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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.

The recent global outbreak of the monkeypox (mpox) virus in humans was declared a public health emergency by the World Health Organization in July 2022. The smallpox and mpox vaccine (JYNNEOS; Modified Vaccinia Ankara-Bavarian Nordic; MVA-BN), provided as a two-dose regimen, is currently the primary vaccine utilized against mpox. However, the efficacy of MVA-BN against mpox has never been demonstrated in clinical trials to date. Due to the limited supply of vaccines, the World Health Organization has recommended prioritizing the vaccination of high-risk groups. We evaluated the real-world effectiveness of a single, subcutaneous dose of MVA-BN in this observational, retrospective cohort study, which included the analysis of electronic health records of all members of Clalit Health Services eligible for the vaccine on 31 July 2022. We used a Cox proportional hazards regression model with time-dependent covariates to estimate the association between vaccination and mpox while adjusting for sociodemographic and clinical risk factors. In an analysis of 2,054 male individuals who met vaccine eligibility criteria, 1,037 (50%) were vaccinated during the study recruitment period and completed at least 90 d of follow-up. During the study period, 5 and 16 infections were confirmed in vaccinated and unvaccinated individuals, respectively. The adjusted vaccine effectiveness was estimated at 86% (95% confidence interval, 59–95%). Our results suggest that a single dose of subcutaneous MVA-BN in this high-risk cohort is associated with a significantly lower risk of MPXV infection. Effectiveness of one subcutaneous dose of MVA-BN, the smallpox and mpox vaccine, was estimated to be 86% in a cohort of vaccine-eligible males in Israel, supporting its use to curtail the outbreak of mpox virus.

Two doses of the BNT162b2 vaccine were associated mainly with low-grade local adverse effects that lasted 2 days or less and afforded nearly 50% protection against omicron infection and symptomatic illness, which was lower than that seen against delta. Greater protection in the youngest group was noted.

Resistance necessarily erupts in a surprising, spontaneous and authentic manner, manifested as an emotionally powerful, often physical phenomenon. Resistance signifies the client's unwillingness to participate in the therapeutic process. Scholars have tried to understand resistance, and proposed therapeutic interventions. The present study relies on Kohut's approach to the \"self-object\" as the relationship for consideration. A mixed-methods paradigm using quantitative and qualitative tools, collected therapists' viewpoints on their clients' resistance patterns, to clarify therapists' coping methods, when facing, different emotional, behavioral and physical resistances. It also investigated whether clients could be equipped with professional tools to provide a space for anchors, alternative innovative viewpoints, variation of emotional, behavioral and movement expressions and other ways of expressing the resistance experience. Respondents included 14 occupational therapists, 23 para-medical carers and 17 students on a group leaders' course. Data were collected from questionnaires, eliciting therapists' reactions to resistance situations, and perceptions of the resistant client and from the therapists' observations, reflective writings, case presentations and works on children resisting therapy. Findings indicate that learning in an experiential workshop, field work and reflective writing altered therapists' perceptions of resistance as expressed in movement, behavior and emotions. There was a change in the therapeutic relationship and the intervention methods, and in the therapist's self-image and professional identity. This study alters the image of the resistant other, being perceived not as belligerent, but rather as struggling to experience their self and to express their inner world.

Objective: Pediatric overweight and obesity represent a growing public health concern with significant long-term implications. In children diagnosed with attention-deficit/hyperactivity disorder (ADHD), stimulant medications may alter appetite, potentially impacting body weight and growth patterns. However, real-world data on the effect of these treatments on body mass index (BMI) classification remains scarce. We aimed to evaluate the effect of ADHD stimulant therapy on transitions in the BMI categories among children. Study Design: We conducted a large-scale observational cohort study assessing longitudinal changes in BMI classification following the initiation of stimulant treatment, utilizing data from Clalit Health Services, Israel’s largest healthcare provider. BMI was categorized into four groups: normal weight, overweight, obesity, and severe obesity. Subgroup analysis was performed by sex and age groups: <7 years; >7 <13 years and >13 <18 years. Results: At baseline, 26,930 children met the study inclusion criteria. 12,448 (46%) were classified as overweight or obese. Most children with normal weight at baseline maintained their BMI classification (90%). 48% of children with overweight, 42% with obesity, and 29% with severe obesity transitioned to a lower BMI category. 39% of children with underweight transitioned to normal weight. Similar patterns in BMI category transitions were observed between sexes. Transition to a lower BMI category was more prevalent in the younger age group. Conclusions: Stimulant therapy for ADHD is associated with significant shifts in BMI classification among pediatric patients. While many children, especially younger with higher baseline BMI, experienced improvements in weight status, a notable minority exhibited weight gain. These findings underscore the importance of routine BMI monitoring and weight management strategies during ADHD treatment.

Background: The outbreak of the COVID-19 pandemic led to a decrease in primary health care in-person visits and a simultaneous increase in virtual encounters. Objective: To quantify the change in the total volume of primary care visits and mix of visit types during the two years of the pandemic in Israel. Design: Cross-sectional study. Participants: All primary care visits by members of the largest healthcare organization in Israel, during three one-year periods: the pre-COVID-19 year (March 2019–February 2020), the first year of COVID-19 (March 2020–February 2021), and the second year of COVID-19 (March 2021–February 2022). Main measures: Total volume of primary care visits and mix of visit types. Results: More than 112 million primary care visits were included in the study. The total visit rate per 1000 members did not change significantly between the pre-COVID year (19) and the first COVID year (19.8), but was 21% higher in the second COVID-19 year (23). The rate of in-person visits per 1000 members decreased from 12.0 in the pre-COVID year to 7.7 in the first COVID year and then increased to 9.6 in the second. The rate of phone visits and asynchronous communication increased from 0.7 and 6.3, respectively, in the pre-COVID year, to 4.1 and 8, respectively, in the first COVID year, and remained unchanged in the second. There was substantial variation across age groups and sectors in the adoption of virtual platforms. Conclusions: The rapid introduction of virtual encounters in primary care tended to displace in-person visits in the first year of the pandemic, but they appear to have been additive in the second. This transition should be monitored, with the goal of ensuring appropriate planning efforts and resource allocation to deal with the potential added burden on medical staff. Efforts should be invested in encouraging the use of virtual platforms in patient groups that currently underutilize it, such as minorities.

REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, has been approved as a treatment for high-risk patients infected with SARS-CoV-2 within five days of their diagnosis. We performed a retrospective cohort study, and used data repositories of Israel’s largest healthcare organization to determine the real-world effectiveness of REGEN-COV treatment against COVID-19-related hospitalization, severe disease, and death. We compared patients infected with Delta variant and treated with REGEN-COV (n = 289) to those infected but not-treated with REGEN-COV (n = 1,296). Demographic and clinical characteristics were used to match patients and for further adjustment as part of the C0x model. Estimated treatment effectiveness was defined as one minus the hazard ratio. Treatment effectiveness of REGEN-COV was 56.4% (95% CI: 23.7–75.1%) in preventing COVID-19 hospitalization, 59.2% (95% CI: 19.9–79.2%) in preventing severe COVID-19, and 93.5% (95% CI: 52.1–99.1%) in preventing COVID-19 death in the 28 days after treatment. In conclusion, REGEN-COV was effective in reducing the risk of severe sequelae in high-risk COVID-19 patients. REGEN-COV is a SARS-CoV-2 combined monoclonal antibody treatment which has been shown to be effective in randomised controlled trials. Here, the authors assess its real-world effectiveness using data from Israel during the Delta wave and find that it reduced the risk of hospitalisation, severe disease and death.