Health Scan: Working Out

Breaking news (photo credit: JPOST STAFF)
Breaking news
(photo credit: JPOST STAFF)
In many countries, including Israel, people whowant to join a health club must get written permission from a doctor oreven undergo an exercise-tolerance test. Now an Israeli team has shownthat such screening does not reduce the risk of sudden death inlow-risk persons, and could discourage them from exercising. The studyby Dr. Dror Lahav (of Tel Aviv Sourasky Medical Center), Dr. MosheLeshno (of Tel Aviv University) and Prof. Mayer Brezis (of the HadassahUniversity Medical Center) was published in the August issue of theJournal of General Internal Medicine.
Brezis,a nephrologist and public health expert who is responsible forpreventing medical errors at Hadassah, has tried for years to get theHealth Ministry to cancel the screening requirement, and it was one of10 recommendations of a Health Ministry-appointed committee - of whichBrezis was a member - on how to promote exercise by Israelis. ButBrezis charged that all the recommendations were ignored. A seniorministry official told The Jerusalem Post that "everybody in theministry agrees about eliminating the requirement, but such a decisionmust be taken by another ministry."
The study used a technique called a "Monte Carlo simulation" (aformula in which samples are taken randomly over and over) to determinewhat would result if people at low to high risk of heart diseaseunderwent an exercise-tolerance test. The researchers said suchscreening would prevent some sudden deaths only in people at moderateto high risk from unaccustomed exercise. A low-risk person could getfalse-positive results and be discouraged from exercise, they argued,noting that sudden death from working out is very rare, "far lesscommon than the mortality resulting from a sedentary lifestyle."
Brezis called the existing law "ridiculous, since it doesn'trequire a physician to see me before I run in the street, where I canget hurt even more easily."
In any case, nobody needs a license or a doctor'snote to get out on the sidewalk and jog, argues Brezis, who stressesthat "couch potatoes" should always start exercising gradually, andstop immediately if they suffer from symptoms such as dizziness orchest pain. Anyone who knows he has heart disease should of courseconsult his doctor before exercising anywhere. They also urge thatsports facilities install semi-automatic defibrillators to resuscitateanyone whose heart suddenly stops.
EQUITY THROUGH TELEMEDICINE

Although the nationalbasket of health services is officially the same for all residents,many Israelis in the periphery and in the lower socioeconomic groupshave less opportunity to access the best treatment and health-promotionactivities. Thus, Maccabi Health Services - the second largest healthfund - has launched a unique program to promote equity in healthservices.
Maccabi director-general Dr. Ehud Kokia hasannounced that videoconference facilities are being set up among healthfund branches to allow doctors working in the periphery to consult withleading specialists in the center of the country. In addition, Maccabiis training its staffers in "cultural competency" to understand thecultural norms and practices among various ethnic groups, hiringtranslators to communicate with those who do not speak the country'sofficial languages. In addition, mobile facilities will bring advancedtechnology to the periphery so that members will not often be requiredto travel to the center of the country to get it.
Kokia said the health fund has identified a number of ethnicgroups that receive fewer services than those to which they areentitled; the problem for many was that they did not speak Hebrew butonly Russian. A team of Russian-speaking Maccabi nurses was sent to thenew-immigrant health fund members in their hostel and explained theirrights and where to get the health services they needed.
Maccabi also noted that certain low socioeconomic groups didnot go for early detection of colon cancer; information efforts werecarried out among them to encourage them to get tested. The health fundproduced its first-ever "social map" of members that showed where thedisadvantaged and those receiving fewer health services live. They wererated on a scale of 1 to 20. Although Maccabi is known for insuring thewealthier and better-educated populations -- with 26 percent includedin the highest levels (16 to 20), it has a substantial number in thelowest rungs. There are some 40,000 relatively young Arab Maccabimembers, for example, who are in the lowest levels of the scale. Whilerates of mammography are increasing in the whole population, there arestill social and ethnic groups where too few women go for testing. Thehealth fund has targeted these to promote equity.