BACKGROUND: Attention deficit-hyperactivity disorder (ADHD) is the most common neuro-developmental disorder in childhood. Its pharmacologic treatment mostly includes methylphenidate, yet many parents seek alternative, "natural," therapeutic options, commonly omega-3 fatty acids. Previous studies of supplementation with fish oil or long-chain omega-3 fatty acids to children with ADHD yielded mixed results. The use of alpha-linolenic acid (ALA), a medium-chained, plant-based omega-3 fatty acid (18:3 n-3), has not been sufficiently examined in this population. METHODS: Forty untreated children with ADHD, aged 6-16 years, were randomized to receive either 2 g/day of oil containing 1 g ALA or placebo, for 8 weeks. Before and after supplementation, the children underwent a physician assessment of ADHD symptoms and a computerized continuous performance functions test. The children's parents and teachers filled out Conners' and DSM questionnaires. RESULTS: Seventeen (42.5%) children completed the study, eight in the supplementation group, nine in the placebo group. Main drop-out reasons were capsule size, poor compliance, and a sense of lack of effect. No significant difference was found in any of the measured variables tested before and after supplementation, in both study groups. No between-group difference was found in the changes of the various measures of ADHD symptoms throughout the study period. CONCLUSION: Supplementation of 2 g/day of oil containing 1 g ALA did not significantly reduce symptoms in children with ADHD. Future studies in this field should consider an alternative method to deliver the oil, a higher dose, and a larger sample size.

Red blood cell distribution width (RDW) has been shown to predict cardiovascular mortality in various populations, but studies were less conclusive regarding cardiovascular morbidity. We aimed at evaluating the prognostic effect of RDW on cardiovascular morbidity and all-cause mortality in the largest community cohort to date.We utilised the computerised database of a large community based healthcare maintenance organization (HMO) in Israel to identify a cohort of 225,006 eligible patients aged 40 or above who performed a blood count during 2006. We evaluated the relationship between 1% increments of RDW values and major cardiovascular events and all-cause mortality over a period of five years. A total of 21,939 incident cases of a major cardiovascular event and 4,287 deaths were documented during a total of six years of follow up, respectively. In comparison with patients with RDW level <13%, the hazard ratio for total mortality gradually increased to 4.57 (95% confidence interval [CI]: 3.35-6.24, p<0.001) among male patients and to 3.26 (95% CI: 2.49-4.28, p<0.001) among female patients with a RDW of 17% or above. Similar results were evident in anaemic and non-anaemic populations. RDW above 17% was also associated with a modest increased risk of major cardiovascular events in females 1.26 (95% CI: 1.03-1.52, p=0.021), while in men it was not significant, 1.08 (95% CI: 0.82-1.41, p=NS). In conclusion, increasing RDW levels significantly increased risk of cardiovascular morbidity and all-cause mortality. Our observation is evident in both anaemic and non-anaemic patients.

PURPOSE: The aim of this population-based study is to describe trends in the characteristics and treatment patterns of statin initiators over the first decade of the 21st century. METHODS: New statin use was studied retrospectively using the database of Maccabi Healthcare Services (MHS), a large Israeli health maintenance organization. Statin initiators were defined as MHS members aged ≥ 30 years who first purchased statins between 2000 and 2010. The starting dose was calculated in simvastatin equivalents based on the World Health Organization's daily defined dose index. Persistence was calculated as the percentage of days covered (PDC) with statins during the first year of therapy. RESULTS: Statin initiation peaked in 2005 and decreased from 38.6 to 18.6 per 1,000 in the period 2005-2010. The average age at therapy initiation decreased from 58.9 (± 12.0) to 54.5 (± 11.7) years, and the average (SD) baseline low-density lipoprotein cholesterol (LDL-C) decreased from 4.2 (± 1.1) to 4.0 (± 0.9) mmol/l during the study period. Women were on average 3 years older than men at treatment initiation, with a higher baseline LDL-C. Among statin initiators, the prevalence of ischemic heart disease (IHD) decreased from 17.8 to 6.7 %, and diabetes prevalence increased from 8.6 to 15.7 %, peaking in 2008 (18.0 %). The PDC with statins ranged between 52.9 and 57.7 %. Simvastatin use at initiation increased from 27.5 % in 2000 to >90 % since 2002. Starting dose increased from 18.5 (± 8.9) to 24.3 (± 13.7) mg simvastatin equivalent. CONCLUSIONS: Among the study population, statin initiators were increasingly characterized by a lower cardiovascular risk-namely, younger individuals without IHD and with a lower baseline LDL-C. These trends underscore the important shift towards statin initiation for primary prevention, as well as the need to balance between benefits and the potential side effect of statins.

Serum vitamin D concentrations (25[OH]D) are associated with physical performance in the general population, but few studies have been published in athletes. 80 competitive adolescent swimmers from both sexes were tested for serum 25(OH)D concentrations, grip strength, balance and swimming performance at several speeds. Spearman's correlations were used to examine the associations between 25(OH)D concentrations and age-adjusted measures of performance. Performance parameters were also compared between vitamin D sufficient (n = 27), insufficient (25[OH]D ranging 20-29.9 ng/ml, n = 42), and deficient (25[OH]D < 20 ng/ml, n = 11) participants. No significant associations were found between serum 25(OH)D concentrations and any of the performance measures, with no significant differences found between vitamin D sufficient, insufficient and deficient participants. In competitive adolescent swimmers, serum vitamin D concentrations were not associated with strength, balance or swimming performance. Vitamin D insufficient/deficient swimmers did not have reduced performance.

Serum vitamin D concentrations (25[OH]D) are associated with physical performance in the general population, but few studies have been published in athletes. 80 competitive adolescent swimmers from both sexes were tested for serum 25(OH)D concentrations, grip strength, balance and swimming performance at several speeds. Spearman's correlations were used to examine the associations between 25(OH)D concentrations and age-adjusted measures of performance. Performance parameters were also compared between vitamin D sufficient (n = 27), insufficient (25[OH]D ranging 20-29.9 ng/ml, n = 42), and deficient (25[OH]D < 20 ng/ ml, n = 11) participants. No significant associations were found between serum 25(OH)D concentrations and any of the performance measures, with no significant differences found between vitamin D sufficient, insufficient and deficient participants. In competitive adolescent swimmers, serum vitamin D concentrations were not associated with strength, balance or swimming performance. Vitamin D insufficient/deficient swimmers did not have reduced performance.

It is hypothesized that vitamin D insufficiency in athletes might negatively affect sport performance. The objective of this study was to examine the effect of vitamin D3 supplementation on physical performance of adolescent swimmers with vitamin D insufficiency. Fifty-three adolescent competitive swimmers with vitamin D insufficiency (serum 25-hydroxyvitamin-D concentrations (25(OH)D)<30ng/ml, mean 24.2±4.8ng/ml) were randomized to receive 2,000IU/day of vitamin D3 or placebo for 12 weeks. Swimming performance at several speeds, arm-grip strength, and one-legged balance, were measured before and after supplementation. The age-adjusted changes in performance variables during the study were compared between groups. 25(OH)D concentrations at study end were significantly higher in the vitamin group compared with the placebo group (29.6±6.5ng/ml vs. 20.3±4.2ng/ml, p<0.001), yet only 48% of the vitamin group became vitamin D sufficient with this dosing. No between-group differences were found in the changes of the performance variables tested. No significant differences in performance were found between participants that became vitamin D sufficient, and those who did not. No significant correlation was found between the change in serum 25(OH)D and age-adjusted balance, strength or swimming performance at study end. Vitamin D3 supplementation that raised serum 25(OH)D concentrations by a mean of 9.3ng/ml above placebo in adolescent swimmers with vitamin D insufficiency, did not improve physical performance more than placebo.