Sometimes, it is difficult for parents to accept or understand that the pediatrician or family physician is not prepared to prescribe antibiotics for their sick child or adolescent. The reluctance may be due to the fact that doctors cannot treat everything with antibiotics; furthermore using them without a good reason creteas resistance. Public health experts have warned us over the past decade that inappropriate antibiotic use contributes to development of antibiotic resistance on both the individual and country levels (1). The Centers for Disease Control and Prevention (CDC) examined trends in pediatric antibiotic prescribing in physician offices for the period 1993–1994 to 2007–2008 (1). They found that antibiotic prescribing rates for persons aged up to 14 years who had visited physician offices decreased by 24% from 300 antibiotic courses per 1000 office visits in 1993–1994 to 229 antibiotic courses per 1000 office visits in 2007–2008. Among the five acute respiratory infections (ARIs) examined, antibiotic prescribing rates decreased by 26% for pharyngitis and by 19% for nonspecific upper respiratory infection (common cold); prescribing rates for otitis media, bronchitis, and sinusitis did not change significantly. Although the overall antibiotic prescribing rate decreased, it is still high, but nevertheless physician prescribing behaviors have changed over the study period (1). Antibiotics influence the overall bacterial flora and result in the selection of resistant types of bacteria. This increases the proportion of resistant bacteria and the risk of developing and disseminating resistant pathogenic bacteria. Some pathogenic bacteria have become so resistant to antibiotics that the available antibiotics are barely adequate to treat those who acquire the resulting infections. In addition, few new antibiotics are expected to become available in the near future (2). Many countries have initiated guidelines for physician prescription of antibiotics for systemic use. For example, Denmark initiated several guidelines (2) as listed below. – Antibiotic treatment must be expected to prevent severe or life-threatening events or to considerably reduce the period of illness. – Clinical and diagnostic testing must be carried out such that they can at least determine that bacteria are the likely cause of illness. – The selected antibiotic must be as narrow a spectrum as possible and influence the normal bacterial flora as little as possible, in accordance with the general and local guidelines for the use of antibiotics. – If the initial treatment is not successful, the choice of antibiotic must be reassessed and perhaps changed based on microbiological testing. – The treatment must be as brief as possible and be in accordance with the evidence available in the field. – The diagnosis that results in the prescription must be specifically outlined in the prescription system, including those stated in the prescription and in the medical records.

Obesity is an important risk factor for many chronic diseases, such as cardiovascular disease, diabetes, and cancer. Children who are overweight are at an even greater risk of developing such diseases because of their extended exposure to the harmful effects of excessive weight, and there is often an accelerated onset of chronic disease within this population. In addition, children who are overweight are more likely to suffer from impaired physical, psychological, and social development.

INTRODUCTION:Adults 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 to 2008 and further data on trends in employment of psychiatrists from 1998 to 2009 and psychotropic medication use from 1998 to 2008. Data was collected from annual questionnaires sent out to all residential care centers 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 centers 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 intellectual disabilities and challenging behaviors is important. This is best conducted using a multidisciplinary approach, which may include psychiatric assessment. Non-pharmacological interventions should always be considered either alongside, or instead of medication.

The Office of the Medical Director of the Ministry of Social Affairs in Israel 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. The present paper presents the findings of the 2009 national survey, for which the following information was gathered via questionnaires: age, gender, and level of ID 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 2009, 7067 persons were served in nine government, 41 private, and 13 public centers. The average number of persons served per center was 112.17 (range 21–324). The survey in 2009 showed that 78% of the population with ID in residential care in Israel was between the ages of 20 and 60 years old, 45% with severe or profound ID, 41% with moderate, and 13% with mild ID. In total, 25% were nursing patients, 19% were confined to a wheelchair, 33% had epilepsy, 87% were found to be receiving medication daily for chronic illness, and 54% received psychotropic medication for psychiatric illness.

In 1998, a questionnaire was developed by the Health Services, Office of the Medical Director at the Ministry of Social Affairs and Social Services. This questionnaire was 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 during 1999-2008. We demonstrated 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 12.8% in 2008.

IntroductionIn England, the life expectancy for people with Down syndrome (DS) was 9 years in 1929, 12 years in 1949, and in the 1960s was still low at 18 years. In the 1970s, it increased to 30 years, over the 1980s to 35 years, in the 1990s to 56 years, and in the new millennium to 60 years, for example in Australia (1,2). Such a trend has been observed in the developed world, where today a child born with DS will have a 96% chance to survive to one year of age (reduced to 80% if congenital heart disease is present), although in the developing world these figures are much lower (1).A change has also been observed in both professional and parental attitudes toward people with DS, with a tendency toward inclusion and integration into the regular kindergarten and school system, and fewer placements and abandonment.In Israel, the Division for Mental Retardation (DMR) of the Ministry of Social Affairs and Social Services has the responsibility for the assessment, treatment, rehabilitation, and services for people with intellectual disability (ID). By the end of 2010, the total population in Israel was 7.5 million (3) and the DMR was in contact with close to 35,000 people with ID of all ages. Residential care is provided to about 7,000 persons in 60 residential centers all over the country; in about another 50 locations, residential care is provided to an additional 2,000 persons in hostels or in group homes in the community, whereas the remainder are served with day-care kindergarten, day-treatment centers, sheltered workshops, or integrated care in the community while living at home with their families (4). Today, most children with DS in Israel live at home, and unless they have severe medical problems that cannot be handled at home, very few will be in residential care. Some people with DS are still residing in residential care, and we found it of interest to study the trend in the population of people with DS living in residential care in Israel.MethodsIn 1997-1998, a questionnaire was developed for an annual survey of medical clinic activity for all residential care centers for people with ID in Israel (5). The questionnaire or survey instrument has the following sections: information on the age, gender, and level of ID of persons served at the residential care center in question; status of the population served (educational, treatment, rehabilitation, nursing, and challenging behavior); profile (various aspects of the nursing load, such as number of people with gastric tubes, catheters, gastrostomy, dialysis, oncology, epilepsy, diabetes, hypertension, blindness, etc); nursing, medical, and allied professional staff; number of annual examinations; preventive medicine aspects; medications; number of annual cases of infectious disease; annual unintentional injury; number of deaths; number of hospitalizations; internal residential center hospitalization; ambulatory out-patient utilization; utilization of outside laboratory examinations; and dental care. We studied the questionnaires for 1998-2007 with regard to the number of people with DS.ResultsThe data extracted from the 1998-2007 questionnaires are shown in table 1. We have only the number of people with DS without any other detail. As can be seen from the table, the population has been relative stable over the years, with around 500 to 600 persons or about 9% of the total population in residential care. Unfortunately, we do not have data on the age of the person with Down syndrome from these annual surveys.DiscussionFrom a review of the institutional history of disability and residential care (6), the tradition of asylum for people with intellectual disability (ID) seems to have been introduced by the Arabs in Baghdad, Fez, and Cairo in the eighth century and in Damascus and Aleppo in 1270. This concept was exported to Europe with the establishment of the Bethlem Hospital (Bedlam) in London in 1247 (6)From being ? …

IntroductionLife expectancy for people with intellectual disability has changed over time. In the 1930s, the mean age at death for people with intellectual disability (ID) was about 19 years, in the 1970s about 59 years, and in the 1990s 66 years, whereas for people with Down syndrome, the mean age at death was 9 years in the 1920s has increased to about 60 years (1). Such an increase in lifespan can be seen as the consequence of progress in medical technology and improved social awareness in the twentieth century. In the past, most individuals with intellectual disability died at a young age due to their additional medical problems, congenital malformations and infections with the result that very few went through the aging process. Therefore, today we see the first generation of older people with ID, which is a challenge for service providers, but also for the family, who may experience parents or siblings passing away or becoming ill and may subsequently become unable to provide care for their family member with ID.Since 1908 (2) mental retardation or intellectual disability has been defined and re-defined by the American Association of Intellectual and Developmental Disability (formerly AAMR and now AAIDD founded in 1876) with about ten years apart in recent years with a new definition. The last revision (the tenth) took place in 2002 (2), where mental retardation/intellectual disability is defined as a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social and practical adaptive skills and originating before age 18 years. There are five assumptions essential to the application of this definition:· Limitations in present functioning must be considered within the context of community environments typical of the individual's age peers and culture.· Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor and behavioral factors.· Within an individual, limitations often coexist with strengths.· An important purpose of describing limitations is to develop a profile of needed supports.· With appropriate personalized supports over a sustained period, the life functioning of the person with mental retardation/intellectual disability generally will improve.This definition and standards are used worldwide. In Israel the Division for Mental Retardation (DMR) of the Ministry of Social Affairs and Social Services has the responsibility for the assessment, treatment, rehabilitation and service for persons with ID. Today, the total population in Israel is about 7.5 million people (3) and the DMR is in contact with close to 35,000 people with ID of all ages. Residential care is provided to about 10,000 people in residential centers, hostels or in group homes in the community, whereas the remainder, live at home with their families (4).The aim of this paper was to look at the trends of aging in the population of people with intellectual disability living in residential care centers in Israel over the 1999-2007 period.MethodsIn 1997/1998, a questionnaire was developed to annually evaluate medical clinic activity of all residential care centers for people with ID in Israel (5). The questionnaire or survey instrument has the following sections: information on the age, gender and level of intellectual disability of persons served at the residential care center in question, status of the population served (educational, treatment, rehabilitation, nursing and challenging behavior), profile (various aspects of the nursing load like number of persons with gastric tubes, catheters, gastrostomy, dialysis, oncology, epilepsy, diabetes, hypertension, blindness etc), nursing, medical and allied professional staff, number of annual examinations, preventive medicine aspects, medications, number of annual cases of infectious disease, unintentional injuries, number of deaths, number of hospitalizations, internal residential center hospitalization, ambulatory out-patient utilization, utilization of outside laboratory examinations and dental care. …

IntroductionSterilization and in particular involuntary sterilization of people with intellectual disability (ID) has been a moral, ethical, legal and public issue for at least 100 years, if not more (1-3) and has been very closely related to the development of the civil rights movement for this population (4). Closely related to the eugenics movement and social Darwinism in 1907 several states in the United States began passing laws to allow involuntary sterilization of persons with ID and in 1927 the US Supreme Court santified a lower court decision in the now famous case of the sterilization of the 17 year old institutionalized Carrie Buck (1,2). This case (called Buck versus Bell) resulted in a routine practice of sterilization for the institutionalized population and by the 1960s more than 60,000 persons (male and females) had been sterilized in the United States (1,2), but even more in Nazi Germany and many other countries around the world (1,2). In fact, Carrie Buck's mother had mild ID, Carrie had normal intelligence and her child also normal intelligence, but Carrie had been institutionalized to hide the shame of her pregnancy that had resulted from rape (2).Due to this controversial history of involuntary sterilization laws have been passed in most countries to protect people with ID from forced sterilization, but contraception is a major concern for parents, caregivers and service providers. In recent years society has become more accepting of sexual relations by and among people with intellectual disability. This population is now increasingly being allowed and also able to enjoy more normal and satisfying sexual experiences. There has therefore grown a need for counseling on sexual activity, sexual abuse issues and borders, temporary contraception and sterilization. These issues require a balancing act between the needs of this population, the attitude of the parents/guardians and the people caring for this population. The rights, wishes, health and safety of the person with intellectual disability should remain paramount.Sex education and counseling on the options of contraceptive methods should be discussed with the individual and, if appropriate, with their support networks. Today there are several contraceptive options for this population (5). Non-permanent methods include the use of oral contraceptives, contraceptive patchs, depot-medroxyprogesterone acetate (DMPA or depo-provera) injections and progestin intrauterine devices (5). If these options are not working, surgical intervention can be considered, such as endometrial ablation, tubal ligation or hysterectomy (5).The present study was conducted in order to look at the trends of contraception methods for females with intellectual disability in residential care centers in Israel.MethodsIn 1997-1998, a questionnaire was developed by the Office of the Medical Director, Ministry of Social Affairs and Social Services for annual surveys of medical clinic activity for all residential care centers for people with ID in Israel (6). The questionnaire or survey instrument has the following sections: information on the age, gender and level of intellectual disability of persons served at the residential care center in question, status of the population served (educational, treatment, rehabilitation, nursing and challenging behavior), profile (various aspects of the nursing load like number of persons with gastric tubes, catheters, gastrostomy, dialysis, oncology, epilepsy, diabetes, hypertension, blindness etc), nursing, medical and allied professional staff, number of annual examinations, preventive medicine aspects, medications, number of annual cases of infectious disease, annual unintentional injury, number of deaths, number of hospitalizations, internal residential center hospitalization, ambulatory out-patient utilization, utilization of outside laboratory examinations and dental care. For the purpose of this study, the data concerned with contraception for females from the 1999-2007 period was analyzed. …

Over the past decade we have observed an increase in life-span for people with intellectual disability (ID), which can be seen as the consequence of progress in medical technology and improved social awareness in the 20th century. In the past, most individuals with ID died at a young age due to their additional medical problems, congenital malformations and infections with the result that very few survived into adulthood or went through the aging process. This trend has resulted in not only pediatricians but now also adult physicians involved in the management of this population, and currently we, in fact, really see the first generation of aging individuals with ID, which is a challenge for service providers. 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. 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. Medical needs from pediatric to adult care can be met by enrollment in universal healthcare or programs. Periodic health assessments and healthcare should be normalized and provided as an overall system of support, when needed or as assistance provided for the adequate self-directed use of general or specialty health services. Risk assessments and health reviews should be part of the individual's life plan and provided to detect diseases and conditions that could compromise longevity. This field of medicine also needs to evaluate the applicability of a new discipline of lifespan developmental medicine to lead in interdisciplinary care, healthcare education, service delivery and research for people with ID within an academic framework.

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 conducted in 1998. This present paper presents the findings of the 11th national survey in 2008, for which the following information was gathered via questionnaires: age, gender, and level of ID 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 2008, 6988 persons were served in nine government, 41 private, and 13 public centers. The average number of persons served per center was 110.92 (range 16–332). The survey in 2008 showed that 78% of the population with ID in residential care in Israel was between the ages of 20 and 60 years old, 45% with severe or profound ID, 41% with moderate and 14% with mild ID. Twenty-four percent were nursing patients, 19% were confined to a wheelchair, 33% had epilepsy, 87% were found to be receiving medication daily for chronic illness, and 55% received psychotropic medication for psychiatric illness.

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.

The aim of this brief report is to stimulate a debate and to advocate life-long treatment with phenylalanine restricted diet to persons with phenylketonuria. We present a case of an adolescent male who today is a 65 year old with moderate mental retardation. He was previously observed as having severe challenging and self-injurious behaviour, sleeping disorder, hyperactivity, and masturbation. In the last year before reassessment he displayed loss of weight, muscle weakness resulting in wheelchair placement, upper respiratory infections, and fungal skin infections. After reassessment in 1998 the patient was started on treatment with a phenylalanine-restricted diet supplemented with vitamin B12, iron, and folic acid. At follow-up one year later the patient had regained his weight and was walking around freely. The challenging and self-injurious behaviour, and the masturbation, had ceased, and he was participating in social activities which he had previously not been able to participate in. At follow-up four years later he was still at this level of accomplishment. In general, this patient's quality of life had increased. We therefore recommend life-long treatment with phenylalanine restricted diet for persons with previously treated, and also for those with untreated, phenylketonuria.