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Among 843,208 participants in Israel who were 50 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, those who received a booster had 90% lower mortality due to Covid-19 than those who did not receive a booster. The study period was 54 days; adverse effects were not recorded.

The rapid emergence of the B.1.1.529 (Omicron) variant of SARS-CoV-2 led to a global resurgence of coronavirus disease 2019 (COVID-19). Israeli authorities approved a fourth COVID-19 vaccine dose (second booster) for individuals aged 60 years and over who had received a first booster dose 4 or more months earlier. Evidence for the effectiveness of a second booster dose in reducing hospitalizations and mortality due to COVID-19 is warranted. This retrospective cohort study included all members of Clalit Health Services who were aged 60–100 years and who were eligible for the second booster on 3 January 2022. Hospitalizations and mortality due to COVID-19 in participants who received the second booster were compared with those for participants who received one booster dose. Cox proportional hazards regression models with time-dependent covariates were used to estimate the association between the second booster and hospitalization and death due to COVID-19 while adjusting for demographic factors and coexisting illnesses. A total of 563,465 participants met the eligibility criteria. Of those, 328,597 (58%) received a second booster dose during the 40 day study period. Hospitalization due to COVID-19 occurred in 270 of the second-booster recipients and in 550 participants who received one booster dose (adjusted hazard ratio, 0.36; 95% confidence interval (CI): 0.31–0.43). Death due to COVID-19 occurred in 92 second-booster recipients and in 232 participants who received one booster dose (adjusted hazard ratio, 0.22; 95% CI: 0.17–0.28). This study demonstrates a substantial reduction in hospitalizations and deaths due to COVID-19 conferred by a second booster in Israeli adults aged 60 years and over. A retrospective analysis of data from a large healthcare insurance provider in Israel shows that a second booster shot (fourth dose) of BNT162b2 in people aged 60 years and over results in a substantial reduction in hospitalizations and deaths due to COVID-19.

In a retrospective cohort study from Israel, 149,032 patients who had recovered from SARS-CoV-2 infection were followed over a 270-day period to assess the rate of reinfection according to whether they had subsequently received a Covid-19 vaccine or had remained unvaccinated. The reinfection rate was 10.21 cases per 100,000 persons per day among unvaccinated patients and 2.46 cases among vaccinated patients.

In late 2022, the SARS-CoV-2 omicron (B.1.1.529) BA.5 sublineage accounted for most of the sequenced viral genomes worldwide. Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the omicron BA.4 and BA.5 sublineages. Since September, 2022, a single bivalent mRNA vaccine booster dose has been recommended for adults who have completed a primary SARS-CoV-2 vaccination series and are at high risk of severe COVID-19. We aimed to evaluate the effectiveness of a bivalent mRNA vaccine booster dose to reduce hospitalisations and deaths due to COVID-19. We did a retrospective, population-based, cohort study in Israel, using data from electronic medical records in Clalit Health Services (CHS). We included all members of CHS who were aged 65 years or older and eligible for a bivalent mRNA COVID-19 booster vaccination. We used hospital records to identify COVID-19-related hospitalisations and deaths. The primary endpoint was hospitalisation due to COVID-19, which we compared between participants who received a bivalent mRNA booster vaccination and those who did not. A Cox proportional hazards regression model with time-dependent covariates was used to estimate the association between the bivalent vaccine and hospitalisation due to COVID-19 while adjusting for demographic factors and coexisting illnesses. Between Sept 27, 2022, and Jan 25, 2023, 569 519 eligible participants were identified. Of those, 134 215 (24%) participants received a bivalent mRNA booster vaccination during the study period. Hospitalisation due to COVID-19 occurred in 32 participants who received a bivalent mRNA booster vaccination and 541 who did not receive a bivalent booster vaccination (adjusted hazard ratio 0·28, 95% CI 0·19–0·40). The absolute risk reduction for hospitalisations due to COVID-19 in bivalent mRNA booster recipients versus non-recipients was 0·089% (95% CI 0·075–0·101), and the number needed to vaccinate to prevent one hospitalisation due to COVID-19 was 1118 people (95% CI 993–1341). Participants who received a bivalent mRNA booster vaccine dose had lower rates of hospitalisation due to COVID-19 than participants who did not receive a bivalent booster vaccination, for up to 120 days after vaccination. These findings highlight the importance of bivalent mRNA booster vaccination in populations at high risk of severe COVID-19. Further studies with longer observation times are warranted. None.

As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. We explored the use characteristics of older adults (aged ≥65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability.

Introduction Multiple gestations are a risk factor for most pregnancy complications. The current study aimed to study whether offspring born after twin pregnancies are at increased risk for long‐term health complications. Material and methods A retrospective cohort study was conducted in a large medical center, including all offspring born between the years 1991–2021, which were followed‐up until 18 years of age. Hospital‐based diagnoses of the offspring were categorized into main groups of morbidities: cardiac, respiratory, infectious, neurological, malignancy, and metabolic. Incidence of hospitalization with diagnoses from each main group was compared between twins and singletons, as well as time to first hospitalization. Cox proportional hazard models were used to study the association between twins vs singletons and hospitalizations by grouped morbidities, while adjusting for maternal age, ethnicity and gender, besides maternal recurrence in the cohort. Results A total of 369 478 offspring were included in the analysis; of these 11 986 (3.2%) were twins and 357 492 (96.8%) were singletons. Twins were more likely to be delivered preterm (odds ratio = 17.65, 95% CI: 16.74–18.60), by cesarean delivery and following infertility treatments. Incidence of hospitalizations with all morbidity groups was slightly, some significantly, higher among twins, including cardiac: 1.9% vs 1.5%, respiratory; 8.4% vs 7.1%, neurological: 7.7% vs 7.4%, infectious: 26.0% vs 24.1%, and malignancies: 0.7% vs 0.4%. The risk remained higher in the multivariable analyses (adjusted hazard ratios ranging between 1.09–1.75). When stratifying by gestational age at delivery, the risk for most morbidities was lower among twins vs singletons born in similar gestational ages. Conclusions Twins as compared to singletons are at increased risk for most morbidities due to their risk of being born earlier. The rates of multiple gestations, including mainly twin gestations, have increased in recent years. Twins face higher risk of health complications that continue throughout childhood, due to their risks of being born earlier.

Background Telemedicine has expanded healthcare accessibility, particularly during the COVID-19 pandemic. However, evidence regarding its economic efficiency and clinical quality remains inconclusive, with some studies suggesting increased costs, service utilization, and inappropriate antibiotic prescribing compared to traditional care modalities. Objective This study evaluated pediatric telemedicine services across three dimensions: clinical outcomes (antibiotic prescribing patterns), resource utilization implications (healthcare utilization and emergency department visits), and equity considerations (sociodemographic distribution of services). Methods We conducted a retrospective cohort study analysis of 1,500 children under 19 years within Israel’s Clalit Health Services (Shron-Shomron District) from January 2021 to January 2022. Participants were randomly sampled from three groups based on their telemedicine utilization patterns: in-person primary care physician (PCP) visits only ( n  = 500); PCP plus phone/video telemedicine ( n  = 500); and PCP plus phone/video plus Tyto device telemedicine ( n  = 500). These children were classified as discrete groups, not only as solitary visits. We assessed emergency department (ED) admission rates, antibiotic prescription frequencies for common pediatric conditions, and sociodemographic characteristics across the groups. Results Analysis of 21,968 visits revealed striking socioeconomic disparities in telemedicine utilization. While 58.1% of all participants had high socioeconomic status (SES), this increased to 68.6% among Tyto device users. Conversely, low-SES patients comprised 26.4% of in-person-only visits but only 3% of Tyto users. ED admission rates for all groups combined were 4.0%, 1.6% for the “PCP only” group, 5.4% for the “PCP + phone/video” group (12% after phone/video visits), and 3.6% for the “PCP + phone/video + Tyto” group (4.1% after Tyto only). Antibiotic prescribing rates were similarly divergent: mean rates of antibiotic prescriptions after PCP visits were 10.3%, after telephone/video visits were 16.8%, and after Tyto visits were 21.4% ( p  < 0.001). Multivariable analysis confirmed those findings and demonstrated higher ED utilization and antibiotic prescribing among low-SES patients and those in remote locations, independent of visit type. Conclusions Our findings challenge prevailing assumptions about telemedicine benefits, revealing unexpected associations between telemedicine services and higher ED utilization and antibiotic prescribing compared to traditional care, particularly among vulnerable populations. These associations may reflect complex interactions between patient characteristics, provider behavior, and care modalities that warrant further investigation. Healthcare systems should reconsider the implementation of telemedicine services to ensure they deliver on promises of expanded access while maintaining quality, appropriate resource utilization, and equitable distribution of benefits across socioeconomic groups. Clinical trial number Not applicable.

Objective To investigate risk factors and pregnancy outcome of patients with placenta previa. Methods A population-based study comparing all singleton pregnancies of women with and without placenta previa was conducted. Stratified analysis using multiple logistic regression models was performed to control for confounders. Results During the study period, there were 185,476 deliveries, of which, 0.42% were complicated with placenta previa. Using a multivariable analysis with backward elimination, the following risk factors were independently associated with placenta previa: infertility treatments (OR 1.97; 95% CI 1.45–2.66; P  < 0.001), prior cesarean delivery (CD; OR 1.76; 95% CI 1.48–2.09; P  < 0.001) and advanced maternal age (OR 1.08; 95% CI 1.07–1.09; P  < 0.001). Placenta previa was significantly associated with adverse outcomes such as peripartum hysterectomy (5.3 vs. 0.04%; P  < 0.001), previous episode of second trimester bleeding (3.9 vs. 0.05%; P  < 0.001), blood transfusion (21.9 vs. 1.2%; P  < 0.001), maternal sepsis (0.4 vs. 0.02%; P  < 0.001), vasa previa (0.5 vs. 0.1%; P  < 0.001), malpresentation (19.8 vs. 5.4%; P  < 0.001), postpartum hemorrhage (1.4 vs. 0.5%; P  = 0.001) and placenta accreta (3.0 vs. 1.3%; P  < 0.001). Placenta previa was significantly associated with adverse perinatal outcomes such as higher rates of perinatal mortality (6.6 vs. 1.3%; P  < 0.001), an Apgar score <7 after 1 and 5 min (25.3 vs. 5.9%; P  < 0.001, and 7.1 vs. 2.6%, P  < 0.001, respectively), congenital malformations (11.5 vs. 5.1%; P  < 0.001) and intrauterine growth restriction (3.6 vs. 2.1%; P  = 0.003). Using another multivariable logistic regression model, with perinatal mortality as the outcome variable, controlling for confounders, such as preterm birth, maternal age, etc., placenta previa was not found as an independent risk factor for perinatal mortality (weighted OR 1.018; 95% CI 0.74–1.40; P  = 0.910). Conclusions Infertility treatments, prior cesarean section, and advanced maternal age are independent risk factors for placenta previa. An increase in the incidence of these risk factors probably contributes to a rise in the number of pregnancies complicated with placenta previa and its association with adverse maternal and perinatal outcomes. Careful surveillance of these risk factors is recommended with timely delivery in order to reduce the associated complications.

Purpose The incidence of women giving birth at advanced maternal age is increasing. Literature regarding the long-term implications of delivery at advanced maternal age is limited. This study aimed to investigate whether advanced maternal age at first delivery correlates with elevated long-term risk of endocrine morbidities. Methods This retrospective population-based study included women who gave birth between 1991 and 2021. Participants were categorized by age at first delivery: < 30, 30–35, 35–40, and > 40 years. Women with pre-existing endocrine disorders before pregnancy were excluded. Kaplan–Meier survival curves assessed cumulative incidence of endocrine disorders, while Cox proportional hazards models calculated adjusted hazard ratios (HR), accounting for confounders including fertility treatments, ethnicity, gestational diabetes mellitus, and hypertensive disorders. Results A total of 77,746 women were included. Advanced maternal age at first delivery was significantly associated with increased risk for endocrine morbidity, particularly diabetes and hyperlipidemia, both showing a clear age-related progression. No significant differences were observed for thyroid, parathyroid disorders, or obesity. Kaplan–Meier curves showed the highest endocrine morbidity risk among women delivering after age 40 (log-rank p  < 0.001). After adjustment, hazard ratios were: 30–35 years aHR 1.29 (95% CI 1. 19 –1.4 0 , p  < 0.001), 35–40 years aHR 1.27 (95% CI 1.10–1.47, p  < 0.001), and > 40 years aHR 1.15 (95% CI 0.86–1.54, p  = 0.339), compared to women < 30 years. Conclusions Advanced maternal age at first delivery is independently associated with an increased risk of long-term endocrine morbidity, particularly diabetes and hyperlipidemia. This graded association underscores the need for long-term follow-up and preventive care in these women.

While women experiencing intimate partner violence (IPV) face significant health consequences, their patterns of healthcare services (HCS) utilization are unclear, as are the effects of IPV screening and receiving information on these patterns. 1. Compare utilization patterns of five HCS (visits to family physician, gynecologist, specialist and emergency room, and hospitalization) in a cohort of perinatal women who reported experiencing versus not experiencing any IPV and IPV types (physical and/or sexual; emotional and/or verbal; social and economic); 2. Examine whether IPV screening, receiving information on support services, or both, affect patterns; and 3. Compare these associations between ethnic groups (Arab and Jewish women). We conducted a prospective study using registry data on HCS utilization obtained from Israel's largest Health Fund (Clalit) in the year following a 2014-2015 survey of a cohort of 868 perinatal women in Israel (327 Arab minority, 542 Jewish) on their reports of experiencing IPV, IPV screening, and receiving information. Using multivariate analysis, we calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the five HCS utilizations in association with reports of any IPV and IPV types. We adjusted for IPV screening, receiving information about services, and both, in the total sample, and separately among ethnic groups. Any IPV and IPV types had significant associations with some HCS utilization variables, with different directions and patterns for the ethnic groups. Experiencing IPV was associated with higher HCS utilization among Arab women, lower utilization in Jewish women. Arab women experiencing IPV were twice as likely to visit a gynecologist than women not experiencing IPV (AOR (95% CI) was 2.00, 1.14-3.51 for any IPV; 2.17, 1.23-3.81 for emotional and/or verbal IPV, and 1.83, 1.04-3.22, for social and economic IPV). Among Jewish women, experiencing any IPV was associated with lower likelihood of emergency-room visits (0.62, 0.41-0.93); and experiencing physical and/or sexual IPV was associated with lower likelihood of family physician visits (OR = 0.20, 0.05-0.82). Both IPV screening and receiving information were associated with lower HCS utilization among Arab women only. Different HCS utilization patterns among women who reported experiencing versus not experiencing IPV in different ethnic groups suggest complex relationships that hinge on how HCS address women's needs, starting with IPV screening and providing information. This might inform tailored programs to tackle IPV at the HCS, particularly for minority women.