Background: Recent studies suggest that prunes are one of the most effective fruits for preventing and reversing bone loss. Objectives: The purpose of the present systematic review was to summarize the evidence from the randomized controlled studies on the effect of prunes on bone health in humans and to pool the results in a meta-analysis. The hypothesis of the present review was that bone mineral density of the pulled intervention group would be higher than that of the control group. Methods: We conducted a systematic review of randomized controlled studies with a three-level mixed-effects meta-analysis. Results: Of two hundred and eighty-four studies that were initially identified in PubMed, Scopus, and Web of Science using the search words, eleven papers (747 participants) were considered eligible. The effect of prune intervention in postmenopausal women was borderline significant at the lumbar spine, with BMD slightly higher in the intervention group (SMD [95% CI] = 1.30 [-0.03, 2.63]; I2 = 98%; p < 0.001). No significant differences were observed at other individual BMD sites. Heterogeneity across studies was high for all measured sites. The difference between the intervention and control groups in the levels of bone formation and resorption markers was not significant. The risk of bias of the included randomized controlled studies, assessed by the RoB v.2 tool, was low. Conclusions: Our meta-analysis provides preliminary evidence of modest skeletal benefits associated with consumption of 50-100 g of prunes, particularly at the lumbar spine, a trabecular-rich site. However, the overall body of research remains limited.

CONTEXT:Cognitive abilities in children, often reflected in their academic performance, predict educational and occupational performance, socioeconomic attainment, health, and longevity. Identification of modifiable factors affecting these abilities can influence multiple spheres across their lifespan. OBJECTIVE:The aim of this review and meta-analysis was to systematically summarize and quantify the existing empirical evidence on associations between adherence to the Mediterranean diet (MD) and cognition outcomes and academic performance in school-aged children (aged 6-19 years). DATA SOURCES:PubMed, Scopus, and Web of Science electronic databases were systematically searched in April 2025 for studies, examining cognitive effects of adherence to the MD in childhood. DATA EXTRACTION:Study screening and risk-of-bias assessment were conducted independently by the authors. DATA ANALYSIS:Multilevel meta-analyses accounted for dependent observations: individual effect sizes (level 1), nested within studies (level 2), and further comprised various cognition domains (level 3). Of 1140 articles initially identified, 39 studies with a total of 26 307 participants, were reviewed and analyzed. From these studies, we found a positive, small but significant correlation of 0.18 (95% CI, 0.10-0.26) between adherence to the MD and overall cognition in school-aged children. The findings persisted in the meta-analysis of studies with adjusted coefficients (0.12; 95% CI, 0.08-0.17). In subgroup analyses, correlations between adherence to the MD and specific facets of cognition were also small but significant for academic achievement: 0.21 [95% CI, 0.09-0.32], I2 = 82%, for cognitive abilities: 0.12 [95% CI, 0.04-0.19], I2 =63%, and for motivation and learning strategies, 0.35 [95% CI, 0.14-0.52], I2 = 99%. CONCLUSIONS:Adherence to the MD has a small but significant positive correlation with multiple cognition facets and academic performance in children aged 6-19 years. Promoting the MD may be considered as part of a broader approach to supporting cognitive health and academic success. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration No. [CRD420251049164].

Background Pediatric palliative care (PPC) aims to improve the quality of life of children with life-limiting or life-threatening conditions through early integration alongside disease-directed treatment. However, many eligible children remain under-recognized and underserved. We aimed to characterize acute healthcare utilization among children with life-limiting chronic conditions in Israel from diagnosis to death, with emphasis on the final year of life, and to compare utilization across age groups and geographic regions. Methods This retrospective population-based cohort study used electronic medical records from Clalit Health Services, Israel's largest health maintenance organization. Children aged 0–18 years diagnosed with life-limiting or life-threatening chronic conditions between 2000 and 2025 were included. Healthcare utilization throughout follow-up was analyzed. Results The cohort included 83,419 children (59.2% male; mean age at diagnosis 5.9 ± 5.9 years), of whom 3,267 (3.9%) died during follow-up. During the final year of life, 43.5% had ≥ 5 hospitalizations (mean 6.3 ± 7.7), 52.7% were admitted to the intensive care unit, and 16.0% had ≥ 5 emergency department visits. Community specialist consultations and imaging were frequent. In contrast, access to palliative care was minimal: 95.7% received no palliative consultation, while only 0.2% received hospice referral or pain consultation. Healthcare utilization differed significantly by age group and geographic region (both p < 0.001). Conclusions Children with life-limiting conditions experience intensive acute healthcare utilization, particularly near the end of life, despite extremely limited access to pediatric palliative care. These findings highlight a persistent gap and support expansion of pediatric palliative care services.

INTRODUCTION:"Digital Health" includes a variety of health services delivered through technological means, such as: booking an appointment, talking to a doctor, viewing personal information and more. The use of digital services in Clalit Health Services (CHS) clinics in the Bedouin sector is low compared to the general sector. OBJECTIVES:To examine the usage of digital services, the characteristics of users, and the barriers to use it among patients from the Bedouin sector at the Segev Shalom Clinic of CHS. METHODS:A cross-sectional study among visitors to the CHS Segev Shalom clinic, aged 18-65 years during the period 17.05.2023-31.05.2023). The clinic's members belong to the Bedouin sector and have a low socioeconomic level. About 50% of the clinic's members live around the settlement of Segev Shalom. The visitors were interviewed using a structured research questionnaire that examined the use and barriers to use of telehealth services among the Arab population in Israel. RESULTS:A total of 196 clinic visitors were interviewed. Of these, 37.3% were males, average age 34.5±11.2 years and 58% live in a permanent settlement. About 44% of the respondents do not book a doctor appointment in advance but come to the clinic when necessary; 38.8% book an appointment by phone, and only 16.8% book an appointment through digital services. The main reason for not using digital services (80.5% of respondents) was lack of knowledge on how to use the service. In a logistic regression model for predicting patients who will not make a doctor's appointment in advance, it was found that the influential factors are: gender (male) (OR=1.92, (p=0.04), age in years (OR=1.03, p=0.01), little/very little consent that fast service can be obtained via digital services (OR=2.24, p=0.02) and smartphone ownership (OR=0.08, p=0.02). CONCLUSIONS:Among the study population, there is a lack of awareness of digital services and a lack of knowledge of its operation. Work should be taken to raise awareness and knowledge in a variety of ways at the clinic level, the community level and the sector level.

Physicians who become patients—especially those involved in teaching—hold a dual perspective that may influence their comfort with medical student involvement in their care. Understanding these attitudes is essential for shaping medical education policies related to consent, patient assignment, and professional boundaries. This study explored Israeli family physicians’ willingness to be examined by medical students and examined implications for clinical teaching policy. A cross-sectional survey was conducted among Israeli family physicians during June–July 2024. A total of 149 participants completed a structured questionnaire assessing their comfort with students observing, taking medical histories, and performing physical, intimate, and invasive examinations. Data were analyzed using descriptive statistics and chi-square tests to compare subgroups by gender, age, and teaching status. Among the 149 respondents (mean age 47.2 years; 65.1

BackgroundWe carried out a systematic review of the medical literature on potential effects of caregiving on the health and well being of spouses of Fibromyalgia (FM) patients and pooled the results in a meta-analysis.MethodsThe review is comprised of original studies that examined the mood states and well-being of husbands/wives, or long-term intimate partners, of FM patients. The authors searched the PubMed, Scopus, APA PsycNet and Web of Science databases using the key words “fibromyalgia and spouses,” “fibromyalgia and partners,” and “fibromyalgia and husbands.” Of 570 papers that were initially identified using the search words, 18 papers were considered eligible. We used the Joanna Briggs Institute Critical Appraisal Checklist (JBICAC) and Critical Appraisal Skills Program (CASP) tools to assess the risk of bias in the analytical cross-sectional and qualitative studies, respectively.ResultsThe overall score in mood states was significantly higher among spouses of FM patients than among spouses of individuals without FM (SMD [95% CI] = 0.52 [0.30; 0.74]). The strongest evidence was found for depression, SMD [95% CI] = 0.68 [0.33; 1.03]. The overall standardized score of quality of life was significantly lower among spouses of FM patients, SMD [95% CI] = −0.59 [−0.79; −0.38], with significant differences in physical function and role, emotional role, and mental health subscales.LimitationLimitation of this review is the scant number of studies that addressed several health domains, which made it impossible to carry out meta-analyses in these domains.ConclusionSpouses of FM patients show the emotional and physical consequences of caregiving, and impaired quality of life. Addressing these problems can prevent deterioration of their health and improve their quality of life.

Background The prevalence of obesity has been increasing worldwide and is associated with increased risk of morbidity and mortality. Weight management can reduce the risk of complications and improve the quality of life of patients with obesity. This study explored primary care physicians’ (PCPs’) attitudes and knowledge about weight management. Methods An anonymous questionnaire was distributed to 400 PCPs between 2020 and 2021. The survey included questions on treatment approaches (pharmaceutical and surgical) and items regarding the respondents’ demographic characteristics. We compared PCPs with low or high proactivity toward weight management. We explored attitudes and knowledge with the chi-square test for categorical variables or the Mann-Whitney test for continuous variables. Results A total of 145 PCPs answered our survey (a response rate of 36.25%). More than half (53.8%) of the respondents showed low proactivity toward weight management in their practice. Proactive respondents were more likely to believe that pharmaceutical treatment effectively reduces weight and offered medical and surgical treatment options more frequently to their patients. Lack of knowledge was the most predominant reason for PCPs avoiding offering treatment to their patients, especially in less proactive PCPs (33.3% vs. 5.3%, p-value < 0.001). When comparing different pharmaceutical options, 46.6% of PCPs report they tend to prescribe liraglutide to their patients compared with only 11% who prescribe orlistat and 10.3% who prescribe phentermine (p-value < 0.001). Conclusions Many PCPs still do not actively provide obesity treatment despite improved awareness and therapeutic options. PCPs’ proactivity and attitudes are vital to this effort.

BACKGROUND:Public and medical interest in the use of cannabis has increased in Israel and the world over recent years. STUDY QUESTION:The aim of the study was to assess the attitudes of medical students from the Faculty of Health Sciences of Ben-Gurion University of the Negev on the use of medical cannabis. STUDY DESIGN:This is a cross-sectional study using a self-administered questionnaire completed by medical students from Ben-Gurion University of the Negev, Beer-Sheva, Israel. MEASURES AND OUTCOMES:Attitudes and knowledge toward the use of medical cannabis were evaluated. RESULTS:A total of 243 medical students participated in the study. Of these, 111 (46.1%) were from preclinical years. The mean age was 27.31 ± 3.07, and 138 (57.3%) were female students. Most students (N = 193, 79.4%) agreed to a great degree or to a very great degree that there was a role for cannabis for medical purposes. Most students thought that medical cannabis should be recommended for use by pain specialists (N = 231, 95.1%), by oncologists (N = 208, 85.6%), and by psychiatrists (N = 192, 79%). A little more than half of the participants (N = 127, 52.5%) would agree to be licensed, as future physicians, to prescribe medical cannabis. A logistic regression analysis found that the students strongly agreed with legalization of medical cannabis and students who strongly agreed that medical cannabis should be in the health basket predicted a very strong agreement about its use (OR = 2.623, P ≤ 0.002, and OR = 3.285, P ≤ 0.001, respectively). CONCLUSIONS:Most medical students support the use of medical cannabis for medical purposes and are in favor of its legalization. As physicians of the future, it is important to assess the attitudes of medical students on medical cannabis.

Purpose To assess whether ethnicity affects the association between A1C and fasting glucose in people with type 2 diabetes. Methods This investigation was an epidemiological, cross-sectional study based on computerized medical records of the Southern District of Clalit Health Services. The study population comprised patients ≥40 years of age with type 2 diabetes who underwent blood tests between 8 August 2015 and 20 July 2020. A normal-error multiple linear regression model was used to assess differences in associations among ethnic groups (i.e., Arabs, Ethiopian Jews, and non-Ethiopian Jews) and A1C. Results A total of 59,432 patients with type 2 diabetes were included in the study. Of these, 1,804 were Jews of Ethiopian origin, 49,296 were non-Ethiopian Jews, and 8,332 were Arabs. Compared with non-Ethiopian Jews, A1C levels were increased by 0.1% (1 mmol/mol) among Ethiopian Jews and by 0.3% (3 mmol/mol) among Arabs. Ethnicity was a strong predictor of A1C, explaining 0.6% of its variance. An A1C level of 7% (53 mmol/mol) correlated with fasting glucose levels of 141, 136, and 126 mg/dL in non-Ethiopian Jews, Ethiopian Jews, and Arabs, respectively. Conclusion Ethnic differences in A1C should be considered by clinicians, researchers, and policymakers.

The unique health-related traditions, perceptions, and communication patterns of Ethiopian immigrants are challenging to Israeli healthcare providers who are trained in western medicine. The aim of this review was to conduct a survey of traditions, beliefs, and symptom reporting by Ethiopian immigrants and culturally oriented interventions to improve the care of Ethiopian immigrants. We used the keywords “Ethiopian immigrants Israel" and “Ethiopian Jews.” Of 418 articles initially retrieved, 35 satisfied the inclusion and exclusion criteria. We described health-related traditions and their possible complications. Possession syndrome was frequently misdiagnosed as a neurological or psychiatric disorder. The medical staff was unfamiliar with these health and illness beliefs, somatization patterns, and the communication style of Ethiopian immigrants. There were successful interventions that involved liaisons from the Ethiopian community and community-based educational activities. Medical professionals working with African immigrants worldwide can use the Israeli experience to develop effective, culturally oriented interventions to optimize the health care for these immigrants.

BACKGROUND:Marketing by pharmaceutical companies has become an increasingly controversial issue for the medical community and the public. This controversy stems from the potential influence that pharmaceutical companies can wield through marketing on the medical community. This study assesses community physicians' attitudes towards pharmaceutical companies and their representatives to get a better understanding of how their activities affect daily work in community clinics.METHODS:A cross-sectional anonymous questionnaire-based study of 170 community physicians in southern Israel was conducted via convenience sampling. The questionnaire was designed to assess physicians' attitudes about the nature of their relationships with representatives of pharmaceutical companies and possible associations with physicians' demographic and professional profiles. The questionnaire was distributed, at weekly staff meetings in the study clinics, to a convenience sample of physicians, who agreed to participate in the study.RESULTS:Most physicians did not have an extreme attitude on interactions with representatives of pharmaceutical companies. Interestingly, while they thought that pharmaceutical companies play an important role in medical progress, they did express concern regarding the risk of misleading information. While they believed that interactions between physicians and representatives of pharmaceutical companies had a negative effect on the clinic workflow, they were not in favor of prohibiting such interactions. Physicians who graduated from medical schools in Israel held a less sympathetic position towards these interactions.CONCLUSION:The anticipated heterogeneous attitudes of community-based physicians on interactions with representatives of pharmaceutical companies reflect an inherent complex relationship, with aspects that are specific to the Israeli medical field. Interestingly, physicians trained in other countries than Israel also have divergent attitudes, further affecting the socio-cultural impact on practitioner's attitudes towards this intricate and often politicized topic. Open professional dialogue and targeted educational programs on the physician-pharmaceutical relationship, with more explicit regulation, could potentially ease the discomfort experienced by physicians, especially in the Israeli context and result in a clearer framework of interaction that would leverage the potential advantages while accounting for ethical and regulatory pitfalls.

Our aims were to compare fibromyalgia (FM) rate, drug treatment and factors associated with the use of opiates in two ethnic sectors. A retrospective cross-sectional study in southern district of Israel was performed on diagnosed FM patients in 2019–2020 [7686 members (1.50

AIM:The cost to the healthcare system of management and treatment for fibromyalgia patients is high. The aims of the study were to identify and compare factors associated with the use of healthcare services among fibromyalgia patients in southern Israel from two ethnic groups. METHODS:A cross-sectional study of patients insured in the southern district of the Clalit Healthcare Services in Israel in 2019-2020. The data were collected from the central computerized system. Multivariable regression models were developed for healthcare services utilization. RESULTS:During the study period, 7686 members were diagnosed with fibromyalgia. The median for specialist consultations was 47 and for imaging tests was eight. About 47% made emergency room visits and 25% were hospitalized. The median of imaging tests was significantly higher in Jewish patients than in Arab patients (8 vs. 6; p = .000). In contrast, a significantly higher rate of Arab patients visited the Emergency Room at least once (51.6% vs. 46.75%; p = .000) and they had a higher median number or Emergency Room visits (2 vs. 1; p = .003), compared with Jewish patients. In the Arab group there was a strong effect coefficient for another localized pain syndrome with specialist consultations (odds ratio [OR] 1.699; 95% confidence interval [CI] 1.266-2.241) and imaging tests (OR 2.511; 95% CI 1.496-4.146). CONCLUSIONS:The utilization rate of healthcare services is high among fibromyalgia patients. The factors associated with high healthcare utilization are different in the two ethnic groups. Future studies could show if interventions designed to address modifiable factors could reduce the overutilization of healthcare services.

BACKGROUND:There is a decrease in the supply of physicians in Israel resulting from the declining flow of immigrant physicians from the former Soviet Union, a large proportion of whom have reached retirement age in recent years. This problem could become worse because the number of medical students in Israel cannot increase quickly, especially because the number of clinical training sites is inadequate. The quick population growth and anticipated ageing will exacerbate the shortage. The aim of our study was to accurately assess the current situation and factors that affect it, and to propose systematic steps to improve the physician shortage.MAIN BODY:The number of physicians per capita is lower in Israel than in the OECD at 3.1 vs. 3.5 per 1000 population, respectively. About 10% of licensed physicians live outside of Israel. There is a sharp increase in the number of Israelis returning from medical school abroad, but some of those schools are of low academic standard. The main step is a gradual increase in the number of medical students in Israel with a transition of clinical practice to the community, and hospital clinical hours in the evening and in the summer. Students with high psychometric scores who were not admitted to an Israeli medical school would get support to study in quality medical schools abroad. Additional steps include encouraging physicians from abroad to come to Israel, especially in specializations in distress, recruitment of retired physicians, transferring functions to other medical professions, economic incentives for departments and teachers, and incentives to prevent physicians from quitting or migrating to other countries. It is also important to close the gap between the number of physicians working in central Israel and the periphery through grants, employment opportunities for physicians' spouses, and preferential selection of students from the periphery for medical school.CONCLUSIONS:Manpower planning requires a broad, dynamic perspective and collaboration among governmental and non-governmental organizations.

ObjectiveTo conduct a systematic review of the literature on the association between fibromyalgia and mortality and to pool the results in a meta-analysis. MethodsThe authors searched the PubMed, Scopus, and Web of Science databases using the key words 'fibromyalgia' and 'mortality' to identify studies that addressed an association between fibromyalgia and mortality. Original papers that assessed associations between fibromyalgia and mortality (all or specific causes) and provided an effect measure (hazard ratio (HR), standardised mortality ratio (SMR), odds ratio (OR)) quantifying the relationship between fibromyalgia and mortality were included in the systematic review. Of 557 papers that were initially identified using the search words, 8 papers were considered eligible for the systematic review and meta-analysis. We used a Newcastle-Ottawa scale to assess the risk of bias in the studies. ResultsThe total fibromyalgia group included 188 751 patients. An increased HR was found for all-cause mortality (HR 1.27, 95% CI 1.04 to 1.51), but not for the subgroup diagnosed by the 1990 criteria. There was a borderline increased SMR for accidents (SMR 1.95, 95% CI 0.97 to 3.92), an increased risk for mortality from infections (SMR 1.66, 95% CI 1.15 to 2.38), and suicide (SMR 3.37, 95% CI 1.52 to 7.50), and a decreased mortality rate for cancer (SMR 0.82, 95% CI 0.69 to 0.97). The studies showed significant heterogeneity. ConclusionsThese potential associations indicate that fibromyalgia should be taken seriously, with a special focus on screening for suicidal ideation, accident prevention, and the prevention and treatment of infections.

OBJECTIVE:To characterize and compare occupational injuries among population sectors in southern Israel and to evaluate their use of healthcare services and analgesic drugs.METHODS:Retrospective cross-sectional study.RESULTS:There were 100,000 occupational injuries among 70,037 insured individuals over the study period from January 1, 2009 to December 31, 2016. There was a large increase in occupational traffic injuries over this period. Compared to the veteran Jewish population, Bedouin Arabs, new immigrants and foreign workers had significantly lower rates of use of ambulatory services and imaging tests ( P < 0.001). Arabs had significantly higher odds for recurrent occupational injuries (OR = 1.29, P < 0.001), and being a new immigrant protected against recurrent injuries (OR = 0.70, P < 0.001).CONCLUSIONS:Medical staffs should invest greater effort into explaining the spectrum of diagnostic and treatment options for vulnerable groups as well as workers' rights.

Musculoskeletal pain is one of the leading complaints in the ambulatory setting. There are many ways to treat it, including pharmacologic and non-pharmacologic approaches. Dry needling (DN) is an option that is easy to learn, cheap and has a good safety profile. The aim of this study was to assess the association between DN performed by GPs for acute myofascial pain syndrome (MPS) and pain relief and to evaluate factors associated with treatment success. In this prospective cohort study, two GPs performed DN in their clinics. Patients were asked to rank their pain using the Short-Form McGill Pain Questionnaire (SF-MPQ) before, 10-min and 1-week after the procedure. The SF-MPQ index consists of 3 parts; visual analog scale (VAS), pain rating index (PRI) and present pain intensity (PPI). Logistic regressions were performed to assess the variables associated with short- and medium- term success. Fifty two patients were recruited from September 2019 until August 2020. VAS was 6.0 ± 2.3 (before), 4.1 ± 2.5 (10-min after) and 2.6 ± 2.71 (1-week after), P < 0.05. PRI was 17 ± 9.1 (before), 10.8 ± 8.5 (10-min after) and 5.1 ± 6.5 (1-week after), P < 0.05. PPI was 2.6 ± 1.0 (before), 1.7 ± 1.0 (10-min after) and 1.1 ± 1.2 (1-week after), P < 0.05. Short-term success was associated with the physician who performed the procedure (OR 10.08, 95

Background: There is no clear-cut evidence in the existing medical literature of an association between iron deficiency and nonscarring alopecia. Objective: The objective of the study was to conduct a systematic review of the medical literature on the prevalence of iron deficiency in women with nonscarring alopecia and compare their ferritin levels with those of women without this condition. Methods: The electronic databases PubMed, Scopus, and Web of Science were searched between June 15, 2019, and July 24, 2019. Studies that evaluated the prevalence of iron deficiency in women with nonscarring alopecia and/or compared ferritin levels in women with and without this condition were entered into the meta-analysis. Thirty-six of 928 identified studies entered the systematic meta-analysis. The meta-analysis was performed using the random-effects method. Results: The overall number of participants was 10,029. The prevalence of ferritin levels from 10 to 15 ng/dL and below was 21% (12; 29). Women with nonscarring alopecia had lower ferritin values at MD = −18.51 ng/dL (−25.85; −11.16, p < 0.01). Conclusion: Women with hair loss can benefit from higher ferritin levels.

Minority populations suffer from adolescent obesity at increasing rates and develop diabetes type 2 at a younger age. To assess the prevalence of adolescent obesity in the minority Bedouin population of Israel and its association with obesity and diabetes type 2 during young adulthood. A retrospective cohort study, based on computerized medical records. The study cohort was comprised of Bedouin adolescents, born in 1988–1990, who had BMI measurements at ages 14–19 years in their medical records (N = 3310). The prevalence of obesity was 17.3

BACKGROUND:Anorexia nervosa (AN) is a severe psychiatric disease that is refractory to treatment. To date, there is no effective pharmacological therapy and existing psychotherapy treatment is only partially effective. In neuropsychological terms, AN is characterized by cognitive inflexibility and an overly detailed processing style. Creating artwork and drawing requires integrative thinking that encompasses the big picture.OBJECTIVES:To describe preliminary observations of drawing treatment modality based on precise scientific drawing.METHODS:The artwork method is based on the classic work by squares and on additional techniques from scientific drawing. The method was developed and implemented in a sheltered home for patients with eating disorders in Parma, Italy. Five patients, four women and one man, agreed to participate in a 10-session workshop as a part of multidisciplinary intervention. The ages of participants were 17-28 years and all had presented with AN for several years.RESULTS:Using the method of copying drawings on squares made it possible to identify features that were common to all the patients, such as focusing on the external form of the drawing rather than on the internal details, exerting strong pressure on the pencil without consideration of the need for future corrections, drawing distorted perceptions of curves, and the adding of significant volume.CONCLUSIONS:Precise scientific drawing could be a useful instrument in the understanding and correction of a patient's distorted world and self-perspective. More evidence could be provided by further studies with a larger sample and a control group.