Maccabi Health Care Services

Ocular manifestations (OMs) are recognized extraintestinal complications in inflammatory bowel disease (IBD), but their incidence remains understudied. We aimed to evaluate the incidence and trends of OM in a large population-based cohort of adults with newly diagnosed IBD over the past 2 decades. We conducted a retrospective cohort study including all adult-onset IBD patients between 2005 and 2024 in a large health maintenance organization. Patients with pre-existing OM diagnoses were excluded. The primary outcome was incident OM (uveitis, episcleritis/scleritis, or orbital inflammation) after IBD diagnosis. Annual incidence trends were assessed using the Cochran-Armitage test. Risk factors were analyzed via multivariable Cox regression, stratified by IBD type. Among 15 035 newly diagnosed IBD patients (51.8% Crohn's disease [CD], 48.2% ulcerative colitis [UC]), 349 developed an OM over 119 669 person-years (incidence: 2.9 per 1000 person-years; 95% confidence interval [CI], 2.62-3.24). OM incidence was higher in CD than UC (log-rank P < .001) and remained stable over time (P = .125). The median time to OM was 45 months. In CD, female sex (hazard ratio [HR], 1.62; 95% CI, 1.24-2.13) and systemic corticosteroid use (HR, 1.62; 95% CI, 1.18-2.22) were significant risk factors. In UC, corticosteroids (HR, 2.17; 95% CI, 1.40-3.37) and intestinal surgery (HR, 3.50; 95% CI, 1.69-7.28) were associated with increased OM risk. OMs in adult-onset IBD are infrequent but clinically relevant, particularly among CD patients and those with markers of severe disease. Clinician awareness and early referral remain essential for prompt diagnosis and management.

Evidence supporting the association between breastfeeding patterns and autism is inconsistent. This study examined sociodemographic and birth factors related to breastfeeding duration and subsequent autism spectrum disorder (autism) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, compared to a neurotypically developing cohort, based on electronic health records. Demographics, feeding preferences, and breastfeeding duration as reported by parents during routine baby wellness visits were analyzed for a cohort of 11,766 (1.9%) children with autism spectrum disorder diagnosis and a random subsample of 12,000 (2.03%) neurotypically developing children. Autism spectrum disorder diagnosis was based on a national autism registry and assigned after electronic health records were completed. Preterm, very low birth weight, multiple births, and complex medical comorbidities were excluded. Infants subsequently diagnosed with autism were breastfed for an average of 5.0 months, 1.5 months shorter than neurotypically developing. Fewer autism spectrum disorder infants were exclusively breastfed in the first year of life. Two-way analysis of variance indicated a significant effect of socioeconomic status and autism spectrum disorder on breastfeeding duration, and a significant interaction of socioeconomic status with autism spectrum disorder. Shorter breastfeeding duration among infants with subsequent autism spectrum disorder was confirmed, calling for closer monitoring for autism traits in infants with breastfeeding difficulties. These challenges were independent of birth parameters; however, they were influenced by socioeconomic factors.Lay AbstractThis study found that infants later diagnosed with autism were breastfed for a shorter duration than their typically developing peers, with differences influenced by socioeconomic status. These findings highlight the importance of monitoring breastfeeding challenges as a potential early indicator of autism, particularly in families of mid-range socioeconomic status.

Sex‐based disparities in the incidence, prevalence and disease manifestations have been observed across various medical conditions, including type 1 diabetes (T1D). Differences in glycaemic control and quality of life between men and women have been reported, with women experiencing lower rates of glycaemic targets and a higher risk for long‐term complications, particularly cardiovascular disease. Additionally, women face a greater economic and mental health burden related to T1D. This narrative review explores the challenges that complicate glycaemic management in women living with T1D, including hormonal influences during puberty, pregnancy and the (peri‐) menopausal period. We also summarize current available evidence on the safety and efficacy of the MiniMed™ 780G (MM780G) system in addressing these challenges for women living with T1D. Finally, recent real‐world data are reported on the absence of significant sex‐related differences in glycaemic outcomes of over 280 000 real‐world users of the MM780G, across various age groups from childhood and adolescence to the (peri‐) menopausal period.

BackgroundInfluenza poses significant health risks to young children, who are more vulnerable to severe complications. Despite effective vaccines, influenza vaccination rates among children are suboptimal. This study aims to identify the key predictors of influenza vaccine uptake among children aged 6 months to 6 years.MethodsA retrospective cohort study used data from Maccabi Healthcare Services in Israel. Electronic medical records provided demographics, vaccination status, comorbidities, healthcare use, and parental vaccination. Logistic regression identified factors associated with influenza vaccine uptake.ResultsAmong 293,078 children aged 6 months to 6 years during the 2022–2023 flu season, only 41,885(14.3%) received the influenza vaccine. Patients with higher socioeconomic status were more often vaccinated (51.1% vs. 26.4%, p < 0.001). Parental smoking was inversely associated with more non-smoking parents in the vaccinated group (72.6%) compared to the unvaccinated (66.1%, p < 0.001). The factor most strongly associated with child vaccination was parental vaccination status (OR 41.86, 95% CI [40.54–43.22], p < 0.001). Other significant predictors were higher socioeconomic status (OR = 2.29, 95% CI [2.15–2.43], p < 0.001) and frequent healthcare utilization, such as a high rate of doctor visits during the preceding year (four or more visits: OR = 2.09, 95%, CI [1.90–2.29], p < 0.001). Conversely, children from minority populations and those with parents who smoked were less likely to be vaccinated (one smoking parent, OR = 0.85, 95% CI [0.82–0.88], p < 0.001; and two smoking parents, OR = 0.80, 95% CI [0.74–0.87], p < 0.001). For children aged 18 months to 6 years (n = 247,381), vaccination in the previous year was also a significant predictor (OR 10.35, 95% CI [9.97–10.74]).ConclusionThe study highlights the critical role of parental vaccination status in influencing child vaccination rates. A family-centered approach to vaccination promotion can enhance vaccine coverage among young children, contributing to better health outcomes and robust community immunity.

Mobility and cognitive functions are closely linked in old age. Although a relationship between mobility and cognitive function has also been demonstrated in midlife, it has not been tested under conditions that might reflect real-life locomotion. In this study, the association between attention and processing speed, as measured by choice reaction time (CRT), and mobility in midlife was examined using spatiotemporal gait indices during outdoor walking and a self-perceived mobility questionnaire. Fifty middle-aged adults (53.98 ± 5.32 years) completed a 2-minute walk in an urban environment with and without a dual task of texting on a smartphone. Gait speed, gait variability (stride time variability), and gait similarity (dynamic time warping) in the anteroposterior and medio-lateral axes were measured, and self-perceived mobility was assessed using the Mobility in Middle Age Questionnaire (MMQ). Attention and processing speed were measured with the Deary-Liewald CRT. Slower CRT was associated with reduced medio-lateral similarity during dual-task walking (r = 0.316, p = 0.032) and with lower self-perceived mobility (MMQ, r = -0.422, p = 0.007). Hierarchical regression analysis showed that medio-lateral gait similarity explained 10.0% of the variance in CRT, while self-perceived mobility explained 14.4%. The relationship between mobility and cognition in ecologically valid contexts may indicate a common age-related mechanism that emerges in midlife and can be exploited by interventions and monitoring programs aimed at promoting healthy aging.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-32121-8.

Abstract In recent decades, global crises like the COVID-19 pandemic and natural disasters have significantly challenged the ability to provide care for older adults, highlighting a critical research priority. Israel, with its advanced system of care for older adults and strong community support, performed well during COVID-19. This report describes efforts to maintain care during the June 2025 Israel-Iran war, a period of physical threat, disrupted medical services, psychological distress, and weakened social supports due to displacement and infrastructure damage. We highlight innovative strategies ensuring continuity of medical, mental health, and essential social services for older adults. Israel’s approach to emergency care for older adults rested on three pillars: (i) Leveraging past experience: Protocols from previous emergencies, including COVID-19, were quickly activated. This ensured continuity of care for older adults, especially those evacuated or in unsafe apartments, balancing safety with independence. (ii) Coordinated communication: Ongoing national and municipal collaboration and communication about at-risk older adults, enabled effective and timely, targeted interventions. (iii) Volunteerism and Civil Initiatives: A massive surge of community-led volunteer efforts provided transport, medications, and evacuee assistance, critically addressing urgent needs beyond government capacity. In conclusion, these three pillars – rapid response based on prior experience, a strong national and municipal system of communication and collaboration, and robust volunteerism – enabled continuous, high-quality care for older adults during this major crisis., These lessons can inform other systems aiming to enhance their resilience and capacity to provide care to older adults during emergency situations.

Definitively prove noninferiority of biosimilar infliximab to originator. The advent of biosimilar agents has made biological medications for inflammatory bowel diseases (IBD) more affordable and widely available. We conducted a noninferiority assessment of the effectiveness of the infliximab biosimilar agent CT-P13 versus the original for treatment of IBD in a nationwide analysis. We used the Epidemiology Group of the Israeli Inflammatory Bowel Disease Research Nucleus Cohort (epi-IIRN), including data on patients with IBD from all Health Maintenance Organizations (HMO) and conducted a noninferiority analysis of infliximab originator and biosimilar CT-P13 based on time from induction of treatment until failure. Treatment failure was defined as steroid dependency, need for IBD-related surgery, or treatment change to an alternative biological. The groups were matched using a propensity score of 0.15 caliper based on sex, ethnicity, district, socio-economic status, age at diagnosis, disease activity, time until biological treatment, prior biological treatments, surgeries, and hospitalizations. We compared 564 patients treated with infliximab originator matched to 564 treated with CT-P13. The results proved noninferiority in all parameters, with a margin of d=10% or smaller over 5 years (P<0.05). In time to failure, noninferiority was demonstrated with a d=1% (P=0.0004). Noninferiority was also demonstrated in time to steroid dependency (d=5%, P=0.005), surgery (d=1%, P=0.0006), and transfer to alternative biological drug (d=1%, P<0.001). Subanalyses for Crohn's disease and ulcerative colitis separately yielded similar results. This study demonstrated noninferiority of infliximab biosimilar CT-P13 in comparison to the original in long-term management of IBD.