The rate of occupational noise-induced hearing loss among male workers in Israel and implication on hearing surveillance frequency.

OBJECTIVES: To investigate the annual rate of NIHL in Israel, a modern economy with relatively low industrial hazardous noise exposure. To review international protocols of hearing surveillance. To recommend an effective, efficient, hearing screening frequency protocol. METHODS: A historical cohort study was conducted. Audiometric surveillance data from the Jerusalem occupational medicine registry of male employees in various industries from 2006 to 2017 were used. Mean individual annual threshold shifts simulating 1-8 checkup interval years were calculated. Joinpoint regression analysis was used to assess the interval in which the slope of the calculated ATS variability moderates significantly. RESULTS: A total of 263 noise-exposed workers and 93 workers in the comparison group produced 1913 audiograms for analysis. Among the noise-exposed workers, using the 1-4 kHz average, threshold shifts stabilized from 3 years onwards at around 1 dB per year in all age groups and 0.83 dB in the stratum younger than 50 years. No enhanced decline was detected in the first years of exposure. CONCLUSION: Although most countries conduct annual hearing surveillance, hearing threshold shifts of noise-exposed workers become more accurate and show less variability when calculated at 3-year checkup intervals onwards than shorter intervals. Since margins of errors of the test method are much larger than the annual shift found, screening schedule that enables each subsequent test to identify a real deterioration in hearing is necessary. Triennial audiometric screening would be a better surveillance frequency for noise-exposed workers younger than 50 years of age in the category of 85-95 dBLAeq,8 h without other known risk factors.

Occupational Chronic Contact Dermatitis Successfully Treated with Dupilumab: A Case Series.

BACKGROUND: Occupational contact dermatitis may progress to a chronic course with an unfavorable prognosis. Dupilumab has been shown to be effective as a treatment for moderate-to-severe atopic dermatitis as well as other types of dermatitis. OBJECTIVES: The aim of the study was to describe cases of chronic recalcitrant occupational contact dermatitis treated with dupilumab and with long-term follow-up. METHODS: A retrospective review of 6 patients treated with dupilumab for chronic occupational contact dermatitis for periods of up to 30 months was performed. RESULTS: All 6 patients had a positive and sustainable response, with dermatitis clearance and the ability to sustain work tasks. CONCLUSIONS: We report a case series of atopic and nonatopic workers with occupational chronic contact dermatitis who failed to achieve remission under various systemic modalities but did so using dupilumab. We suggest considering dupilumab treatment for recalcitrant occupational contact dermatitis.

The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial.

OBJECTIVE: To study the long-term effectiveness of case-management rehabilitation intervention on vocational reintegration of patients after myocardial infarction (MI). DESIGN: Blinded simple randomization was used to construct an intervention and control groups that were followed up for two years. SUBJECTS AND SETTING: 151 patients, aged 50.3 ± 5.9 years, who experienced uncomplicated MI and were enrolled in a cardiac rehabilitation program were recruited. INTERVENTIONS: included an early referral to an occupational physician, tailoring an occupational rehabilitation program, based on individual patient needs, coordination with relevant parties, psychosocial intervention, intensive follow-up sessions during a two-year follow-up. MAIN MEASURES: Return to work within six months of hospitalization and maintenance of employment at one and two years of follow-up. RESULTS: Return-to-work (RTW) rate in the intervention group was 89% and nearly all maintained employment at one year of follow-up (92%) and two years of follow-up (87%). Moreover, almost all of them returned to and maintained their previous jobs. The corresponding figures were: 98%, 94% and 98%, respectively. The figures for the RTW and employment maintenance for the control group were: 74%, 75%, and 72%, respectively. Only about 75%, in this group kept their previous job. The case-management intervention was associated with increased odds of maintaining employment at follow-up of one year (OR = 5.89, 95% CI 1.42-24.30) and two years (OR = 3.12, 95% CI 1.01-10.03). CONCLUSIONS: The extended case-management rehabilitation intervention had a substantial positive impact on both the RTW of MI patients and their maintenance of employment at one and two years of follow-up. TRIAL REGISTRATION: This trial is registered at US National Institutes of Health #NCT04934735.

The relationship between atopy and allergic contact dermatitis in Israeli patients.

Introduction: Whether individuals with atopic diseases have a different risk of contact allergy compared to those who are non-atopic is controversial and data are conflicting. Aim: To explore the association between atopy and allergic contact dermatitis (ACD). Material and methods: This retrospective cross-sectional study included 301 patients referred to a tertiary clinic to evaluate ACD. Demographic details including personal and familial mucosal or cutaneous atopic status were recorded. Patch tests were tailored to their clinical presentations and relevant exposures. Results: At least 1 positive patch test reaction was observed in 177 patients (59% of the study cohort), of which 52% had a history of atopic diseases, compared with 44% of patients with a negative patch test result (p = 0.2). Additionally, 147 patients had an atopic background, of which 92 (62%) had ≥ 1 positive patch test result, compared with 55% of non-atopic patients (p = 0.2). Nickel sulphate was the most common contact allergen (13.4% of the patch test reactions). Conclusions: We identified a positive tendency for atopic diseases among individuals with ACD and vice versa. Our study supports the aggregate data from previous studies despite the non-significant differences between the study and control groups. However, further research performed in larger populations of patients is necessary to evaluate the real association between atopy and ACD on a solid basis. Our results indicate the necessity of systematic patch testing in patient setups with atopic background and chronic dermatitis.

The correlation between the ACR questionnaire and fitness for work of fibromyalgia patients.

OBJECTIVES: Fibromyalgia (FM) is a central pain syndrome characterised by widespread pain, fatigue, unrefreshing sleep, memory impairment and cognitive changes, predominantly in women, and is a cause for disability and frequent sick leave. So far, no assessment has been made of the use of the American College of Rheumatology (ACR) 2010 questionnaire in the fitness for work (FFW) assessment of FM patients. To assess the correlation between the severity of FM as measured by the ACR questionnaire and other parameters and FFW. METHODS: We conducted a retrospective cross-sectional study involving women with FM who had their FFW assessed at an occupational health clinic between 2014-2018. The ACR questionnaire was completed during the medical assessment. RESULTS: We examined 60 files of women, mean age 48.8 years. Absolute loss of working capacity (ALWC) was calculated in relation to a standard 8-hour workday, while relative loss of working capacity (RLWC) was based on the patient's actual appointment percentage before the examination. The average ALWC determined by the occupational physicians was 59% ± 33%. Age group correlated significantly with ALWC (correlation coefficient = 0.03, p<0.05). The Part 2b symptoms (0-41) also correlated significantly with ALWC (mean ± SD 21.8±5.6, correlation coefficient = 0.23, p<0.05). Medical treatment correlated significantly with RLWC (correlation coefficient = 0.02, p<0.05). The rate of disability was high compared to what was reported in other studies. The correlation between different parts of the ACR questionnaire and disability demonstrated that symptom severity is a predictor of loss of working capacity. CONCLUSIONS: When performing a FFW assessment of FM patients, physicians may use the ACR questionnaire, since FFW correlates with its score. We assume that patients who experience more pain visit their physicians more often and consume more analgesics.

Fitness for work during the COVID-19 disease: principles and suggested assistive tool for protecting workers during the pandemic era.

OBJECTIVE: Amongst the many intricacies engendered by the COVID-19 pandemic was the posed risk of exposure to SARS-COV2 infections among workers and the need to evaluate fitness for work (FFW) of individuals in high exposure groups or those with background morbidity. A designated task force of the Israeli Association of Occupational Medicine has evaluated the relevant literature and published guidelines concerning medical work restrictions for employees in high-risk occupations during the epidemic of novel COVID-19. METHODS: The study depicts a case series of 17 FFW evaluations performed in Maccabi Health Services occupational clinics using the guidelines formulated by the Israeli Occupational Medicine Association. RESULTS: 17 patients, mainly healthcare workers, whose major health hazards were immunodeficiency, respiratory diseases and pregnancy, were assessed in this case series. We present the essential parameters of these FFW evaluations and discuss decision-making in selected cases. CONCLUSIONS: Applying guidelines in various work settings and health risk levels during the SARS-CoV-2 pandemic allows for both patients' health preservation and efficient workforce deployment.

Occupational influences on Spondylolysis and Spondylolisthesis in a cohort of 18-year-old male military conscripts.

BACKGROUND: The reported prevalence of spondylolysis (SL) in the adult population is 6-7%. Data concerning adolescent-onset spondylolisthesis (SLS) and the impact of certain activities on it is scarce. We examined the risk of clinical progression of SL and SLS as a function of primary severity and occupational strain among military recruits. METHODS: Based on the Israel defense Force (IDF) central human resources database, we identified 1521 18-year-old males inducted to the IDF with SL/SLS between the late nineteen nineties and early two-thousands. We followed changes in the SL/SLS status during the 3 years of obligatory military service. Disease severity was classified as Cat2: radiological findings of SL without clinical findings; Cat3: painful SL or asymptomatic grade 1 SLS; Cat4: grade 1 SLS with pain; Cat5: Grade 2 SLS. The soldiers were subdivided into the following occupational categories: administrative, combat, maintenance, and driving. The purpose was to compare the progression rates in different medical categories and job assignments. RESULTS: There were 162 recruits in Cat2, 961 in Cat3, and 398 recruits in Cat4. The overall progression rate to Cat5 (grade 2 SLS) was 1.02%. Significant progression rates were seen amongst administrative soldiers with a relatively higher risk of progression from Cat4 (painful-grade-1 SLS: 2.2%) vs. Cat3 (asymptomatic SLS: 0.5%, relative risk = 4.7, p < 0.02). Other occupational categories did not exhibit significant progression rates. CONCLUSION: Progression of SL/SLS was highest in Cat4, i.e. for recruits already diagnosed with painful SLS (i.e. with a more severe baseline disorder). Progression did not correlate with military occupation. We recommend further follow-up studies that include, aside from progression rates, incidence rates of newly diagnosed grade 2 SL during military service.

The relationship between low back pain and professional driving in young military recruits.

BACKGROUND: Episodes of low back pain (LBP) are very common among workers. A number of occupational risk factors have been shown to increase the risk for LBP. One of these risk factors is exposure to whole body vibration, which is a known characteristic in driving professions. The aim of this study was to assess the impact of driving on LBP amongst young professional drivers. METHODS: This is an historical-prospective cohort study based on the Israel Defense Forces (IDF) database of male soldiers drafted between the years 1997-2006. Subjects' medical history with specific reference to LBP medical history, clinical and radiographic findings were taken as part of the recruitment process to the IDF. The study group included subjects (n = 80,599) from three occupational groups: administrative units (AU), car drivers (CD) and truck drivers (TD) that were followed for 3 years. The incidence and recrudescence rates of LBP were calculated based on standardized LBP severity tiers. RESULTS: The total incidence rate for LBP was 0.65%, 0.7% and 0.34% for AU, CD and TD respectively. In a comparison between subjects without a history of LBP (category 1) to subjects with a history of LBP without clinical findings (category 2) and subjects with a history of LBP with mild clinical / radiographic findings (category 3), the relative risk (RR) for severe LBP exacerbation was 1.4 (p < 0.001) and 3.8 (p < 0.01), respectively. The LBP exacerbation rates within different severity tiers yielded a similar trend amongst all profession groups. CONCLUSIONS: This study included 80,000 soldiers who represent a population of driving and administrative occupations aged 18-21. The significant risk factors for developing LBP were a previous history of LBP and presence of LBP symptoms at the start of work. A correlation was identified between severity of LBP at the initial examination and further exacerbation of LBP in all examined occupations. Driving as a profession in our (young) age-group was not identified as a risk factor for LBP.

[IONIZING RADIATION AND THE RISK FOR CATARACT AND LENS OPACITIES].

INTRODUCTION: The lens of the eye is among the most sensitive organs to ionizing radiation in the human body. The cataract is the earliest documented side effect of ionizing radiation, first reported in lab animals in 1897, only a year after the discovery of X-rays, and in 1906 among human radiation technicians. However, the exact mechanisms underlining this pathology have yet to be uncovered. In particular, the question as to whether radiation-induced cataract is a deterministic event, meaning a threshold dose must be exceeded in order for it to develop, still remains. Recent epidemiological studies, performed on populations exposed to lower radiation doses than those previously perceived cataractogenic, have led the International Commission on Radiological Protection (ICRP) in April 2011 to reduce its eye dose threshold for cataract induction from 2 Gy to 0.5 Gy, and the occupational annual dose limit from 150 mSv to 20 mSv/year. However, the ICRP have yet to support a stochastic effect (linear non-threshold) for radiation- induced cataract, although suggested by several studies. In this article, we review the current knowledge on radiation-induced cataract, including the speculated mechanism for its development, evidence for genetically predisposed populations, and the main recent epidemiological studies.

[TRENDS IN THE RATE OF OCCUPATIONAL PHYSICIANS VERSUS MANPOWER IN ISRAEL - STATUS AND SOLUTIONS].

BACKGROUND: The specialization in occupational health was recognized in Israel in 1990. The number of specialists grew gradually over the years, yet a systematic analysis of occupational health physicians (OHP)/workers' ratio was never conducted. OBJECTIVES: To determine the trends of OHP/workers' ratio in Israel and the future activities needed in order to achieve the standards of developed countries. METHODS: The socio-demographic data was obtained by personal communication, from the Israeli Association of Occupational Medicine and Maccabi Health Services. The remaining data was obtained from publications of the Ministry of Health and the National Insurance Institute. RESULTS: By March 2014, 157 OHPs were registered in Israel, 104 active specialists and 25 residents. Among the specialists, 78 worked in the Health Maintenance Organizations (HMO), 18 in the public sector (other than HMOs) and 8 in the private sector. Even though the number of workers rises every year, the number of OHP has remained stable in the last 10 years, around 90-100 physicians. The ratio of occupational health physicians/workers in the HMOs is 1:48,000. CONCLUSIONS: The ratio of OHP/workers in Israel is comparable to the ratio in developing countries and 8-10 times less in comparison to the developed countries with a Gross Domestic Product (GDP) similar to Israel. The rate has decreased since 2007. The reason for the stable numbers is the lack of payments by the employers and the fact that the subject has been ignored by the regulatory authorities. DISCUSSION: The way to improve this situation is by doubling the number of residents every year by providing the required resources to support this new arrangement. The funds have to come from the employers, the Ministry of Economy and the Ministry of Health.

Vocational factors which predict seizure prognosis in young adults during military service.

BACKGROUND: The vocational parameters regarding epilepsy are not well established. Our aim was to assess the risk of seizures as a function of occupational stress and disease severity in military recruits of the IDF (Israel Defense Force) and to examine the effect of new classification criteria (used between the late nineties and early two thousands) in comparison with that of previous criteria (used during the mid-eighties to mid-nineties). METHODS: The medical records of over 150,000 18-year-old men recruited to the IDF between the mid-nineties and the mid-two thousands were used to assemble a cohort, which was followed for a period of 36months. The severity of the disease was determined according to 3 categories, according to the medical history. The recruits were subdivided according to their occupational categories to Combat Units (CUs), Maintenance Units (MUs), and Administrative Units (AUs). We compared the incidence rates of the different groups with the findings from a previous follow-up. RESULTS: The annual incidence rates during 36months of follow-up were 0.026%, 4.7%, and 8.8%, in categories 1 to 3, respectively. The relative risk of seizure incidence in CU and MU was lower than in AU (0.42 and 0.81, p<0.0001). Similar findings were found in other disease categories. CONCLUSIONS: Job assignment to CU (less convenient conditions like sleep deprivation and strenuous physical activity) did not increase the incidence of seizures. It was found that EEG examination is an important criterion in the vocational evaluation of subjects that have had one or more seizures. This study supports the establishment of vocational criteria and recommends the integration of people diagnosed with epilepsy in most occupations.

The incidence and worsening of newly diagnosed low back pain in a population of young male military recruits.

BACKGROUND: Low back pain (LBP) is a leading cause of referral to occupational health clinics and of consequent work absenteeism. There is lack of data concerning ages 18-21. The objective of our study was to evaluate the occurrence of newly diagnosed LBP and the recurrence and worsening of preexisting LBP in young male military recruits. METHODS: In this retrospective cohort study, we examined the medical history of army recruits during the 30-month period after their induction into the Israel Defense Forces (IDF). The duty status of soldiers in combat units (CU), maintenance units (MU) and administrative units (AU) was evaluated according to their morbidity. The study's end point was defined as significant findings on clinical examination with presence of neurological deficits which correlate to radiological findings on CT or MRI showing herniated disks, spinal stenosis or pressure on neurological roots. RESULTS: The annual incidence rate of LBP in a total of 159,295 recruits was 0.05 %. The relative risk (RR) for developing LBP was significantly higher among subjects who were assigned to AU as compared to CU and MU in all LBP categories. The RR for LBP recurrence in soldiers with a positive history of LBP (categories 3 and 4) was 4.1 and 10.7 compare to category 1 respectively. CONCLUSIONS: The lower than expected overall incidence rate of 0.05 % reflects the fact that severe LBP occurrences are not common at this age group. This finding is a more truthful reflection of LBP occurrence rates relative to other studies since the end point is based on precise clinical definitions in medical records and not on questionnaires, as in most studies. The RR for developing LBP was significantly higher among subjects who were assigned to AU as compared to CU and MU in all LBP categories. Childhood history of LBP was found as a significant risk factor for LBP exacerbations at adulthood. Positive history of LBP was found as a risk factor for the recurrence of LBP in all occupation types and particularly in sedentary ones.

Atopy as a risk factor for the development of asthma in young recruits.

OBJECTIVE: Asthma is one of the most common chronic diseases globally. Atopy, and especially allergic rhinitis (AR), was found as an important risk factor for asthma. The purpose of this study was to examine the association between different atopic parameters and military professions to the incidence of asthma. METHODS: In a retrospective study, we included 128 591 Israel Defense Forces soldiers drafted between the mid-nineties to the early-2000s. We examined the incidence rates of asthma in relation to atopic background and to military profession. RESULTS: The relative risk (RR) for the development of asthma in persons with a history of AR and the RR for asthma in atopics vs. nonatopics was 1.86 (95% CI: 1.57-2.21) and 1.73 (95% CI: 1.47-2.04), respectively. The RR for the development of asthma in persons with a history of AR was higher in Combat Units (CU) and Administrative and Driving units (ADU) (RR = 2.80; 95% CI: 2.09-3.76 and RR = 1.58; 95% CI: 1.19-2.12, respectively) than in Maintenance Units (MU) (RR = 1.27; 95% CI: 0.93-1.74). When comparing the risk for asthma amongst persons with AR, we found it lower in MU compared to ADU (RR = 0.65; 95% CI: 0.43-0.97). In atopics vs. non-atopics, the risk for asthma was higher in ADU as compared to other occupations. CONCLUSIONS: Atopy, particularly AR, is a risk factor for the development of new-onset asthma in young adults. Atopy has the highest significant effect in CU where the physical demands are higher.

Physical and psychosocial work demands associated with pain and disability among skilled male Arab waiters.

BACKGROUND: Physical and psychosocial demands (e.g., serving, cleaning, fulfilling orders) can lead to work-related musculoskeletal pain (WRMSP). OBJECTIVE: To assess the prevalence of WRMSP in the upper quadrant and lower back among skilled male Arab waiters; to evaluate the disability related to WRMSP; to evaluate the association between work demands and WRMSP with related disability. METHODS: 100 skilled male Arab waiters working full-time, aged 18-60, participated in the cross-sectional study. Participants completed basic demographics and working conditions; the NDI; QuickDASH; the OswestryQ; workload, burnout, and job satisfaction at work; the adjusted NordicQ; and the TaskQ, compiled especially for this study. RESULTS: A 12-month pain prevalence, pain frequency, and work avoidance were high: neck- 42%, 60.5%, 89.5%; shoulders -53%, 78.2%, 94.4%; elbows- 46%, 78.6%, 83.3%; lower back- 45%, 44%, 78.7%, respectively. Pain prevalence in at least one site was 83%. The OswestryQ, QuickDASH, and NDI revealed mild-moderate pain and disability (14.85/50, 25.54/75, 13.74/50, respectively). Burnout score was positively associated with OswestryQ, QuickDASH, and NDI. Job satisfaction was negatively associated with 12 months of pain in the lower back, hands, arms, shoulders, and hands (NordicQ). TaskQ was positively associated with OswestryQ. CONCLUSION: Male Arab waiters who work in physically and psychologically challenging conditions report high levels of WRMSP with a high frequency and related work avoidance. Many of them must keep their jobs as they are their families' primary or sole providers. It is possible that they are trying to prevent more severe disabilities in the future by ensuring temporary rest and pain prevention.

Prevalence of Occupational Contact Dermatitis Among Dental Personnel Using the Nordic Occupational Skin Questionnaire-2002: A Prospective Cross-Sectional Study.

BACKGROUND: Occupational skin disease (OSD), such as contact dermatitis, is widespread among dental professionals; however, reports regarding its prevalence have inconsistent findings and methodology. Therefore, we conducted a cross-sectional survey using a self-reported questionnaire to estimate the prevalence of work-related and occupational exposure-induced skin diseases. METHODOLOGY: A self-administered questionnaire, based on the validated Nordic Occupational Skin Questionnaire-2002, was distributed to 15 dental clinics in Israel in the first half of 2022. The questionnaire included questions about the occupation, exposure, and history of atopic disease, dry skin, and hand/arm and wrist eczema, as well as participant demographics. RESULTS: Overall, 312 dental professionals completed the questionnaires. Response rate was 80%. The lifetime prevalence of self-reported skin symptoms was 19.23%. Significant risk factors included exposure to metal objects, odds ratio (OR): 2.43, 95% confidence interval (CI): [1.02, 5.78]; p < .05, dry skin (OR: 3.54, 95% CI: [1.93, 6.5]; p < .001), itching when sweating (OR: 2.89, 95% CI: [1.39, 6]; p < .05), contact urticaria (OR: 10.67, 95% CI: [4.46, 25.49]; p < .001), hay fever (OR: 2.25, 95% CI: [1.14, 4.42]; p < .05), allergic symptoms (OR; 2.33, 95% CI: [1.18, 4.58]; p < .05), and asthma (OR: 4.8, 95% CI: [2.17, 10.36]; p < .001). CONCLUSIONS: This is the first study to use the NOSQ-2002 among dental professionals. Our study provides a better understanding of the prevalence and consequences of OSDs among dental personnel by utilizing the validated tool NOSQ-2002.

The association between occupation and the incidence of knee disorders in young military recruits.

OBJECTIVE: To investigate the association between occupational risk factors and the incidence of knee disorders in a young adult population. METHODS: Israeli recruits to the Israel Defense Forces go through a rigorous medical investigation. Study participants were classified by prior knee condition status and divided into 5 categories of prospective occupational exposure to physical activity according to their assigned military duties, and were then followed for 30 months for the development of severe knee disorders (SKD). Logistic regression analysis was used to estimate the occupational risks for incident SKD, adjusted for any previous mild or moderate disorder, body mass index, and body height at induction. RESULTS: The study population consisted of 76,491 males. SKD developed in 615 (0.8%). Compared to administrative workers as referents, a higher risk of developing SKD was manifest among high intensity combat occupations, (odds ratios [OR] 2.15), those in moderate intensity combat occupations (OR 2.57) and maintenance (OR 1.59). Drivers did not demonstrate increased risk of knee disorders compared to referents. CONCLUSIONS: Occupational factors during military service are associated with incident SKD, even when taking into account previous knee disorders, body mass index, and height, which also had independent effects in our study population.