Publications by authors named "Barak Gordon"

42 Publications

Self-reported symptoms in healthy young adults to predict potential coronavirus disease 2019.

Clin Microbiol Infect 2021 Jan 6. Epub 2021 Jan 6.

Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Objective: To assess the utility of self-reported symptoms in identifying positive coronavirus disease 2019 (COVID-19) cases among predominantly healthy young adults in a military setting.

Methods: A questionnaire regarding COVID-19 symptoms and exposure history was administered to all individuals contacting the Israeli Defence Forces Corona call-centre, before PCR testing. Surveyed symptoms included cough, fever, sore throat, rhinorrhoea, loss of taste or smell, chest pain and gastrointestinal symptoms. Factors were compared between positive and negative cases based on confirmatory test results, and positive likelihood ratios (LR) were calculated. Results were stratified by sex, body mass index, previous medical history and dates of questioning, and a multivariable analysis for association with positive test was conducted.

Results: Of 24 362 respondents, 59.1% were men with a median age of 20.5 years (interquartile range 19.6-22.4 years). Significant positive LRs were associated with loss of taste or smell (LR 3.38, 95% CI 3.01-3.79), suspected exposure (LR 1.33, 95% CI 1.28-1.39) and fever (LR 1.26, 95% CI 1.17-1.36). Those factors were also associated with positive PCR result in a multivariable analysis (OR 3.51, 95% CI 3.04-4.06; OR 1.86, 95% CI 1.65-2.09; and OR 1.34, 95% CI 1.19-1.51, respectively). Reports of loss of taste or smell increased gradually over time and were significantly more frequent during the late period of the study (63/5231, 1.21%; 156/7941, 1.96%; and 1505/11 190, 13.45%: p < 0.001).

Conclusion: Loss of taste or smell, report of a suspicious exposure and fever (>37.5°C) were consistently associated with positive LRs for a positive SARS-CoV-2 PCR test result, in a population of predominantly young and healthy adults.
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http://dx.doi.org/10.1016/j.cmi.2020.12.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837233PMC
January 2021

Injuries associated with the use of ejection seats: a systematic review, meta-analysis and the experience of the Israeli Air Force, 1990-2019.

Injury 2020 Jul 12;51(7):1489-1496. Epub 2020 May 12.

Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel.

Introduction: All modern military jet aircraft are equipped with rocket-assisted ejection systems. Jet aircraft operate in the majority of the conflict regions throughout the world, and in nearly all modern countries during peacetime. Civilian and military emergency services may be called upon to treat aircrews that have ejected and should be familiar with the common injury patterns associated with aircraft ejection.

Methods: A systematic review and meta-analysis of the literature were undertaken using the preferred reporting for systematic reviews and meta-analyses (PRISMA) methodology. Peer-reviewed journal and conference papers published between 1 January 1971 and 15 June 2019 were included. Our primary outcomes of interest were mortality and major injury rates. The I test was used to assess heterogeneity among the included studies, and data were pooled under random effects models. In addition, all ejection cases in the Israeli Air Force (IAF) between 1990 and 2019 were studied. The data were manually extracted from the accident records and the electronic medical records system.

Results: We identified 14 studies that included 1710 aircrew ejections. Heterogeneity was high (I>75%). Pooled mean mortality and major injury rates were 10.5% (95% CI 6.8-14.8%) and 29.8% (95% CI 20.1-40.6%), respectively. The major injuries included spinal fractures (61.6%), extremity trauma (27.3%), and head trauma (8.9%). During the IAF study period, a total of 37 aircrew ejected from 26 IAF aircraft. The fatality rate was 5.4% and 18.9% suffered major injuries.

Conclusions: Although ejection is lifesaving, it is associated with unique injury patterns that should be addressed during clinical evaluation. Because of their high prevalence, spinal precautions are paramount until spinal injury can be ruled out, generally by advanced imaging. Looking forward, injury patterns will continue to evolve in parallel with improving ejection seat systems.
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http://dx.doi.org/10.1016/j.injury.2020.04.048DOI Listing
July 2020

Myopia and Childhood Migration: A Study of 607 862 Adolescents.

Ophthalmology 2020 06 9;127(6):713-723. Epub 2019 Dec 9.

Medical Corps, Israeli Defense Forces, Israel; The Faculty of Medicine, The Hebrew University, Jerusalem, Israel.

Purpose: Immigration studies can shed light on myopia development and reveal high-risk populations. To this end, we investigated the association among immigration, age at immigration, and myopia occurrence during adolescence.

Design: Population-based, retrospective, cross-sectional study.

Participants: Six hundred seven thousand eight hundred sixty-two adolescents, Israeli born and immigrants, with origins in the former Union of Soviet Socialist Republics (USSR), Ethiopia, or Israel, assessed for medical fitness for mandatory military service at 17 years of age between 1993 and 2016.

Methods: Myopia and high myopia were defined based on right eye refractive data. Age at immigration was categorized into 0 to 5 years of age, 6 to 11 years of age, and 12 to 19 years of age. Univariate and multivariate logistic regression models were created. Myopia odds ratios (ORs) were calculated according to immigration status, with Israeli-born natives as controls. Next, myopia ORs were calculated according to age at immigration, with Israeli-born of same origin as controls.

Main Outcome Measures: Myopia prevalence and ORs.

Results: Myopia was less prevalent among immigrants than Israeli-born controls. When stratified according to age at immigration, a decrease in myopia prevalence and ORs with increasing age at migration were observed, most prominent in immigrants arriving after 11 years of age, who also showed lower high-myopia ORs. The immigrants from the USSR and Ethiopia arriving after 11 years of age showed a myopia OR of 0.65 (95% confidence interval [CI], 0.63-0.67; P < 10) and 0.52 (95% CI, 0.46-0.58; P < 10) compared with the Israeli-born controls. Notably, Ethiopians arriving earlier than 5 years of age showed a 2-fold higher myopia OR than those migrating after 11 years of age.

Conclusions: Immigrants arriving after 11 years of age showed markedly lower ORs for myopia and high myopia relative to Israeli-born controls or those arriving during early childhood, likely because of environmental and lifestyle changes. Differences between immigrants arriving up to 5 years of age and those arriving between 6 and 11 years of age were relatively smaller, suggesting exposures at elementary school age play a greater role in this population.
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http://dx.doi.org/10.1016/j.ophtha.2019.12.001DOI Listing
June 2020

Success Rates at an Air Force Pilot Academy and Its Relation to Methylphenidate Use.

Aerosp Med Hum Perform 2019 Sep;90(9):788-791

Attention deficit hyperactivity disorder (ADHD) is a chronic neurological disorder characterized by persistent patterns of inattention, impulsivity, and hyperactivity. The most common treatment for this disorder is methylphenidate, which is a disqualifying medication for flight. Candidates with previous use of methylphenidate are not necessarily disqualified from the Israeli Air Force (IAF) flight academy. Flight cadets from 12 consecutive flight courses who have used methylphenidate at least once in the past were identified according to their medical records. The graduation ratio of cadets with previous use of methylphenidate was compared with that of the rest of the cadets. A comparison was also made with regard to the causes of disqualification from the flight course. Statistical significance was assessed using the Fischer Test. Among the 90 flight cadets who have used methylphenidate, only 2 (2.2%) successfully graduated from the IAF flight academy. Among the 2983 flight cadets who have no history of methylphenidate use, 461 (15.4%) successfully graduated. We found no significant differences in the disqualification causes between the two groups. The IAF flight academy graduation rate was meaningfully and significantly lower among cadets who reported previous use of methylphenidate. The study design, however, limits the inference of causal relationship.
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http://dx.doi.org/10.3357/AMHP.5335.2019DOI Listing
September 2019

Adherence to antidepressant medications is associated with reduced premature mortality in patients with cancer: A nationwide cohort study.

Depress Anxiety 2019 10 22;36(10):921-929. Epub 2019 Jul 22.

Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.

Background: Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer.

Materials And Methods: We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality.

Results: During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities.

Conclusions: The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients.
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http://dx.doi.org/10.1002/da.22938DOI Listing
October 2019

Hypertension and childhood migration: a nationwide study of 2.7 million adolescents.

J Hypertens 2019 04;37(4):702-709

Sackler Faculty of Medicine, Tel Aviv University.

Objectives: Immigration studies can shed light on hypertension development and reveal high-risk populations. To this end, we investigated the association between age at immigration and hypertension occurrence at adolescence among immigrants to Israel.

Methods: We analyzed cross-sectional data on 2 681 294 adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2016. The study population constituted of 410 488 immigrants with origins in Ethiopia, Middle East and North Africa, Former USSR and Western Countries. Age at immigration was categorized into 0-5, 6-11 and 12-19 years. Odds ratios (ORs) for hypertension were calculated according to age at immigration with Israel-born participants as controls. Models were made to account for possible confounders. Additionally, the study population was stratified by country of origin and each immigrant group referenced to Israel-born participants of the same origin.

Results: In the fully-adjusted model, immigrants arriving until age 11 years had comparable ORs for hypertension to the Israeli-born reference group, whereas recent immigrants, arriving at age 12-19 years had a marked lower OR of 0.30 (95% CI 0.27-0.33; P < 0.001). The lower hypertension odds among recent immigrants persisted in all models and when the study sample was stratified by sex and origin, with all but those of Western origin showing a graded decrease with increasing age at migration categories.

Conclusion: Immigrants arriving earlier in childhood lose their protection against hypertension at adolescence relative to the Israeli-born, likely because of lifestyle acculturation. Prevention programs are needed, beginning upon arrival and placing emphasis on nutritional and physical activity habits.
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http://dx.doi.org/10.1097/HJH.0000000000001957DOI Listing
April 2019

Coronal Knee Malalignment in Young Adults and Its Link to Body Measures.

J Knee Surg 2019 May 4;32(5):421-426. Epub 2018 May 4.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Our aim was to report the prevalence of knee varus-valgus malalignment (KVVM) and its association with body mass index (BMI) and body height in a healthy and fit young adult population. Information on the disability codes associated with KVVM according to the Regulations of Medical Fitness Determination was retrieved from a medical database containing records of 17-year-old males and females before their recruitment into mandatory military service. Logistic regression models assessed the association between the BMI and body height to KVVM. The study cohort included 821,381 subjects (460,674 males and 360,707 females). The prevalence of KVVM was 0.9% in males and 0.6% for females. Under/overweight subjects were associated with higher prevalence of KVVM. The odds ratios (ORs) had a "J" curve pattern, increasing for underweight males and females, and even more so for above-normal BMIs (for obese males and for both overweight and obese females). The strongest association was between obese females and KVVM: an obese female had an OR of 22.864 (confidence interval [CI] = 20.683-25.725,  < 0.001) to have KVVM and an obese male had an OR of 4.483 (CI = 4.158-4.833  < 0.001). When the BMI was analyzed as a continuous variable, each increase in one BMI unit was associated with an increase in OR of 7.6% for males and 24.1% for females. There is a strong association between BMI and KVVM in both underweight and overweight young adults. KVVM is more common in males, but most strongly associated with overweight and obese females.This is a Level III, case-control study.
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http://dx.doi.org/10.1055/s-0038-1646928DOI Listing
May 2019

Aviator's Fluid Balance During Military Flight.

Aerosp Med Hum Perform 2018 Feb;89(2):94-98

Aeromedical Unit, Israeli Air Force, and the Israeli Defense Forces, Tel Hashomer, Israel.

Introduction: A loss of 1% or more of bodyweight due to dehydration has a negative effect on cognitive performance, which could critically affect flight safety. There is no mention in the literature concerning the amounts of military pilots' fluid loss during flight. The aim of this study was to quantify fluid loss of pilots during military flight.

Methods: There were 48 aviators (mean age 23.9) from the Israeli Air Force who participated in the study, which included 104 training flights in various flight platforms. Bodyweight, urine specific gravity, and environmental heat strain were measured before and after each flight. Fluid loss was calculated as the weight differences before and after the flight. We used a univariate and one-way ANOVA to analyze the effect of different variables on the fluid loss.

Results: The mean fluid loss rate was 462 ml · h-1. The results varied among different aircraft platforms and depended on flight duration. Blackhawk pilots lost the highest amount of fluids per flight, albeit had longer flights (mean 108 min compared to 35.5 in fighter jets). Jet fighter pilots had the highest rate of fluid loss per hour of flight (up to 692 ml, extrapolated).

Conclusion: Overall, at 11 flights (11%) aircrew completed their flight with a meaningful fluid loss. We conclude that military flights may be associated with significant amount of fluid loss among aircrew.Levkovsky A, Abot-Barkan S, Chapnik L, Doron O, Levy Y, Heled Y, Gordon B. Aviator's fluid balance during military flight. Aerosp Med Hum Perform. 2018; 89(2):9498.
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http://dx.doi.org/10.3357/AMHP.4920.2018DOI Listing
February 2018

Vision improvement in pilots with presbyopia following perceptual learning.

Vision Res 2018 11 24;152:61-73. Epub 2017 Nov 24.

Goldschleger Eye Research Institute, the Sackler Faculty of Medicine, Tel Aviv University, Tel-Hashomer, Israel; Faculty of Life Sciences, School of Optometry and Vision Science, Bar-Ilan University, Israel. Electronic address:

Israeli Air Force (IAF) pilots continue flying combat missions after the symptoms of natural near-vision deterioration, termed presbyopia, begin to be noticeable. Because modern pilots rely on the displays of the aircraft control and performance instruments, near visual acuity (VA) is essential in the cockpit. We aimed to apply a method previously shown to improve visual performance of presbyopes, and test whether presbyopic IAF pilots can overcome the limitation imposed by presbyopia. Participants were selected by the IAF aeromedical unit as having at least initial presbyopia and trained using a structured personalized perceptual learning method (GlassesOff application), based on detecting briefly presented low-contrast Gabor stimuli, under the conditions of spatial and temporal constraints, from a distance of 40 cm. Our results show that despite their initial visual advantage over age-matched peers, training resulted in robust improvements in various basic visual functions, including static and temporal VA, stereoacuity, spatial crowding, contrast sensitivity and contrast discrimination. Moreover, improvements generalized to higher-level tasks, such as sentence reading and aerial photography interpretation (specifically designed to reflect IAF pilots' expertise in analyzing noisy low-contrast input). In concert with earlier suggestions, gains in visual processing speed are plausible to account, at least partially, for the observed training-induced improvements.
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http://dx.doi.org/10.1016/j.visres.2017.09.003DOI Listing
November 2018

Influenza Season Hospitalization Trends in Israel: A Multi-Year Comparative Analysis 2005/2006 Through 2012/2013.

J Hosp Med 2017 09;12(9):710-716

The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel.

Background: Influenza-related morbidity impacts healthcare systems, including hospitals.

Objective: To obtain a quantitative assessment of hospitalization burden in pediatric and internal medicine departments during influenza seasons compared with the summer months in Israel.

Methods: Data on pediatric and internal medicine hospitalized patients in general hospitals in Israel during the influenza seasons between 2005 and 2013 were analyzed for rate of hospitalizations, rate of hospitalization days, hospital length of stay (LOS), and bed occupancy and compared with the summer months. Data were analyzed for hospitalizations for all diagnoses, diagnoses of respiratory or cardiovascular disease (ICD9 390-519), and influenza or pneumonia (ICD9480-487), with data stratified by age. The 2009-2010 pandemic influenza season was excluded.

Results: Rates of monthly hospitalizations and hospitalization days for all diagnoses were 4.8% and 8% higher, respectively, during influenza seasons as compared with the summers. The mean LOS per hospitalization for all diagnoses demonstrated a small increase during influenza seasons as compared with summer seasons. The excess hospitalizations and hospitalization days were especially noticed for the age groups under 1 year, 1-4 years, and 85 years and older. The differences were severalfold higher for patients with a diagnosis of respiratory or cardiovascular disease and influenza or pneumonia. Bed occupancy was higher during influenza seasons compared with the summer, particularly in pediatric departments.

Conclusions: Hospital burden in pediatric and internal medicine departments during influenza seasons in Israel was associated with age and diagnosis. These results are important for optimal preparedness for influenza seasons.
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http://dx.doi.org/10.12788/jhm.2824DOI Listing
September 2017

Immigration to Israel during childhood is associated with diabetes at adolescence: a study of 2.7 million adolescents.

Diabetologia 2017 11 19;60(11):2226-2230. Epub 2017 Aug 19.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Aims/hypothesis: Immigration studies can shed light on diabetes pathogenesis and risk factors. To this end, we investigated the association between age at immigration and diabetes occurrence at adolescence among immigrants to Israel.

Methods: We analysed cross-sectional data on 2,721,767 Jewish adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2014. The study population comprised 430,176 immigrants with origins in Ethiopia, former USSR, Middle East and North Africa (ME/NA) and western countries. ORs for diabetes were calculated for men and women, grouped according to age at immigration, with Israel-born participants as controls. Unadjusted and fully adjusted models were made to account for possible confounders. Additionally, the study population was stratified by origin and each immigrant group was referenced to Israel-born participants of the same origin.

Results: There was a graded decrease in OR for diabetes across the study groups in the fully adjusted model. Immigrants arriving at age 0-5 years had comparable OR for diabetes to the Israeli-born reference group; those arriving at age 6-11 years had an OR of 0.82 (95% CI 0.70, 0.97; p = 0.017) and recent immigrants, arriving at age 12-19 years, had the lowest OR of 0.65 (95% CI 0.54, 0.77; p < 0.0001). When age at immigration was treated as a continuous variable, there was an adjusted risk for occurrence of diabetes of 0.97 (95% CI 0.96, 0.99; p = 0.001) for every year increment. The lower risk for diabetes among recent immigrants persisted in the unadjusted model and persisted when the study sample was stratified by sex and origin, except for immigrants arriving from ME/NA. Notably, Ethiopians born in Israel had a sixfold higher diabetes crude prevalence than Ethiopian immigrants arriving after the age of 5 years.

Conclusions/interpretation: Immigrants of different ethnic groups arriving earlier in childhood lose their protection against diabetes at adolescence, relative to children born in Israel. This is perhaps due to environmental and lifestyle changes, especially those beginning at an early age.
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http://dx.doi.org/10.1007/s00125-017-4399-8DOI Listing
November 2017

The prevalence of medical symptoms in military aircrew.

Disaster Mil Med 2017 2;3. Epub 2017 Feb 2.

Medical Corps, and Chief Surgeon of the Air Force Headquartes, Israeli Defense Forces, Tel Hashomer, Israel.

Background: The prevalence of medical symptoms in aviators has not been described in the medical literature.

Methods: An anonymous questionnaire was handed to all Israeli Air Force aviators who went through the routine yearly examination. Because only two women filled the questionnaire, we excluded them. The questionnaire contained a list of 49 symptoms and the aviators were asked to mark symptoms that were present in the last month before the examination as well as age, estimated weekly flying hours, military service status (reserve or career) and type of aircraft (jet-fighter, helicopter or transport). A general linear model was used to determine the association between age, weekly flying hours, type of aircraft and type of service with the number of symptoms. Binary logistic regression analyses was used to assess the association of these factors with lack of symptoms, and the top five ranking symptoms.

Results: Data was available for 323 male aviators. 62.5% of the aviators reported at least one symptom in the previous month. 26.9% reported three or more symptoms. 25.1% reported spinal symptoms, 22% respiratory symptoms, 21.4% fatigue, 11.5% headache and 6.5% general weakness. Career service was associated with the number of symptoms, fatigue and general weakness. Age was associated with fatigue and general weakness. Aircraft type and weekly flying hours were not associated with any symptom.

Conclusions: Medical symptoms are prevalent in military aviators. Career personnel report on medical symptoms, especially fatigue, more often than reserve personnel. Further study is warranted to examine this association.
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http://dx.doi.org/10.1186/s40696-017-0031-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329958PMC
February 2017

The Prevalence of Cruciate Ligament and Meniscus Knee Injury in Young Adults and Associations with Gender, Body Mass Index, and Height a Large Cross-Sectional Study.

J Knee Surg 2017 Jul 23;30(6):565-570. Epub 2016 Nov 23.

Medical Corps, Israeli Defense Forces, Israel.

Anterior cruciate ligament and meniscal injuries are associated with secondary osteoarthrosis which may lead to functional impairment and economic burden. The prevalence of knee injury has not been studied in depth. Our purpose was to report the prevalence of knee ligament and meniscal injuries and their associations with gender, body mass index (BMI), and height in young adults and to characterize individuals with meniscal injuries who gained full recovery. A cross-sectional, population-based study was conducted. Information on the disability codes of knee ligament and meniscal injury according to the Regulations of Medical Fitness Determination was retrieved from a medical database containing records of young prerecruits into mandatory service. Logistic regression assessed the association between genders, BMI, and body height to knee injuries. A total of 825,187 subjects were included. Prevalence of knee injuries was 0.35%. Males had 2.2-fold more knee injuries than females. Increased BMI was associated with increased prevalence of knee injury in both genders, more significantly in females (overweight and obese females had an odds ratio of 1.406 and 1.519, respectively, to suffer from concomitant meniscal and ligamentous knee injury). Being underweight was associated with a lower prevalence of knee injury. An above normal BMI was more significantly associated with meniscal and/or ligament injuries that did not fully recover (females > males). Body height was associated with isolated meniscal injury in both genders. We found an association between BMI, body height, and knee injury in both males and females. Higher body height and higher BMI might be risk factors for knee injuries. Higher BMI was associated with greater probability of disability coding. Meniscal and ligament injuries are more common among males.
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http://dx.doi.org/10.1055/s-0036-1593620DOI Listing
July 2017

Hearing Loss in Israeli Air Force Aviators: Natural History and Risk Factors.

Mil Med 2016 07;181(7):687-92

Wolfson Medical Center, 62 Halohamim Street, Holon 5822012, Israel.

Objective: To investigate the natural history of hearing loss (HL) in Israeli military aviators and its risk factors.

Methods: Audiometric results of aviators with available audiometry at ages 30 and 40 years, and up to their last available audiometry were retrieved. HL DEFINITION: pure-tone threshold (PTT) of 30 dB or higher in at least one frequency in at least one ear, moderate-to-severe (M-S) HL as PTT of 45 dB or higher, and suspected noise-induced HL (NIHL) as HL at 3 to 6 kHz. Potential risk factors for HL were assessed by the χ(2) test and logistic regression models.

Results: 298 aviators were included. Rates of HL increased with age, up to 57.5% at age 50. All M-S HL at age 50 years had clues on previous examinations, but new HL was observed in all ages. Age was found as a statistically significant risk factor, but aircraft type was not. Total flying hours were found to be an independent risk factor for suspected NIHL only. Self-reported earplug use was not found to protect from HL, with methodological limitations.

Conclusions: HL is prevalent in aviators. Age and total flying hours are risk factors, the latter probably only for NIHL, whereas aircraft type is not.
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http://dx.doi.org/10.7205/MILMED-D-15-00289DOI Listing
July 2016

The Ecology of Medical Care Among Israeli Military Aviators.

Aerosp Med Hum Perform 2016 Dec;87(12):1036-1040

Medical Corps, Israeli Defense Forces, Tel Hashomer, Israel.

Background: The ecology of medical care model has been used in various populations with varying results. We aimed to apply this model in the population of Israeli Air Force (IAF) aviators.

Methods: An anonymous questionnaire was presented to all Israeli Air Force aviators during their mandatory yearly check-up over 1 yr starting on November 26th, 2012. The questionnaire contained items on demographic, personal, and military details, as well as items on the presence of clinical symptoms, and various health care contacts in the previous month. We assessed the differences between career and reserve personnel using a X2 test.

Results: There were 325 aviators who completed the questionnaire (2 women, 132 reserves). Clinical symptoms were reported by 62.5% of the responders. Over half (52.6%) had any health care encounter: 23.7% with a dentist, 17.9% with non-MD therapists, 12.6% with a specialist, and 11.7% with a primary physician. A significant difference between reserve and career personnel was found only in primary care visits. Out of the aviators who reported having clinical symptoms, 70.9% did not visit a physician. Of those who did not seek medical care, 42.4% reported that the symptoms were viewed as unimportant, 41% thought they would disappear by themselves, 40.3% could not find time for treatment.

Conclusions: Aviators in the IAF have similar rate of clinical symptoms as in other unselected populations. Those who report symptoms usually do not visit a physician for treatment. When they do seek advice it is mostly from non-MD practitioners.Gordon B, Levy Y, Yemini T, Carmon E, Erlich Y, Hermoni D. The ecology of medical care among Israeli military aviators. Aerosp Med Hum Perform. 2016; 87(12):1036-1040.
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http://dx.doi.org/10.3357/AMHP.4406.2016DOI Listing
December 2016

Scrotal Hematoma Precipitated by Centrifuge Training in a Fighter Pilot with an Asymptomatic Varicocele.

Aerosp Med Hum Perform 2015 Dec;86(12):1063-5

Israeli Air Force Aero Medical Center, IDF Medical Corps, Tel Hashomer, Israel.

Background: Varicocele is quite common in the general population, affecting up to 15% of men. It is not considered disqualifying for the pilot's training program of the Israeli Air Force as long as there are no related symptoms or associated pathologies. During combat flight, increased venous pressure due to acceleration forces and anti-G straining maneuvers, used to counteract high gravitational G forces, can theoretically aggravate the venous blood pooling in varicocele, leading to rupture.

Case Report: We describe a case of a young fighter-jet pilot presenting with a painful inguinal hematoma extending to the scrotum a day after participating in centrifuge training. Sonographic examination demonstrated dilated spermatic veins and intratesticular varicocele along with subcutaneous thickening of the scrotal wall consistent with hematoma.

Discussion: The effects of high G loads on blood flow in spermatic veins, and especially in varicocele, still need to be determined. Varicocele rupture has been described in relation to increased intra-abdominal pressure and could theoretically occur during anti-G straining maneuvers. Such an acute adverse event during combat flight can be detrimental to flight safety and the pilot's well-being.
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http://dx.doi.org/10.3357/AMHP.4338.2015DOI Listing
December 2015

Interventricular Septum and Posterior Wall Thickness Are Associated With Higher Systolic Blood Pressure.

J Clin Hypertens (Greenwich) 2016 07 26;18(7):703-6. Epub 2015 Nov 26.

Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.

Elevated blood pressure (BP) is a known factor that affects the structure of the left ventricle. The association between left ventricular hypertrophy (LVH) and BP in normotensive individuals is poorly understood. All individuals who underwent routine echocardiography and BP measurements as aircrew candidates for the Israeli Air Force in the years 2006 to 2012 were identified. Participants with normal values were included. Associations between echocardiographic characteristics and BP were studied. A total of 2386 participants were included. Mean systolic BP was 125.31±11.18 mm Hg and mean diastolic BP was 68.69±9.02 mm Hg. Interventricular septal (IVS) thickness was positively correlated with systolic BP (P<.001, correlation coefficient 0.121) and significantly inversely correlated with heart rate and hematocrit level (P<.001 for both). Men with evidence of IVS or posterior wall thickening on echocardiography, even within the normal range, may require a closer follow-up of BP.
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http://dx.doi.org/10.1111/jch.12738DOI Listing
July 2016

Association between asthma and body mass index and socioeconomic status: A cross-sectional study on 849,659 adolescents.

Respirology 2016 Jan 22;21(1):95-101. Epub 2015 Sep 22.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background And Objective: Asthma is associated with body mass index (BMI), but its association with socioeconomic status (SES) is controversial. The combined effect of SES and BMI on asthma prevalence is undetermined.

Methods: Seventeen-year-old pre-recruits to the Israeli Defense Forces underwent routine physical examinations. SES was determined according to established criteria based on place of residence. The study population was divided according to classic weight groups and three SES groups (low, medium and high). Univariable and multivariable logistic regression models were applied to assess odds ratios (OR) of BMI and SES groups for asthma prevalence. The combined effect of BMI and SES was also calculated.

Results: The 849,659 subjects included 480,993 males (9.5% asthma prevalence) and 368,666 females (6.7% asthma prevalence). Increased BMI were associated with increased OR for asthma in females (1.44, 95% CI 1.36-1.52 for obese vs normal weight). Males had a J-shaped curve (OR 1.24 95% CI 1.2-1.29 for obese, 1.12, 95% CI 1.08-1.16 for underweight, both vs normal weight). OR adjusted to SES did not change significantly. All SES groups produced a linear curve (1.59 95% CI 1.53-1.66 for females and 1.79 95% CI 1.74-1.84 for males). Adjustment of SES to BMI produced no significant change in OR. When all groups were compared with the normal weight/lower SES group, the highest OR was for the obese/higher SES group (2.32 95% CI 2.05-2.64 for females and 1.99 95% CI 1.83-2.13 for males).

Conclusions: Both BMI and SES are co-independently associated with asthma in adolescent males and females.
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http://dx.doi.org/10.1111/resp.12645DOI Listing
January 2016

Managing the increasing shortage of acute care hospital beds in Israel.

J Eval Clin Pract 2015 Feb 14;21(1):79-84. Epub 2014 Oct 14.

Tel Hashomer Medical Center, Ramat Gan, Israel.

Rationale, Aims And Objectives: Israel's healthcare system has been facing increasing hospital bed shortage over the last few decades. Community-based services and shortening length of stay have helped to ease this problem, but hospitals continue to suffer from serious overload and saturation. The objective of this study is to present hospitalization trends in Israel's internal medicine departments.

Methods: The data is based on the National Hospital Discharges database (NHDR) in the Israeli Health Ministry, pertaining to hospitalizations in all internal medicine departments nationwide between 2000 and 2012.

Results: Total yearly hospitalization days, representing healthcare burden, had increased by 4.2% during the study period, driven mainly by the most advanced age groups. The rate of total hospitalization days per 100,000 people for all the age groups has decreased by 17.6%, but the oldest patient group had a modest reduction in comparison (7.5%). The parameter of age correlated with length of stay and readmission rates, and neither decreased during the surveyed years.

Conclusions: These results demonstrated that the healthcare burden on acute internal medicine services has been reduced mostly for middle-aged populations but only modestly for elderly populations. The length of hospital stay and the readmission rates have reached and maintained a plateau in recent years, regardless of age. The findings of this study call for planning specific to elderly populations in light of changing demographics. Possible directions may include renewed emphasis on internal medicine and geriatric medicine, and efforts to shorten hospitalization time by extended utilization of multidisciplinary primary care.
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http://dx.doi.org/10.1111/jep.12246DOI Listing
February 2015

A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults.

J Foot Ankle Surg 2015 Mar-Apr;54(2):183-7. Epub 2014 Aug 16.

Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.

Up to 40% of ankle sprains can result in chronic ankle instability (CAI). The prevalence of CAI and its association with body mass index (BMI) and height in the general young adult population has not been reported. The database records of young adults before recruitment into mandatory military service were studied. Information on the disability codes associated with CAI was retrieved. Logistic regression models were used to assess the association between the BMI and body height with various grades of CAI severity. The study cohort included 829,791 subjects (470,125 males and 359,666 females). The prevalence was 0.7% for mild CAI and 0.4% for severe instability in males and 0.3% and 0.4%, respectively, for females (p < .001). An increased BMI was associated with ankle instability in males (overweight, odds ratio [OR] 1.249, p < .001; obese, OR 1.418, p < .001) and females (overweight, OR 1.989 p < .001; obese, OR 2.754, p < .001). The body height was associated with an increased risk of CAI when the highest height quintile was compared with the lowest height quintile in both males (OR 2.443, p < .001) and females (OR 1.436, p < .001) for all levels of instability severity. The present study has shown a greater prevalence of CAI among males than females in a general healthy young adult population. CAI was associated with an increased BMI and greater body height for all grades of instability severity.
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http://dx.doi.org/10.1053/j.jfas.2014.06.001DOI Listing
November 2015

Cognitive function and the risk for diabetes among young men.

Diabetes Care 2014 Nov 4;37(11):2982-8. Epub 2014 Aug 4.

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel Gertner Institute for Epidemiology, Tel Hashomer, Israel.

Objective: Diabetes is a risk factor for an accelerated rate of cognitive decline and dementia. However, the relationship between cognitive function and the subsequent development of diabetes is unclear.

Research Design And Methods: We conducted a historical-prospective cohort study merging data collected at premilitary recruitment assessment with information collected at the Staff Periodic Examination Center of the Israeli Army Medical Corps. Included were men aged 25 years or older without a history of diabetes at the beginning of follow-up with available data regarding their general intelligence score (GIS), a comprehensive measure of cognitive function, at age 17 years.

Results: Among 35,500 men followed for a median of 5.5 years, 770 new cases of diabetes were diagnosed. After adjustment for age, participants in the lowest GIS category had a 2.6-fold greater risk for developing diabetes compared with those in the highest GIS category. In multivariable analysis adjusted for age, BMI, fasting plasma glucose, sociogenetic variables, and lifestyle risk factors, those in the lowest GIS category had a twofold greater risk for incident diabetes when compared with the highest GIS category (hazard ratio 2.1 [95% CI 1.5-3.1]; P < 0.001). Additionally, participants in the lowest GIS category developed diabetes at a mean age of 39.5 ± 4.7 years and those in the highest GIS group at a mean age of 41.5 ± 5.1 years (P for comparison 0.042).

Conclusions: This study demonstrates that in addition to a potential causal link between diabetes and enhanced cognitive decline, lower cognitive function at late adolescence is independently associated with an elevated risk for future diabetes.
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http://dx.doi.org/10.2337/dc14-0715DOI Listing
November 2014

The immigration effect on obesity and overweight in Israeli Jewish male adolescents born 1970-1993.

Ann Epidemiol 2014 Jun 3;24(6):424-31. Epub 2014 Mar 3.

Sackler Faculty of Medicine, Tel Aviv University, Israel; Sheba Medical Center, Ramat Gan, Israel; Department of Management, Bar Ilan University, Ramat Gan, Israel.

Purpose: The aim of the study was to assess the relationship between age of arrival of male pediatric immigrant populations in Israel and their risk for subsequent high-weight morbidity at adolescence.

Methods: The study analyzed a pooled cross section of 89,744 foreign-born male Jewish study participants, who were born in the former Soviet Union or Ethiopia (1970-1993) and immigrated in childhood to Israel. Each participant's body mass index was measured at approximately 17 years of age. Odds ratios were calculated for obesity and overweight according to age on arrival to Israel. A total of 52,503 Israel-born participants with origins in those same countries were measured at the same age and used as references. A total of 52,258 native Israelis without known immigrating ancestry were also used for comparison. The risk stratification accounted for possible socio-demographic confounders and birth year.

Results: Foreign-born immigrants had decreased risk for obesity and overweight relative to Israeli-born immigrants when measured at the age of 17 years. However, those who arrived in Israel during infancy and early childhood (before the age of 3 years) had greater risk for high weight compared with those immigrating during late childhood and adolescence.

Conclusions: Although generally protective against obesity and overweight relative to native, these beneficial effects of immigration are diminished for those arriving in early childhood rather than later in adolescence.
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http://dx.doi.org/10.1016/j.annepidem.2014.02.012DOI Listing
June 2014

Adolescence BMI and trends in adulthood mortality: a study of 2.16 million adolescents.

J Clin Endocrinol Metab 2014 Jun 6;99(6):2095-103. Epub 2014 Mar 6.

Department of Medicine (G.T.), The Dr Pinchas Bornstein Talpiot Medical Leadership Program (G.T., A.T.), The Chaim Sheba Medical Center Management (A.A., A.S.), Tel-Hashomer 52621, Israel; The Israel Defense Forces Medical Corps (G.T., E.D., M.L.R., D.T., B.G.), Israel. The Sackler School of Medicine (A.A., A.S., E.D., M.L.R., B.G.), Tel-Aviv University, Tel-Aviv 69978, Israel; The Division of Endocrinology, Diabetes, and Hypertension (A.T.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.

Context: The consequence of elevated body mass index (BMI) at adolescence on early adulthood mortality rate and on predicted life expectancy is unclear.

Objective: The objective of the investigation was to study the relationship between BMI at adolescence and mortality rate as well as the mortality trend over the past 4 decades across the entire BMI range.

Design And Setting: The study included a nationwide longitudinal cohort.

Participants: A total of 2 159 327 adolescents (59.1% males) born between 1950 and 1993, who were medically evaluated for compulsory military service in Israel, participated in the study.

Interventions: Height and weight were measured at age 17 years, and BMI was stratified based on the Centers for Disease Control and Prevention-established percentiles for age and sex.

Main Outcome Measure: Incident cases of all-cause mortality before age 50 years were recorded. Cox-proportional hazard models were used to assess mortality rates and its trend overtime.

Results: During 43 126 211 person-years of follow-up, 18 530 deaths were recorded. As compared with rates observed in the 25th to 50th BMI percentiles, all-cause mortality continuously increased across BMI range, reaching rates of 8.90/10(4) and 2.90/10(4) person-years for men and women with BMI greater than the 97th percentile, respectively. A multivariate analysis adjusted for age, socioeconomic status, education, and ethnicity demonstrated a significant increase in mortality at BMI greater than the 50th percentile (BMI > 20.55 kg/m(2)) for men and the 85th percentile or greater in women (BMI > 24.78 kg/m(2)). During the last 4 decades, a significant decrease in mortality rates was documented in normal-weight participants born between 1970 and 1980 vs those born between 1950 and 1960 (3.60/104 vs 4.99/10(4) person-years, P < .001). However, no improvement in the survival rate was observed among overweight and obese adolescents during the same time interval. Significant interaction between BMI and birth year was observed (P = .007).

Conclusions: BMI at adolescence, within the normal range, is associated with all-cause mortality in adulthood. Mortality rates among overweight and obese adolescents did not improve in the last 40 years, suggesting that preadulthood obesity may attenuate the progressive increase in life expectancy.
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http://dx.doi.org/10.1210/jc.2014-1213DOI Listing
June 2014

The association between body mass index and increased utilization of healthcare services: a retrospective cohort study of 51,521 young adult males.

Endocr Pract 2014 Jul;20(7):638-45

Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Objective: To examine the association between the entire body mass index (BMI) range and healthcare utilization.

Methods: Weight and height were measured during medical examinations of recruits prior to their entry into the military in Israel. All recruits were followed-up during service and all of their medical information was recorded in a central electronic medical record. We extracted medical and sociodemographic data for all Jewish male combat recruits during their first year of service. The study included 51,521 subjects who were divided into quintiles according to BMI. Using logistic regression models, we determined the association between BMI and high numbers of physician encounters, emergency room visits, referrals to specialists, imaging, laboratory tests, and medication prescriptions.

Results: In comparison with the lowest BMI quintile, there was a significant increase in the highest quintile with regard to an increased number of physician encounters (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19-1.36), emergency room visits (OR, 1.2; 95% CI, 1.12-1.29), referrals to specialists (OR, 1.22; 95% CI, 1.14-1.31), and medication prescriptions (OR, 1.23; 95% CI, 1.15-1.32). An increase in the number of laboratory tests was not statistically significant and there was no difference in imaging referrals. Adjustment for various sociodemographic variables and medical conditions did not significantly change the results.

Conclusion: Higher BMI is related to increased utilization of healthcare services, even for BMI values in the normal range.
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http://dx.doi.org/10.4158/EP13419.ORDOI Listing
July 2014

Association between body mass index, body height, and the prevalence of spinal deformities.

Spine J 2014 Aug 19;14(8):1581-7. Epub 2013 Oct 19.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel.

Background Context: The most common spinal deformities among adolescents are adolescent idiopathic scoliosis (AIS; 2%-3% prevalence) and Scheuermann kyphosis (SK; 1%-8% prevalence). Both are believed to have a genetic influence in their etiology. The association between body mass index (BMI) and body stature and their possible association to spinal deformities is uncertain.

Study Design: A cross-sectional prevalence study.

Purpose: To examine the prevalence of all adolescent spinal deformities according to the extent of their severity as well as their possible association to BMI and body height.

Outcome Measures: Subjects diagnosed as having spinal deformities were classified into one of three severity groups; "Mild," "Intermediate," or "Severe," according to their curve scoliosis or kyphosis measurement with a standing X-ray.

Methods: The data for this study were derived from a medical database containing records of 17-year-old male and female patients before their recruitment into mandatory military service. Information on the disability codes associated with spinal deformities according to the Regulations of Medical Fitness Determination was retrieved. Logistic regression models were used to assess the association between the BMI and body height to various degrees of spinal deformities by severity.

Results: The study cohort included 829,791 consecutive subjects, of whom 103,249 were diagnosed with spinal deformities (76% were mild in degree). The prevalence of spinal deformities was significantly greater among the underweight male and female patients (p<.001). Increased BMI had a protective effect for developing spinal deformities. The odds ratios for severe spinal deformities were greater compared with mild spinal deformities in the underweight groups. The risk for developing spinal deformities increased significantly with height for both genders (p<.001).

Conclusions: An association between height and the risk for spinal deformities by severity was found for all height groups. Below normal BMI is associated with severity of spinal deformities, whereas above-normal BMI apparently has a protective effect. Body height is also positively associated with the severity of spinal deformities.
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http://dx.doi.org/10.1016/j.spinee.2013.09.034DOI Listing
August 2014

Correlation between spirometry values and pulmonary artery pressure in young healthy subjects.

Respir Care 2014 Mar 6;59(3):371-4. Epub 2013 Aug 6.

Israeli Air Force Aero Medical Center, Tel Hashomer, Israel.

Background: Pulmonary hypertension is frequently associated with parenchymal lung disease. We evaluated the association between spirometry values and pulmonary artery systolic pressure (PASP) in young subjects without lung disease

Methods: : We studied applicants to the Israeli Air Force, who undergo routine evaluation that includes resting spirometry and echocardiography. Applicants with overt lung disease were excluded. All echocardiographic studies performed in the years 1994 through 2010 (n = 6,598) were screened, and files that included PASP and spirometry values were analyzed for the association between PASP and FVC, FEV1, FEV1/FVC, peak expiratory flow, and forced expiratory flow during the middle half of the FVC maneuver.

Results: Of the 647 air force applicants who underwent echocardiography in which PASP was measurable and had spirometry data, 607 (94%) were male, and their average age was 18.16 ± 0.73 years. Mean PASP was 26.4 ± 5.2 mm Hg (range 10-41 mm Hg). None of the spirometry values significantly correlated with PASP.

Conclusions: PASP in young healthy subjects is not significantly associated with spirometry values. Lung mechanics probably do not contribute significantly to PASP in this population.
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http://dx.doi.org/10.4187/respcare.02701DOI Listing
March 2014

Inter-arm blood pressure differences in young, healthy patients.

J Clin Hypertens (Greenwich) 2013 Aug 10;15(8):575-8. Epub 2013 May 10.

Israeli Air Force Aero Medical Center, Tel Hashomer, Israel.

The prevalence and magnitude of inter-arm BP difference (IAD) in young healthy patients is not well characterized. Flight academy applicants and designated aviators undergo annual evaluation that includes blood pressure (BP) measurement on both arms. All BP measurements performed from January 1, 2012, to April 30, 2012, were recorded and IAD was calculated. Results were compared between patients in whom BP was initially measured in the right arm (group 1), those in whom BP was initially measured in the left arm (group 2), and those in whom the arm in which BP was initially measured was not recorded (group 3). A total of 877 healthy patients had BP measured during the study period. In the entire group, mean systolic BP was the same in both arms. Absolute IAD was 5.6±5.5 mm Hg for systolic and 4.7±4.5 mm Hg for diastolic BP. IAD >10 mm Hg was recorded in 111 (12.6%) and 77 (8.8%) patients for systolic and diastolic BP, respectively. IAD was the same in the 3 groups and was unrelated to age, body mass index, and heart rate, but was related to systolic BP. IAD is common in young healthy patients, is not dependent on which arm was measured first, and unrelated to age, body mass index, and heart rate.
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http://dx.doi.org/10.1111/jch.12125DOI Listing
August 2013

M-mode echocardiographic values in a cohort of young healthy individuals.

J Cardiovasc Med (Hagerstown) 2015 Jan;16(1):45-50

aThe Israeli Air Force Aero Medical Center, Tel Hashomer bDepartment of Internal Medicine E, Rabin Medical Center, Beilinson Campus Affiliated to Tel Aviv University Sackler Medical School, Petah Tikva cUnit of Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer dSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Objectives: To determine normal M-mode values in healthy young adults and to evaluate whether these values differ among those in whom echocardiography was performed routinely and those in whom echocardiography was performed based on clinical grounds.

Methods: A cross-sectional study evaluating a large cohort of young academy applicants of the Israeli air force in the years 1994-2010. Studies were divided into those performed routinely and those performed because of abnormal ECG or physical examination findings. Echocardiographic variables were compared between the two groups and values are expressed as mean ± SD.

Results: Echocardiography was performed routinely in 3525 applicants (age 18.5 ± 1.0 years) and following a clinical referral in 3517 applicants (age 18.2 ± 0.9 years). Those in whom echocardiography was performed routinely had slightly higher left ventricular end-systolic diameter (31.2 ± 3.3  vs. 30.7 ± 3.4 mm; P < 0.0001) and aortic root diameter (28.5 ± 2.1 vs. 27.9 ± 2.2 mm; P < 0.0001), and slightly lower left ventricular mass index (108.8 ± 15.8  vs. 109.9 ± 16.5 g/m; P = 0.005). No differences were noted between the two groups in left atrial diameter, left ventricular end-diastolic volume, posterior wall thickness and interventricular septum thickness.

Conclusion: Certain M-mode characteristics may differ (although to a slight degree) in young healthy individuals with electrocardiographic and physical findings compared with those with normal physical examination and electrocardiography.
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http://dx.doi.org/10.2459/JCM.0b013e3283641bf0DOI Listing
January 2015

Flexible pes planus in adolescents: body mass index, body height, and gender--an epidemiological study.

Foot Ankle Int 2013 Jun 24;34(6):811-7. Epub 2013 Jan 24.

Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Background: Most studies on the prevalence of flexible pes planus (FPP) have been conducted in pediatric populations and older adults. There is limited comparable information on these parameters for the adolescent age group. The purpose of this study was to report the prevalence of FPP and its association with body mass index (BMI), body height, and gender among healthy and fit adolescents.

Methods: The data for this study were derived from a medical database containing records of 17-year-old males and females before their recruitment into mandatory military service. Information on the disability codes associated with FPP according to the Regulations of Medical Fitness Determination was retrieved. Logistic regression models were used to assess the association between BMI, body height, and gender to various grades of FPP severity.

Results: The study cohort included 825 964 adolescents (467 412 males and 358 552 females). The prevalence was 12.4% for mild FPP and 3.8% for severe FPP among the males and 9.3% and 2.4%, respectively, for the females. An increased BMI was associated with FPP in both males (overweight: odds ratio [OR] 1.385, confidence interval [CI] 1.352-1.419, P < .001; obese: OR 1.765, CI 1.718-1.813, P < .001) and females (overweight: OR 1.408, CI 1.365-1.620, P < .001; obese: OR 1.549, CI 1.481-1.620, P < .001). Body height was associated with a decreased risk of FPP when the highest height quintile was compared with the lowest height quintile in both males (OR 0.782, CI 0.762-0.802, P < .001) and females (OR 0.730, CI 0.707-0.754, P < .001) for all FPP severity grades.

Conclusions: There was a greater prevalence of FPP among males compared with females in a general healthy adolescent age group. FPP was associated with increased BMI and shorter body height for all grades of FPP severity.

Level Of Evidence: Level II, diagnostic study.
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http://dx.doi.org/10.1177/1071100712472327DOI Listing
June 2013