Adolescents' mental health was severely compromised during the COVID-19 pandemic. Longitudinal real-world studies on changes in the mental health of adolescents during the later phase of the pandemic are limited. We aimed to quantify the effect of COVID-19 pandemic on adolescents' mental health outcomes based on electronic health records. This was a retrospective cohort study using the computerized database of a 2.5 million members, state-mandated health organization in Israel. Rates of mental health diagnoses and psychiatric drug dispensations were measured among adolescents 12 to 17 years of age with and without pre-existing mental history, for the years 2017 to 2021. Relative risks were computed between the years, and interrupted time series (ITS) analyses evaluated changes in monthly incidence rates of psychiatric outcomes. The average population size was 218,146 in 2021. During the COVID-19 period, a 36% increase was observed in the incidence of depression (95% CI = 25-47), 31% in anxiety (95% CI = 23-39), 20% in stress (95% CI = 13-27), 50% in eating disorders (95% CI = 35-67), 25% in antidepressant use (95% CI = 25-33), and 28% in antipsychotic use (95% CI = 18-40). A decreased rate of 26% (95% CI = 0.80-0.88) was observed in ADHD diagnoses. The increase of the examined outcomes was most prominent among youth without psychiatric history, female youth, general secular Jewish population, youth with medium-high socioeconomic status, and those 14 to 15 years of age. ITS analysis confirmed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to those in previous years. This real-world study highlights the deterioration of adolescents' mental health during the COVID-19 pandemic and suggests that youth mental health should be considered during health policy decision making. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

On December 20, 2020, Israel initiated a national vaccination program against COVID-19. National and international vaccine guidelines did not preclude patients who have previously been diagnosed with Guillain-Barré Syndrome (GBS) from receiving the COVID-19 vaccine.^1,2 However, previous association between vaccines and GBS raises the level of caution and hesitancy among clinicians and patients regarding administering the vaccine.^3-5 The aim of this study was to establish rates of GBS relapse among Pfizer-BioNTech BNT162b2 vaccine receivers.

Urinary tract infections (UTIs) often prompt empiric outpatient antibiotic prescriptions, risking mismatches. This study evaluates the impact of “UTI Smart-Set” (UTIS), an AI-driven decision-support tool, on prescribing patterns and mismatches in a large outpatient organization. UTIS integrates machine learning forecasts of antibiotic resistance, patient data, and guidelines into a user-friendly order set for UTI management. From 6/1/2021–8/31/2022, 171,010 UTI diagnoses were recorded, with UTIS used in 75,630 cases involving antibiotic prescriptions. Overall acceptance rate of UTIS recommendations was 66.0%. Among 19,287 cases with urine cultures, antibiotic mismatch rate was significantly lower when UTIS recommendations were followed (8.9% vs. 14.2%, p < 0.0001). Among women over 18, mismatch rate was 47.5% lower, and among women over 50, 55.6% lower (p < 0.001). Additionally, an overall reduction of 80.5% in ciprofloxacin usage (6.4% vs 32.9%, p < 0.0001) was observed. UTIS improved prescribing accuracy, reduced mismatches, and minimized quinolone use, highlighting AI’s potential for personalized infection management.

Background: COVID-19 vaccine safety is of major interest worldwide, since there is no prior experience with it. Israel was one of the first countries to widely use the Comirnaty vaccine. Aim: We aimed to assess the vaccine's short-term side effects directly from a large population and to predict influencing factors for self-reporting side effects. Methods: In a retrospective cohort study, we investigated self-reported systemic vaccine side-effects using electronic surveys sent to vaccinated individuals between 20 December 2020 and 11 March 2021, within 3 days following administration of the first and second dose. We determined predictors for reporting systemic side effects by logistic regression. Results: A total of 1,213,693 patients received at least one vaccine dose and 301,537 (24.8%) answered at least one survey. Among them, 68,162 (30.4%) and 89,854 (59.9%) individuals filled the first and the second dose surveys, respectively, and reported one or more side effects. Most common side effects were fatigue, headache and myalgia. Several respondents reported facial paraesthesia after first and second dose, respectively (n = 1,675; 0.7% and n = 1,601; 1.1%). Individuals younger than 40 years and women reported side effects more frequently than others, but pregnant women reported less. Pregnancy was a weak predictor for reporting any side effect in general and in particular fatigue, myalgia, headache, chills and fever. Conclusions: We found further support for minor short-term side effects, within 3 days of receiving the Comirnaty vaccine. These findings from vaccine recipients in general and pregnant women in particular can improve vaccine acceptance.

Aim: The effect of reopening schools on children's contribution to SARS‐CoV‐2 transmission, especially within households, remains controversial. This study describes the clinical presentation of a large ambulatory COVID‐19 paediatric cohort and evaluates the role of children in household transmission prior to and following school reopening.Methods: A retrospective database cohort study was conducted in a large Health Maintenance Organization in Israel. Data of all paediatric, laboratory‐confirmed Coronavirus cases between 28/2/2020 and 20/6/2020 were extracted. All cases were analysed for household contacts and primary cases within each family cluster.Results: A total of 1,032 cases under 18 years old (median age 12 years) were included. Of these cases, 432 (41.9%) were asymptomatic; 122 (11.8%) cases acquired the infection at school, and 45 of them were part of two school clusters; 846 children had at least one positive household contact, in 498 family clusters, and among them, 293 primary cases were identified. Only 27 (9.2%) primary cases were under 18 years of age and six (2%) were below 10. The proportion of primary cases did not change after the re‐opening of educational facilities.Conclusion: Children, particularly under 10 years of age, are less likely to be the vector for SARS‐CoV‐2 infection within household settings. Opening educational facilities did not change transmission dynamics.

Urgent care centers (UCCs) are a growing segment of healthcare with high rates of inappropriate antibiotic use. MeMed BV® (MMBV) is a blood test that differentiates bacterial from viral infections. Between April 2022 and March 2023, we introduced MMBV into routine care at ten UCCs. The primary objective was to assess MMBV’s impact on antibiotic use; the secondary objective was to assess whether MMBV aided in patient management. A pragmatic prospective cohort study. Physicians who ordered MMBV reported electronically (in real-time) whether they intended to prescribe antibiotics before ordering the test and upon UCC discharge whether MMBV aided in patient management. Hospitalizations were recorded for 7 days post-UCC discharge. During implementation, 3920 MMBV tests were ordered for adults (age ≥ 18) by 144 physicians. The study cohort had 59% female patients and the median age was 42 years (IQR 31–58). For the primary objective, 3262 cases were included. MMBV indicated 629/3262 (19.3%) cases of potentially unwarranted antibiotics, of which physicians avoided prescriptions in 397/629 (63.1%). MMBV indicated 405/3262 (12.4%) cases of potentially missed bacterial infections. Physicians prescribed antibiotics to 283/405 (69.9%). MMBV adherence was associated with fewer hospitalizations (7.8% vs. 30.3%, p < 0.001). For the secondary objective, 2901 cases were included. Physicians reported MMBV aided patient management in 2494/2901 (86.0%) cases and contributed to avoiding emergency department referrals in 595/2901 (20.5%). Implementing MMBV aided urgent care center physicians in their clinical decision-making and may have contributed to appropriate antibiotic use, better resource utilization, and patient management.