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Immune protection following either vaccination or infection with SARS-CoV-2 is thought to decrease over time. We designed a retrospective study, conducted at Leumit Health Services in Israel, to determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. Antibody titers were measured between 31 January 2021, and 31 July 2021 in two mutually exclusive groups: (i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and (ii) SARS-CoV-2 convalescents who had not received the vaccine. A total of 2653 individuals fully vaccinated by two doses of vaccine during the study period and 4361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8–5644.6]) after the second vaccination than in convalescent individuals (median 355.3 AU/mL IQR [141.2–998.7]; p < 0.001). In vaccinated subjects, antibody titers decreased by up to 38% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group.

Aims/hypothesis Not all people with type 2 diabetes who undergo bariatric surgery achieve diabetes remission. Thus it is critical to develop methods for predicting outcomes that are applicable for clinical practice. The DiaRem score is relevant for predicting diabetes remission post-Roux-en-Y gastric bypass (RYGB), but it is not accurate for all individuals across the entire spectrum of scores. We aimed to develop an improved scoring system for predicting diabetes remission following RYGB (the Advanced-DiaRem [Ad-DiaRem]). Methods We used a retrospective French cohort ( n  = 1866) that included 352 individuals with type 2 diabetes followed for 1 year post-RYGB. We developed the Ad-DiaRem in a test cohort ( n  = 213) and examined its accuracy in independent cohorts from France ( n  = 134) and Israel ( n  = 99). Results Adding two clinical variables (diabetes duration and number of glucose-lowering agents) to the original DiaRem and modifying the penalties for each category led to improved predictive performance for Ad-DiaRem. Ad-DiaRem displayed improved area under the receiver operating characteristic curve and predictive accuracy compared with DiaRem (0.911 vs 0.856 and 0.841 vs 0.789, respectively; p =  0.03); thus correcting classification for 8% of those initially misclassified with DiaRem. With Ad-DiaRem, there were also fewer misclassifications of individuals with mid-range scores. This improved predictive performance was confirmed in independent cohorts. Conclusions/interpretation We propose the Ad-DiaRem, which includes two additional clinical variables, as an optimised tool with improved accuracy to predict diabetes remission 1 year post-RYGB. This tool might be helpful for personalised management of individuals with diabetes when considering bariatric surgery in routine care, ultimately contributing to precision medicine.

Out of hospital cardiac arrest (OHCA) remains a major cause of morbidity and mortality. The survival rates are poor and even more frustrating are the rates of neurologically favorable outcomes at hospital discharge. In a recent IJHPR article, Einav et al. concluded that many primary care clinics are underequipped and the physicians underprepared to initiate life-saving services. The chance of having an OHCA in a primary care clinic is very low. But although the impact is small, primary care teams as well as other out-of-hospital healthcare personal should be familiar with the telephone number for summoning emergency medical services (EMS), be aware of the location of the defibrillator in their clinic, and know how to use it. The literature about effective ways to keep long-standing competencies in cardiopulmonary resuscitation among medical personnel outside the hospital is scarce. It is very difficult to evaluate the actual effectiveness of interventions on better outcome; the events are rare and unique in their nature and it hard to generalize the conclusions. The “chain of survival” concept involves a series of steps that should be taken at the scene in the community: early recognition of symptoms and activation of an emergency response system; early bystander cardiopulmonary resuscitation; rapid defibrillation, if needed; early advanced cardiac life support and integrated post-resuscitation care. In this “chain” there is an important role for healthcare personal in the community via improving their own skills and performance and via a deeper involvement in the education of the public. We should take all the needed steps so that community clinic personnel can be role models for effective and successful out of hospital cardiac resuscitation (OHCR).

Aim: To evaluate the natural history of diabetic retinopathy (DR) in diabetic patients and to assess long term risk for other chronic diseases associated with DR. Methods: Retrospective, community-based study. Diabetics who underwent their first fundoscopic examination during 2000-2002, and had at least one follow- up examination by the end of 2007 were included. The primary outcome was the development of DR (proliferative diabetic retinopathy (PDR), non PDR (NPDR) or macular edema. Patients were followed for another 9 years for documentation of new diagnosis of related diseases. Results: 516 patients' (1,032 eyes) records were included and were followed first for an average of 4.15 ± 1.27 years. During follow-up, 28 (2.7%) of the total 1,032 eyes examined were diagnosed with PDR. An additional 194 (18.8%) eyes were diagnosed with new NPDR. The cumulative incidence of NPDR was 310/1,032 (30.0%). All the patients who developed PDR had prior NDPR. By the end of the 9 years extended follow up, patients with NPDR had a greater risk for developing chronic renal failure HR = 1.71 (1.14-2.56), ischemic heart disease HR = 1.57 (1.17-2.09), and had an increased mortality rate HR = 1.26 (1.02-1.57) Conclusion: DR is associated with a higher rate of diabetes complications. Patients with DR should be followed more closely. Key points During a mean follow-up of 4.5 years, the cumulative incidence of diabetic retinopathy in a community cohort was 18.8%. NDPR (non-proliferative diabetic retinopathy) is a predictor of PDR (proliferative diabetic retinopathy). In a real life setting NPDR is a marker of a poorer prognosis. Patients with NDPR should be monitored more closely.

The war in Ukraine led to a flood of refugees consisting mainly of women, children and elderly. This study aimed to explore healthcare use by elderly Ukrainian refugees. In this retrospective cohort study, we examined patterns of healthcare services used by elderly Ukrainian refugees in Israel between 30 July 2022 and 1 May 2023 (  = 2269). We compared them to controls, matched for age and gender, among the general Israeli population (  = 2271). We performed Poisson regressions for statistical analysis. The Ukrainian refugee cohort was predominantly female (77.4%) with a mean age of 71.4 ± 7.1 years. Compared to their controls, the refugees were much less likely to participate in face-to-face, digital and video doctor visits (IRR = 0.838, 0.457 and 0.329, respectively; value < 0.001). Across almost all medical fields (except cardiology), refugees were less likely to have consultations with specialists. Additionally, refugees had fewer emergency room visits (IRR = 0.42, value < 0.001), fewer hospitalisations (IRR = 0.54, value < 0.001) and shorter hospitalisations (IRR = 0.489, value < 0.001). In a healthcare system with full coverage, Ukrainian refugees were less likely to utilise healthcare services. These findings suggest that refugees may face significant barriers to access and may be underutilising needed care. Healthcare systems should adopt proactive and culturally responsive approaches to address these disparities and ensure equitable access. This study highlights the need for targeted interventions and further research to better understand and reduce healthcare barriers among refugee populations.

Background Previous studies have shown that more temporally regular primary care visits are associated with improved patient outcomes. Objective To examine the association of temporal regularity (TR) of primary care with hospitalizations and mortality in patients with chronic illnesses. Also, to identify threshold values for TR for predicting outcomes. Design Retrospective cohort study. Participants We used data from the electronic health record of a health maintenance organization in Israel to study primary care visits of 70,095 patients age 40 + with one of three chronic conditions (diabetes mellitus, heart failure, chronic obstructive pulmonary disease). Main measures We calculated TR for each patient during a two-year period (2016–2017), and divided patients into quintiles based on TR. Outcomes (hospitalization, death) were observed in 2018–2019. Covariates included the Bice-Boxerman continuity of care score, demographics, and comorbidities. We used multivariable logistic regression to examine TR’s association with hospitalization and death, controlling for covariates. Key results Compared to patients receiving the most regular care, patients receiving less regular care had increased odds of hospitalization and mortality, with a dose–response curve observed across quintiles ( p for linear trend < 0.001). For example, patients with the least regular care had an adjusted odds ratio of 1.40 for all-cause mortality, compared to patients with the most regular care. Analyses stratified by age, sex, ethnic group, area-level SES, and certain comorbid conditions did not show strong differential associations of TR across groups. Conclusions We found an association between more temporally regular care in antecedent years and reduced hospitalization and mortality of patients with chronic illness in subsequent years, after controlling for covariates. There was no clear threshold value for temporal regularity; rather, more regular primary care appeared to be better across the entire range of the variable.

Background: Chronic mast cell–mediated angioedema (MC-AE) and chronic spontaneous urticaria (CSU) both involve mast cell activation but may differ in long-term systemic outcomes. Limited data exist comparing their comorbidity profiles over extended follow-up. Objective: To compare systemic comorbidities in patients with chronic MC-AE versus CSU using a large, population-based dataset. Methods: We conducted a retrospective matched case–control study using electronic health records from Leumit Health Services, a nationwide Israeli health maintenance organization. Patients diagnosed with chronic MC-AE between 2005 and 2023 (n = 2133) were matched 1:1 by age, sex, and year of diagnosis to patients with CSU (n = 2133). Comorbidities were assessed at diagnosis and after a mean follow-up of 10.2 ± 2.9 years. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multivariable logistic regression was used to assess the association between medications and MC-AE diagnosis. Results: MC-AE patients exhibited significantly higher baseline rates of hypertension (23.8% vs. 18.5%), ischemic heart disease (5.67% vs. 3.84%), and type 2 diabetes (10.45% vs. 6.42%) compared to CSU. These differences persisted or increased at follow-up, including myocardial infarction (4.13% vs. 2.25%) and chronic kidney disease (4.13% vs. 2.91%). CSU patients had consistently higher rates of atopic dermatitis, viral infections, and herpes zoster. Statin use was inversely associated with MC-AE (adjusted OR = 0.63; 95% CI: 0.44–0.90). Conclusions: Chronic MC-AE is associated with a distinct and sustained cardiometabolic and renal comorbidity burden compared to CSU, supporting its classification as a systemic disease phenotype requiring differentiated long-term care.

Background The COVID-19 pandemic has transformed healthcare, affecting the diagnosis and management of common diseases. Our study aimed to assess the effect of the changes in reasons for primary care visits on primary care physicians’ (PCPs’) workload from 2019 to 2023, focusing on non-COVID-related diseases. Methods A cross-sectional study of electronic medical records conducted at Leumit Health Services between 2019 and 2023, approximately 510,000 patients who had at least one consultation with a PCP were included. The study categorized visits using ICD-9 codes and calculated the number of visits and the accumulated annual duration of time (AADT) for each code group. Results In 2023, there was a significant 38.9% increase in administrative visits compared to 2019, with these visits accounting for 21.8% of AADT. Additionally, a consistent rise in visits for hyperlipidemia, obesity, and diabetes was noted. Conversely, the AADT for respiratory tract infections and sexually transmitted diseases markedly declined. A lesser, yet still notable, decrease was observed in other infectious diseases, injuries, heart diseases, and pulmonary diseases. Conclusions COVID-19 altered the distribution of primary care visit reasons and subsequently impacted the burden on PCPs. Notably, there was an increase in visits for bureaucratic issues and a concerning reduction in follow-ups for cardiovascular risk factors, alongside a rise in metabolic conditions. These trends persisted even after the pandemic waned, despite the removal of social restrictions. Policymakers should evaluate how to optimize the utilization of PCPs’ time and explore methods to regulate demand for improved efficiency.