Ministry of Health (Israel)

Background Proper nutrition is fundamental to the regular mental and physical development of infants, toddlers, and children. Overexposure to manganese (Mn) in infants has been correlated to various behavioral and neurological symptoms such as lower IQ, attention deficit hyperactivity disorder, and impairment in fine motor skills. The following study aims to evaluate exposure to Mn in formula-fed infants in Israel from birth to nine months of age. Methods Over 200 infant formulas of multiple brands were sampled by the Israeli National Food Service, as part of a routine monitoring of levels of various nutritional components, including Mn. Data on levels of Mn in water was drawn from routine monitoring programs carried out by the Ministry of Health (MOH). Total energy requirements were calculated based on current infant weight and growth data collected over the past decade in MOH-operated family care centers. Dietary exposure was assessed for infants from birth to six months as the sum of Mn intake from infant formula and potable water. For infants aged seven-nine months, Mn intake from complementary feeding was assessed based on national surveys of feeding behavior in infants aged nine-twelve months. Results Milk-based infant formula brands consistently demonstrated lower levels of Mn compared to other formulations. Almost half of the sampled formula brands exceeded regulatory tolerance to deviation from labelling of nutritional components. Though some variation in Mn concentrations is evident in water sources across Israel, the overall contribution of water to Mn intake is negligible given the high levels of desalination in Israel. Excessive Mn intake in formula-fed infants is evident across multiple formula brands. Conclusions When breastfeeding is not optional, milk-based formulas are the most suitable in terms of their relative contribution to Mn intake. Equating maximal levels of Mn in potable waters to levels set in EU and USA regulations is advisable. A greater regulatory tolerance for deviation from labelling of mineral content is advisable so as not to hinder importation of infant formulas.

Introduction: Aligned with the Innovative Medicines Initiative (IMI) ConcePTION project’s goal of advancing drug safety research in pregnancy, we explored the feasibility of employing a standardized list of core data elements (CDEs) and statistical outputs to harmonize data collection and analysis across various study partners. Methods: Study partners from public research institutions and pharmaceutical companies extracted pregnancy safety data on disease-modifying therapies for multiple sclerosis from their databases, mapped them to the CDE framework, and analysed datasets using a common statistical analysis plan (SAP). Questionnaires were used to gather contextual information on data collection practices, including data definitions and infant follow-up, and to evaluate the feasibility and practicality of the proposed methodology. Results: The study demonstrated the feasibility of harmonizing pregnancy safety data using standardized CDEs and a common SAP. All six study partners successfully mapped their data into the CDE framework and produced standardized outputs. Challenges were identified in aligning with recommended definitions, such as classifying ‘prospective cases’ based on differing criteria—pregnancies reported while ongoing, before fetal malformation diagnosis, or before any prenatal screening—and categorizing congenital anomalies using the EUROCAT system. The feasibility questionnaires revealed strong support for the methodology, with all six study partners reporting access to the necessary expertise and all six finding the statistical guidance easy to follow. Conclusions: This study demonstrates the feasibility of employing standardized CDEs and a common SAP to describe pregnancy exposure and outcome data across diverse data providers. The methodology shows promise for improving consistency in pregnancy safety research but requires addressing challenges such as resource constraints and variability in data collection for broader adoption.

Since May 2024, Israel has been experiencing a large West Nile virus (WNV) outbreak. We aimed to compare the clinical characteristics and outcomes of hospitalized cases to previous years and identify predictors of poor outcomes. A retrospective study. We compared WNV infection cases hospitalized during the 2024 outbreak (from 29 May to 29 July) to cases hospitalized during 2018–2023. For the entire cohort, risk factors for poor outcomes were investigated using multivariable analyses. The primary outcomes were death and a composite outcome of 30-day all-cause mortality, prolonged hospitalization (≥ 28 days), or discharge to an institution. We included 134 patients, 103 admitted during 2024 and 31 during 2018–2023. The majority (109/134, 81%) had neuroinvasive disease, mostly encephalitis. In 2024, patients were older, with a lower functional state, and a higher proportion were severely immunocompromised. Mortality was numerically higher in 2024 (15/103, 15% versus 2/31, 6%). Altogether, nearly 40% of patients had poor outcomes, including 13% (17/134) mortality and 25% (34/134) discharged to institutions. Nearly 30% of patients who were severely immunocompromised died; all had B-cell depletion. Age was the only significant predictor of poor outcomes in multivariable analysis; however, patients with B-cell depletion had > 3 times higher odds for mortality (odds ratio 3.26, 95% confidence interval 0.73–13.07). The large 2024 outbreak of WNV was associated with considerable mortality and functional impairment among hospitalized patients that was higher compared with previous years. Poor outcomes were particularly observed in older adults and patients with B-cell depletion. The observation of severe disease and poor outcomes in patients with B-cell depletion, as well as possible therapeutic implications, should be further investigated.

Background Dietary guidelines for families with children are designed to meet the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear. Methods The age distribution and the number of children per household by income quintile and geographic area in Israel in 2018 were obtained from the Central Bureau of Statistics. Food cost information was purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children (by age group) was calculated using standard food portions and meal frequency and expressed as a percentage of the households net income. The proportion of households for which food expenditures exceeded 15% of the net income was calculated, followed by changes in food prices during 2018. Results The average daily cost of a healthy diet for an average Israeli family was 35.5 ± 7.7 New Israeli shekels (equivalent to $9.7 ±$2.11). For households with children, the median monthly cost of the recommended diet, as a percentage of net household income was 20%. There was an inverse association with socioeconomic status, as the median monthly food expenses for the first (lowest) quintile were 55% of the household's net income and only 9.3% of the 5th (highest) income quintile. By geographic residential area, the median percentage of the net income from monthly dietary costs was 23%. The highest costs were in Judea, Samaria, and Jerusalem. Lunch made up 47% of food expenditures, if theoretically omitted, diet expenditures for households with children would decrease by an average of 15%. The food group that composed the highest component of the food budget was the vegetable group, with an average cost of 29% monthly, followed by the meat and meat substitutes group (19%). Conclusion This theoretical calculation shows that two-thirds of the households with children in Israel could not purchase the recommended diet in 2018, with significant disparities according to socioeconomic status. Policymakers should consider steps to decrease health inequality in food affordability, targeting the three middle-lower income quintiles. Our findings suggest the need to expand the provision of school lunches. Further research is required to examine how changes in household food costs influence consumers’ food choices and the potential health implications of the high expenses identified in this study.

Phlebotomine sand flies (Diptera: Psychodidae: Phlebotominae) are the principal vectors of Leishmania spp. (Kinetoplastida: Trypanosomatidae) worldwide. The subgenus Adlerius is taxonomically challenging and currently comprises about 20 species with a wide geographic distribution from eastern Asia to southeastern Europe. Some species are confirmed or suspected vectors of Leishmania donovani/infantum, L. major, and L. tropica, and are thus of high medical and veterinary relevance. A single record of Phlebotomus (Adlerius) simici in Austria from 2018 marks its sporadic northernmost and westernmost occurrence, with the origin of its appearance remaining unclear. To better understand Adlerius diversification and particularly post-glacial spread of Ph. simici to northern parts of Europe, we combined phylogenetic analyses with climatic suitability modelling. Divergence time estimates well supported the currently observed geographic distribution of the studied species and revealed several taxonomic challenges in the subgenus. We clearly delineated three distinct genetic and geographic Ph. simici lineages and phylogeographically assessed diversification that were well supported by climatic models. This study provides a comprehensive phylogenetic analysis of the subgenus Adlerius, enhancing our understanding of the diversification in relation to changing climate of this understudied group, and we present new insights into the post-glacial spread of Ph. simici, a suspected vector of L. infantum.

Importance Detecting and addressing potentially modifiable factors associated with healthy development is key to optimizing a child’s potential. When investigating the outcomes of child development, it is important to account for disparities in feeding practices and avoid confounding bias. Objectives To estimate the independent association between breastfeeding and attainment of developmental milestones or neurodevelopmental conditions. Design, Setting, and Participants This retrospective cohort study used data from a national network for routine child development surveillance in Israel linked with national social insurance financial entitlements for neurodevelopmental deficiencies. Participants were children born between January 2014 and December 2020 after at least 35 weeks’ gestation without severe morbidity and with at least 1 follow-up surveillance visit at 2 to 3 years of age. Outcome data were collected in March 2023. Exposures Duration and exclusivity of breastfeeding in infancy. Main Outcomes and Measures The primary outcomes were delays in attainment of developmental milestones and diagnosis of prespecified neurodevelopmental conditions. Multivariable regression, matching, and within-family analyses were used to estimate adjusted odds ratios (AORs) after accounting for potential confounding factors related to the child (gestational age, birth weight, multiple gestation, and child order in the family) and mother (age, socioeconomic status, educational level, marital status, employment, nationality, and postpartum depression). Results Of 570 532 children (291 953 [51.2%] male), 20 642 (3.6%) were preterm, 38 499 (6.7%) were small for gestational age, and 297 571 (52.1%) were breastfed for at least 6 months (123 984 [41.7%] were exclusively breastfed). Children who were breastfed for at least 6 months exhibited fewer delays in attaining language and social or motor developmental milestones compared with children exposed to less than 6 months of breastfeeding (AOR, 0.73 [95% CI, 0.71-0.76] for exclusive breastfeeding; AOR, 0.86 [95% CI, 0.83-0.88] for nonexclusive breastfeeding). Among 37 704 sibling pairs, children who were breastfed for at least 6 months were less likely to demonstrate milestone attainment delays (OR, 0.91 [95% CI, 0.86-0.97]) or be diagnosed with neurodevelopmental conditions (OR, 0.73 [95% CI, 0.66-0.82]) compared with their sibling with less than 6 months of breastfeeding or no breastfeeding. Conclusions and Relevance In this cohort study, exclusive or longer duration of breastfeeding was associated with reduced odds of developmental delays and language or social neurodevelopmental conditions. These findings may guide parents, caregivers, and public health initiatives in promoting early child development.

Objective To identify global research priorities for improving hand hygiene in healthcare settings and develop a 2023–2030 research agenda to guide funding, coordinate research, promote investment, and inform policy for enhanced healthcare quality and safety. Design Expert consensus study using a modified Delphi process. Participants A 105-member panel of international hand hygiene experts including the World Health Organization (WHO) Technical Advisory Group of Experts on Hand Hygiene in Healthcare representing all WHO regions and World Bank income levels. Methods The research priorities were identified through a multiphase approach including a meta-review to establish knowledge gaps and inform initial priorities, followed by expert consultations using a modified Delphi process. 192 preliminary priorities were included in a two-round Delphi survey. Experts rated each priority in the first round, and then reviewed and adjusted responses based on the panel’s aggregated, anonymous responses in the second round. Ratings were collected on a five-point Likert scale. Consensus was defined as a combined “strongly agree” and “agree” frequency of at least 70%. Results Consensus was achieved for 178 of 192 priorities (92.7%), categorized into six domains: system change; training and education; evaluation and feedback; reminders and communications; institutional safety climate; and hand hygiene improvement impact on healthcare-associated infections and antimicrobial resistance. Of these, 121 priorities reached >80% consensus. The Delphi process, maintained a 92% response rate over two rounds. Conclusions A structured consensus process yielded a research agenda to address gaps in hand hygiene improvement, supporting enhanced healthcare quality and safety globally.

This study aimed to evaluate the perceived quality of pre‐ and post‐test explanations given to women carrying BRCA1/2 variants, and to compare these outcomes between two cohorts: female BRCA1/2 carriers identified through self‐reported population‐based screening (the screening group), in comparison to self‐reported formal pre‐test genetic counseling due to personal or familial cancer history (genetic counseling group). This cross‐sectional survey of female BRCA1/2 carriers employed an anonymous questionnaire distributed through the “Good Genes – a support and information group for BRCA carriers” association from January to March 2023. Main evaluated outcomes included the perceived quality of pre‐ and post‐test explanations, first analyzed in the overall cohort, and then compared between the 110 respondents in the screening group, to 444 women in the counseling group. In the screening group, 45.5% rated the perceived quality of pre‐test explanations as unsatisfactory, compared to 27.4% in the genetic counseling group ( p = 0.0005). In terms of result delivery, the screening group reported higher instances of inappropriate timing (61.8% vs. 40.3%, p < 0.0001), suboptimal mode of delivery (55.5% vs. 37.5%, p = 0.0008) and suboptimal perceived quality in post‐test explanations (51.4% vs. 33.9%, p = 0.0006), as well as elevated stress levels (74.3% vs. 64.3%, p = 0.043). In the screening group, 21.5% of the women reported that the results were communicated by phone, letter, or online notice, compared to 17.2% in the counseling group, a non‐statistically significant difference. A logistic regression model controlling for timing and mode of delivery showed that both timing ( β = 0.46, p < 0.001) and mode of delivery ( β = 0.39, p < 0.001) remained significant predictors of dissatisfaction of post‐test counseling. The findings of this survey underscore the pressing need for enhancements in pre‐test explanation, as well as the post‐test counseling for positive results, especially within the realm of BRCA screening.

Background/Objectives: Nurse practitioners (NPs) play a pivotal role in delivering medical care, leveraging their specialized training and broader range of authorities than registered nurses, as approved by the Ministry of Health. Since 2009, Israel has expanded NP training to include diverse specialties such as palliative care, geriatrics, diabetes, surgery, and health policy. Introducing a new professional role into the health system is a complex, resource-intensive process that requires collaboration across stakeholders. Globally, NPs are recognized for preventing hospitalizations and achieving improved care outcomes, with high patient satisfaction. However, in Israel, NPs’ perceptions of their role and contributions remain underexplored. This study aims to assess NPs’ role perception, contributions to the health system, and attitudes toward their professional development in palliative and geriatric care. Methods: The mixed-methods study included 26 in-depth interviews with palliative and geriatric NPs and an online survey of 89 NPs (29 in geriatrics and 60 in palliative care). Results: Most NPs are women (84%), Israeli natives (69%), and Jewish (64%). More than half (53%) have 1–4 years of experience as practitioners, and 71% are employed full time. Regarding their work environment, the NPs feel that their supervisors and patients are appreciative of their work and that they are considered professional authorities. The qualitative findings also point to several challenges in their work: (1) The NPs’ status vis-à-vis medical staff and patients is insufficiently established; (2) the NPs lack practical and theoretical learning over time; (3) there is a shortage of positions; and (4) there is a sense of high work and emotional load and difficulty in implementing palliative care within the health system. With regard to their training, 58% of NPs were satisfied with the course, while 71% felt it lacked content. Looking forward, 76% of the NPs believed that over the next five years, the NP role would expand significantly, and 88% would recommend that other nurses become NPs. Conclusions: To maximize NPs’ potential, the study recommends clarifying their role, expanding authorities, aligning training with professional demands, and fostering trust between NPs and the medical establishment. Branding efforts and emotional support for NPs, especially in palliative care, are essential to enhance their integration and effectiveness in the health system.

Objective To explore the views of Israeli gynecologists regarding the use of vaginal pessaries for management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI), which are common medical conditions that affect women and can significantly impact their quality of life. Methods An electronic survey containing questions assessing knowledge, training, and attitudes regarding the use of vaginal pessaries for POP and SUI was distributed among Israeli gynecologists. Data were collected and recorded anonymously. Descriptive statistics were used to summarize the responses. Results A total of 700 emails were sent, with a response rate of 53% (371 responses). The majority of respondents (76.4%, n = 283) consulted a urogynecologist before and after fitting a pessary; however, 60.4% (n = 224) felt that any gynecologist should be able to follow up on such cases. When stratified by years of experience, physicians with fewer than 10 years of experience were more likely to offer pessary treatment (31.6%, n = 117 vs. 19.1%, n = 71, P < 0.01). However, those who did not offer pessaries felt more uncertain about fitting them and were more likely to report a lack of experience (24.8%, n = 92 vs. 13.6%, n = 50, P < 0.01, and 18.0%, n = 67 vs. 6.2%, n = 23, P < 0.01, respectively). Conclusions Our survey highlights a gap in knowledge and training among Israeli gynecologists regarding the conservative management of POP and SUI with vaginal pessaries. There is a clear desire among physicians to acquire these skills. The establishment of formal training programs is crucial to bridging this gap and improving women's health outcomes.

Video consultations in primary care settings demonstrate substantial benefits, including improved accessibility, reduced waiting times, and enhanced health management. These services could particularly benefit ultra-Orthodox women in Israel, who typically manage large families and face unique healthcare access challenges as primary caregivers. However, eliciting preferences within this closed religious community presents distinct methodological challenges because of cultural sensitivities and religious restrictions regarding technology use. We aimed to develop and validate a culturally sensitive, discrete choice experiment questionnaire for eliciting ultra-Orthodox women’s preferences regarding video versus in-clinic consultations in primary care settings. A three-stage mixed-methods approach was employed: (1) 33 semi-structured interviews with key stakeholders (women, men, rabbis, and healthcare providers) to identify attributes and levels; (2) an attribute-ranking exercise with 88 ultra-Orthodox women to refine attributes; and (3) cognitive interviews with 15 women to validate the discrete choice experiment questionnaire. Four key attributes emerged as most important for ultra-Orthodox women when choosing between video and in-clinic consultations: (1) consultation timing (regular hours/after 20:00); (2) travel time; (3) waiting time; and (4) familiarity with the healthcare provider. Importantly, the study revealed the necessity for a dedicated device exclusively for healthcare provider communication, closed to open Internet networks, as a fundamental prerequisite for implementing video consultations in this community. Additional unique findings emerged through this methodological process, contributing to the understanding of technological adoption in closed religious patients’ communities. This study provides a comprehensive example of implementing pre-discrete choice experiment stages while addressing unique considerations of a special population. The findings provide a framework for developing inclusive telemedicine services for traditionally underserved populations.

Objective To compare the Respiratory Syncytial Virus (RSV) hospitalization burden among 29–34 weeks gestational age (wGA) preterm infants between seasons with and without routine palivizumab prophylaxis, by utilizing the 2021 off‐season RSV surge. Methods This multi‐center retrospective study was conducted in 11 medical centers across Israel. We included infants < 1 year‐old, with wGA data, hospitalized with RSV infection from November 2017‐August 2021. National palivizumab compliance data were collected separately. We compared two periods: in‐season (November−March) with routine palivizumab prophylaxis as the reference, and off‐season (April−October) without prophylaxis as the primary risk factor. The primary outcome was the proportion of RSV hospitalizations in 29–34 wGA infants relative to total RSV admissions, calculated separately for each period. Secondary outcomes included clinical severity parameters. Results A total of 3296 infants were admitted during the RSV in‐season, and 1044 during the off‐season. National palivizumab compliance among eligible infants during the in‐season study years was 91%−95%. The proportion of 29−34 wGA infants was significantly higher during the off‐season compared to the in‐season period (7% vs. 2.1%, p < 0.001). In a multivariable logistic regression model, the odds of hospitalization for 29–34 wGA preemies were 2.6 times higher during the off‐season compared to the in‐season (95% CI: 1.8–3.9, p < 0.001), independent of demographic covariates. Clinical severity was similar between the two periods. Conclusions Our results revealed a significantly higher proportion of 29−34 wGA infants hospitalized during seasons without palivizumab prophylaxis compared to seasons with palivizumab prophylaxis. These findings highlight the importance of including 29−34 wGA infants into future RSV immunoprophylaxis recommendations.

There is increasing demand for novel antimicrobial agents to tackle the antimicrobial resistance crisis. Here we report that two Enterobacteriaceae-produced siderophores, enterobactin and salmochelin S4, inhibit the growth of Staphylococcus aureus isolates, including methicillin-resistance S. aureus (MRSA) clinical isolates. The IC50 for different S. aureus isolates were 2-5 µM for salmochelin S4 and 5-10 µM for enterobactin. This inhibitory activity was partially repressed by adding Fe⁺³. These siderophores also inhibited the growth of Enterococcus strains, including vancomycin-resistant enterococci (VRE) clinical isolates, though less effectively than for S. aureus. The growth of various Gram-negative bacteria was barely affected by these siderophores. These results shed new light on the role of enterobactin and salmochelin in bacterial physiology and ecology and have potential for the development of novel strategies to combat the rapid rise of multidrug-resistant bacteria.

There are differences in the rates of short stature (WHO height-z score < -2SD) between the various sectors in Israeli children aged 6–7 years, with higher rates in the ultraorthodox Jewish population. We aimed to: (a) Compare the anthropometric data at 0–2 years of age and the obstetric and demographic data of children with short stature at 6–7 years of age with those of children with normal height. (b) Assess risk factors for short stature at the age of 6–7 years. (c) Evaluate the impact of clinical and socioeconomic factors on linear growth from birth to the age of 6–7 years. This was a retrospective cohort study. Anonymized anthropometric data measured at the first grade of school during 2015–2019 were collected from the Ministry of Health records. The participants were stratified into sectors according to the affiliation of their school. Retrospective growth and sociodemographic data were extracted for each child from the national birth registry and Maternal Child Health Clinics files. The cohort included 368,088 children, with a median age of 6.7 years (IQR 6.3,7.0). Short stature was more prevalent in ultraorthodox Jewish boys (3.8%) and girls (3.2%), and least prevalent in Arab boys (0.8%) and girls (0.7%) compared with all other sectors (P < 0.001). The rate of stunting in Bedouin children was similar to that in the general population (1.6%). In a logistic regression model, the variables that predicted short stature at the age of 6–7 years were female sex, longer gestation, lower height z-score at 2 months of age, birth weight < 90th percentile, being in the ultraorthodox Jewish sector, and a smaller change in height z-score until 2 years of age. Growth gaps between different sectors of school-aged Israeli children emerge during the first 2 years of life. The most vulnerable population for stunting is the ultraorthodox population. Public health services, including Maternal Child Health clinics and primary caregivers, should prioritize this group and closely monitor for growth faltering during the first and second years of life.

Background Severe mental illness may affect health behaviors and outcomes during pandemics. Few studies have assessed whether people living with schizophrenia spectrum disorders (SSD) experienced adverse COVID-19 outcomes. Methods In a population-based historical cohort study comprising members of a health maintenance organization, we included 1273 patients with SSD and 12,730 age- and sex-matched controls tested for SARS-CoV-2 between March 2020 and May 2022. We assessed the association between schizophrenia and hospitalization, hospital length-of-stay, 30-day, and one-year mortality, constructing multiple linear regression and logistic regression models adjusting for sociodemographic factors, BMI, smoking, number of comorbidities, and vaccinations. We also assessed whether vaccination modified the association between schizophrenia and mortality. Results Among patients with SSD, 477 (37.5%) had a positive test, compared to 6203 (48.7%) in the comparison group. patients with SSD were at increased risk of hospitalization (adjusted odds ratio (ORadj) 3.44, 95% confidence interval (CI): 2.88–4.11, p < 0.001); longer length-of-stay (β = 1.20, p < 0.001); increased 30-day (ORadj 9.07, 95%CI 3.11–26.44); and one-year mortality (ORadj 6.27, 95%CI: 2.73–14.39). Further adjustment for vaccination altered the OR for 30-day mortality (ORadj 4.54, 95%CI: 1.54–13.38). Additionally, the association between schizophrenia and 30-day mortality was attenuated in strata of vaccinated (OR 4.79, 95%CI: 0.82–28.13, p = 0.082), vs. unvaccinated individuals (OR 7.53, 95%CI 2.19–25.92, p = 0.001), respectively. Conclusions In our cohort, patients with SSD experienced a significantly higher rate of hospitalization, length of stay, and mortality following a positive SARS-CoV-2 test, even after adjusting for important prognostic factors. COVID-19 vaccination modified these risks.

OBJECTIVE We assess diabetes risk in adulthood among adolescents with isolated glucosuria. RESEARCH DESIGN AND METHODS Included were adolescents (16–19 years) examined before military service between 1993 and 2015. Data were linked with the Israeli National Diabetes Registry. Glucosuria was confirmed following normal renal function and glucose tolerance tests. Cox models were applied. RESULTS The study included 1,611,467 adolescents, of whom 755 (0.05%) had glucosuria. The latter group had a higher proportion of males (75% vs. 57%) and a lower proportion of BMI ≥ 85th percentile (10.4% vs. 16.3%) compared with nonglucosuric (all P < 0.001). During follow-up, 10,328 diabetes cases were recorded with an incidence rate of 87.5 and 43.3 per 100,000 person-years for those with versus without glucosuria, respectively. Individuals with glucosuria had an adjusted hazard ratio of 2.17 (95% CI, 1.17–4.04) for diabetes. CONCLUSIONS Glucosuria in adolescents is associated with an increased risk of early-onset diabetes.