In the wake of the SARS-CoV-2 pandemic, a novel condition, termed Post-COVID Syndrome (PCS) has emerged, impacting a significant portion of the global population. Concurrently, the global impact of the virus has extended beyond physical health, leading to the emergence of COVID-19 related stigma. This study investigates the link between PCS and self-stigma, shedding light on this underexplored phenomenon. To examine whether exposure to PCS is associated with higher levels of COVID-19–related self-stigma and to identify potential risk factors. A retrospective observational cohort study among adult Israeli citizens who tested positive for COVID-19 in a polymerase chain reaction (PCR) test at least twelve weeks before the interview, serving as a pivotal criterion for diagnosing PCS based on self-reported symptoms. The study sample was drawn from the Israeli Ministry of Health’s comprehensive COVID-19 database and data were obtained via a computerized telephone questionnaire conducted from June through December 2021. The quantification of self-stigma entailed the utilization of the COVID-19 self-stigma scale. The study examined the adjusted association between exposure to PCS and self-stigma, controlling for socio-economic characteristics. Seven hundred fifty-nine participants (48.7

Current emergency department (ED) protocols in prone regions recommend monitoring for at least 4–6 h after paediatric scorpion envenomation. Since only limited evidence supports these guidelines, particularly for asymptomatic children, we evaluated routine ED observation in these patients. We conducted a retrospective cohort study of southern Israeli children presenting with scorpion envenomation over a 15-month period using a validated envenomation severity score. The primary outcome was the development of delayed systemic symptoms requiring intervention. Children with Grade 1 scores (mild) were compared to those with Grade ≥ 2 scores (more severe). Of 287 patients, 238 (83%) presented with mild, and 49 (17%) with more severe envenomation. Less than 1% of mild patients developed delayed symptoms, all of which resolved with conservative management, and 99% were discharged. More severe patients were younger (median age 3.1 vs. 5.8 years), had a higher prevalence of allergy (31% vs. 13%), and 94% developed immediate symptoms requiring hospitalisation. A risk-stratified approach taking into consideration age, time since envenomation, history of allergies, and symptom severity could safely reduce ED observation time since children with mild scorpion envenomation symptoms had a low risk of developing significant delayed complications.

Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a wide spectrum of clinical severity. The gold standard diagnosis of infection is reverse transcription polymerase chain reaction of nasopharyngeal swabs, which also provides a semiquantitative assessment of viral loads by measuring cycle threshold (CT) values. Objective: To assess whether CT values at admission can predict mortality and oxygen needs among individuals hospitalized for coronavirus disease 2019 (COVID-19). Methods: The retrospective study included adults hospitalized for COVID-19 between 1 August 2020 and 30 April 2021 at Barzilai University Medical Center. Patients were categorized according to initial CT values as high (>= 25) or low (< 25) values. The primary outcome was the association between CT values during admission and overall mortality. Results: The study group included 636 patients, with a mean age of 67.2 years, 54.4% males. Overall mortality of patients with CT values < 25 was significantly higher (odds ratio for mortality 1.78 vs. patients with CT >= 25, P = 0.002). Significantly more patients in the low CT group required oxygen support than in the high CT group, 50% vs. 31.9% (P < 0.001). An inverse association between CT values and mortality rates remained significant in multivariate regression analysis, such that a 1-unit decrease in CT was associated with a 6% increased mortality. Conclusions: Lower CT values at admission were associated with increased mortality among patients hospitalized for COVID-19. CT values can be used to predict outcomes among such patients.

AIM:Current emergency department (ED) protocols in prone regions recommend monitoring for at least 4-6 h after paediatric scorpion envenomation. Since only limited evidence supports these guidelines, particularly for asymptomatic children, we evaluated routine ED observation in these patients. METHODS:We conducted a retrospective cohort study of southern Israeli children presenting with scorpion envenomation over a 15-month period using a validated envenomation severity score. The primary outcome was the development of delayed systemic symptoms requiring intervention. Children with Grade 1 scores (mild) were compared to those with Grade ≥ 2 scores (more severe). RESULTS:Of 287 patients, 238 (83%) presented with mild, and 49 (17%) with more severe envenomation. Less than 1% of mild patients developed delayed symptoms, all of which resolved with conservative management, and 99% were discharged. More severe patients were younger (median age 3.1 vs. 5.8 years), had a higher prevalence of allergy (31% vs. 13%), and 94% developed immediate symptoms requiring hospitalisation. CONCLUSION:A risk-stratified approach taking into consideration age, time since envenomation, history of allergies, and symptom severity could safely reduce ED observation time since children with mild scorpion envenomation symptoms had a low risk of developing significant delayed complications.

Background: Cardiopulmonary exercise testing (CPET) is a valuable diagnostic and prognostic tool for assessing the integrated function of the cardiopulmonary and muscular systems during exercise. The initiation of a CPET program is complex, and data on early implementation in academic centers remain relatively limited. Objective: to evaluate the initial integration of CPET within a pulmonary department, focusing on patient demographics, referral indications, test performance, and factors associated with anaerobic threshold achievement. Methods: A retrospective cohort study was conducted at a single tertiary care center, including all patients who underwent their first CPET between February 2016 and December 2022. Demographic, clinical, and functional parameters were extracted. Multivariable logistic regression was used to identify variables associated with anaerobic threshold achievement, defined as a respiratory exchange ratio (RER) ≥ 1.1. Results: The cohort included 434 patients (mean age 60.3 ± 14.1 years; 54% male; mean BMI 29.2 ± 5.6 kg/m2). The most common indication for testing was dyspnea (50%). Tests were most frequently terminated due to leg discomfort (39%) and dyspnea (38.8%). Achievement of RER ≥ 1.1 was independently associated with lower BMI (aOR = 0.91; 95% CI: 0.88-0.95; p < 0.001), higher FVC % predicted (aOR = 1.02; 95% CI: 1.00-1.03; p = 0.028), and greater minute ventilation volume (aOR = 1.02; 95% CI: 1.01-1.03; p < 0.001), and it was less likely in patients referred for cardiovascular disease (aOR = 0.37; 95% CI: 0.21-0.64; p < 0.001). No consistent temporal trend in RER achievement was observed across the study period. Conclusions: CPET was most commonly utilized in response to patient-reported dyspnea, with test termination frequently driven by subjective symptoms rather than objective clinical criteria. Anaerobic threshold achievement was more strongly associated with individual physiological characteristics than with institutional experience. These findings underscore the importance of patient preparation and pulmonary functional capacity in optimizing CPET performance.

BackgroundWhile individual socioeconomic attributes have been widely studied in relation to child growth, the associations with broader, area-level socio-demographic characteristics of residential areas have not been thoroughly assessed.ObjectivesTo examine the associations between area-level socio-demographic features of small residential areas and child growth trajectories.MethodsWe conducted a population-based retrospective cohort study, including all children born in Israel from 2004 to 2018, who underwent postnatal follow-up in the Mother and Child Health Clinics (MCHC) of the Ministry of Health. The MCHC network covers a significant proportion of the Israeli paediatric population, providing vaccination and developmental assessments to children up to 6 years old. Socio-demographic scoring was retrieved from the Israel Bureau of Statistics' geographical unit grading system, established for 990 rural areas and 1629 micro-geographical areas in 81 cities, using various population measurements. Height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated using data from MCHC visits at birth and specific intervals.ResultsA total of 1,485,198 children were included (51.3% male). The mean birthweight and length were 3210 +/- 52.2 g (z = -0.22) and 49.4 +/- 3.33 cm (z = -0.06), respectively. Children resided in low (47%), intermediate (24.4%) and high (28.5%) socioeconomic areas. Throughout follow-up, children from low SES areas had consistently lower HAZ and WAZ scores across all birthweight groups, particularly among those with normal and high birthweight. In linear mixed-effects models, birth HAZ and WAZ scores were higher in high vs. low SES areas (beta = 0.3 and beta = 0.1, respectively), with non-linear growth trajectories characterised by early advantages in higher SES groups, a plateau in mid-childhood and renewed growth acceleration later in childhood.ConclusionsThe study provides evidence of impaired child growth in lower socio-demographic areas. This underscores the importance of identifying areas based on global attributes to identify regions predisposed to child growth impairment, particularly in developed nations.

BACKGROUND:Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a wide spectrum of clinical severity. The gold standard diagnosis of infection is reverse transcription polymerase chain reaction of nasopharyngeal swabs, which also provides a semiquantitative assessment of viral loads by measuring cycle threshold (CT) values. OBJECTIVES:To assess whether CT values at admission can predict mortality and oxygen needs among individuals hospitalized for coronavirus disease 2019 (COVID-19). METHODS:The retrospective study included adults hospitalized for COVID-19 between 1 August 2020 and 30 April 2021 at Barzilai University Medical Center. Patients were categorized according to initial CT values as high (≥ 25) or low (< 25) values. The primary outcome was the association between CT values during admission and overall mortality. RESULTS:The study group included 636 patients, with a mean age of 67.2 years, 54.4% males. Overall mortality of patients with CT values < 25 was significantly higher (odds ratio for mortality 1.78 vs. patients with CT ≥ 25, P = 0.002). Significantly more patients in the low CT group required oxygen support than in the high CT group, 50% vs. 31.9% (P < 0.001). An inverse association between CT values and mortality rates remained significant in multivariate regression analysis, such that a 1-unit decrease in CT was associated with a 6% increased mortality. CONCLUSIONS:Lower CT values at admission were associated with increased mortality among patients hospitalized for COVID-19. CT values can be used to predict outcomes among such patients.

Obesity is a risk factor for differentiated thyroid cancer (DTC), but the association with DTC aggressiveness is controversial. To evaluate the association between preoperative body mass index (BMI)/other metabolic parameters and DTC aggressiveness in our surgical cohort, we retrospectively evaluated patients following thyroid surgery who were diagnosed with DTC between December 2013 and January 2021. Baseline characteristics, histopathological features, treatment modalities, and follow-up data were studied. We conducted logistic regression to analyze the association between BMI/other metabolic parameters and adverse DTC features. The final study cohort included 211 patients (79.6% women; mean age± standard deviation 48.7 ± 15.9 years): 66 (31.3%) with normal weight, 81 (38.4%) with overweight, and 64 (30.3%) with obesity. The median follow-up was 51 months (range 7–93). Complete versus partial thyroidectomy was more common among patients living with overweight or obesity than in normal weight patients (79.7% versus 61.7%, p = 0.017, respectively). Logistic regression demonstrated that higher BMI was associated with mildly increased risk for lymph nodes metastases (odds ratio [OR] 1.077, 95% CI: 1.013–1.145), and higher triglycerides/high-density lipoprotein–cholesterol (TG/HDL-C) ratio was associated with aggressive histological variants of DTC (OR 1.269, 95% CI 1.001–1.61). To conclude, specific adverse clinical and histopathological DTC features were indeed associated with higher BMI and higher TG/HDL-C ratio.

COVID-19 vaccination and acute infection result in cellular and humoral immune responses with various degrees of protection. While most studies have addressed the difference in humoral response between vaccination and acute infection, studies on the cellular response are scarce. We aimed to evaluate differences in immune response among vaccinated patients versus those who had recovered from COVID-19. Materials and Methods: This was a prospective study in a tertiary medical centre. The vaccinated group included health care workers, who had received a second dose of the BNT162b2 vaccine 30 days ago. The recovered group included adults who had recovered from severe COVID-19 infection (<94% saturation in room air) after 3-6 weeks. Serum anti-spike IgG and cytokine levels were taken at entry to the study. Multivariate linear regression models were applied to assess differences in cytokines, controlling for age, sex, BMI, and smoking status. Results: In total, 39 participants were included in each group. The mean age was 53 +/- 14 years, and 53% of participants were males. Baseline characteristics were similar between the groups. Based on multivariate analysis, serum levels of IL-6 (beta=-0.4, p<0.01), TNF alpha (beta=-0.3, p=0.03), IL-8 (beta=-0.3, p=0.01), VCAM-1 (beta=-0.2, p<0.144), and MMP-7 (beta=-0.6, p<0.01) were lower in the vaccinated group compared to the recovered group. Conversely, serum anti-spike IgG levels were lower among the recovered group (124 vs. 208 pg/mL, p<0.001). No correlation was identified between antibody level and any of the cytokines mentioned above. Conclusions: Recovered COVID-19 patients had higher cytokine levels but lower antibody levels compared to vaccinated participants. Given the differences, these cytokines might be of value for future research in this field.

BACKGROUND:Waning immunity after the coronavirus disease 2019 (COVID-19) vaccinations creates the constant need of boosters. Predicting individual responses to booster vaccines can help in its timely administration. We hypothesized that the humoral response to the first two doses of the BNT162b2 vaccine can predict the response to the booster vaccine. METHODS:A prospective cohort of hospital health care workers (HCW) that received three doses of the BNT162b2 vaccine. Participants completed serological tests at 1 and 6 months after the second vaccine dose and 1 month after the third. We analyzed predictive factors of antibody levels after the booster using multivariate regression analyses. RESULTS:From 289 eligible HCW, 89 (31%) completed the follow-up. Mean age was 48 (±10) and 46 (52%) had daily interaction with patients. The mean (±standard deviation) antibody level 1 month after the second vaccine was 223 (±59) AU/ml, and 31 (35%) had a rapid antibody decline (>50%) in 6 months. Low antibody levels 1 month after the second vaccine and a rapid antibody decline were independent predictors of low antibody levels after the booster vaccine. CONCLUSIONS:The characteristics of the humoral response to COVID-19 vaccinations show promise in predicting the humoral response to the booster vaccines.

Background: Both COVID-19 vaccination and acute infection result in cellular and humoral immune responses with variant degrees of protection. Most studies address the difference in humoral response (antibody levels) between these two groups, while evaluations of the cellular response are scarce. Aims: To evaluate the differences in immune responses between patients that were vaccinated or recovered from COVID-19 and their correlations. Methods: Prospective study in a large medical center. The vaccinated group included health care workers 30 days after the second dose of the BNT162b2 vaccine. The recovered group included adults 3-6 weeks after proven COVID-19 infection. Serum anti-spike IgG and cytokine levels were taken at inclusion. Multivariate linear regression models with age, sex, BMI, and smoking status were used to assess differences in cytokines. Results: 39 participants were included in each group. The mean age was 53 ±14 and 53% were males. Baseline characteristics were similar between the groups. Serum levels of IL-6 (β=-0.4, p<0.01), TNFα (β=-0.3, p=0.02), IL-8 (β=-0.4, p<0.01), CCL2 (β=-0.4, p<0.01), VCAM-1 (β=-0.3, p<0.02), and MMP-7 (β=-0.6, p<0.01) were higher in the recovered group compared to the vaccinated group using the multivariate analyses. Serum anti-spike levels were lower among the recovered group than the vaccinated (124 vs. 208 pg/ml, p<0.001). We did not find any correlations between antibody levels and the cytokines mentioned above. Conclusions: Recovered COVID-19 patients had higher cytokines levels but lower antibodies than vaccinated participants. Cytokines might be of higher value as markers for immunity against COVID-19 infection.

BACKGROUND: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. METHODS: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. FINDINGS: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). INTERPRETATION: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. FUNDING:None.

BACKGROUND:Respiratory sequela after acute COVID-19 is common and requires medical follow-up. Considering its vast economic impact, there is still no consensus regarding the mid-term follow-up plan after recovery. OBJECTIVE:To evaluate the necessity of a close pulmonary follow-up schedule after acute COVID-19 and its related investigations. METHODS:A prospective cohort study including adult patients after acute COVID-19 pneumonia. Patients were invited or referred to a 3- and 6-month follow-up visits at a large pulmonary institute in a tertiary center. Before each visit, patients completed demographic and clinical questionnaires, pulmonary function tests (PFTs), and chest CT scans. RESULTS:168 patients were included after completing both visits (medians of 80 and 177 days). Their mean age was 58 ± 15 and 52% recovered from severe or critical COVID-19. Between the two visits, there was no change in DLCOc (mean 73 ± 18 %predicted in both visits) and FVC (mean 90 ± 16 vs. 89 ± 16 %predicted). The COPD assessment tool and modified Medical Research Council scale had inverse correlations with the DLCOc, and similarly did not change between the visits. Occupational exposures were the only factor associated with a change in DLCOc during follow-up (3% decrease, p = 0.04). An improvement in chest CT findings at the second visit was not associated with a change in PFTs. CONCLUSIONS:Most clinical variables did not change during a close follow-up schedule in the first six months after acute COVID-19. Such a follow-up plan does not appear necessary and should be personalized to limit excessive costs and resources.

Medical follow-up of symptomatic patients after acute Coronavirus Disease 2019 (COVID-19) results in major burdens on patients and healthcare systems. The value of serological markers as part of this follow-up remains undetermined. We aimed to evaluate the clinical implications of serological markers for follow-up of acute COVID-19. For this purpose, we conducted an observational cohort study of patients 3 months after acute COVID-19. Participants visited a respiratory-clinic between October 2020 and March 2021, and completed pulmonary function tests (PFTs), serological tests, symptom-related questionnaires, and chest CT scans. Overall, 275 patients were included at a median of 82 days (IQR 64–111) post infection. 162 (59

Background: Respiratory sequela after acute COVID-19 is common and requires medical follow-up. Considering its vast economic impact, there is still no consensus regarding the mid-term follow-up plan after recovery. Aims and Objectives: To evaluate the necessity of a close pulmonary follow-up schedule after acute COVID-19 and its related investigations. Methods: A prospective cohort study including adult patients after acute COVID-19 pneumonia. Patients were invited or referred to a 3- and 6-month follow-up visits at a large pulmonary institute in a tertiary center. Before each visit, patients completed demographic and clinical questionnaires, pulmonary function tests (PFTs), and chest CT scans. Results: 275 patients were included during their first visit, 129 (47%) recovered from severe COVID-19, and 168 (61%) completed both clinic visits. Between the two visits, there was no change in DLCOc (mean 73 ±18 %predicted in both visits) and FVC (mean 90 ±16 vs. 89 ±16 %predicted). The COPD assessment tool and modified Medical Research Council scale had an inverse correlation with DLCOc, and similarly did not change between the visits. Occupational exposures were the only factor associated with a change in DLCOc during follow-up (p=0.04). Initial abnormal chest CT scan was an independent predictor for lower DLCOc (β=-0.25, p<0.001), while its improvement at the second visit was not associated with a change in PFTs. Conclusions: Most clinical variables did not change during a close follow-up schedule in the first six months after acute COVID-19. Such a follow-up plan does not appear necessary and should be personalized to limit excessive costs and resources.

Background: To compare the epidemiologic, microbiologic and imaging characteristics of urinary tract infections (UTI) in children <2 years of age with and without anatomic urinary tract abnormalities (AA). Methods: All children hospitalized with UTI during 1.1.2005-31.12.2018 were included. The study group (patients with AA) included 76 patients. The control group (99 patients) included patients without AA. Results: 1163 children were hospitalized. Age at diagnosis was younger in the study group vs. controls (5.2 +/- 6.0 vs. 7.9 +/- 7.5 months, P = 0.038). Uropathogens distribution was different (P = 0.007), with lower Escherichia coli (Ec) and Proteus mirabilis (Pm) percentages in the study group and higher percentages of Enterococcus spp. (Ent) in controls. In the study group, Ec nonsusceptibility rates to ampicillin, amoxicillin/clavulanic acid, cefazolin, cefuroxime, TMP/SMX and ceftriaxone were 58%, 40%, 14%, 14%, 12% and 10%, respectively, with no differences vs. controls. Ultrasound (US) was performed in 69/76 ( 98%) patients with AA (84.1%, abnormal); bilateral (39.7%) and unilateral (32.7%) ureteral dilatation were the most frequent findings. Voiding cystourethrography was performed in 46 patients (pathologic in 35, 76%); 31 (81.6%) patients had vesicoureteral reflux ( VUR) (bilateral in 11, 35.5%; grade 4/5 in 7 patients). Uropathogens distribution in VUR patients differed between study and control groups, with lower Ec and Pm in the first group and higher Pseudomonas aeruginosa and Ent percentages in the control group. Conclusion: Age at diagnosis was lower and pathogen distribution was different in patients with AA. Antibiotic susceptibility patterns of the main uropathogens were similar between patients with or without AA. Copyright (C) 2022, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC.

Background: SARS-CoV-2 is a novel human pathogen causing Coronavirus Disease 2019 that has caused widespread global mortality and morbidity. Since health workers in Israel were among the first to be vaccinated, we had a unique opportunity to investigate the post-vaccination level of IgG anti-S levels antibodies (Abs) and their dynamics by demographic and professional factors. Methods: Prospective Serological Survey during December 2020–August 2021 at Barzilai Medical Center among 458 health care workers (HCW) followed for 6 months after the second BNT162b2 vaccine dose. Results: Antibody levels before the second dose, and 30, 90 and 180 days after were 57.1 ± 29.2, 223 ± 70.2, 172.8 ± 73.3 and 166.4 ± 100.7 AU/mL, respectively. From GEE analysis, females had higher Abs levels (β = 26.37 AU/mL, p = 0.002). Age was negatively associated with Abs, with a 1.17 AU/mL decrease for each additional year (p < 0.001). Direct contact with patients was associated with lower Abs by 25.02 AU/mL (p = 0.009) compared to working with no such contact. The average decline rate overall for the study period was 3.0 ± 2.9 AU/mL per week without differences by demographic parameters and was faster during the first 3 months after vaccination than in the subsequent 3 months. Conclusions: All demographic groups experienced a decline in Abs over time, faster during the first 3 months. Findings of overall Abs lower in males, workers with direct contact with patients, and older workers, should be considered for policy-making about choosing priority populations for additional vaccine doses in hospital settings.

The importance of acquiring knowledge of pregnant women on prenatal care lies in its leading to confidence and ability in decision-making. There is a growing need for a model of prenatal care that will allow nurses to provide the most efficient pregnancy-related guidance with minimum need for additional staff. This study compares the level of knowledge on subjects pertaining to pregnancy and birth in low-risk pregnancies when delivered in group versus individual settings. The study is an open, controlled, semi-randomized community trial. The intervention arm received prenatal care services in a group setting led by a nurse. The control arm received prenatal care services in routine individual meetings with a nurse. Knowledge of prenatal subjects was evaluated by questionnaires. The level of knowledge of the women in the group setting for the pre-service questionnaire was lower than that of the women in the individual group, but higher for the final questionnaire. After accounting for a starting point difference (the women in the individual care arm started with a higher knowledge score), the women in the group setting had a three-fold improvement in score compared to the women in the individual setting (p = 0.043). Prenatal care provided in a group setting may lead to better knowledge acquisition, leading to better awareness of pregnancy-related medical conditions and to enhanced adherence to recommended pregnancy tests and healthy lifestyle.

Background: A third dose of the BNT162b2 SARS-CoV-2 vaccine leads to a significant increase in antibody levels, however, concerns regarding the long-term persistence of this response exist. We assessed the humoral response for one year following vaccination.Methods: A prospective study among immunocompetent healthcare workers (HCW) who received three doses of BNT162b2. anti-spike antibody titers were measured at six predefined timepoints, from before the second vaccine dose, and up to one year afterwards, which is 4-6 months after the third dose. HCW with a history of SARS-CoV-2 infection were excluded.Results: Seventy-six HCW had all the six serological measurements. Antibody titers significantly increased shortly following the third vaccine dose, and while declining, remained higher from all previ-ous measurements for up to six months.Conclusions: A third dose of BNT162b2 leads to a profound humoral response, which remains signifi-cantly higher than previous measurements, even after 6 months.(c) 2022 Elsevier Ltd. All rights reserved.