Harefuah
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Off-label use of drugs is common in all areas of medicine, but is specifically prevalent in pediatrics, oncology and in treating rare diseases. Such use may benefit patients, but on the other hand, there is concern about the safety aspects of these treatments. Besides the legal, ethical and safety issues associated with off-label use, arises the issue of whether such prescribing should be reimbursed by public funds. ⋯ Occasionally, health plans agreed to subsidize critically needed off-label treatments, although they did not receive public funding for off-label indications. In this article we review the problems associated with off-label prescribing, the reasons why the MoH changed its policy at the beginning of 2009 to permit, in very special circumstances, reimbursement of off-label treatment. We also provide a brief summary of off-label policies in a few western countries.
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The sexual and reproductive behaviors of Ethiopians immigrating to Israel have changed drastically as they transition to a new culture. With the postponement of age of marriage and an increase in sexual activity prior to marriage, there is an increased risk of unplanned pregnancy among young people in this group. The increasing rates of unplanned pregnancy among immigrants in developed countries have become a formidable public health challenge. ⋯ Israeli women of Ethiopian origin have a considerably higher risk of requesting an abortion than other Israeli women of the same age. Although women of Ethiopian origin born in Israel had a lower rate of requests for abortions compared to those born in Ethiopia, this rate is still higher in comparison to other Israelis. Females born in Ethiopia have even higher rates. It is evident that these youth need exposure to appropriate preventive interventions and that this group cannot be considered homogenous. We recommend that appropriate interventions should be based on the specific needs of sub-groups within them and on appropriate analytical and development research.
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Anatomical restraining of tongue movement (tongue-tie, ankyloglossia) has been known for centuries and the subject of dozens of articles. The heated debate persists on its clinical significance and indications for treatment. Most authorities in the field of infant feeding and Lactation agree that breastfeeding problems, such as nipple pain and latching difficulties, are common signs of clinicaLly significant tongue-tie and indications for performing a frenotomy, while the sole presence of a visible lingual frenulum is not. ⋯ When it is indicated, frenotomy is performed by lifting the tongue and snipping the frenulum with scissors. Complications of frenotomy are rare and consist mainly of self-limited minor bleeding. The significance of posterior tongue tie and the long-term effects of frenotomy performed during early infancy are unresolved issues.
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Scaphoid fracture is the most common fracture in carpal bone of the wrist and represents 11% of all upper extremity fractures. In most cases, the mechanism of injury is a fall with an outstretched hand. Scaphoid fracture detection can be made by clinical examination and standard radiography. ⋯ Displaced fractures of scaphoid, should be treated operatively, as they carry a greater risk for nonunion and malunion, which are associated with the development of radiocarpal arthritis, stiffness and wrist instability. Computed tomography is more useful as an assessment tool in pre-operative planning to determine the fracture location and fragment displacement. Early detection and appropriate treatment of scaphoid fractures is the key to favorable outcome in the treatment of scaphoid fractures.
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On December 27th, 2008, the Israeli Defense Forces initiated operation "Cast Lead", aiming to strike the infrastructure of the terror organizations in the Gaza Strip. An emergency situation was declared on the home front, allowing the security forces special jurisdiction over the area. The Home Front Command's Medical Operation Center, in cooperation with the Superior National Health Authority of the Ministry of Health, coordinated the delivery of community health services. ⋯ The delivery of community health care services during operation "Cast Lead" efficiently addressed the needs of the population in the area. The delivery of medical emergency services and the access to medical specialists should be reassessed. It is important to plan ahead surveys such as the survey described above, and to cooperate with the HMO's and the Israel Defense Forces (IDF) in order to improve emergency preparedness.