Importance:The safety of plant-based family diets, particularly vegan diets, during pregnancy and infancy is debated. Large population data on infant growth are scarce. Objective:To examine whether family dietary patterns (vegan, vegetarian, and omnivorous) are associated with growth trajectories, weight, and length among infants. Design, Setting, and Participants:This retrospective cohort study used data collected from January 1, 2014, through December 31, 2023, from a national network of public family care centers in Israel providing health and developmental surveillance for infants. Singleton births of infants gestational age 32 weeks or later without congenital malformations or birth weight less than 1500 g were followed up for 24 months. The data were analyzed between November 17, 2024, and December 6, 2025. Exposure:The family diet as recorded at least 6 months after delivery. Main Outcomes and Measures:The primary outcome was infant length. Secondary outcomes included weight, head circumference, stunting (length-for-age z score less than -2), underweight (weight-for-length z score less than -2), and overweight (weight-for-length z score >2). Growth trajectories were analyzed using linear mixed-effects models, and nutritional status at birth, early infancy (ie, first 60 days of life), and 24 months were analyzed using logistic regression. Results:Among 1 198 818 infants (mean [SD] gestational age, 39.2 [1.5] weeks; 53.2% male), 98.5% were from omnivorous households; 0.3% from vegan households, and 1.2% from vegetarian households. Differences in early-infancy length and length-for-age z scores among dietary groups were small (World Health Organization z score ≤0.3), and stunting prevalence was similar across groups (from 7.0% in the vegan and vegetarian groups to 7.1% in the omnivorous group), while underweight was more common in infants in the vegan vs omnivorous groups (adjusted odds ratio, 1.37 [95% CI, 1.15-1.63]). By age 24 months, stunting prevalence declined to 3.1%, 3.4%, and 3.9% in omnivore, vegetarian, and vegan groups, respectively, with no significant differences among the groups. Underweight and overweight were also low, with no differences by dietary group at age 24 months. Mean differences for weight, length, and head circumference were clinically minor (World Health Organization z score <0.2) and diminished further in adjusted longitudinal models. Conclusions and Relevance:In this cohort study, infants from vegan households had growth patterns similar to those from omnivorous households, with a higher odds of early underweight that decreased by age 24 months. In the context of developed countries, these findings seem reassuring. Further research should examine vegan diet quality and the impact of nutritional counseling during pregnancy and infancy in supporting optimal infant development.
Objective To investigate relationships between patient characteristics, length of stay (LOS) and functional improvement among rehabilitation patients following hip fracture, utilizing data from Israel’s National Program for Quality Indicators. Design Nationwide retrospective cohort study (2016-2019) analyzing admission and discharge Functional Independence Measure (FIM) scores. Participants Population-based sample (N=13,161) of patients aged ≥65 who underwent institutional rehabilitation after hip fracture between 2016 and 2019. Main outcome measure FIM gain and rehabilitation efficiency, calculated from FIM scores. The analysis focused on how these outcomes were influenced by patient age, gender, initial FIM scores, LOS, and type of rehabilitation setting. Results FIM gain showed a significant inverse correlation with patient age and very high or very low admission FIM scores. A positive correlation was found between LOS and FIM gain, with slope moderation beyond 20 days. Multivariate analysis identified significant effects of age, gender, initial FIM score, and LOS on FIM gain (all p<.001). Conclusions Functional improvement, as measured by FIM gain, is influenced by various factors. Current large-scale, long-term national study demonstrates that in prolonged hospitalizations (>20 days), the improvement associated with extending the LOS is smaller than the improvement associated with extending LOS in shorter hospitalizations (<20 days). These findings can help guide nursing care plans, resource allocation, patient referral and policy adjustments. Further research is needed to validate those findings.
In 2010, a devastating earthquake struck Haiti, killing over 200,000 and injuring over 250,000. Dozens of countries sent medical teams, with Israel’s being one of the first to arrive. These teams saved lives and salvaged limbs. However, other responses were not as professional, resulting in criticism in the medical community of “Disaster Tourism.” For example, certain physicians attempted to perform procedures or surgeries that they were not certified to perform. There was a call to develop a framework for disaster response. The World Health Organization spearheaded this project by initiating the formation of Foreign Medical Teams, which later became known as Emergency Medical Teams (EMTs). The EMT Initiative involves a vision of saving lives in the context of transparency and global cooperation. It includes an emphasis on safe care, ethical care, and an accountable, coordinated response to disasters. There are three general types of teams, with an additional group of specialized care teams. An EMT-1 is similar to a clinic and open only during the day. An EMT-2 adds operating room and inpatient capabilities. EMT-3 which is the most complex, includes a minimum of 40 inpatient beds, four intensive care unit (ICU) beds, and the capacity to treat 100 outpatients a day. The Israel Defense Forces Field Hospital was the first in the world to be recognized as an EMT-3. The Israeli EMT-3 includes an emergency department, inpatient services, surgical capabilities, and an intensive care unit. Pediatric services, infectious disease care, and women’s health are integral parts of the EMT-3. Logistical and ancillary services also play a key role in the success of the field hospital. The Israeli field hospital responded to recent disasters in Haiti (2010), the Philippines (2013), Nepal (2015), and Turkey (2023). The main lesson learned is that the success of the Israeli EMT-3 is based on professionalism and flexibility within the framework of the EMT initiative. The staff consists of highly trained professionals, including board-certified physicians and nurse specialists who convert their everyday skills into those used in the disaster setting. Flexibility includes having these professionals take on logistical responsibilites. Operational flexibility includes the last-minute decision to implement a hybrid versus a standalone model, to using local supplies to quickly adapt to an urgent need. While the lessons here are from the perspective of an EMT-3, they can be applied to other response teams to improve outcomes for disaster victims throughout the world.
OBJECTIVE:Maternal diabetes increases offspring risk for neurodevelopmental disorders, but its association with delayed developmental milestones is unknown. We examined milestone attainment in offspring of mothers with gestational diabetes mellitus (GDM) and pregestational type 1 and type 2 diabetes compared with unexposed control individuals. RESEARCH DESIGN AND METHODS:We examined a nationwide retrospective cohort study of 466,462 term singleton infants born January 2018 to December 2021 using linked national maternal-child health clinic and hospital discharge data. Developmental data were obtained from nurse-administered structured assessments at routine well-child visits through 24 months of age. Adjusted hazard ratios (aHRs) and 95% CIs for failure to attain developmental milestones were estimated by diabetes type and infant sex. RESULTS:Pregestational diabetes was associated with increased risk for delayed milestone attainment in language, personal-social, and gross motor domains compared with control groups. Offspring of mothers with type 1 diabetes showed the highest risk, followed by those with type 2 diabetes. The association between type 1 diabetes and developmental delay was primarily driven by female offspring, with elevated risks in personal-social (aHR, 1.64; 95% CI, 1.14-2.36), language (aHR, 1.44; 95% CI, 1.09-1.89), and gross motor (aHR, 1.41; 95% CI, 1.05-1.89) domains. GDM was associated with modestly increased risk limited to the fine motor domain (aHR, 1.11; 95% CI, 1.06-1.16). CONCLUSIONS:Pregestational diabetes is associated with delayed milestone attainment, with risk varying by diabetes type, developmental domain, and infant sex. Further research should explore long-term trajectories to inform early intervention for children exposed to maternal diabetes.
MBL-producing Enterobacterales pose an urgent global healthcare problem with limited treatment options. We aimed to gain a greater understanding of international perspectives on the management of serious infections due to MBL-producing Enterobacterales, using a modified Delphi process to assess expert-based opinion and establish consensus. Per Figure 1, a Delphi panel comprising 10 infectious disease experts with experience in treatment of antimicrobial-resistant bacterial infections completed a survey on epidemiology, disease, testing, and optimal management of infections caused by MBL-producing Enterobacterales. Draft consensus statements developed from the survey results were reviewed by the panel and either endorsed or edited to achieve unanimous consensus during a virtual meeting. The consensus statements showed that all panelists identified MBL-producing Enterobacterales as a major source of antimicrobial resistance and infections in most countries. All panelists agreed that these infections are associated with high morbidity and mortality, potential need for critical-level care, increased length of hospitalization, and significant healthcare costs. In addition, the adverse impact of MBL was exacerbated by inappropriate use of multidrug antimicrobial regimens; hence, an MBL-targeting agent was deemed preferable. When aztreonam-avibactam (ATM-AVI) and cefiderocol are available, based on in vitro data showing activity of ATM-AVI against > 90% of New Delhi MBL-producing Enterobacterales, the preferred first-line treatment should be ATM-AVI. Where ATM-AVI and cefiderocol are not available, treatment options are limited to the co-administration of antimicrobials. The panel also highlighted key factors to guide earlier initiation of appropriate treatment: patient factors, local epidemiology, available testing, and drug characteristics. This Delphi panel achieved consensus on optimal management of MBL-producing Enterobacterales, finding preference for targeted MBL treatment, with monotherapy preferred where available. Study sponsored by Pfizer Inc. A genAI tool (Pfizer) developed the 1st draft; authors assume content responsibility. Yehuda Carmeli, MD, Basilea: Advisor/Consultant|Enlivex: Advisor/Consultant|Omnix: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Roche: Advisor/Consultant Mark A. Price, MA, MEd, Pfizer: Advisor/Consultant George L. Daikos, MD, MSD: Honoraria|Pfizer: Honoraria|Pfizer: Travel expenses to attend ESCMID Global 2025|Roche: Advisor/Consultant Marco Falcone, MD, Gilead: Grant/Research Support|Infecto Pharm: Honoraria|Menarini: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria|ViiV: Grant/Research Support Ana C. Gales, MD, BioMerieux: Advisor/Consultant|BioMerieux: Speaker|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Speaker Stefen Hagel, MD, Gilead: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria Ali S. Omrani, FRCP, FRCPath, BioMérieux: Advisor/Consultant|BioMérieux: Honoraria|Cepheid: Advisor/Consultant|Cepheid: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Hikma: Advisor/Consultant|Hikma: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Mundi Pharma: Advisor/Consultant|Mundi Pharma: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria Maria Gheorghe, PhD, Pfizer: Stocks/Bonds (Public Company) Brett Hauber, PhD, Pfizer Inc: Stocks/Bonds (Private Company) Christopher Little, PhD, Pfizer: Stocks/Bonds (Public Company) Andrew Ian Townsend, PhD, Pfizer: Stocks/Bonds (Public Company) Nathalie Baillon-Plot, MD, Pfizer: Stocks/Bonds (Public Company)
