Diagnoses and Health Care Utilization for After-Hours Telemedicine Versus Primary Care Visits.

OBJECTIVE: The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP). METHODS: This is a retrospective cross-sectional study using Israel's largest health care provider database. We included children aged 0 to 18 years using either PO or PCP between 2015 and 2018. We compared the baseline characteristics, matching by socioeconomic status, chronic illness, and diagnosis, and compared their admission rates, laboratory testing, and medication prescription. RESULTS: During this study period there were 262,541 PO visits and a random 10% sample of PCP visits which yielded 1,813,103 visits. Users of PO were more likely to have a higher socioeconomic status (43% vs 28.9%), fever (13.3% vs 4.4%) and less likely to have acute respiratory conditions (8.8% vs 16.7%). Users of PO had higher rates of emergency department admissions (2.9% vs 0.4%), hospital admissions (0.9% vs 0.2%), and lower rates of laboratory testing (3.7% vs 7.4%) and medication prescription (42.0% vs 52.0%) within 24 hours. All differences were statistically significant (P < .005). CONCLUSIONS: Our pediatric telemedicine service operating after-hours has been found to be feasible, and widely used, for a myriad of clinical conditions. Significant differences exist between PO and PCP visit characteristics and outcomes. However, it remained unclear whether these differences reflect the difference in the patient population or whether they are the result of the different clinical services. Further research is warranted to clarify this matter.

Pain sensitivity and athletic performance.

BACKGROUND: The objective of the study is to determine whether higher pain thresholds are associated with better performance in long-distance runners. METHODS: Seventy participants, divided into groups of fast and non-fast runners according to peak results in a 10km run. Main Outcome Measures, Cold pressor test. RESULTS: Of the 70 participants, 28 were in the fastest group (less than 39 minutes in a 10km run) and 42 in the non-fast group. The faster group was characterized with older age (34.0±8.5 vs. 29.5±5.7, P=0.01), greater mean weekly running time (5.5 [0-17]) vs. 2 [0-10], P<0.001), and more years of running (10 [1.5-34.0] vs. 7 [0-20, P=0.05]). In a multivariable analysis longer cold pressor time was associated with faster 10Km run (OR 1.01, 95% CI 1.00-1.01). CONCLUSIONS: It seems that higher pain thresholds play an important role in the superior ability of long distance runners.