Nili Stein

Objectives: Integrative medicine programs are increasingly being implemented in clinical settings, including gynecology and obstetrics. This study explores an integrative obstetric and maternity care (IObM) model designed for real-life peri-labor settings, comparing perspectives among parturient women to obstetric healthcare professionals (HCPs) regarding operative components of the model. Methods: A 26-item questionnaire was prospectively administered to women hospitalized from the 22nd week of gestation (antenatal, early labor, or immediate postpartum) and to obstetric HCPs, primarily obstetricians and nurse-midwives, in three obstetric wards. Four core items addressed key aspects of the IObM model: the source of and indications for referral to IObM treatments, preferred IObM modalities, and willingness to receive care from uncertified IObM providers. Results: The two respondent groups (63 parturient women and 60 HCPs; response rate 95 and 100%, respectively) showed similar patterns regarding language, religiosity, spiritual relatedness, prior complementary medicine use (>66%), and perceived effectiveness and risks during pregnancy and labor. Internal consistency within each of the four core items was moderate and acceptable (parturients, α = 0.61–0.69; HCPs, α = 0.62–0.68). HCPs showed greater support than parturients for nurse-midwife referrals (p = 0.002) and mind-body trained therapies (p = 0.002). Both groups recommended labor-related indications for IObM referral, primarily labor pain, anxiety, and labor progression. Parturients were more supportive of nurse-provided IObM care (p = 0.012). Conclusions: Exploring expectations of parturient women and HCPs is essential when designing IObM models of care. Four core aspects should be prioritized: source of and indication for the referral to IObM treatments and mapping of preferred IObM modalities and providers. These findings reflect acceptability, expectations, and preferences in a single center with an established integrative service and should not be read as evidence of clinical effectiveness or of successful implementation. Further prospective research should explore implementation of these models in real-life practice, assessing effectiveness, risks, and birth experience.

Background: Patients with severe chronic anemia often require frequent blood transfusions. Many are elderly with comorbidities and limited mobility, making regular hospital visits burdensome. In some cases, patients may receive transfusions despite hemoglobin levels being above the clinical threshold due to logistical challenges, leading to unnecessary exposure to risks, inefficient use of blood units, and resource strain. This study aims to evaluate the use of point-of-care (POC) hemoglobin measurements under controlled outpatient clinic conditions, as an initial step toward potential future home-based monitoring by the patients or their caregivers, with the goal of optimizing transfusion timing, aiming to reduce unnecessary hospital visits while maintaining patient safety. Methods: A total of 127 patients from a hemato-oncology outpatient clinic at Carmel Medical Center were evaluated using a nurse-operated POC device to sample capillary blood, with 236 paired measurements concurrently analyzed via venous blood in the laboratory. Demographic and clinical data were assessed to evaluate factors associated with agreement between POC and laboratory measurements. Statistical analysis included Bland–Altman plots and Pearson correlation coefficients. Results: The POC device showed a moderate correlation with laboratory results (r = 0.73, p < 0.001), with a mean difference of 1.20 g/dL (SD = 1.94 g/dL) but wide limits of agreement (−3.20 to 5.50 g/dL). No significant differences were observed across demographic or clinical subgroups. Notably, all 156 paired measurements with POC-measured hemoglobin >7 g/dL were confirmed by laboratory testing. Conclusions: Although POC hemoglobin devices are not suitable as standalone tools for routine monitoring of chronic anemia, the high negative predictive value observed at the 7 g/dL threshold suggests that they may be useful for ruling out severe anemia. If validated in larger multicenter and home-use studies, POC Hb devices might contribute to reducing unnecessary hospital visits and transfusions.

Background/Objective: The emergence of the COVID-19 pandemic has raised significant concerns regarding its impact on immune-mediated diseases, particularly with respect to disease induction and exacerbation. We aimed to investigate the potential association between SARS-CoV-2 infection and COVID-19 vaccination and the development of Psoriatic Arthritis (PsA). Methods: A retrospective nested case-control study in a cohort of 3,122,602 adults without a diagnosis of PsA was conducted using a database of a large health care provider. Newly diagnosed patients with PsA aged 18 years and older were identified from the database between 1 January 2021 and 30 June 2022 and were matched by age and sex to 10 non-PsA controls. Patients were tracked to assess their exposure to SARS-CoV-2 within six months prior to diagnosis (inception date). The primary outcome of exposure to SARS-CoV-2 was compared in the cases and controls. Univariate and multivariate conditional logistic regression analyses were performed, adjusting for Body Mass Index (BMI), smoking, socioeconomic status (SES), the Charlson comorbidity index, ethnicity, psoriasis and COVID-19 vaccination status within six months. Results: Overall, 718 patients had a new diagnosis of PsA and were matched with 7180 controls. SARS-CoV-2 exposure among PsA cases was (N = 88/718, 12.3%) compared to controls (N = 755/7180, 10.5%), the difference was not statistically significant (p = 0.115). No statistically significant association was found between SARS-CoV-2 infection and PsA development after adjusting for all confounders (OR = 1.08, 95% CI [0.76–1.54], p = 0.652). COVID-19 vaccination was also not associated with PsA development (OR = 1.10, 95% CI [0.86–1.41], p = 0.45). Conclusions: This study found no statistically significant association between SARS-CoV-2 exposure or COVID-19 vaccination and PsA development within six months post-exposure; however, small differences cannot be excluded.

Background: Type 2 diabetes mellitus (T2DM) is common among patients with chronic obstructive pulmonary disease (COPD). We examined the association between glycemic control and clinical outcomes in patients with COPD exacerbation and T2DM. Methods: A retrospective study of patients with T2DM and COPD exacerbation comparing controlled (HbA1c < 7.5%) to uncontrolled (HbA1c ≥ 7.5%) glycemia prior to admission. The primary endpoint is defined as a composite of 6-month rehospitalization/mortality. Secondary endpoints included 6-month mortality and 6-month readmission. Results: Of 426 admissions, 179 (42%) had uncontrolled glycemia. The risk of rehospitalization/mortality was significantly increased in the uncontrolled group in univariate (HR1.6, 95%CI 1.11–2.3, p = 0.01) and multivariate (HR 1.82, 95%CI 1.24–2.67, p = 0.002) analyses. The risk of 6-month rehospitalization was increased in the uncontrolled group in both univariate (HR1.94, 95%CI 1.16–3.23, p = 0.011) and multivariate (HR1.98, 95%CI 1.19–3.27, p = 0.008) analyses. No difference was found between 6-month mortality risks. Conclusions: Optimal glycemic control may improve COPD management and reduce adverse outcomes.

Background: Research on quality of life (QoL)-related concerns among patients with both diabetes mellitus (DM) and cancer is limited. This study compared the QoL-related concerns and characteristics among chemotherapy-treated patients with cancer and DM to those without DM. Methods: Chemotherapy-treated patients were evaluated during integrative oncology (IO) consultations, which included evidence-based complementary therapies recommended by their healthcare providers to address quality of life (QoL) concerns. During these consultations, the participants were assessed for comorbidities, including diabetes mellitus (DM). QoL-related concerns were measured using the Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Of the 1171 patients referred for an IO consultation, 272 (23.2%) had an established diagnosis of DM. The DM patients were older, presented with more advanced stages of cancer, and had more chronic comorbidities (p < 0.001). While fatigue was the most frequently reported QoL-related concern in both groups, the patients with DM had more severe pain scores in the ESAS (4.9 vs. 4.4, p = 0.022) and lower ESAS well-being scores (5.9 vs. 5.5, p = 0.021). Conclusions: Chemotherapy-treated patients with cancer and DM are characterized by higher rates of comorbidities and report more severe scores for pain and for poorer general well-being. Oncologists and diabetologists should consider referring patients with both diagnoses for an IO consultation to address their QoL-related concerns. More research is needed to understand the impact of IO consultations and treatments on well-being among patients diagnosed with both DM and cancer.

Limited information is available on the effectiveness of COVID-19 vaccination in patients with psoriasis and psoriatic arthritis (psoriatic disease (PsD)). The objective of our research was to assess the effectiveness of mRNA COVID-19 vaccination in preventing SARS-CoV-2 positivity and severe infection in a cohort of patients with PsD and the association of immunosuppressants on SARS-CoV-2 infection-related outcomes from December 2020 to December 2021. Vaccine effectiveness was assessed in a matched nested case control study using conditional logistic regression adjusted for demographics, comorbidities and immunosuppressant use. Study outcomes included SARS-CoV-2 positivity and severe COVID-19 (moderate-to-severe COVID-19-related hospitalizations or death). At least one dose of mRNA COVID-19 vaccine was associated with reduced risk of SARS-CoV-2 positivity and severe COVID-19 (OR = 0.41 (95% CI, 0.38–0.43) and OR = 0.15 (95% CI, 0.11–0.20), respectively). A more significant effect was found among patients who received three vaccines doses compared with those who did not receive any (OR (for positive SARS-CoV-2) = 0.13 (95% CI, 0.12–0.15) and OR (for severe disease) = 0.02 (0.01–0.05)). Etanercept and methotrexate were associated with higher risk of SARS-CoV-2 positivity (1.58 (1.19–2.10), p = 0.001 and 1.25 (1.03–1.51), p = 0.03, respectively). In conclusion, our results show that mRNA COVID-19 vaccines are effective in reducing both infection and severe COVID-19-related outcomes.

The data on the risk of herpes zoster (HZ) in spondyloarthropathy (SpA) patients are sparse, especially regarding its association with the novel mRNA COVID-19 vaccines and immunosuppressants. We aimed to evaluate whether SpA diagnosis and/or immunosuppressant use affect HZ risk and the influence of mRNA COVID-19 vaccination. We assessed the association between SpA (psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) diagnoses and HZ in a large population database with patients matched by age and sex to controls. We also assessed the association between the COVID-19 vaccine and new-onset HZ using two nested case–control studies, identifying all new HZ cases diagnosed from 1 January–31 December 2021 within the SpA and general population cohorts, matched randomly by sex, age and HZ index date to controls without HZ. Exposure to mRNA COVID-19 vaccination was ascertained in the 6 weeks prior to the index date both in cases and controls. In our results, the incidence rate of HZ was higher in PsA patients vs. the general population, at 1.03 vs. 0.64 per 100 person-years, respectively (adjusted HR = 1.55; 95%CI, 1.19–2.02). Within the SpA group, Jak-I treatment was associated with a higher risk of developing new-onset HZ (adjusted OR = 3.79; 1.15–12.5). Multivariable conditional logistic regression models we used showed no association between COVID-19 vaccination and new-onset HZ among the SpA patients (OR = 1.46; 0.68–3.14).

Development of autoantibodies following BNT162b2 mRNA COVID-19 vaccination and their association with disease flares in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) and the general population: results of 1-year prospective follow-up study. We conducted a prospective study aimed at investigating the incidence of appearance of autoantibodies (antinuclear, antiphospholipid, and rheumatoid factor) in the sera of 463 adult patients with AIIRD compared to 55 controls from the general population prior to, and following the second and third vaccine doses, and at 1-year of follow-up. Pre- and post-vaccination disease activity indices and the association of autoantibodies with rheumatic disease flares and new onset AIIRD were examined. Autoantibody development of any type in AIIRD patients vs. the controls was 4.0% (vs. 6.7%, p = 0.423) following two vaccine doses and 7.6% (vs. 0%, p = 0.152) after three doses. There was no significant difference in sex, age, or disease-type among individuals with and without autoantibody development, regardless of the immunosuppressant use. More patients developed autoantibodies following the third than the second vaccine dose (p = 0.004). Disease flares occurred in 5.8% and 7.2% of AIIRD patients following second and third vaccine doses, respectively, with autoantibody production increasing the risk of flares following the second (p = 0.002) and third (p = 0.004) vaccine doses. BNT162b2 vaccination resulted in the development of autoantibodies in a minority of AIIRD patients and controls. Autoantibody development was associated with disease flares in patients, but no new-onset autoimmunity was observed.