Some communities have peripheral zones inhabited by persons with a different culture than the majority of the general population, such as the Aboriginals in Australia, the Native Americans in the U.S. and Canada, the Eskimos in Lapland, and the Bedouins in Israel. These citizens are not receiving the same medical or rehabilitation services as the citizens of the metropolitan areas due to the fact that health and welfare programs are not adapted to their unique needs. At the Soroka University Medical Center in Beer-Sheva, Israel, the health and rehabilitation services have a very large and heterogeneous catch-up population serving most of the south of Israel. The purpose of this study was to look at the utilization and the number of appointments for child rehabilitation services by the Bedouin population compared to the general population in the south of Israel at the Zusman Child Development Center (CDC).The records of appointments to the CDC between the years 19951999 inclusive were studied and we randomly chose to limit the study to January, April, July, and October of each year, and randomly chose the daily records of nine therapists, three from each discipline (occuptional therapy [OT], physical therapy [PT], and speech and language therapy [SLT]). There were 8,504 appointments during these 4 months of the years 19951999, 2,255 of which were for Bedouin and 6,249 for Jewish children. Noncompliance with therapy appointments (NCTA) for the same period for both the Bedouins (31%) and Jewish children (26%), with a significant difference between the two populations, was noted. Of all the Jewish childrens appointments, the percentage of all three services was similar: 33% to PT, 38% to OT, and 29% to SLT, but for the Bedouin children, the percentage between the three services was significantly different: 62% to PT, 34% to OT, and 3% to SLT. These results seem to indicate that the Bedouin families prefer the PT and OT over the SLT. Our results enhanced the need for planning a model for supplying health services adapted to clients coming from different cultures. According to this model, we need to take into consideration the cultural differences, the accessibility to rehabilitation services, and the economical impact on the family; all in all, to give a better solution to the patient with special needs.

Hasia Lubetzky

Shifra Shvarts

Joav Merrick

Gideon Vardi

Aharon Galil

The Use of Developmental Rehabilitation Services. Comparison between Bedouins and Jews in the South of Israel

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.

Isack Kandel

Mohammed Morad

Health Needs of Adults with Intellectual Disability Relevant for the Family Physician

Persons with intellectual disability (ID) and associated multiple disabilities have been found by many researchers to be a population with deficient physical fitness measures, which can be explained by an inactive lifestyle, a result of lack of awareness of the positive physical effects of physical exercise, or lack of motivation for any motor activity. Various plans for physical exercise have been put forward, but many are found impractical in nonresearch-based intervention. In this study, 15 children with ID on a motor functioning level of 7—14 months used a treadmill daily for 2 months. Our findings indicated a most significant improvement in the level of physical fitness of the participants (p &lt; 0.005), as measured by pulse at rest and during effort. The improvement in physical fitness modestly (r = 0.5), but significantly (p &lt; 0.05), correlated with a significant (p &lt; 0.0007) improvement in functional ability of the participating children. Further examination a year after intervention terminated showed a return to preintervention pulse-at-rest values. The research examined the treadmill training method and found that it can be operated with the support of an unskilled staff person under the supervision of a physiotherapist. The research was performed under real-life conditions, enabling relatively easy implementation in the existing conditions of special education centers. This method is a type of exercise that is easy to operate without entailing long-term budgetary expenses and might improve the health status of children with ID, who are a population at risk for developing heart-related diseases at a young age.

Meir Lotan

Eli Isakov

Shlomo Kessel

Physical Fitness and Functional Ability of Children with Intellectual Disability: Effects of a Short-Term Daily Treadmill Intervention

Abortion is an issue as long as history and hotly debated in all societies and communities. In some societies and countries it is legal, while other countries have no legal basis, and some countries have made it a crime. Today up to 90% of abortions take place in the first trimester, about 9% in the second trimester, and the rest in the third trimester.This paper deals with the issue of late termination of pregnancy, the practical medical aspects, legal issues, international aspects, and the dilemma for the professional.In early history, abortion was accepted by clergy and societies, but in recent history it is more restricted and in some countries prohibited. It does not seem that restriction leads to a lower abortion rate, but rather an active contraceptive policy, campaign, and availability to prevent pregnancies that are unwanted. In countries where abortion is restricted, the trend has been an increase in illegal abortion that leads to unsafe abortion with complications, permanent injuries, and maternal mortality.Unsafe and illegal abortion is a public health concern that governments should try to prevent and instead find ways to strengthen their commitments toward better and safer health and family planning services for women.Late termination of pregnancies is an issue of grave concern with many practical medical aspects, ethical questions, and professional dilemmas. This is especially of concern because of the viability of the fetus and should only take place in order to prevent harm to the physical and mental health of the mother or due to an anomaly or disability of the fetus.

Late Termination of Pregnancy. Professional Dilemmas

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.

Tagrid Morad

Attitudes of Bedouin and Jewish Physicians Towards the Medical Care for Persons with Intellectual Disability in the Bedouin Negev Community. A Pilot Study

Intrauterine neural tube defects, meningomyelocele, and diastematomyelia are developmental errors at different stages of the closure of the neural tube. The familial aggregation of these neural tube defects is not previously reported in the literature and should make one think about a common embryogenesis and a possible common mechanism of etiopathogenesis leading to anomalies at different stages of this embryogenesis. This paper presents a 12-year-old Turkish boy with diastematomyelia who was suspected with a demonstrative dermatologic finding without any neurologic sign and diagnosed with magnetic resonance imaging (MRI). He has a positive family history of a stillbirth with neural tube defect, an exitus with meningomyelocele, and an epileptic child in his female siblings.

Nuray &#214;ks&#252;z Kanbur

P&#x131;nar G&#252;ner

Orhan Derman

Nejat Akalan

Ay&#x15F;enur Cila

Tezer Kutluk

Diastematomyelia: A Case with Familial Aggregation of Neural Tube Defects

Patients with photosensitive epilepsy are susceptible to seizures due to photoparoxysmal response (PPR). This response adversely precipitates factors that modify the functional status of the visual system. Such factors may or may not be evident superficially, but may lead to ocular defects due to trauma, hormonal imbalance, abnormal intraocular pressure (IOP), or any other reflex-inducing stimuli. The extent to which photosensitive epileptic patients suffer from PPR-related ocular defects has not been documented fully. In this investigation, ocular defects in patients with photosensitive epilepsy are studied using visual-evoked response (VER). A total of 212 photosensitive epileptic patients were studied to ascertain the magnitude and distribution of ocular defects using the changes in EEG and visual-evoked potential (VEP); 51% of the patients were female, the age range was 146 years. The major ocular defects and complications found were visual field defects, optic nerve abnormalities, nystagmus, cataracts, amblyopia, and migraine. These findings were analyzed according to age and sex. The relationship between the ocular abnormalities and the interpretations of the changes in the characteristics of the VEP indicated that optic-related atrophies, visual defects, optic neuritis, chiasmal compression, nystagmus, migraine headache, cataracts, and amblyopia were prevalent in photosensitive epileptic patients at varying degrees. The results showed that although ocular defects in photosensitive epilepsy may not be obvious differentially, VEP can be used in their diagnosis, contrary to earlier studies reporting that VEP is not of much value in epilepsy diagnosis.

Ebere C. Anyanwu

John Ehiri

Ocular Defects in Photosensitive Epilepsy

Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases.This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000–01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (&#x2264; 0.5 and 0.06–1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.

Frank Mo

Bernard C.K. Choi

Felix C.K. Li

Using Health Utility Index (HUI) for Measuring the Impact on Health-Related Quality of Life (HRQL) Among Individuals with Chronic Diseases

The systemic mucopolysaccharidoses are complex syndromes, which may include corneal clouding as a mechanism leading to decreased vision and hence decreased quality of life. This study presents three young adult patients with mucopolysaccharidoses in order to compare their visual status through retrospective chart review, including patient and guardian interview, history, and examination, including a modified form of the VF-14 questionnaire (visual function with 14 questions).When the visual acuity and VF-14 results of the three patients were compared, the results of the VF-14 correlated with the patients� visual acuity status. The two patients who retained clear corneas or underwent penetrating keratoplasty had a wider range of social and physical activities, and an overall better quality of life than did the patient with decreased vision due to opacified corneas.We conclude that close monitoring of the ocular health of patients with storage syndromes that may compromise visual acuity must be stressed, and intervention to insure good vision is of the utmost importance to maintaining a good quality of life for these patients, especially as new therapies assist these patients to achieve increased longevity with better health.

Katherine L. Bergwerk

Yaron S. Rabinowitz

Rena L. Falk

Quality of Life Related to Visual Function in Three Young Adults with Mucopolysaccharidoses

In Israel today, with a total population of over 6 million persons, the Division for Mental Retardation (DMR) provides services to 23,000 persons with intellectual disability (ID). Of the 23,000, residential services are provided to more than 6,000 in close to 60 residential centers, another 2,000 are provided residential care in hostels or group homes in the community in about 50 locations, while the rest are served with day-care kindergarten, day-treatment centers, sheltered workshops, or integrated care in the community. The first Snoezelen room (controlled multisensory stimulation) in the DMR was established at the Bnei Zion residential care center in 1995. The Snoezelen method is now used in Israel in more than 30 residential care centers and 3 community settings. Since the year 2000, a physiotherapist has been employed in order to supervise the treatment and development of the method nationally. Professional staff meetings take place every 4 months. A certification course has been established on a national basis for individuals from different professions (occupational therapists, physiotherapists, teachers, music therapists, nurses, speech therapists, or caregivers). Snoezelen has proved to be an important instrument and a powerful therapeutic tool among the various treatment modules employed in Israel for persons with ID. This paper presents the concept illustrated with two case stories.

Carmit Cahana

Eli Carmeli

Snoezelen or Controlled Multisensory Stimulation. Treatment Aspects from Israel

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