Continental breakup by a leaky transform: the gulf of elat (aqaba).

The floor of the Gulf of Elat consists of five distinct deeps. Its structure is controlled by faulting which has produced rhomb-shaped grabens. The gulf is a newly formed plate boundary between Arabia and Sinai.

Ocular abnormalities in chronic familial hyperphosphatasemia.

The ocular findings in two patients with Chronic Familial Hyperphosphatasemia are described in detail. They consist mainly of abnormal pigmentation, the presence of retinal folds of variable degree, and angioid streaks. It is suggested that these changes are in relationship to abnormal collagen metabolism and that CHF is not only a bone dysplasia but a more generalized condition with variable extraskeletal manifestations.

[Home visits by family physicians of a primary care clinic--1986].

104 home visits carried out by family physicians in an insured population of 5324 covered by a family practice teaching clinic in Haifa were analyzed. The study included a 3-month period (March, July and December 1986). The rate of home visits was 0.08/person/year. 75% of the visits were to those over the age of 65. 25% of the visits were initiated by the physician, while 20% of visits initiated by the patients, their relatives or others were considered unjustified. However, not all visits initiated by physicians were considered justified. 35% of all visits were considered contributory to the general care of the patients.

[Hypertension in the community].

Hypertension is a major risk factor for cerebral and coronary disease and its early detection is very important for the family physician. We checked the implications of a hypertension survey in the community (from the age of 10 years) on the attitude of the primary care team. We found that although the medical team was aware of the significance of early detection and treatment of hypertension, according to the "law of halves" half the hypertensives were in treatment and of them half had normal blood pressure. This fact is probably not related to the quality of medical care. High risk groups identified were hypertensive patients who smoked, Jewish men of western origin, and Jewish women of Asian-African origin (who had a high rate of strokes). These groups were targeted for active intervention by the primary care team. This survey is part of planned community-intervention by the primary care team in the field of hypertension.

SFAT-AM: short family therapy in ambulatory medicine. Treatment approach in 10-15 minute encounters.

The question of the possibilities latent within an appointment lasting on average only 10-15 minutes, under the pressures of a heavy workload in a public clinic, has occupied the authors for three years. SFAT-AM: Short Family Therapy in Ambulatory Medicine, has been developed with aim of offering solutions to this question. The theoretical background is taken from family medicine with a biopsychosocial (b.p.s.) systems approach. The authors formulated series of basic doctor-patient encounters which last on average 10-15 minutes. The basic encounter is a kind of didactic checklist model which presents to the doctor possibilities latent within. Emphasis is placed on the art of treatment and the meeting itself as therapeutic. During the meeting, patient's satisfaction, psychosocial information and the doctor's inner voice help the participants adjust to each other and move from stage to stage. The approach also relates to the possibility of joint work together with colleagues or with members of different teams in the clinic. The doctor makes use of communication techniques and reaches a b.p.s. diagnosis which will be the basis for suggesting a treatment. The presented model was tried by the authors and by trainees as part of a specialization course in family medicine. The trainees received between 20 and 70 academic hours of instruction. From the doctors' report it can be seen that SFAT-AM can be used in a primary clinic. Future research should give more specific answers to questions about the model's desirability, cost-efficiency, and job satisfaction. (Doctors will be referred to in the male gender throughout the article).

The family medicine team as providers of home dialysis care in kibbutzim in Israel.

Sixteen patients with terminal renal failure who live in kibbutzim in Israel were interviewed. Over 50% of these patients receive dialysis treatment in their home kibbutz under the supervision of the family medicine team as compared with only 12.4% of all dialysis patients in the country who are treated at home. The implications of dialysis in the kibbutz are discussed, particularly the relevance of the overall responsibility of the kibbutz for all its members' needs in the provision of dialysis facilities. The relevance of community-based dialysis in general is discussed.

Responsibility taking and role definition in family practice: effect of training and practice setting.

There is evidence that family physicians (FPs) reduce health care costs by reducing patient referral to more expensive secondary and tertiary care facilities. Presumably, the effectiveness of FPs in meeting patients' needs is related to their role definition and willingness to assume responsibility. The purpose of this study was to determine the influence of training and practice setting on responsibility taking and role definition of FPs. A previously developed and validated self-administered questionnaire was completed by 153 certified FPs and FP residents from five departments of family practice in Israel. The main independent variables were previous training and practice setting. The main outcome measures were self-reported data on responsibility taking, role boundaries, and reported role performance. The results showed that certified FPs were more willing to assume responsibility, to define broader role boundaries, and to perform more specialized interventions than residents. Differences in practice setting affected only reported performance, with physicians who practice in rural clinics performing more specialized activities than those in urban clinics. Multiple regression analysis shows that professional development is associated with an increased willingness to assume responsibility; this willingness affects role boundaries definitions, which affects reported performance. Practice setting alters the tendency to perform a wider range of interventions, but does not affect physicians' attitudes.

Chronic familial hyperphosphatasemia.

Two siblings displaying macrocrania and multiple skeletal deformities, as well as cardiomegaly, had high levels of serum alkaline phosphatase and markedly increased urinary hydroxyproline excretion. The radiological findings of chronic familial hyperphosphatasemia, which are typical of a rare bone-remodeling disease, are presented. Scintigraphy disclosed intense uptake of the radionuclide by the skeletons of both patients. This finding, considered to be related to abnormal collagen metabolism, can be used in the diagnosis and assessment of skeletal involvement in such patients.