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.

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.

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 Characteristics of Allergic Contact Dermatitis in Military and Civilian Populations: A Multicenter Cross-Sectional Study.

Background: Contact dermatitis is a common condition in the general population, with a global prevalence of 20%. It is an inflammatory skin disease that is classified as irritant contact dermatitis (80%) and allergic contact dermatitis (ACD) (20%). In addition, it is the most common presentation of occupational dermatoses and is one of the primary reasons for seeking medical attention among military personnel. Only few studies have compared the characteristics of contact dermatitis in soldiers and civilians. Objective: To compare the characteristics of ACD between civilians and soldiers. Methods: This large retrospective study was conducted in Israel and involved 1800 civilians and 750 soldiers with suspected ACD. All patients underwent relevant patch tests based on their clinical presentation and medical history. Results: At least 1 positive allergic reaction was found in 382 civilians (21.22%) and 208 soldiers (27.73%) (nonsignificant). Moreover, 69 civilians (18.06%) and 61 soldiers (29.32%) had at least 1 positive occupational allergic reaction (P < 0.05). Widespread dermatitis was significantly more common among soldiers. The most frequent occupations among civilians with positive allergic reactions were hairdressers/beauticians. "Professional, technical, and managerial occupations" were the most frequent categories among soldiers (24.6%), with computing professionals being the most common occupation (46.67%). Conclusion: Military personnel and civilians have different characteristics associated with ACD. Therefore, considering these characteristics before placement in a workplace can help prevent ACD.

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 Silica Exposure and Dose-Response for Related Disorders-Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance.

BACKGROUND: The exposure patterns of respirable crystalline silica based on environmental records, as well as the link to different diseases, are not well described. AIMS AND OBJECTIVES: In this study, we evaluated the risk for various diseases in relation to occupational silica exposure, including Silicosis, pulmonary tuberculosis (TB), Autoimmune disorders (AIDs) and Renal diseases. METHODS: We assessed the relationship between silica exposure and the rate of various diseases such as silicosis, pulmonary TB, AIDs and renal diseases in a cross-sectional study. We reviewed the medical records and exposure level of workers exposed to silica during the past two decades. RESULTS: 261 workers were included in the study, total duration of exposure 15.6 years (±SD 8.74); 42.15% of them were employed in the artificial marble industry and 29.5% in manufacturing and construction industries. The average yearly silica exposure levels were 0.23 mg/m3 (±0.34). The average cumulative silica concentration was 3.59 mg/m3/y (±4.80). We found 25 (9.58%) incident cases of silicosis, 10 cases of chronic obstructive pulmonary disease (COPD) and emphysema (3.83%), six cases of several AIDs (2.30%), five cases of pulmonary TB (1.92%), three cases of renal diseases (1.15%), two cases of sarcoidosis (0.77%) and no lung cancer cases. When compared to studies with the same endpoint we found excess risk of silicosis (RR = 2.67/0.13 = 20.5, 95% CI 9.85 to 42.86)), pulmonary TB (RR = 30.70, CI 3.43-274.49, p = 0.002) and AIDs (RR = 2.87, 95% CI = 1.27 to 6.48 p = 0.01). CONCLUSIONS: Silica exposure was a significant risk factor for silicosis, pulmonary TB and AIDs. Our findings are important given persistent worldwide silica-related epidemics in low and high-income countries.

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 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 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 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.

Upper Quadrant Pain and Disability Associated with a Cross-Sectional Area of Deep and Superficial Neck Muscles: A Computed Tomography Study.

STUDY DESIGN: An analytical cross-sectional computed tomography (CT) study. OBJECTIVE: To investigate the association of the cross-sectional area (CSA) and density of neck muscles (sternocleidomastoid, upper trapezius, levator scapulae, anterior scalene, longus coli, longus capitis) with upper quadrant pain and disability. SUMMARY OF BACKGROUND DATA: Neck pain, a common condition, causes substantial disability to individuals. The deep cervical flexor muscles are impaired in persons with neck pain. These muscles play a greater role in maintaining stable head postures, whereas, superficial muscles are responsible for peak exertions and reinforcing spinal stability at terminal head postures. METHODS: Two hundred thirty consecutive individuals suffering from neck pain were referred to CT scans; 124/230 complied with the inclusion and exclusion criteria. Subjects were interviewed and the measurements of the CSA and muscle density were extracted from the scans. RESULTS: Muscles associated with quick disability of the arms, shoulders, and hand questionnaire (QDASH) were the lateral posterior group (LPG) CSA C3-C4 on the right side (beta = -0.31, P = 0.029); the sternocleidomastoid (SCM) CSA C3-C4 on the left side (beta = 0.29, P = 0.031); the LPG CSA C3-C4 on the left side (beta = -0.49, P = 0.000); the LCM CSA C5-C6 on the right side (beta = -0.19, P = 0.049); the LPG CSA C5-C6 on the right side (beta = -0.36, P = 0.012); and the LPG CSA C5-C6 on the left side (beta = -0.42, P = 0.002). Further analyses with radiculopathy acting as an augmenting/enhancing variable (moderator), showed an increase in the model strength (r2 = 0.25) with a stronger prediction of pain and disability. Muscle measurements did not predict neck disability index (NDI) scores. CONCLUSION: By using an accurate measuring tool, we found an association of the deep and superficial neck muscles' CSA with upper extremities' pain and disability. When performing manual work, a special load is placed on the shoulders and neck muscles. Future research should focus on examining the effectiveness of exercise-type intervention programs to strengthen the deep neck and upper extremities' muscles in order to prevent muscle fatigue.Level of Evidence: 2.

The Correlation between Clinical and Demographic Parameters and Sickness Absence in Diabetic Employees.

Objectives: Diabetes mellitus is one of the most significant and prevalent chronic diseases. Individuals with diabetes can still encounter substantial difficulties in finding and keeping their job because of their condition. The purpose of this study was to examine the scope of diabetes-related absence from work and its relationship with variables such as type of employer, workload, the severity of illness, and type of treatment. Materials and Methods: We conducted a case-control study, including 220 diabetic patients and 230 controls. Information regarding absence from work was obtained by reviewing medical records, and general patient information was retrieved by conducting telephone interviews. Results: Patients with diabetes had, annually, more days of absence than non-diabetic patients (8.5 vs. 2.7, respectively p and lt; 0.001). Among diabetic patients, public-sector employees were absent more than private-sector employees (9.0 vs. 7.2 days, respectively, p and lt; 0.05). A positive correlation was found between workload (measured by stamina) and absence (Pearson correlation = 0.098, p = 0.04). Concerning the clinical variables, we found that employees suffering from diabetic complications exhibited higher absence rates (15.5 vs. 5.7 days, respectively, p and lt; 0.003). Parameters like HbA1c levels, patient age, disease duration, and type of treatment did not differ significantly amongst the groups with regards to absence rates. Conclusions: The main variables affecting absence from work were not medical but rather sociodemographic: education, workload, and type of employer. The results of this study reinforce the perception that well-controlled diabetic employees can be combined in most types of occupations without fear of increased absence from work.

Ten Years Follow-Up of a Community-Nurse Managed Intervention to Improve Diabetes Control.

BACKGROUND AND PURPOSE: Diabetes control measures were shown to improve, following multidisciplinary intervention managed by a nurse in short-term follow-ups. However, there is a lack of data regarding the long-term effects of such interventions. We assessed long-term diabetes management and control measures in a central multidisciplinary primary care clinic, following a brief intervention conducted by a community nurse. METHODS: A cross-sectional study in a central, multidisciplinary, primary care clinic. A previous study cohort of randomly selected 100 people with diabetes was followed-up for over 10 years, following a brief intervention managed by a community nurse. Data of diabetes control measures (e.g., hemoglobin A1c [HbA1c], low-density lipoprotein [LDL], and blood pressure) and clinical use of medical services (e.g., nurse, physician, dietician, and hospitalizations) were extracted from the medical records and compared from before the intervention to short and long-term follow-ups (median of 25 months, 10.56 years respectively). RESULTS: During the follow-up period, 18 participants (median age at intervention time 73 years) died. HbA1c dropped significantly (p < .001) from before to after the intervention, and remained low. LDL and Systolic Blood pressure decreased and continued to decrease during the long-term follow-up. While the number of nurse visits per year increased, physician and dietician visits decreased. Annual foot examinations and ophthalmologist visits, which increased following the intervention, remained high. Diabetes-related hospitalizations also decreased from the point of intervention. IMPLICATIONS FOR PRACTICE: Multidisciplinary, brief intervention managed by a community nurse, improve, and even continue to improve, most diabetes management and control measures, for more than 10 years following the intervention.

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.

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 Association Between PHQ-9 and Fitness for Work Among Depressive Patients.

OBJECTIVE: One of the tools to assess depression severity is the Patient Health Questionnaire (PHQ-9). Our aim was to investigate the correlation between PHQ-9 scores and fitness for work (FFW) in major depressive disorder (MDD). METHODS: A cross-sectional study in patients who were evaluated for their FFW and later compared with PHQ-9. RESULTS: Questionnaires were collected for 125 patients. A negative correlation between depression severity and absolute working ability (WA) was found for both women (ß = -0.4, P < 0.001) and men (ß = -0.4, P = 0.05). Multivariate linear regression revealed a negative correlation between WA and depression severity based on PHQ-9 scores (ß = -0.4, P < 0.05). CONCLUSIONS: A negative correlation exists between absolute and relative WA and depression severity, meaning, with the higher severity of depression the lower the WA.

Socialized occupational medicine in Israel: past, present, and future.

Occupational health in Israel is unique as it was originally established as a socialized service which anchored in extensive legislation and is accessible to all employees and employers without copayment. We review historical processes and legal basis that led to current structure of public occupational medicine services in Israel. Some of these go back a century and others extend way back to biblical times. Representative case studies from the field are used to illustrate its scope of practice. Legislative changes that exempted the employers from participation in financing occupational health have led to severe budget cuts, jeopardizing the future provision and key principles of occupational healthcare. We discuss future aspects of recommended development vectors for policy making that will preserve the structure of occupational health services and benefits it offers to all workers in Israel.

[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.