Isr Med Assoc J
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Multicenter Study
Burns in Israel: demographic, etiologic and clinical trends, 1997-2003.
Burns are a major public health problem, with long hospitalization stay in both intensive care units and general wards. In Israel about 5% of all hospitalized injuries are burn injuries. There are no long-term epidemiological studies on burn injuries in adults in Israel. ⋯ The groups at highest risk were children 0-1 years old, males and non-Jews (the incidence rate among non-Jews was 1.5 times higher than their share in the general population). Those with the highest mortality rate were victims of burns > 90% TBSA and patients older than 70. Most burns occurred at home.
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The use of computed tomography in Israel has been growing rapidly during recent decades. The major drawback of this important technology is the exposure to ionizing radiation, especially among children who have increased organ radiosensitivity and a long lifetime to potentially develop radiation-related cancer. ⋯ Pediatric CT scans in Israel may result in a small but not negligible increased lifetime risk for cancer mortality. Because of the uncertainty regarding radiation effects at low doses, our estimates of CT-related cancer mortality should be considered with caution. Nevertheless, physicians, CT technologists, and health authorities should work together to minimize the radiation dose for children to as low as reasonably achievable and encourage responsible use of this essential diagnostic tool.
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Multicenter Study
Ethnic differences in the epidemiological characteristics of severe trauma due to falls from heights among children in northern Israel.
In the western world, trauma is the leading cause of disability and mortality in the 1-39 years age group. Road accidents constitute the most frequent cause of mortality among children older than 1 year and falls from heights are the most frequent cause of injuries requiring hospitalization. ⋯ A very high incidence of severe trauma due to domestic falls from a height was found among non-Jewish children in northern Israel. Domestic falls represent an important epidemiological problem in the non-Jewish pediatric sector, and an effective prevention plan should include measures to modify parents' attitudes towards safety issues and the creation of a safe domestic environment.
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The new Israeli Dying Patient Act is based on principles and processes that have achieved a wide consensus despite the fact that it is a very complex and emotionally loaded issue. It provides clear balancing approaches between opposing values as well as explicit mechanisms for issues that were previously not provided for in Israel or were unclear. These include mechanisms for providing autonomous patient decision making when incompetent in "real time", with legally binding advance medical directives. These include methods of verifying the real and informed wishes of the patient or the appointment of a surrogate decision maker, a national registry of advance medical directives to optimize the validity of these wishes, legally binding palliative care as a citizen's right, clear guidelines for physicians to know what is permitted and what is not in treating terminally ill patients, the appointment of a senior physician with clear directives of his or her responsibilities toward the dying patient, and dispute resolution including the innovative establishment of a National Ethics Committee composed of experts in all relevant fields.