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.

Disparities in occupational health services: an international comparative study.

BACKGROUND: Occupational Health Services (OHS) are comprehensive, multidisciplinary services supplied by various trained workers, including occupational physicians (OP), whose specialty is focused on workers' health. AIMS: Our study questions are whether the OP/worker ratio may reflect the scope and availability of OHS. METHODS: This comparative study, conducted on globally different OHS, was based on literature analysis of peer-reviewed articles published in journals covering topics of occupational medicine and public health that addressed parameters on the type and scope of OHS provision. RESULTS: We described the number of OP/worker ratio, and the correlation to economic parameters (Gross domestic product-GDP, health expenditure, Gini Index-GI) by country. We found that among countries with a GDP per capita higher than US$30,000, only three (US, South Korea and Israel) had a very low OP/worker ratio (about 1:50,000 compared to 1:5,000 in other countries). Looking at all the countries together, there was a statistically significant negative correlation between health expenditure percentage of GDP per capita and OP/worker ratio (rs = -0.54, p = 0.01) and a significant positive correlation between GI and OP/worker ratio (rs = 0.47, p = 0.04). CONCLUSIONS: The lesser the percentage of health expenditure of GDP and the subsequent greater general inequality as reflected by the GI, the lower the OP/worker ratio. The data collected in our comparative study show that the OP/worker ratio is a parameter both easy to define and obtain which best represents the status and disparity of OHS in each country.

The implementation of clinical guidelines concerning return to work after myocardial infarction.

PURPOSE: To examine the implementation, clinical effects, and adherence of occupational physicians to the clinical practice guidelines (CPG) published in 2003 in Israel, regarding return to work following acute myocardial infarction (AMI). METHODS: We analyzed 3 populations referred to Maccabi Health Services occupational clinics for fitness for work examinations following AMI, either before the guidelines were published (group 1), after their first publications in 2003 (group 2) or after they were re-published in Harefuah Journal in 2007 (group3). RESULTS: The documentation among groups 1,2,3 of different parameters like years of education (18.8%, 45.1%. 57.5%, p < 0.001), type of occupation (86.5%, 98.2%, 100.0%, p < 0.001) and New York Heart Association (NYHA) class (69.8%, 81.4%, 92.5%, p < 0.001) has all improved respectively over the years. No significant difference in sick leave was noted between the three populations. CONCLUSION: The CPG should be interdisciplinary in the phase of writing and publication. Economical resources are needed in order to implement CPG.Implications for RehabilitationThe clinical practice guidelines should be interdisciplinary in the phase of writing and should involve all rehabilitation professionals as a team.The clinical practice guidelines need disseminating widely alongside a resource plan in order to implement it.

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.

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.

Postpartum Retained Products of Conception: A Novel Approach to Follow-Up and Early Diagnosis.

PURPOSE: To investigate whether ultrasound follow-up for the detection of postpartum retained products of conception (RPOC) in women considered at risk for this condition may allow for early diagnosis. METHODS: Parturients at risk for RPOC underwent an ultrasound exam on the second postpartum day. Based on the ultrasound findings, women were either: (1) discharged to routine postpartum care in cases of normal scans, (2) invited for follow-up in cases of abnormal scans. We retrospectively analyzed the rates of women requiring uterine evacuation due to persistent abnormal scans. RESULTS: 761 parturients (out of 17 010 deliveries, 4.5 %) were included. Of those, 490 (64.4 %) women had a normal initial scan, but two of them were later readmitted for uterine evacuation. The remaining 271 (35.6 %) women were found to have an abnormal scan: (a) thickened endometrium > 10 mm with hypo- and hyper-echoes and negative Doppler flow considered low suspicion for RPOC was described in 260 cases, of whom 23 (8.8 %) underwent uterine evacuation with placental remnants confirmed in 12/23 (52.2 %), and (b) an echogenic mass with positive Doppler flow considered high suspicion for RPOC was described in 11 cases, all of whom underwent uterine evacuation, with placental remnants confirmed in 9/11 (81.8 %). The number of scans required to detect RPOC in one patient was 33. CONCLUSION: Postpartum ultrasound evaluation may allow for early diagnosis of RPOC in women considered at risk for this condition.

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.

Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors?

OBJECTIVE: To assess the prevalence and risk factors for intrauterine adhesions (IUAs) after hysteroscopic treatment of retained products of conception (RPOC). DESIGN: Retrospective cohort study. SETTING: Gynecologic endoscopy unit. PATIENT(S): A total of 167 women referred to our institution from 2009 to 2013. INTERVENTION(S): Operative hysteroscopy for treatment of RPOC and office hysteroscopic follow-up to assess for IUA. MAIN OUTCOME MEASURE(S): We investigated demographic characteristics, obstetrics parameters, and surgical variables to evaluate which factors could be associated with IUA formation. RESULT(S): Of 167 women treated for RPOC, 84 (50.3%) had undergone a follow-up hysteroscopic evaluation after the operative hysteroscopy and were included in the study. Intrauterine adhesions were found in 16 cases (19.0%), of which only 3 (3.6%) were severe adhesions. Multivariate analysis showed that the presence of IUA was associated with RPOC after cesarean section (5 of 10 [50.5%] developed IUA, vs. 7 of 49 [14.3%] after vaginal delivery). Intrauterine adhesions were also found in 4 of 23 women (17.4%) undergoing hysteroscopy for RPOC after abortion. Patient age, gravidity, parity, and the interval between the index pregnancy and treatment for RPOC were not associated with postoperative IUA. CONCLUSION(S): Hysteroscopic treatment for RPOC had a 3.6% incidence of severe intrauterine adhesions formation in this descriptive series. Women with RPOC occurring after delivery by cesarean section are particularly at risk for development of IUA.