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The “global village” has resulted in the need to tackle cross-cultural issues in the medical school curriculum. The southern region of Israel (the Negev) provides a unique opportunity to study the interaction between medicine and culture. The Negev population is a multicultural society, with Bedouin Arabs comprising almost a fifth of its population. This imposes tremendous challenges to the medical establishment in the region and serves as a “cross-cultural laboratory” for educating medical students in global health issues. Both the traditional Israeli medical school track, as well as the newly established Medical School for International Medicine, incorporate studies of cross-cultural issues in various forms and to different degrees. Studies suggest that the exposure of students to international medical experiences increases their cross-cultural sensitivity and knowledge. We feel that in a region characterized by such ethnic diversity, all medical schools should adopt cross-cultural studies as an integral part of their curriculum.

The extension of universal health service insurance to national populations is a relatively new phenomenon. Since 1995, the Israeli National Health Insurance Law (NHIL) has provided universal health services to every resident, but the effect of this law on health and health services among minorities has not been examined sufficiently. The goals of this study were to track some of the first changes engendered by the NHIL among the Negev Bedouin Arabs to examine the effects of universal health care services. Methods included analysis of historical and health policy documents, three field appraisals of health care services (1994, 1995, 1999), a region-wide interview survey of Negev Bedouins (1997), and key informant interviews. For the interview survey, a sample of 515 households was chosen from different Bedouin localities representing major sedentarization stages. Results showed that prior to the NHIL, a substantial proportion of the Negev Bedouins were uninsured with limited, locally available health service. Since 1995, health services, particularly primary care clinics and health manpower, have dramatically expanded. The initial expansion appears to have been a marketing ploy, but real improvements have occurred. There was a high level of health service utilization among the Bedouins in the Negev, especially private medical services, hospitals, and night ambulatory medical services. The NHIL brought change to the structure of health services in Israel, namely the institution of a national health system based on proportional allocation of resources (based on size and age) and open competition in the provision of quality health care. The expansion of the pool of potential members engendered by the new universal coverage had profound effects on the Health Funds' attitudes towards Negev Bedouins. In addition, real consumer choice was introduced for the first time. Although all the health care needs of this rapidly growing population have yet to be met fully, the assurances under the Law and the new level of competition promise a higher level of service in the future.

Intellectual disability (ID) is a life-long disability characterized by impaired cognitive and adaptive skills. Over the past few decades, a shift has occurred in the conceptualization and treatment of people with ID and research in health policy and health-care delivery has become increasingly global with a notable disparity between the developed and developing world. This review presents a literature overview of global health policy for ID with the intent to focus specifically on the policy and treatment within Israel. The methodology involved sites visits to care centers, discussions with stakeholders in health policy, and a literature review. We believe that Israel is in a unique position between a developed and developing culture. In particular, the distinct problems faced by the Arab and Bedouin community in terms of ID must be formally accounted for in Israel's future policies. Research from the developing world would be instructive to this end. The global approach in this presentation led to certain policy recommendations that take into account the uniqueness of Israel's position from a social, economic, religious, and demographic perspective. It is the hope that this paper will lead to an increased awareness of the challenges faced by persons with ID and their providers in all sectors of Israeli society and that the necessary policy recommendations will ultimately be adopted.

The goal of this study was to determine the prevalence of vitamin B12 deficiency among intellectually disabled persons in a vegetarian remedial community in Israel. In this community, 47 individuals with intellectual disability (ID) live in 7 enlarged families in a kibbutz style agricultural setting. These 47 individuals and 17 of their caregivers were screened for vitamin B12 deficiency. There were 25.5% of the disabled vs. 11.8% of the caregivers found to have levels of vitamin B12 lower than 157 pg/ml. It is concluded that persons with ID in this vegetarian residential care community seemed to be at a higher risk for vitamin B12 deficiency.

It has been assumed that impaired intellectual capacity could act as a buffer to suicidality in the population of children and adolescents with intellectual disability. The few studies that have been conducted contest this assumption, and in fact, the findings showed that the characteristics of suicidality in the population of children and adolescents with intellectual disability are very similar to other adolescents without intellectual disability. This paper reviews the few studies conducted and describe the symptomatology in this population.

Islam prohibits the taking of one's life, because this way you will interfere with the work of G-d (Allah), which is clear from several places in the Quran. Concerning individual suicide or suicide attempts in various Arab countries the literature is sparse and the incidence low. In this paper we present a review of research from Israel showing that suicide epidemiology among the Arab population of children and adolescents display a low incidence, but an increase has been observed over the past decade, but still much lower than the Jewish population. We believe that there is a need for the development of prevention and intervention strategies in order to keep this incidence low.

Parenthood in persons with intellectual disability (ID) is an issue of concern for the family, guardians, and professionals as there are many sentiments and problems involved: financial, technical, medical, legal, and above all moral. People with intellectual, developmental, or other disabilities have feelings, want relationships, and are able to have children also. The attitude of society has changed through time from the early eugenic concern with heredity and fertility, to a focus on the risk to the children due to parental neglect or abuse, to acceptance and a search for solutions to parental training and support. This change can be seen as a result of a shift from institutional care to community care and normalization. This paper reviews available research, prevalence, service issues, experience from around the world, and relates to the situation in Israel. Jewish Law has been very progressive regarding the possibility of marriage between persons with ID (in contrast to American Law where historically this right has been denied, until recently). Recent research has shown that, in the case of such a union resulting in children, although they requiresomesupervision, family, friends, and social welfare agencies have scrutinized these families so much they are in constant fear of their child being taken away. There is little information on the number of such cases and an overall dearth of information on the effects on the children, although one recent study from the U.K. has shown a varied picture of resilience and a close, warm relationship later on with the family and especially the mother.

Biomedicine focuses on the biochemistry of the body, while consciousness-based medicine — holistic medicine — focuses on the individual's experiences and conscious whole (Greek: holos, whole). Biomedicine perceives diseases as mechanical errors at the micro level, while consciousness-based medicine perceives diseases as disturbances in attitudes, perceptions, and experiences at the macro level — in the organism as a whole. Thus, consciousness-based medicine is based on the whole individual, while biomedicine is based on its smallest parts, the molecules. These two completely different points of departure make the two forms of medicine very different; they represent two different mind sets and two different frames of reference or medical paradigms. This paper explains the basic tools of clinical holistic medicine based on the life mission theory and holistic process theory, with examples of holistic healing from the holistic medical clinic.

The biomedical paradigm is so convincing from a biochemical point of view, and highly efficient in many cases of acute medical problems and emergencies, but unfortunately most patients do not get much better only treated with drugs; they need to do something about their lives themselves. It is highly important for the modern physician to understand the strengths and weaknesses of the modern biomedical paradigm, to understand when and when not to administer drugs to their patients. Often a symptom can be eliminated for a while with drugs, but this is not always good as the patient might need to learn to study the imbalances in life that cause the disturbances and symptoms. For the elderly patient, sometimes life can be extended in spite of the subjective fact that life has come to its end. Sometimes treatment with a drug can teach the patient that quality of life is the responsibility of the physician and not the patient. This learned attitude can give the patient problems later or make them less active in helping themselves (responsibility transfer in the wrong direction).This paper gives a number of examples where medical drugs really are the treatment of choice in general practice and some more doubtful examples of using of the biomedical paradigm.

The modern physician is often multiparadigmatic as he serves many different types of people in many different existential circumstances. The physician basically often has three, very different sets of technologies or “toolboxes” at his disposal, derived from three different medical paradigms: classical, manual medicine; biomedicine; and holistic or consciousness-oriented medicine. For lack of a better term, we have called the extended medical science — integrating these three different paradigms and their three strands of tools and methods — the “new medicine”. The excellent physician, mastering the “new medicine”, uses the most efficient way to help every patient, giving him or her exactly what is needed under the circumstances. The excellent physician will choose the right paradigm(s) for the person, the illness, or the situation, and will use the case record to keep track of all the subjective and objective factors and events involved in the process of healing through time. The case or medical record has the following purposes:A. Reflection: To keep track of facts, to provide an overview, to encourage causal analysis, to support research and learning, and to reveal mistakes easily.B. Communication: To communicate with the patient with a printout of the case record to create trust and help the patient to remember all assignments and exercises.C. Evidence and safety: To provide evidence and safety for the patient or to be used in case of legal questions.D. Self-discipline: To encourage discipline, as a good case record is basically honest, sober, brief, and sticks to the point. It forces the physician to make an effort to be more diligent and careful than a busy day usually allows.The intention of the case or medical record is ethical: to be sure that you, as a physician, give the best possible treatment to your patient. It helps you to reflect deeply, communicate efficiently, provide evidence and safety, and back your self-discipline, never to be carried away by the high speed of modern-day clinical work to give less than the optimal treatment. The patient's life, now and in the future, is in the palm of your hand, and to assume this huge responsibility, the physician must be anxious and careful about the quality of the medical record. Much too often, the essence of the session is nowhere to be found in the case record, so most of the generated value is lost between consultations.

Touching is often a forgotten part of medicine. The manual medicine or therapeutic touch (TT) is much more powerful than many modern, biomedically oriented physicians think. Pain and discomfort can be alleviated just by touching the sick area and in this way help the patient to be in better contact with the tissue and organs of their body. Lack of presence in the body seems to be connected with many symptoms that can be readily reversed simply by sensitive touch. When touch is combined with therapeutic work on mind and feelings, holistic healing seems to be facilitated and many problems can be solved in a direct and easy way in the clinic without drugs. This paper gives examples of the strength of manual medicine or therapeutic touch in its most simple form, and points to the power of physical contact between physician and his patient in the context of the theory and practice of holistic healing. Intimacy seems highly beneficial for the process of healing and it is very important to distinguish clearly between intimacy and sexuality for the physician and his patent to be able to give and receive touch without fear and without holding back emotionally.

We believe that the consciousness-based/holistic medical toolbox has a serious additional offer to cancer patients and, as a consequence, designed a treatment for the patient with metastasized cancer. From a holistic perspective, cancer can be understood as a simple disturbance of the cells, arising from the tissue holding on to a trauma with strong emotional content. This is called “a blockage”, where the function of the cells is allocated from their original function in the tissue to a function of holding emotions. We hope to be able not only to improve the quality of life, but also to improve survival and in some cases even induce spontaneous remission of the metastasized cancer. This paper describes how work with a patient with metastasized cancer can be done in the holistic clinical practice in 14 days on an individual basis, helping the patient to recover her human character, purpose of life, coherence, and will to live, thus improving quality of life and possibly also survival time. The holistic therapeutic work includes (1) teaching existential theory, (2) working with life perspective and philosophy of life, (3) helping the patient to acknowledge the state of the disease and the feelings connected to it, and finally (4) getting the patient into the holistic state of healing: (a) feeling old repressed emotions, (b) understanding why she got sick from a holistic point of view, and finally (c) letting go of the negative beliefs and decisions that made her sick according to the holistic theory of nongenetic diseases. The theory of the human character, the quality of life theories, the holistic theory of cancer, the holistic process theory of healing, the theory of (Antonovsky) coherence, and the life mission theory are the most important theories for the patient to find hope and mobilize the will to fight the cancer and survive. The patient went through the following phases: (1) finding the purpose of life and hidden resources; (2) confronting denial; (3) taking responsibility for being very ill; (4) severe existential crises with no wish to live while still fighting; (5) integration of many repressed feelings and negative decisions thus rehabilitating character; (6) confronting lack of intimacy and trust in others and this way rehabilitating the ability to love; (7) rehabilitating the will to live, breaking through and falling in love with life; (8) assuming responsibility for the social relations; and sometimes (9) quality of life is improved radically with indications of spontaneous remission of the liver tumors.

In clinical holistic practice, it is recommended that ample time is spent with the gynecological or pelvic examination, especially in cases of women with suspected old emotional traumas following early childhood cases of incest or sexual abuse. The holistic principles of holding and processing should be followed with the purpose of healing the patient, re-establishing the natural relationship with the body, sexuality, and reproductive organs. Sexual violations are often forcibly repressed. It appears that the tissues that were touched during the violation often bear the trauma. It is characteristic of these patients that their love lives are often problematic and do not provide the necessary support to heal the old wounds in the soul and therapy is therefore indicated. When this is concerned with the reproductive organs, it poses particular difficulties, as the therapy can easily be experienced as a repetition of the original violation, not least due to the risk of projection and transference. There is, therefore, a need for a procedure that is familiar to and safe for the patient, for all work that involves therapeutic touching of sexual organs over and beyond what is standard medical practice. This paper presents one case story of earlier child sexual abuse and one case of temporary infertility. We have established a procedure of slow or extended pelvic examination, where time is spent to make the patient familiar with the examination and accept the whole procedure, before the treatment is initiated. The procedure is carried out with a nurse, and 3 h are set aside. It includes conversation on the present condition and symptoms; concept of boundaries; about how earlier assaults can be projected into the present; establishment of the therapeutic room as a safe place; exercises on when to say “stop”; therapeutic touch; visualization of the pelvic examination step by step beforehand; touching on the outside of the clothes with repetition of the “stop” procedure if necessary; pelvic examination paying special attention to traumatized (damaged/scarred/blocked) areas with feel, acknowledge, and let go of the traumatized areas; postprocessing of emotions and traumas with final healing. The patient cannot be healed until negative decisions are found and dropped with a tour back to the present, to let go of negative sentences and ideas, and a plan for further positive progress.

This study was undertaken to examine the association between the immunological impact of HIV (measured by CD4 count) and global self-assessed quality of life (QOL) (measured with QOL1) for people suffering from HIV, to see if the connection was large and statistically strong enough to support our hypothesis of a strong QOL-immunological connection through the nonspecific, nonreceptor-mediated immune system, and thus to give a rationale for a holistic cure for HIV. This cross-sectional population study in Uganda included 20 HIV infected persons with no symptoms of AIDS and a CD4 count above 200 mill./liter. The main outcome measures were CD4 count, global QOL measured with the validated questionnaire QOL1, translated to Luganda and translated back to English. We found a large, clinically significant correlation between the number of T-helper cells (CD4) and global self-assessed quality of life (QOL1) (r = 0.57, p = 0.021), when controlled for age, gender, and years of infection. Together with other studies and holistic medicine theory, the results have given rationale for a holistic cure for HIV. We suggest, based on our findings and theoretical considerations, that HIV patients who improve their global QOL, also will improve their CD4 counts. Using the technique of holistic medicine based on the life mission theory and the holistic process theory of healing, we hypothesize that the improvement of QOL can have sufficient biological effect on the CD4, which could avoid or postpone the development of AIDS. A holistic HIV/AIDS cure improving the QOL draws on hidden resources in the person and is thus affordable for everybody. Improving global QOL also means a higher consciousness and a more ethical attitude, making it more difficult for the HIV-infected person to pass on the infection.

The modern physician is using pharmaceuticals as his prime tool. Unfortunately, this tool is much less efficient than you might expect from the biochemical theory. The belief in drugs as the solution to the health problems of mankind, overlooking important existing knowledge on quality of life, personal development, and holistic healing seems to be one good reason why approximately every second citizen of our modern society is chronically ill. The biomedical paradigm and the drugs are certainly useful, because in many situations we could not do without the drugs (like antibiotics), but curing infections or diseases in young age is not without consequences, as the way we perceive health and medicine is influenced by such experiences. When we get a more severe disease in midlife, we also believe drugs will make us healthy again. But at this age, the drugs do not work efficiently anymore, because we have turned older and lost much of the biological coherence that made us heal easily when we were younger. Now we need to assume responsibility, take learning, and improve our quality of life. We need a more holistic medicine that can help us back to life by allowing us to access our hidden resources. The modern physician cannot rely solely on drugs, but must also have holistic tools in his medical toolbox. This is the only way we can improve the general health of our populations. Whenever NNT (Number Needed to Treat) is 2 or higher, the likelihood of the drug to cure the patient is less than 50%, which is not satisfying to any physician. In this case, he must ethically try something more in order to cure his patients, which is the crossroads where both traditional manual medicine and the tools of a scientific holistic medicine are helpful.

People with developmental disability, mental retardation, or intellectual disability are living longer and becoming prone to age-related health problems and diseases of old age much like the general population. This worldwide trend is also seen in Israel, where today 39.8% of persons with intellectual disability in residential care are 40 years old and above. There is a need for service and staff providers to receive training; a need for more research and better service for this aging population. This review presents health concerns for older persons with different levels of intellectual disability, health concerns in persons with Down syndrome, and persons with epileptic seizures and cerebral palsy in relation to general practice and family medicine. The review is concluded with recommendations on health and aging in adults with intellectual disabilities and the call for formalized training in the topic for specialists in family medicine.

BACKGROUND This study examines health and health care attitudes, practices and utilization patterns among the Bedouin Arab minority in the south of Israel. Particular attention is given to the effects of the new National Insurance Law that provides universal coverage for the first time, and to the identification of critical issues for further research. METHODS Focus groups, adapted to Bedouin culture, were the primary method of data collection. Twelve groups (158 participants) from throughout the Negev met for 3-7 sessions each, using specially trained local moderators and observers. Issues discussed and analyzed included experience and satisfaction with the current health system (both modern and traditional), health service availability/barriers, health care needs, influences of social change, and the National Insurance Law. RESULTS Participants voice dissatisfaction with modern health services in the Bedouin sector and the state of health of Negev Bedouin. They place great emphasis on the connection between health and the rapid social and economic changes, which this traditionally nomadic group is undergoing. Traditional health care is felt to still exist, but its importance is waning. The National Insurance law is having a major impact on the Bedouin, particularly because it provides universal health insurance coverage where only partial coverage had been in effect. CONCLUSIONS This study, one of the first of its kind in the Bedouin sector, showed that the focus group method, if properly modified to cultural norms, can be a valuable research tool in traditional communities and in health service research. The findings from this research can be used to direct efforts to improve health policy and health services for this group, as well as preparing the way for further qualitative or quantitative studies.

Introduction: People with intellectual disabilities have higher rates of mental ill-health and problem behaviors than the general population. Method: In this study, we present data on trends in challenging behavior in residential care centers in Israel from 1998-2008 and further data on trends in employment of psychiatrists from 1998-2009 and psychotropic medication use from 1998–2008. Data was collected from annual questionnaires sent out to all residential care centres in Israel, from the Office of the Medical Director, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services. Results: Rates of challenging behaviors in people with intellectual disabilities living in residential care centres in Israel continues to rise. Alongside this, trends in regular psychotropic medication use also continues to increase. Conclusion: Consideration of biological, psychological, social and environmental factors in the assessment and management of people with challenging behaviors is important. This is best conducted using a multidisciplinary approach. This may include psychiatric assessment and consideration of medication, although non-pharmacological interventions should always be considered either alongside, or instead of medication.

Background In 1982, Helicobacter pylori (formerly Campylobacter pylori) was identified as a pathogenic factor in peptic ulcer disease by researchers from Australia. Because only a small number of studies of H. pylori infection have been conducted in people with intellectual disability (ID), and none of these were done in Israel, the present authors decided to conduct a pilot study on its prevalence in this population. Methods The Israeli Division for Mental Retardation provides services to over 6000 people in 54 residential care centres (or institutions), and one centre in the south of the country with kibbutz-style living arrangements was selected for this pilot study. The study was performed as part of the yearly routine medical examination of all residents, and blood specimens were drawn for IgG antibodies to H. pylori (ELISA). Results Out of the 47 individuals screened, 75% (n = 36) were seropositive. Conclusion In addition to the reported high rates of H. pylori infection in residents with ID living in large facilities, the present pilot study suggests that people with ID living in smaller, kibbutz-style arrangements are also at high risk.

In 1997-1998 a questionnaire was developed by the Office of the Medical Director, Ministry of Social Affairs and Social Services. This questionnaire has aimed to assess, on a yearly basis, the health of the residents with intellectual disability and the services provided to them by specific residential care centers within Israel. The present study was conducted to examine trends in the number of children with intellectual disability in residential care centers in Israel. We found a clear downward trend with regard to the percent of children living in residential care facilities, from 18.1% of the total population in 1999 to 13.3% in 2006. Children living in residential care in 2006 comprised 4.5% of the population of persons with intellectual disability serviced by the Ministry of Social Affairs and Social Services.

In Israel, the Office of the Medical Director of the Ministry of Social Affairs is responsible for the medical service in residential-care centers for persons with intellectual disability (ID). A standard annual questionnaire was developed during 1997-1998, and the first national survey study was conducted in 1998. This present paper presents the findings of the seventh national survey in 2007, for which the following information was gathered via questionnaires: age, gender, and level of intellectual disability of persons served at the residential care center in question, status of the population served, functional profile, nursing, medical, and allied professional staff, number of annual examinations, preventive medicine aspects, medications, number of annual cases of infectious disease, annual unintentional injuries, number of deaths, number of hospitalizations, internal residential center hospitalization, ambulatory out-patient use, use of outside laboratory examinations, and dental care. In 2007, 6,872 persons were served in 9 government, 37 private, and 13 public centers. The average number of persons served per center was 116.47 (range 24 to 341). The survey in 2007 showed that 79% of the population with ID in residential care in Israel was between the ages of 20 and 60 years old, 44% with severe or profound ID, 43% with moderate and 13% with mild ID. Twenty-seven percent were nursing patients, and 18% were confined to a wheelchair, 34% had epilepsy, 86% were found to be receiving medication daily for chronic illness, and 51% received psychotropic medication for psychiatric illness.

Nursing care has changed over time and the focus has differed according to the need or the culture involved. One of the first descriptions of nursing of people with intellectual disability (ID) is from the United States at the New York Hospital around 1808. Over the next 200 years, ID nursing developed into a subspecialty in both the United States and England with a curriculum and certification. This process has yet to take place in Israel, but it is a change we would like to see in the coming years. The purpose of this paper was to look at the trend in the number of nursing patients in residential care centers for people with ID in Israel. Data were extracted from the 1998-2007 national annual surveys of all residential care centers in Israel. Over this 10-year period, we found that the number of nursing patients was fairly constant, ranging from 23.9% of the total population in 1998 to 26.5% in 2007. Whereas the percent of nursing patients has remained steady, the burden of nursing has increased. Specifically, due to the aging of this population, residential care centers are now dealing with an increased quantity and complexity of medical problems. As a result, we have experienced a need to establish, on a regional basis, long-term nursing care facilities within our residential care centers.

In 1997-1998 a questionnaire was developed by the Office of the Medical Director, Ministry of Social Affairs and Social Services. This questionnaire has aimed to assess, on a yearly basis, the health of the residents with intellectual disability and the services provided to them by specific residential care centers within Israel. The present study was conducted to examine trends in the number of children with intellectual disability in residential care centers in Israel. We found a clear downward trend with regard to the percent of children living in residential care facilities, from 18.1% of the total population in 1999 to 13.3% in 2006. Children living in residential care in 2006 comprised 4.5% of the population of persons with intellectual disability serviced by the Ministry of Social Affairs and Social Services.

Unintentional injuries are the fifth leading cause of death in the general population, but even more of a concern in the population of persons with intellectual disability. The present study was conducted to investigate trends in choking resulting in death of persons with intellectual disability in residential care centers in Israel over the period of 1991-2004.Data for this study came from the Office of the Medical Director (OMD), Division for Mental Retardation (DMR), Ministry of Social Affairs and Social Services. Every case of death in residential centers is reported to the OMD, which has registered the place of residence, date of birth, age at death, sex, ethnic background, level of ID, cause of death, autopsy, and review committee, if this was established, in a data register since 1991. Data concerned with food choking were extracted from the mortality register for the 1991-2004 period.Over the study period (14 years) there was a total of 1019 cases of death with 27 (2.65%) caused by food choking. The average rate was 42.6 per 100,000 study population for food choking.The solution is prevention. In recent years the OMD together with other professionals have produced educational material and seminars on feeding and preventive measures. Not every case can be prevented, but it is important to identify risk factors, educate care givers, and ensure that food products that are common choking hazards are kept away from residents who are at risk.

Life expectancy for persons with Down syndrome has increased over the past 100 years and today ranges around 60 years of age. Improvement in health care and especially a change toward a more positive attitude toward this population has resulted in this trend. This study was conducted to learn the trend of the population of persons with Down syndrome in residential care in Israel.An annual questionnaire sent to the medical clinics in all residential care centers for the 1998-2006 period was analyzed to study the trend of the number of persons with Down syndrome.This survey revealed that the population has been relatively stable over the years with around 500 to 600 persons or about 9% of the total population in residential care. In 2006, a decrease was observed with a total of 529 persons or 7.73% of the total residential care population.The annual questionnaire did not provide details about the Down syndrome population besides its numbers, and we therefore recommend further study of this population in more detail to learn how to keep this population healthy with a good quality of life.

Persons with intellectual disability (ID) have been observed to have more mental health problems than the general population. This study was conducted to study mental health services for persons with ID (all ages) in residential care in Israel.An annual questionnaire sent to the medical clinics in all residential care centers for the period 1998-2006 was analyzed to study the trends over time in the number of recruited psychiatrists, psychiatric medication, and hospitalization for persons with ID in residential care in Israel. The results showed an increased number of psychiatrists working with this population-from 6.14 psychiatrists per 1,000 study population in 1998 to 7.75 in 2006. Psychotropic medication also increased from 46% to 51% over the same period, and psychiatric in-patient hospitalization increased from 5.48 to 7.75 per 1,000 study population. We conclude that the psychiatric services to this residential care population have increased over the study period. We see a need for a formal subspecialty in psychiatry, training, and research.

The past 100 years has revealed a controversial history around the menstrual and contraceptive management of women with intellectual disability in residential care settings. The present study was conducted to examine the trends of contraceptive methods for females with intellectual disability in residential care centers in Israel.An annual survey of all medical clinics in residential care centers in Israel has been conducted since 1998 by the Office of the Medical Director of the Ministry of Social Affairs and data were extracted from the national surveys for 1999-2006.In the 1999-2006 period, 11-16% of females in residential care centers in Israel used oral or injected contraceptives. Depot medroxyprogesterone acetate (DMPA) was the most used method due to its convenience and effectiveness.It is recommended that a more detailed study of contraceptive methods be conducted in Israel to get a clearer picture since the data collected from annual surveys only give a rudimentary picture of the actual situation in the field.

In the last decade it has been observed worldwide that people with intellectual disanility (ID) now experience increased lifespan. The present study was conducted to monitor the trends in aging in persons with ID in residential care centers in Israel.Since 1998-1999, an annual survey of medical-clinic activity for all residential care centers for people with ID has been conducted and data from these surveys were used to investigate the trends in aging.The residential care center population today comprises about 7,000 persons of all ages. From 1999 to 2006, the population of 40-49 year olds remained stable, but the 50-59 year olds increased by 5.6%, while the 60 years and older group increased by 2.9%.Recommendations for service for this population and age group are discussed. Older people with ID have the same needs as other older people do, and they are subject to the same age-related impairments and illnesses (9). Moreover, because many disabled individuals live together with their families, the burden is double because the family members are also aging and with time, will not be able to continue their care-giving. As with older people in general, older people with intellectual disability also have social needs, housing needs, medical needs, the need for activity or work and special care needs for age-associated conditions, such as Alzheimer's disease and related dementias, increasing fragility, or conditions or diseases compromising independent functioning.

Unintentional injury is one of the leading causes for mortality in childhood. Choking or the interruption of respiration by internal obstruction of the airway, usually by food or small toys, is such a case. The present study was conducted to examine choking-related deaths from 1991-2005 among children with intellectual disability younger than 18 years of age living in residential care centers in Israel. The data for this study were obtained from the Office of the Medical Director (OMD), Division for Mental Retardation (DMR), Ministry of Social Affairs and Social Services. Every case of death in residential centers is reported to the OMD, who since 1991 has registered place of residence, date of birth, age at death, gender, ethnic background, level of ID, cause of death, autopsy and review committee, if established in a data register. The data concerned with food choking were extracted from the mortality register for the period 1991-2004. Over the study period (15 years) 1,107 cases of death were reported, with 5 (0.245%) caused by food choking in children. The average rate was 8.98 per 100,000 study population for food choking in children. The solution is prevention. In recent years, the OMD together with other professionals have produced educational material and seminars on feeding and preventive measures. Not every case can be prevented, but it is important to identify risk factors, to educate the care givers and professionals, and to ensure that food products that are common choking hazards are kept away from children, who are at risk.

Information and data are important for planning in any society. The number of children and adolescents in a community determines the demand for schools, health care facilities and other services for children and their families. Health, safety, education, recreation and social development are areas, where society needs to plan and invest, but this must be done according to reasonable predictions in order to be effective. We have in this communication looked at the trends in the number of children in Israel and found that during 1970-2006 the child population in Israel increased by 100% with the most increase in the Muslim child population (190.8%). The percentage of children of the whole population decreased from 39% to 33% in the study period in spite of the increase in number of children over the period. Irrespective of the decrease it is still high compared to for example 26% in the United States, so the population in Israel is still a younger one and service planning must be geared toward this demographic trend.

Life expectancy for persons with intellectual disability has increased over the past 100 years, and today is closer to the life expectancy of the general population (except for Down syndrome). In this study, we looked at trends in the numbers of Arab persons with intellectual disability living in residential care centers in Israel. Analysis of annual questionnaires to the medical clinics in all residential care centers for the period 1998-2006 revealed that the Arab population had increased from 749 to 921 persons in 13 residential care centers (13.5% of the total residential care population). Of the 921 persons in 2006, 58 were children aged 0-9 years and 260 were aged 10-19 years, with the majority having severe or profound intellectual disability. The increase in the number over time can been seen as a longer life expectancy in this population; the lower than expected numbers in residential care can be seen as a result of children staying at home with their families for a longer time than in the Jewish population.

The objective of the study was to study differences in aging phenomena among adults with intellectual disability (ID), who live in community residence versus their peers in residential care centers and to determine the contribution of health status, age, gender, etiology and level of ID to the decline in ADL function with age. Our study was based on matched pairs between persons with ID in community residence (N=101) and their peers living in residential centers (N=101) by age, gender, etiology and level of ID. Fifty-three percent were aged 40-49 years, 23% were aged 50-59 years and 14% were aged 60-71 years. Ten percent had Down syndrome (DS), 16% had cerebral palsy (CP) and the rest had ID with no specific etiology (NSID). Caregivers were interviewed to ascertain health problems, sensory impairments and activity of daily living (ADL). The type of residence alone could not explain the morbidity and health problems of adults with ID, which were affected by age and etiology. Participants with NSID functioned better than those with Down syndrome or cerebral palsy in all ADL areas. MANOVA and regression analysis indicated that age and health status did not contribute to the explained variance of the ADL function of the participants without specific etiology. The CP group had the most vulnerable etiology exposed to medical problems and decline in ADL function with age. Action should be taken to increase the awareness of the staff to health deterioration that can occur among adult persons with ID, especially among various types of etiologies, such as DS and CP.

The normal aging process is not in itself a risk factor for constipation, but age-related morbidities, immobility, neurologic impairment or specific drugs are risk factors for constipation. This study was undertaken to examine the prevalence and risk factors for constipation in a large sample of 2400 persons with intellectual disability (ID) aged 40 years and older living in residential care centers in Israel. Constipation was found in 8% of the total sample with no significant increase in the prevalence of constipation with age. Neurological disease, cerebral palsy, immobility and physical inactivity were risk factors associated with constipation. Mobility and physical activity is recommended in order to lower the prevalence of constipation in this population.

Children, adolescents and adults all benefit from physical exercise and physical fitness can also bring well-being to the person. Tracking physical fitness and activity over time from childhood, adolescence into adulthood will provide information on the benefits and also increase over knowledge on intervention and intervention programs. Many children and adolescents participate in physical activity, but this activity decline in adulthood. This short review provide information from several studies on the benefit of physical exercise and fitness through childhood, adolescence into early adulthood.

Burn injury is a public health concern often associated with individual pain, emotional stress, prolonged hospitalizations, permanent disfigurement and family stress. In this paper we studied the avaliable data on burn injury among adolescents in Israel through a Medline search and found three relevant studies with data on this population. The incidence rate of burn injury was 0.46 per 1,000 children aged 5-14 years for Jews and 0.91 for Bedouin. Most of the burn injury in this age group was caused by hot liquids, followed by fire and chemical burns for both Jews and Bedouin, but electical burns occurred more often in Bedouins. Mortality was very low for the adolescent group. Prevention programs in schools since the 1980s have been found effective, but the public health focus should now be geared towards groups at risk.

Health-risk behaviors that contribute to the leading causes of morbidity and mortality among adolescents and young adults are often established during adolescence and extended into adulthood. Unintentional motor vehicle injury is the leading cause of mortality in childhood and adolescence in developed countries. This review presents some of the risk factors found in research on unintentional injury and death in adolescence, including risk factors for siblings and adolescents with intellectual disability. These findings should be connected with the findings of a recent study that showed that about one third of all unintentional childhood injury deaths in the United States were preventable. For injury prevention to take place and being effective a multidisciplinary approach is needed to identify host, agent and environmental factors using epidemiology research and biomechanics. In the population of adolescents with intellectual disability there has been little research on injury epidemiology or injury prevention and the service provider will need to focus and educate staff on this issue in order to prevent injury that can result in further disability.

Obesity in adolescence has increased significantly over the past 30-40 years and a recent international comparison study (13 European countries, Israel and the US) showed that the highest prevalence in adolescents was found in the US (12.6% in 13 year old boys, 10.8% in girls; 13.9% in 15 year old boys and 15.1% in 15 year old girls) and the lowest in Lithuania. This increase in adolescence is a public health concern, because most obese adolescents continue their obesity into adulthood with serious risk for chronic disease. Focus should therefore be on prevention programs that increase healthier patterns of lifestyle and physical activity.

To determine their health status, we studied 2,282 Israeli adults with intellectual disability who were at least 40 years of age and lived in residential care. Results showed that age is a significant factor in health status. The frequency of different disease categories (e.g., cardiovascular disease, cancer, and sensory impairments) increased significantly with age for both genders. Cardiovascular disease in this population was less prevalent when compared to the general population, suggesting that underdiagnosis of some diseases or conditions may be prevalent in this population. The patterns of organ-system morbidity with increasing age were similar to those in other studies conducted in several countries, suggesting that health status and outcomes could be independent of cultural factors.

Epidemiology is an important and powerful tool in public health used to monitor health, observe trends and identify risk factors for utilization in strategy, policy and planning of services and interventions. Unintentional injury is the leading cause of death in adolescents worldwide with motor vehicle injury and drowning the leading causes. In Israel the mortality rate for motor vehicle mortality rate for adolescents was found to be 10.6 per 100,000 and 1.0 per 100,000 for drowning. Studies have shown a decrease in injury and mortality over time, but there is still much to do and calculation studies have shown that it is possible to prevent further with targeted serious effort and strategies employed.

There has been observed a worldwide increase in childhood asthma and this short communication reviews current research on adolescent asthma in Israel. Several studies have found an overall asthma prevalence of 7.8% for Jewish children, 4.9% for Arab children and 3.7% for the total population, while 7.8% was found in Bedouin children in the south of Israel. For the 1980-1997 period for the 5-34 year age group the AMR (asthma mortality rate) per 100,000 was found to be 0.226 with no significant difference between Jews and Arabs. This is a decrease as a result of increase in the use of inhaled corticosteroids (ICS) and a better anti-inflammatory treatment.

Adolescents with blindness or visual impairment, in order to go through the trying time of adolescence, require extra strength to overcome their disability. This short communication looks at prevalence data for blindness in children and adolescents that range from about 3 per 10,000 children in developed countries (60 blind children per million total population) to 15 per 10,000 in the poorest countries (600 blind children per million total population). Data from the year 2000 in Israel showed a total of 18,509 persons with blindness registered in Israel, including 168 children between the age 0-5 years and 788 between 6-18 years. Children and adolescents comprised 5.2% of the total with a small male dominance (520 males, 436 females). The total prevalence rate for children and adolescents (0-18 years) in Israel was 4.5 per 10,000 and 5.3 per 10,000 for the 6-18 year olds. The causes of blindness for children and adolescents in Israel are also presented, with optic atrophy the most common cause.

The Arab family in Israel is still embedded in the traditional society with extended family support systems, but we see a population in transition influenced by the surrounding society. This paper looks at the different religious attitudes toward the exceptional people in our society (i.e., the family reaction to a child born with intellectual or developmental disability), reviews recent studies on the Arab and Bedouin families in Israel, and presents data on the Arab population in residential care centers.Today, out of 57 residential care centers in Israel for persons with intellectual disability, 13 (22.8%) are providing service to the non-Jewish population. The Arab population constitutes 12–13% of the total residential care population, lower than the 19–20% in the total population. In residential care, the Arab population is characterized by younger children with severe and profound intellectual disability. The informal family support system is still a very important factor in the Arab family in Israel, a fact that we believe should be strengthened by implementing the British and Danish model of nurse home visitation.

Change in the attitudes of staff or the public towards people with intellectual disability (ID) can impact their life and health, but that change has not been studied among physicians who belong to an ethnic minority undergoing dramatic social and economic transition. The goal of this study was to explore the change of attitudes of Negev Bedouin physicians serving their community and their satisfaction with policy, care, and knowledge in the field of ID. Seventeen community physicians (7 Bedouins and 10 Jewish) were interviewed using a simple questionnaire that consisted of items measuring attitude and satisfaction. The vast majority of the Bedouin and Jewish physicians had positive attitudes toward inclusion of those in the community with ID and were ready to provide the care needed in the community with special assistance. There was a need for further education in ID and more resources. There was a belief that there is discrimination between the Bedouin and Jewish community in the provision of care to people with ID. General dissatisfaction was expressed about the policy, resources, care provision, and expertise offered to Bedouins with ID. More efforts must be directed to empower the physicians with knowledge, expertise, and resources to handle the care of Bedouins with ID in a culturally appropriate way.

This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. Consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.

The prevalence of chronic illness or disability in adolescence has increased in recent years. In the past, children with certain chronic diseases did not reach adolescence, but over the last decade the survival rate has increased manyfold. The old morbidity (infectious disease, poor housing, poverty, lack of immunisation) has been exchanged with a new morbidity of adolescence, where a longer life expectancy is followed by an increase in lifelong disability. This review discusses issues concerned with the definition of disability in adolescence, reviews prevalence studies in several countries, the causes of disability, disparities, access and expenditure of health care, psychosocial aspects, and how to promote better outcomes.

Leo Kanner described autism in 1943, and Hans Asperger described the syndrome in 1944. The term Pervasive Developmental Disorders (PDD) was first used in the 1980s to describe a class of disorders that include (1) Autistic disorder, (2) Rett disorder or syndrome, (3) Childhood Disintegrative Disorder, (4) Asperger's disorder or syndrome, and (5) Pervasive Developmental Disorder Not Otherwise Specified, or PDDNOS. Autism prevalence studies published before 1985 showed prevalence rates of 4 to 5 per 10,000 children for the broader autism spectrum, and about 2 per 10,000 for the classic autism definition. Since 1985 there have been higher rates of autism reported from several countries. From the UK a prevalence rate of 16.8 per 10,000 children for autistic disorder was reported, and 62.6 per 10,000 for the entire autistic spectrum disorders. Sweden reported a prevalence of 36 per 10,000 for Asperger and 35 per 10,000 for social impairment, or a total prevalence of 71 per 10,000 for suspected and possible cases. From the US, 40 per 10,000 in three to ten year old children for autistic disorder and 67 per 10,000 children for the entire autism spectrum was reported. From the north region in Israel for children born between 1989-93 in the Haifa area, an incidence rate of 10 per 10,000 was found for autism. In recent years concern has been shown about the possible increase in the prevalence of autistic spectrum disorders. Studies have shown an increase, but during these last twenty years diagnostic criteria and definition have also changed. Although many factors are at play, it is evident that there has been an increase.

The purpose of this study was twofold: (1) to compare whether children from polygamous family structures significantly differ from children from monogamous family structures with regard to the frequency of parent-child conflict, and (2) whether children from these two structures employ different patterns of family conflict resolution.To address these questions, a random sample of 212 high school students (60.8% monogamous) completed a self-administered survey. The results of MANOVA show no significant differences (p > 0.05) between these two structures with regard to the frequency of parent-child conflict. The results also show similar conflict management styles between these two family structures within each of the following five domains (privacy, school and career, money spending, going out and leisure, and physical appearance).This study is unique in that it is the first empirical research to be conducted in the field of conflict resolution among youth and adolescents in polygamous marital structures and therefore, further investigation is needed to replicate these results utilizing different cross-cultural populations practicing polygamy.

Teenage or adolescent pregnancy requires the extensive involvement of health care workers in respect to the medical and social aspects of pregnancy, delivery, and later care of both mother and child. Trends in adolescent pregnancy over the last few years from the United States, Canada, and the United Kingdom are presented and related to data from Israel. Adolescent pregnancy in Israel has been on the decline, but in 1999 it was still 3.4% of all live births (131,936 children) with more pregnancies in this group among the non-Jewish population (7.2%) than in the Jewish population (1.7%).