional well-being and family function.

478 Validation of the hebrew version of the prolapse and incontinence knowledge questionnaire (PIKQ) during pregnancy

Pregnancy and delivery have a major effect on Pelvic Floor Disorders (PFD). Assessing knowledge regarding PFD in childbearing age women will enable women to make more informed decisions regarding perinatal care, and seek appropriate medical advice once PFD have developed. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a simple questionnaire assessing women's knowledge regarding urinary incontinence (UI) and pelvic organ prolapse (POP). Validation of a Hebrew version for the PIKQ has never been carried out. The purpose of this study was to validate the psychometric characteristics of the PIKQ in the Hebrew language. Translation of the PIKQ to the Hebrew language was performed according to international recommended guidelines. A cross sectional study of pregnant women was conducted from June to September 2020 in the Soroka University Medical Center, Israel, with the recommended 10:1 ratio between the number of subjects and the number of items in the questionnaire (n=24). A total of 240 third trimester pregnant women have completed the Hebrew version of the PIKQ. Construct validity, criterion validity and reliability tests were performed. Factor analysis for both domains of the Hebrew version of the PIKQ demonstrated 12 strong positive factor loadings to one principal factor in each domain (FL>0.3). The Hebrew PIKQ had an internal consistency, with Cronbach alpha coefficient of 0.748 for the UI domain and 0.793 for the POP domain. Significant correlations were found between women's perceived knowledge of UI and POP to PIKQ scores. The Hebrew version of the PIKQ is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding PFD in Hebrew speaking pregnant women. This instrument may be used to assess women's knowledge about pelvic floor disorders and the need for educational interventions that can improve the level of knowledge and enable women to make informed decisions about perinatal care.

443 Association between striae gravidarum and pelvic floor dysfunction symptoms during the third trimester of pregnancy

The exact pathophysiology of striae gravidarum (SG) is unknown but it has been postulated that some pregnancy induced changes in the connective tissue (CT) might be a contributing factor. Pelvic floor distress (PFD) symptoms are also known to be linked to CT weakness. We sought to examine whether an association exists between presence of SG and presence of pelvic floor distress (PFD) symptoms during late pregnancy. A prospective cohort study was conducted using the Pelvic Floor Distress Inventory -20 (PFDI-20) questionnaire which is a validated questionnaire serving as a quality-of-life instrument developed to measure the extent of injury to the pelvic floor , that has been validated in non-pregnant and pregnant women. Our cohort included women who visited the Soroka University Medical Center for routine pregnancy follow up during the 3d trimester of pregnancy and were asked to complete the PFDI-20 questionnaire regarding third trimester PFD symptoms. The severity of SG was calculated using the Davey scoring system. Women with connective tissue disease, those in active labor, with multiple pregnancy, polyhydramnios (defined as amniotic fluid index greater than 25) or with a history of pelvic floor surgery where excluded from the study. Univariate analysis was carried using appropriate tests, PFDI ranking was compared between the groups using Mann Whitney test. Of 187 women who were found eligible and had completed the questionnaire , 81 (43.3%) did not have SG, 24 (12.8%) had mild SG, 43 (23%) had moderated SG and the remaining 39 (20.9%) had severe SG. The distribution of median PDFI-20 scores according to presence and severity of SG are presented in table 1. The overall and median PFDI-20 scores differed between the groups, yet a distinct trend of an association between the PFDI-20 score and severity of SG was not demonstrated. In our population, we were able to demonstrate an association between PFD symptoms as evident by the PFDI-20 scores and presence of SG. Our findings highlight the theory of a common CT involvement in the pathophysiology of both conditions.