Glucose levels are not the same for everyone: a real-world big data study evaluating fasting serum glucose levels by sex and age among children.

OBJECTIVES: Understanding the normal range of laboratory values as pertained to different age groups and males or females is paramount in health care delivery. We aimed to assess the distribution of morning fasting serum glucose levels by age and sex in the general population of children using a large-scale population-based cohort. METHODS: A retrospective study with real-world de-identified data from a large, state mandated health fund in Israel among children aged 2-18 years old between 2006 and 2019. Age, sex, and BMI differences in mean glucose levels were evaluated. RESULTS: Study included 130,170 venous blood samples from 117,411 children, 53.3 % were female. After adjusting for age boys had higher fasting serum glucose levels than girls, with a mean of 89.21 ± 8.66 mg/dL vs. 87.59 ± 8.35 (p<0.001) [4.95 ± 0.48 mmol/L vs. 4.86 ± 0.46]. Compared to the 15 to 18 year-olds (88.49 ± 7.63 mg/dL) [4.92 ± 0.42 mmol/L], 2 to 5 year-olds had lower glucose levels (84.19 ± 10.65, [4.68 ± 0.59] (p<0.001)), 11 to 14 year-olds had higher glucose (90.40 ± 7.42 [5.02 ± 0.41], (p<0.001)) and 6 to 10 year-olds showed no difference (88.45 ± 8.25) [4.91 ± 0.46]. 33.0 % (n=42,991) had a BMI percentile record the same year as their glucose test result. There was a weak yet significant positive association between blood glucose levels and BMI. CONCLUSIONS: Our large cohort indicates that boys have slightly higher fasting serum glucose levels than girls, as do adolescents compared to younger children. This finding is important for the delivery of adequate health care, screening for illness and avoiding unnecessary investigations and tests.

Mild Hyponatremia as an Early Marker for Intrathoracic Cancer: A Cohort Study.

BACKGROUND: Intrathoracic cancer can cause hyponatremia, but it is uncertain whether mild hyponatremia in the outpatient setting should be regarded as an early sign of intrathoracic cancer. OBJECTIVES: To evaluate the risk of undiagnosed intrathoracic cancer in patients with new persistent mild hyponatremia. METHODS: We conducted a retrospective cohort study using the electronic health record database of a large healthcare organization. The hyponatremia group included patients with sodium concentration of 130-134 mmol/L twice, after a previous normal value and without previous history of cancer or diseases related to hyponatremia. A control group with normal sodium concentration was matched by sex, age, and year of testing. We measured specific intrathoracic cancer incidence during 3 years of follow-up after sodium concentration test date. A logistic regression was used to adjust for further clinical information including smoking history, symptoms, and medications. RESULTS: The study comprised 1539 participants with mild hyponatremia and 7624 matched controls. New intrathoracic cancer diagnosis was more common in the hyponatremia group during a 3-year follow-up; 1.49% in the hyponatremia group and 0.39% in the control group, crude odds ratio (OR) 3.84, 95% confidence interval (95%CI) 2.22-6.63. After adjustment, hyponatremia remained a significant risk factor for the diagnosis of intrathoracic cancer; adjusted OR 3.61, 95%CI 2.08-6.28. CONCLUSIONS: New mild persistent hyponatremia might be a significant predictive marker to a yet undiagnosed intrathoracic cancer.

Risk of major osteoporotic fractures among ultra-orthodox Jews.

The Ultra-Orthodox Jewish population has behaviors that can influence the risk for osteoporotic fractures. We investigated whether this population is more prone to osteoporotic fractures than non-Orthodox Jewish. We did not find a significant difference in osteoporotic fracture rates between the two populations despite major differences in exposure to potential risk factors. INTRODUCTION: The Ultra-Orthodox Jewish population is a conservative population with unique cultural behaviors such as modest clothing and specific dietary restrictions, which can influence bone density and risk for osteoporotic fractures. The aim of this study is to investigate whether the Ultra-Orthodox Jewish population is more prone to osteoporotic fractures than the non-Orthodox Jewish population. METHODS: This retrospective cohort study utilized computerized records from Maccabi Health Service. Study population included patients 65 years and older without a history of osteoporotic fracture, who reside in regions of Ultra-Orthodox and non-Orthodox Jews. The primary outcome was the adjusted risk to osteoporotic fracture during 9 years of follow-up. Cox regression included patient characteristics and risk factors for osteoporosis. RESULTS: A total of 115,134 patients were included in this study: 5397 patients residing in Ultra-Orthodox regions (51.0% female) and 109,737 patients residing in non-Orthodox regions (52.6% female). A total of 16,352 (14.2%) patients had an osteoporotic fracture during the study period. There was no significant difference in fracture rate between Ultra-Orthodox and non-Orthodox (14.3% vs. 14.2%, p = 0.827). Among Ultra-Orthodox and non-Orthodox females and males, there were no significant differences in fracture rates (19.1% vs. 19.1% p = 0.982 and 9.3% vs. 8.8% p = 0.311, respectively). The adjusted hazard risk for the Ultra-Orthodox Jews was 1.026, 95% CI: 0.95-1.11, p = 0.512. CONCLUSION: We did not find a significant difference in the rate of osteoporotic fractures between Ultra-Orthodox and non-Orthodox populations despite major differences in exposure to potential risk factors. Results suggest that the perception of risk factors relevant for the religious communities should be re-evaluated.

Childhood Asthma - The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review.

BACKGROUND: Childhood asthma is the most common chronic disease throughout the western world. Improving asthma control is a leading health management goal. PURPOSE: To evaluate the effect of an intervention by a visit to an asthma specialist on asthma control in children. MATERIALS AND METHODS: This retrospective study was conducted using the electronic database of Maccabi Health Services. All members ages 5-16 with an asthma diagnosis during 2000-2016, and at least one visit to a specialist were included. Asthma outcomes during the 2 years before and after the visit to the asthma specialist were compared. RESULTS: A total of 37,066 children were diagnosed with asthma. Among them, 13,533 (36.5%) had at least one visit to an asthma specialist and were included. Children with asthma visited their primary care physician more often in the period before the specialist visit (4.4± 4.4 vs 3.16± 3.9 visits, respectively; p<0.01). After visiting a specialist, average number of visits to emergency departments (0.52± 1.3 vs 0.45±1), all cause hospitalizations (0.13±0.45 vs 0.08±0.4) and hospitalizations due to asthma exacerbations (0.08±0.345 vs 0.05±0.3) decreased (p<0.01 for all comparisons). Prescription of short-acting beta agonists decreased (2.85±3.6 vs 2.2 ±3.7, p<0.01) and inhaled steroid prescriptions increased (1.9±2.9 vs 2.7±3.7, p<0.01), respectively, after the intervention. A substantial reduction in the prescription of corticosteroids (0.81±1.9 vs 0.43±1.4, p<0.01) after specialist visit was also noted. CONCLUSION: We found significant positive outcomes after a single consultation with an asthma specialist. Referring pediatric asthma patients to an asthma specialist should be one of the goals of an asthma management plan.

Effects of sodium glucose co-transporter 2 inhibitors on genital infections in female patients with type 2 diabetes mellitus- Real world data analysis.

AIMS: Sodium glucose co-transporter 2 (SGLT2) inhibitors are associated with increased risk of genital infections. We aimed to assess incidence and risk factors associated with genital infections among female patients with type 2 diabetes mellitus (T2DM) treated with SGLT2 inhibitors. METHODS: We retrieved data on adult female patients with T2DM who initiated treatment with empagliflozin or dapagliflozin during March 2015-March 2018, in a large Israeli health maintenance organization (HMO). Genital infections were identified by diagnosis codes or relevant dispensed prescriptions. The proportion of days covered with SGLT2 inhibitors (SGLT2i-PDC) was measured. Univariate and multivariate analyses were performed to identify risk factors. RESULTS: Of 1542/6153 patients, 25.1% had events of genital infections during a mean of 2.3 years. The adjusted hazard ratio (HR) was 4.25 for the highest versus lowest SGLT2i-PDC group. Younger age, history of genital infection, and estrogen therapy were associated with increased risk of genital infections. Chronic Kidney Disease and DPP4 inhibitor therapy at baseline were associated with lower risk of genital infections. CONCLUSIONS: Potential risk factors for genital infections were identified in women initiating SGLT2 inhibitors.

Primary care physicians' attitudes toward research: a cross-sectional descriptive study.

BACKGROUND: Clinical research in family medicine can improve health outcomes and increase physicians' professionalism, yet is modest compared to other disciplines and receives little funding. OBJECTIVES: To identify factors that promote and impede engagement of family physicians in research and to compare characteristics of family physicians who do and do not engage in research. METHODS: During September to October 2018, e-mail questionnaires were sent to 1424 primary care physicians of one health maintenance organization. Respondents were classified as researchers and non-researchers based on their research experience. Responses were analysed using univariate analysis, principal component analysis and multivariate logistic regression. RESULTS: Of 235 respondents, 48 (20.4%) were categorized as researchers. The respondents generally agreed that research in primary care improves medical services and provides professional prestige; and that workload, bureaucracy and lack of dedicated time hinder engagement in research. Logistic regression analysis identified several factors associated with being a researcher, including advanced research training (P = 0.001, AOR = 8.49, 95% CI [2.49-29.14]), reading more research articles (P = 0.013, AOR = 14.16, 95% CI [1.76-113.5] and self-employment (P = 0.005, AOR = 5.92, 95% CI [1.71-20.44]). In a factor analysis, only 'importance of research' was associated with being a researcher (P = 0.039, AOR = 1.89, 95% CI [1.03-3.48]). Compared to non-researchers, researchers were older (83.3% versus 51.3% aged >40 years, P < 0.001), more often men (60.4% versus 37.4%, P = 0.02) and worked more (41.7% versus 16.7% worked >41 hours weekly, P = 0.02). CONCLUSIONS: Providing time dedicated to research, administrative support, research training and education about the importance of research could increase participation in research by primary care physicians.

A Clinician-Researcher Training Program for Family Medicine Residents.

PURPOSE: Research training for clinicians is becoming relatively common for postdoctoral trainees in academic institutions. In contrast, there are relatively few such training programs for family physician residents. The purpose of this article is to describe a novel program for family medicine trainees in Maccabi Health Services, a large Israeli health fund. METHODS: Following organizational approval and budget allocation, a call for family residents resulted in 18 applications, 15 of whom were selected for a two-year research training program. Each trainee submitted a research proposal, dealing with a community- based research question. Each protocol was allocated a budget. The Program, overseen by a steering committee of family physicians and scientists, has a designated clinical epidemiologist who coordinates all activities. The Project runs monthly face-to-face meetings where trainees present their research proposals. The group reviewed the protocols ahead of time, commented on them and criticized them. In parallel, the trainees participate in a detailed discussion of their research proposals face-to-face with the program director and clinical epidemiologist, and the revised research proposal is submitted to the Institution Review Board. RESULTS: The Program received enthusiastic responses from the trainees and from Maccabi Health Services, which has already approved the budget for the second year of the Program with a new stream of trainees. The approved research proposals dealt with original and important community-based clinical questions. CONCLUSIONS: With the aim of developing clinician-researchers in the field of family medicine, this novel program will help change the research climate in a large organization, where community-based family practitioners were not typically involved in research.