Publications by authors named "Jonathan Bar��"

12 Publications

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Mental Health Self-Stigma of Syrian Refugees With Posttraumatic Stress Symptoms: Investigating Sociodemographic and Psychopathological Correlates.

Front Psychiatry 2021 13;12:642618. Epub 2021 Jul 13.

Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig (ISAP), Leipzig, Germany.

The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization. Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale - Short Form (SSMIS-SF), consisting of four subscales ( , ), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales. On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on to 28.3 (SD = 7.5) points on . Results showed higher scores on for individuals who were younger ( = 2.65, = 0.009) and single ( = 5.70, = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher stigma (β = 0.18, = 0.044), controlling for sociodemographic covariates. Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.
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http://dx.doi.org/10.3389/fpsyt.2021.642618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313733PMC
July 2021

Herpes Simplex Virus-Associated Keratitis.

J Emerg Med 2021 Jul 15;61(1):e11-e12. Epub 2021 May 15.

Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jemermed.2021.02.032DOI Listing
July 2021

Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial.

BMC Fam Pract 2021 Apr 2;22(1):61. Epub 2021 Apr 2.

Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.

Background: The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network.

Methods: In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models.

Results: More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up.

Conclusion: To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results.

Trial Registration: The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).
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http://dx.doi.org/10.1186/s12875-021-01404-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017625PMC
April 2021

Do self-reported hearing and visual impairments predict longitudinal dementia in older adults?

J Am Geriatr Soc 2021 Jun 18;69(6):1519-1528. Epub 2021 Mar 18.

Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.

Background: Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia.

Design: Multi-centric population-based prospective cohort study.

Setting: Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts.

Participants: Older adults (N = 3497) with mean age 79.8 years, 67.2% female.

Measurements: Standardized interviews and questionnaires were used to assess self-reported HI and VI at baseline and all-cause dementia in 9 follow-ups, spanning over 20 years.

Methods: Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality.

Results: HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04-1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90-1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81-1.46, p = 0.567).

Conclusions: Hearing impairment is associated with an increased incidence of all-cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long-term risk of dementia.
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http://dx.doi.org/10.1111/jgs.17074DOI Listing
June 2021

Laboratory monitoring during antifungal treatment of paediatric tinea capitis.

Mycoses 2021 Feb 27;64(2):157-161. Epub 2020 Oct 27.

Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.

Griseofulvin and terbinafine are considered effective first-line therapies for tinea capitis (TC). Haematological dyscrasias and hepatic injury are possible adverse effects with both drugs. There is a debate in the literature regarding the necessity of laboratory monitoring during griseofulvin and terbinafine treatment. We aimed at assessing the prevalence and severity of haematological and hepatic laboratory test abnormalities in a paediatric cohort of African immigrants in Tel-Aviv with TC who were treated with Terbinafine or Griseofulvin. We conducted a retrospective study of all TC cases diagnosed and treated at the paediatric dermatology clinic, Tel-Aviv Medical centre, between June 2013 and March 2019. Epidemiologic, clinical and laboratory data were collected. Our cohort included 321 patients of whom 225 (70%) were treated with Griseofulvin and 96 (30%) with Terbinafine. We identified a total of 64 (20%) patients with haematological or hepatic laboratory test abnormalities that in most cases (96.3%) were considered as mild. No difference in laboratory abnormalities prevalence was identified between the griseofulvin and terbinafine groups (21.3% and 16.6%, respectively). Only one patient treated with Griseofulvin revealed significantly increased levels of hepatic aminotransferases that required discontinuation of treatment. Mild elevation in hepatic transaminases is relatively common among paediatric patients treated with systemic antifungal treatment for TC. However, significant laboratory abnormalities are extremely rare and may be diagnosed and addressed early through periodic laboratory tests monitoring.
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http://dx.doi.org/10.1111/myc.13197DOI Listing
February 2021

Griseofulvin vs terbinafine for paediatric tinea capitis: When and for how long.

Mycoses 2019 Oct 18;62(10):949-953. Epub 2019 Aug 18.

Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Outbreaks of tinea capitis (TC) can be a source of medical and economic burden for healthcare systems; Griseofulvin and terbinafine are considered to be effective first-line treatments for TC. In order to compare the efficacy of griseofulvin and terbinafine for the treatment of TC in a paediatric population of African immigrants in the Tel Aviv area, we conducted a retrospective cohort study of all cases of TC diagnosed and treated between March 2016 and February 2018 at a dedicated TC paediatric dermatology clinic at the Tel Aviv Medical Center (which serves as a referral centre for the paediatric refugee population in the Tel Aviv metropolitan area). Epidemiologic, clinical and laboratory data were collected, and 304 patients were included. Trichophyton violaceum (TV), Trichophyton soudanense (TS) and Microsporum audouinii (MA) were the prominent causative organisms. Treatment with griseofulvin suspension for 12 weeks was compared with (a) griseofulvin suspension for 8 weeks and with (b) terbinafine tablets for 4 weeks. There was no statistically significant difference between the groups regarding age, sex, country of birth, ethnicity and the causative organism. Twelve weeks of griseofulvin treatment had a statistically significant better cure rate than 4 weeks of terbinafine. Treatment was significantly more effective when TC was due to infections with MA and TS as compared with TV. No statistically significant difference was observed between 12- and 8-week treatment with griseofulvin.
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http://dx.doi.org/10.1111/myc.12970DOI Listing
October 2019

Pearls & Oy-sters: Diagnosis and monitoring of elevated intracranial pressure through ultrasound of the optic nerve.

Neurology 2019 02;92(6):299-301

From the Departments of Emergency Medicine (J.B., W.C., N.P.) and Neurology (J.R.), Hospital of the University of Pennsylvania, Philadelphia.

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http://dx.doi.org/10.1212/WNL.0000000000006888DOI Listing
February 2019

Accidental Hydrogen Peroxide Ingestion.

Clin Pract Cases Emerg Med 2018 Aug 18;2(3):262-263. Epub 2018 May 18.

Lancaster General Hospital, Department of Emergency Medicine, Lancaster, Pennsylvania.

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http://dx.doi.org/10.5811/cpcem.2018.4.37749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075491PMC
August 2018

[Social Loss Experiences and their Association with Depression in Old Age - Results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)].

Psychiatr Prax 2019 Apr 25;46(3):141-147. Epub 2018 May 25.

Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig.

Objective: Loss experiences in old age are common and can be accompanied by serious consequences such as depression. This study aimed at investigating the distribution of loss experiences and their association with depression in old age.

Methods: Based on the Leipzig Longitudinal Study of the Aged 75+ (LEILA 75+), a sample of 706 individuals was assessed via structured clinical interviews. Data on social loss experiences were collected via the Leipziger Lebensereignis-Liste. Descriptive and interferential statistical analyses were conducted in order to examine the association between loss experiences and depression.

Results: Overall, 16.4 % of the oldest old reported at least one social loss experience in the last 6 months while the death of a loved one (46.6 %) and severe illness (43.1 %) were the most frequent types of social loss experiences. Analyses revealed that social loss experiences were significantly associated with depression.

Conclusion: This study provides, for the first time in Germany, data on loss experiences in the oldest old. These findings may contribute to the development of interventions and effective treatment for the bereaved elderly with depression.
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http://dx.doi.org/10.1055/a-0596-9701DOI Listing
April 2019

Assessing Coagulation by Rotational Thromboelastometry (ROTEM) in Rivaroxaban-Anticoagulated Blood Using Hemostatic Agents.

Prehosp Disaster Med 2017 Oct 19;32(5):580-587. Epub 2017 Jun 19.

2Department of Emergency Medicine,New York-Presbyterian Hospital, New York,New YorkUSA.

Introduction The use of direct oral anticoagulants (DOACs) such as rivaroxaban (Xarelto) is increasingly common. However, therapies for reversing anticoagulation in the event of hemorrhage are limited. This study investigates the ability of hemostatic agents to improve the coagulation of rivaroxaban-anticoagulated blood, as measured by rotational thromboelastometry (ROTEM). Hypothesis/Problem If a chitosan-based hemostatic agent (Celox), which works independently of the clotting cascade, is applied to rivaroxaban-anticoagulated blood, it should improve coagulation by decreasing clotting time (CT), decreasing clot formation time (CFT), and increasing maximum clot firmness (MCF). If a kaolin-based hemostatic agent (QuikClot Combat Gauze), which works primarily by augmenting the clotting cascade upstream of factor Xa (FXa), is applied to rivaroxaban-anticoagulated blood, it will not be effective at improving coagulation.

Methods: Patients (age >18 years; non-pregnant) on rivaroxaban, presenting to the emergency department (ED) at two large, university-based medical centers, were recruited. Subjects (n=8) had blood drawn and analyzed using ROTEM with and without the presence of a kaolin-based and a chitosan-based hemostatic agent. The percentage of patients whose ROTEM parameters responded to the hemostatic agent and percent changes in coagulation parameters were calculated.

Results: Data points analyzed included: CT, CFT, and MCF. Of the samples treated with a kaolin-based hemostatic agent, seven (87.5%) showed reductions in CT, eight (100.0%) showed reductions in CFT, and six (75.0%) showed increases in MCF. The average percent change in CT, CFT, and MCF for all patients was 32.5% (Standard Deviation [SD]: 286; Range:-75.3 to 740.7%); -66.0% (SD:14.4; Range: -91.4 to -44.1%); and 4.70% (SD: 6.10; Range: -4.8 to 15.1%), respectively. The corresponding median percent changes were -68.1%, -64.0%, and 5.2%. Of samples treated with a chitosan-based agent, six (75.0%) showed reductions in CT, three (37.5%) showed reductions in CFT, and five (62.5%) showed increases in MCF. The average percent changes for CT, CFT, and MCF for all patients were 165.0% (SD: 629; Range:-96.9 to 1718.5%); 139.0% (SD: 174; Range: -83.3 to 348.0%); and -8.38% (SD: 32.7; Range:-88.7 to 10.4%), respectively. The corresponding median percent changes were -53.7%, 141.8%, and 3.0%.

Conclusions: Rotational thromboelastometry detects changes in coagulation parameters caused by hemostatics applied to rivaroxaban-anticoagulated blood. These changes trended in the direction towards improved coagulability, suggesting that kaolin-based and chitosan-based hemostatics may be effective at improving coagulation in these patients. Bar J , David A , Khader T , Mulcare M , Tedeschi C . Assessing coagulation by rotational thromboelastometry (ROTEM) in rivaroxaban-anticoagulated blood using hemostatic agents. Prehosp Disaster Med. 2017;32(5):580-587.
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http://dx.doi.org/10.1017/S1049023X17006641DOI Listing
October 2017

Electronic tablet augmented simulation: a pilot study.

Wilderness Environ Med 2015 Jun 12;26(2):282-4. Epub 2015 Mar 12.

College of Physicians and Surgeons Columbia University Emergency Medicine Department New York, NY.

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http://dx.doi.org/10.1016/j.wem.2014.12.023DOI Listing
June 2015

Combined vaginal-cesarean delivery of twins: risk factors and neonatal outcome--a single center experience.

J Matern Fetal Neonatal Med 2015 Mar 18;28(5):509-14. Epub 2014 Jun 18.

Helen Schneider Hospital for Women, Rabin Medical Center , Petah Tikva , Israel and.

Objective: We aimed to characterize risk factors for combined twin delivery and assess neonatal outcome.

Methods: This was a retrospective cohort study of all women admitted for trial of labor (TOL) with twin gestation, in a single, tertiary, university-affiliated medical center. Eligibility was limited to gestations with twin A delivered vaginally.

Results: During the study period, 44 263 women delivered in our center, of whom 1307 (2.9%) delivered twins. Overall, 221 out of 247 women (89.5%) undergoing TOL delivered twin A vaginally. Parturients who delivered twin B by cesarean delivery (n = 23) were compared with those delivered twin B vaginally (n = 198). Multivariate analysis demonstrated that risk factors combined delivery were included non-cephalic twin B at admission (aOR 11.5, 95% CI 3.8-34.9, p < 0.001) or after delivery of twin A (aOR 17.7, 95% CI 6.6-47.2, p < 0.001), and dichorionic-diamniotic (DCDA) twins (aOR 8.9, 95% CI 1.8-44.0, p = 0.008). Spontaneous version of a cephalic twin B was not found to increase the risk (above the baseline risk of non-cephalic twin B) for combined delivery. Combined delivery was associated with slightly higher risk for hemorrhagic-ischemic encephalopathy of twin B (4.3% versus 0%, p = 0.003).

Conclusion: Non-cephalic twin B at admission or following delivery of twin A poses higher risk for combined delivery. Neonatal outcome of twin B following combined delivery are comparable with those of vaginal delivery.
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http://dx.doi.org/10.3109/14767058.2014.927430DOI Listing
March 2015
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