Early childhood allergy linked with development of attention deficit hyperactivity disorder and autism spectrum disorder.

BACKGROUND: Previous studies reported controversial results regarding the association between allergic disorders and attention deficit hyperactivity disorder (ADHD)/autism spectrum disorder (ASD). The aim of this article was to investigate whether allergic disorders are associated with ADHD/ASD in a large cohort of pediatric patients. METHODS: A retrospective study using the pediatric (0-18 year) database (ICD-9-CM codes) of Clalit Health Services during the years (2000-2018). Diagnosis of all disorders was made by specialist physicians. RESULTS: A total of 117 022 consecutive non-selective allergic children diagnosed with one or more allergic disorder (asthma, rhinitis, conjunctivitis, skin, food, or drug allergy) and 116 968 non-allergic children were enrolled to our study. The mean follow-up period was 11 ± 6 years. The presence of allergic disorders in early childhood (mean age of allergic diagnosis 4.5 ± 4.3 years) in boys as well as in girls significantly increased the risk to develop ADHD (O.R 2.45, CI 2.39-2.51; p < .0001), ASD (O.R 1.17, CI 1.08-1.27; p < .0001), or both ADHD + ASD (O.R 1.5, CI 1.35-1.79; p < .0001). Children with more than one allergic comorbidity revealed a much higher risk. In a multivariable analysis (adjusted for age at study entry, number of yearly visits, and gender), the risk of allergic children to develop ADHD and ADHD + ASD, but not ASD alone, remained significantly higher. CONCLUSION: Allergic disorder in early childhood significantly increased the risk to develop ADHD, and to a less extend ASD, in later life.

Screening practices of Israeli doctors' and their patients.

OBJECTIVE: Doctors' health matters because healthy physicians are more productive and because physicians' health practices affects their patient counseling habits, but there are few objective data on this topic. METHODS: An examination of differences in screening quality health indicators between physicians (n=429) and 1621 age, gender, and socioeconomically matched patient controls from our district Health Maintenance Organization in Israel during the first half of 2008. RESULTS: Doctors and matched patients had similar rates for low-density lipoprotein measurement (85%/84%=NS), colorectal cancer screening (23%/27%=NS), influenza vaccine among the chronically ill (23%/24%=NS), and mammography (for women, 55%/57%=NS). Doctors with hypertension had blood pressures clinically recorded considerably less frequently than matched patients do (56%/77%, p<0.001), and their smoking habits were recorded less often, but their recorded tobacco habits were significantly better. Physician-patient contrasts were also minimal (again except for clinician-recorded blood pressure and smoking) among the chronically ill. CONCLUSIONS: These are the first objective data of which we know that test (and confirm) prior self-reported data that physicians' screening experiences are similar to patients'. Improving physicians' personal screening could also improve patient screening: physicians' self-reported primary prevention habits are considerably better than patients' and have been shown repeatedly to strongly and consistently positively influence patient counseling practices, and hence the health of the public.

Association between rosiglitazone use and decline in renal function in patients with type 2 diabetes mellitus.

BACKGROUND: Use of thiazolidinediones (TZDs) in treatment of type 2 diabetes mellitus (T2DM) has recently become a matter of major controversy regarding their cardiovascular and renal safety. The aim of this study is to investigate the association between rosiglitazone use and renal function in diabetic patients. METHODS: This is a retrospective cohort study conducted on a population of patients with T2DM treated at a large public health service organization. All patients who received continuous rosiglitazone therapy for at least 1 year were included in the study group. For each patient in the study group, control patients with T2DM never treated with rosiglitazone were selected from the same population and matched for age, sex, HbA1c% and date of study entry. Level of renal function was expressed as estimated glomerular filtration rate (eGFR), calculated by the simplified Modification of Diet in Renal Disease (MDRD) Study equation. RESULTS: In total, 5,666 patients were included in the study: 1,304 were treated with rosiglitazone, and 4,362 were matched controls. Baseline eGFR was similar in both groups (74.6 +/- 22.9 vs. 73.8 +/- 23.3 ml/min per 1.73 m(2), respectively; p=0.291). After 5 years of follow-up, eGFR was significantly lower in the rosiglitazone-treated group than in control group (67.7 +/- 23.6 vs. 73.8 +/- 25.2 ml/min per 1.73 m(2), p<0.001). CONCLUSION: The use of rosiglitazone may be associated with a decline of renal function in patients with T2DM. Further studies are needed to better quantify the risk-benefit trade-offs associated with rosiglitazone therapy.

Is rosiglitazone use associated with an increase in intensive eye treatment in diabetic patients? A community based study.

OBJECTIVE: To evaluate the effect of rosiglitazone on diabetic retinopathy in the usual care setting. METHODS: Type 2 diabetic patients, aged over 40, who received rosiglitazone therapy for at least one year during the study period, were considered for the study group. All diabetic patients who had never received rosiglitazone or insulin were candidates for the control group. For each subject treated with rosiglitazone, up to five controls were randomly selected and matched on age, gender, and HbA1c%. We retrieved information about ophthalmologist visits, retinal argon laser therapy, vitrectomy and the date of the procedure. Time from the first rosiglitazone prescription to the first intervention was calculated. RESULTS: A total of 6689 subjects, 1304 in the rosiglitazone group and 5385 in the control group were followed for a median of 3.6 years. The baseline level of HbA1C% was slightly higher in the rosiglitazone group (9.2 versus 8.8). There were more ophthalmologist visits in the rosiglitazone group compared to the control group. 115/1304 (8.8%) patients in the study group had an event compared to 379/5385 (7.0%) control group (P = 0.027). HR for the study group was 1.3 (95% CI: 1.08-1.64) for any event compared to control group (P = 0.008). CONCLUSION: Rosiglitazone was associated with increased laser treatments and vitrectomy. Caution may be needed when treating diabetic patients with rosiglitazone.

Adherence with statins over 8 years in a usual care setting.

OBJECTIVE: To describe adherence with statin treatment in a usual practice setting and to investigate potential determinants of better adherence. STUDY DESIGN: Retrospective cohort study using administrative claims data. METHODS: Study patients were 47,680 individuals enrolled in the Central District of Clalit Health Services HMO in Israel who filled at least 1 prescription for statins between January 1, 1999, and December 31, 2006. Data were retrieved on patients' sex, year of birth and immigration, socioeconomic status, and whether they had diabetes mellitus, hypertension, and other cardiovascular diseases. RESULTS: Mean age at the beginning of treatment was 61.3 +/- 11.8 years; 53.3% of the study patients were women. The proportion with at least 1 chronic disease before starting statins was 40.1%; and 38.9%, 21.8%, and 9.6% of the patients were continuously adherent after 1, 3, and 6 years, respectively. Risk of discontinuation was highest among new immigrants (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.14, 1.27). Adherence was higher in patients having a chronic disease before starting statins (HR = 0.88; 95% CI = 0.84, 0.94) or after starting statins (HR = 0.90; 95% CI = 0.86, 0.95). Patients age <50 or >79 years had lower adherence rates. Low socioeconomic state did not affect adherence. CONCLUSIONS: Adherence with statin therapy was poor, though adherence rates were better in patients with accompanying chronic diseases. Of particular concern was the low level of adherence in new immigrants. Intervention programs are needed and should target all patient groups.