Attention-deficit hyperactivity disorder (ADHD) affects about five percent of the general population in Israel and other developed countries, and underlies social problems from car accidents to crime, with possible links to substance abuse. Only a handful of private clinics provide treatment, and they charge high fees. Israel's four public health funds offer the option of diagnosis and evaluation, but according to Nomi Yakir, director of the ADHD diagnosis and treatment center for children and adults at Hadassah Optimal (Hadassah Medical Center's "quality of living" outpatient clinic), these services are limited, marked by long (usually six-month) waiting lists and minimal treatment upon diagnosis. "Beyond medication, these services offer no actual treatment or longer-term management," maintains Yakir. Hadassah Optimal, in the Malha Technological Park, thus established a reasonably priced program called Hidhud ("Echoing") - a social-change initiative for the treatment of ADHD. "Given the minimal capacity of public services, and the client-oriented approach of private clinics, there is currently no work being done in Israel to address the phenomenon on an institutional level," she says. "Hidhud represents a holistic approach to the social challenge represented by ADHD. Above all, the program aims to provide access for disadvantaged populations to vital diagnoses and treatments; to educate the general public about ADHD, its implications and possibilities for treatment; and to train professionals and educators to deal with the phenomenon in both the classroom and the workplace." The center, continues Yakir, focuses on parent-oriented therapy, giving parents tools directing their children to take responsibility for their difficulties. "Aside from working with parents, we work with six schools on personal programs developed for children in the school setting and organizational programs to screen, diagnose and treat children with behavioral difficulties." An English-speaking unit within the center will deal with immigrants and other English-speaking populations such as diplomats and Arabs who send their children to English-speaking schools. "Hidhud is geared to bridge social gaps and ensure that Israelis from all economic backgrounds are given access to treatments that can make a substantial difference in their lives." DESPERATE MEASURES Josh Westfield, a Canadian who volunteered on a Magen David Adom ambulance team for six months after taking a 60-hour resuscitation course, worked for two hours on his flight home this week to save the life of an elderly man who had a heart attack on the plane. Four hours before the scheduled arrival in Toronto, the steward asked if there was a doctor on board. When no one answered, Westfield told him he had trained with MDA and offered his help to the patient, who had chest pains, an irregular heartbeat and was sweating and weak. When the airline staff again called for a doctor, an Israeli physician - who hadn't performed lifesaving resuscitation for years - joined Westfield, who instructed the doctor about the latest techniques. The two used the half-automatic defibrillator on board to deliver electrical shocks to the man's heart after he lost consciousness. They also inserted a breathing tube into his trachea, administered drugs and did mouth-to-mouth resuscitation. They advised the pilot to make an emergency landing in Ottawa, two hours away. Westfield and the doctor fought for the man's life nonstop for two hours, but when the plane landed in Ottawa, he was declared dead. The Canadian medical teams were amazed when they heard they had tried to resuscitate him for two hours straight. "It was clear to us that the chances of reviving him were close to zero, but we were stubborn and did all we could to save him, as I had been taught in MDA. The passengers [who stood in their places for many minutes after the plane landed] came to us, looked at us and tried to encourage us with hugs and words," Westfield said about the sad ending. "The training I got at MDA made it possible for me to try to help this man. I recommend that everyone go and takes a MDA first-aid and resuscitation course." INSURANCE MONOPOLY BROKEN Clal Insurance has become the first competitor in years to the Madanes company in the provision of comprehensive malpractice insurance. The first hospital to sign a year-long policy is Jerusalem's Bikur Holim, which had been pressured by Madanes to take out policies at increasingly high rates that the facility (recently purchased by billionaire Arkadi Gaydamak) refused to pay. The new Clal policy offers the same general conditions and benefits as the Madanes policy, but is significantly cheaper. Now that the virtual monopoly has been broken, other non-state hospitals are expected to follow suit. Bikur Holim sources called the new policy a "breakthrough." HOT AND COLD BLOOD If you get your blood pressure tested only in the winter, you may be misled. According to research presented at the American Heart Association's Scientific Sessions in Orlando, Florida by Dr. Ross Fletcher, chief of staff at the Veteran's Administration Medical Center in Washington, blood pressure rises in winter and falls in summer. He and colleagues performed a meta-analysis of 443,000 hypertension records in 15 Veterans Administration hospitals in hotter and colder cities around the US, with readings taken on three different days. Even though the tests were conducted indoors, Fletcher found a significant difference depending on the temperatures in the various cities. The average difference in the rate of patients returning to normal was 7.76 percent between the two seasons.