The prevalence of obesity and associated morbidity among 17-year-old Israeli conscripts.

BACKGROUND: There has been a significant increase in the prevalence of obesity among children and adolescents over the last few decades. Obesity is associated with significant psychosocial and physical morbidity. OBJECTIVE: The aim of this study was to define the prevalence of obesity and associated morbidity, including type 2 diabetes and hypertension, among 17-year-old adolescents. A comparison between the morbidity patterns of females and males was also performed. DESIGN: All 17-year-old Israeli nationals are obliged by law to present at the Israel Defence Forces recruiting office for a medical examination, with the exception of orthodox religious and Arabic adolescents. Height and weight are measured and classified, and a trained specialist evaluates those with suspected associated diseases. The level of education is also recorded. RESULTS: Our survey included 76,732 adolescents, 32,402(42.2%) females and 44,330(57.8%) males. The prevalence of obesity and morbid obesity among 17-year-old Israeli conscripts was 4.1% in males and 3.3% in females. The prevalence of borderline overweight was 12.4% in males and 11.4% in females. The prevalence of hypertension and type 2 diabetes was significantly higher among conscripts with BMI>30 kg/m2 in both genders. There was also a significantly higher prevalence of hypertension and type 2 diabetes in males compared with females(P<0.001, 0.015). A significantly higher prevalence of conscripts without high-school education(<10 years of education) was found among females with BMI>30 kg/m2. There was no significant difference among the male conscripts. CONCLUSIONS: This study found a relatively low prevalence of obesity among 17-year-old Israeli conscripts, but an alarmingly high prevalence of borderline overweight. Obesity was correlated with a higher prevalence of hypertension and type 2 diabetes, and a lower level of education. There was a significant difference between genders in the prevalence of hypertension and type 2 diabetes, and this should be further investigated. These data call for the creation of new education programmes on the prevention of overweight among children and adolescents.

Newspaper advertising by health maintenance organizations during the reform of healthcare services in Israel.

BACKGROUND: On 1 January 1995 a new mandatory National Health Insurance Law was enacted in Israel. The new law fostered competition among the four major Israeli healthcare providers (HMOs or sick funds) already operating in the market due to the possibility that an unlimited number of patients and the relative budget share would shift among the HMOs. This led them to launch advertising campaigns to attract new members. OBJECTIVES: To examine newspaper advertising activities during the early stages of healthcare market reform in Israel. METHODS: Advertising efforts were reviewed during a study period of 24 months (July 1994 to June 1996). Advertisements were analyzed in terms of marketing strategy, costs and quality of information. RESULTS: During the study period 412 newspaper advertisements were collected. The total advertising costs by all HMOs was approximately US$4 million in 1996 prices. Differences were found in marketing strategy, relative advertising costs, contents and priorities among the HMOs. CONCLUSIONS: The content of HMOs' newspaper advertising was consistent with their marketing strategy. The messages met the criteria of persuasive advertising in that they cultivated interest in the HMOs but did not provide meaningful information about them. Future developments in this area should include consensus guidelines for advertising activities of HMOs in Israel, instruction concerning the content of messages, and standardization of criteria to report on HMO performance.

Universal health care? The views of Negev Bedouin Arabs on health services.

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.

From socialist principles to motorcycle maintenance: the origin and development of the salaried physician model in the Israeli Public Health Services, 1918 to 1998.

For more than 70 years, physicians in the Israeli health care system have been employed on a fixed salary rather than on a fee-for-service basis. The present report is a brief review of the origin and development of this unique salaried physician model and its effect on the terms of physicians' employment. Archival documents were reviewed. The salaried physician model was introduced to ensure egalitarian health care for patients rather than equal payment for physicians. It was accepted by physicians because it guaranteed their employment and income. However, over the years, the salaried physician model has evolved into a complex wage scale, with multiple fringe benefits that bypass formal agreements in order to reward individual physicians. In addition, the salaried physician model has encouraged illegal private practice, which is viewed today as one of the major problems of the Israeli Public Health Services.

Health reform in Israel: some aspects of seventy years of struggle (1925-1995).

This work traces attempts to bring about the passage of a compulsory health insurance law in Israel-from initial efforts in 1925 to the actual passage of such legislation in 1995. It examines the course of events in historical perspective, documenting positions adopted by various bodies-governmental, political, quasi-political, professional, and other-at various stages, clarifying why early initiatives failed. Most of this work is founded on historical archival documents found in London and Israel.

Nurses in Israel: the struggle for regulating the profession.

To date (1998), Israel does not have a nurses' law. Israel has 6 million inhabitants, approximately 15,000 physicians, and 33,000 nurses--a ratio of 180 nurses per 100,0000 inhabitants. Since the 1970s, drafts for a nurses' law have been formulated to set a legal framework for the profession, as is customary in many other countries. This framework would define the particularities of nursing as a profession, who may practice it, levels of training, recognized areas of specialization, and expertise in the operation of specific medical equipment and various nursing duties. Between 1993 and 1996, drafts for legislation were deliberated a number of times by committees appointed by the Ministry of Health but were not passed. Many elements opposed the drafts: the physicians and both the nurses' union and the midwives' union--the latter being a separate and an independent professional body from the nurses' organization.

Charity or social right? The controversy over the hospitalization of members of the Jewish Labor Federation in Palestine, 1926-1928.

This paper analyzes the significance of the confrontation between the Jewish Labor Federation and the Hadassah Medical Organization in 1926-1928 over the requirement that unemployed workers produce a "Poverty Certificate" as a condition for an exemption from hospitalization charges. This confrontation lasted 2 years and ended with the revocation of the Poverty Certificate and with the resignation of the director-general of Hadassah. The showdown between Hadassah and the Labor Federation resulted in the endorsement of a doctrine that health services should be provided irrespective of income. Medical care of the poor was considered to be a social right, rather than charity. An additional consequence of this event was the decision of the Labor Federation to institute its own hospitals, rather than to rely solely on Hadassah for the provision of inpatient services.

[Dynamics of diphtheria morbidity and population immunity]. / Dinamika zabolevaemosti difteriei i immuniteta naseleniia.

Observations on the stratum immune to diphtheria among the population, carried out over a period of many years and involving more than 37,000 people, have shown its gradual decrease in all adult age groups. In recent years the number of adults susceptible to diphtheria exceeded the number of susceptible children by 10.6%, and in some age groups by 18.5-21.8%, which makes for the total increase of diphtheria morbidity in recent years owing to its rise among adults. Regular revaccination of the adult population against diphtheria, made simultaneously with that against tetanus, is recommended.

[Characteristics of the immune response of inoculated and intact animals to the administration of toxigenic and nontoxigenic strains of Clostridium tetani]. / Kharakteristika immunnogo otveta privitykh i intaktnykh éksperimental'nykh zhivotnykh na vvedenie toksigennogo i netoksigennogo shtammov Clostridium tetani.

In experiments on guinea pigs the immune reactions of the animals immunized and not immunized against tetanus in response to the injection of C. tetani spores were studied. In the immunized animals an increase in the production of tetanus antitoxin, the development of delayed hypersensitivity and the activation of the mechanisms of cell-mediated immunity were observed. The nonimmunized animals showed specific changes in the T-system of immunity without the appearance of the clinical symptoms of tetanus, which is, probably, one of the mechanisms of natural immunity.