Neck Pain Clinical Prediction Rule to Prescribe Combined Aerobic and Neck-Specific Exercises: Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: A previous randomized controlled trial revealed that combined aerobic and neck-specific exercises yielded greater improvement than neck-specific exercises alone after a 6-month intervention in outpatients with nonspecific neck pain (NP). The aim of this secondary analysis was to identify subgroups of patients in the combined exercises group most likely to benefit from the intervention. METHODS: Sixty-nine patients were included. The original trial was conducted in multiple physical therapy outpatient clinics twice a week for 6 weeks; follow-up was 6 months after assignment. The primary outcome was the therapeutic success rate (Global Rating of Change Score ≥ +5, "quite a bit better") after 6 weeks of training and at the 6-month follow-up. Candidate predictors from patients' medical history and physical examination were selected for univariable regression analysis to determine their association with treatment response status. Multivariable logistic regression analysis was used to derive preliminary clinical prediction rules. RESULTS: The clinical prediction rule contained 3 predictor variables: (1) symptom duration ≤6 months, (2) neck flexor endurance ≥18 seconds, and (3) absence of referred pain (Nagelkerke R2 = .40 and -2 log likelihood = 60.30). The pre-test probability of success was 61.0% in the short term and 77.0% in the long term. The post-test probability of success for patients with at least 2 of the 3 predictor variables was 84.0% in the short term and 87.0% in the long term; such patients will likely benefit from this program. CONCLUSION: A simple 3-item assessment, derived from easily obtainable baseline data, can identify patients with NP who may respond best to combined aerobic and neck-specific exercises. Validation is required before clinical recommendation. IMPACT: Patients experiencing NP symptoms ≤6 months who have no referred pain and exhibit neck flexor endurance ≥18 seconds may benefit from a simple self-training program of combined aerobic and neck-specific exercises.

Effectiveness of combined aerobic exercise and neck-specific exercise compared to neck-specific exercise alone on work ability in neck pain patients: a secondary analysis of data from a randomized controlled trial.

OBJECTIVE: To compare the effect of combined aerobic exercise (AE) and neck-specific exercise to neck-specific exercise alone on the work ability of individuals complaining of neck pain. METHOD: Secondary analysis of data from a previous randomized controlled trial was conducted to compare AE and neck-specific exercise (AE group, n = 69) to neck-specific exercise alone (control group, n = 70). The Work Ability Index (WAI) was administered after the 6-week intervention, and Global Rating of Change (GROC) was assessed after the 6-week intervention and at 12- and 24-week follow-ups. RESULTS: Repeated-measure analyses of variance between groups indicated a significant time × group interaction on the GROC at 12- and 24-week follow-ups. The AE group showed better improvement on the GROC (mean ± SD) from 6 to 24 weeks than controls: 4.7(± 0.12) to 5.3 (± 0.13) vs. 4.4 (± 0.13) to 4.1(± 0.13), respectively, (P < 0.001). There was a significant group × time interaction on the WAI (P < 0.001): the AE group showed better improvement (mean ± SD) from baseline to 6-weeks than controls: 34.9 (± 4.4) to 39.2 (± 3.6) vs. 34.4 (± 4.9) to 35.8 (± 4.9), respectively, (P < 0.001). Work ability of participants with poor/moderate baseline scores improved more (P < 0.001) than those with good/excellent baseline scores (P = 0.48). CONCLUSIONS: Combining moderate AE and neck-specific exercise improved the work ability of patients with NP more than neck-specific exercise alone. The combination should be recommended in health promotion programs, particularly for workers with low baseline work ability. CLINICAL TRIAL: Registered at ClinicalTrial.gov: NCT02451267; date of registration: 21 May 2015. https://clinicaltrials.gov/ct2/home.

A multidisciplinary working model for promoting return to work of cancer survivors.

BACKGROUND: Despite wide recognition of the necessity of an integrative maintenance and return to work (RTW) program for cancer survivors, no such program has been described in the literature. AIMS: To examine a working model of an integrative multidisciplinary health care approach for promoting RTW, using the Delphi method. METHODS: A working model for promoting cancer survivors' RTW by oncology health professionals was subjected to two rounds of evaluation by an expert panel in accordance with the Delphi research method. Twenty-six international experts in oncology (social workers, nurses, psychologists, physicians, and cancer patients) participated in the first round and 16 participated in the second round. RESULTS: The mean score of the working model's applicability was 6.07 (SD = 1.07, range = 1-7). The model outlines in detail an integrative approach for promotion of RTW according to two axes: the oncology health professionals' role and the timeline axis featuring four stages of oncology treatment and follow-up. CONCLUSIONS: Our proposed model addresses the need for an integrated program that may increase the rate of RTW and improve the quality of life of cancer survivors. The model should be subjected to further evaluation, especially its adaptability to different health systems in different countries.

The effectiveness of an aerobic exercise training on patients with neck pain during a short- and long-term follow-up: a prospective double-blind randomized controlled trial.

OBJECTIVE: To examine the effect of adding aerobic exercise (AE) to neck-specific exercise treatment for patients with neck pain (NP) to reduce pain and disability. DESIGN: A prospective multicentre randomized controlled trial. SETTING: Physiotherapy outpatient clinics. SUBJECTS: Patients with nonspecific NP. INTERVENTION: Patients with NP were randomly assigned to six weeks of neck-specific exercise with and without the addition of AE. MEASURES: Patients were classified as having a successful or non-successful outcome according to the Global Rating of Change (GROC). Outcome measures included Visual Analogue Scale (VAS), Neck Disability Index (NDI), Fear Avoidance Beliefs Questionnaire (FABQ) and cervicogenic headache. Assessments were performed at six-week, and three- and six-month follow-ups. RESULTS: A total of 139 participants (mean age: 54.6 ± 10.5 years) were recruited (n = 69 AE, n = 70 control). According to GROC, 77.4% of the AE group reported a successful outcome at six months vs. 40% in the control group (P < 0.001). There was a significant reduction in VAS from baseline to six months in the AE vs. control group 6.73 (±1.69) to 1.89 (±1.37) vs. 6.65 (±1.67) to 3.32 (±1.82), respectively (P < 0.001). Significant improvements were also obtained for NDI and FABQ from baseline to six weeks in the AE group: NDI from 16.10 (±4.53) to 7.78 (±4.78) vs. 17.01 (±4.84) to 11.09 (±5.64) in the control group (P = 0.003); FABQ from 33.53 (±9.31) to 20.94 (±841) in the AE vs. 33.45 (±10.20) to 26.83 (±10.79) in the control group (P < 0.001). The AE group also demonstrated significant reduction in cervicogenic headache from baseline to six months (P = 0.003). CONCLUSION: Adding AE to long-term neck-specific exercises is an effective treatment for reducing NP and headache in patients with NP.

Returning to work after a hand injury: Does ethnicity matter?

BACKGROUND: Hand injuries (HI) are common and may limit participation in work. The objective of this study is to examine the effect of ethnicity and other prognostic variables on return-to-work (RTW) among male manual workers after acute HI. METHODS: A cohort of 178 subjects (90 Arabs, 88 Jews) aged 22 to 65 was studied. Trained bilingual occupational therapists evaluated and interviewed the subjects, using structured validated questionnaires for evaluating personal and environmental factors, body function and structure, and activity limitation and participation restrictions. Employment status 3 months post injury was assessed by a telephone interview. To establish a predictive model for RTW, ethnicity and certain variables of the four domains mentioned above were analyzed using logistic regression analysis. RESULTS: A significant difference in the rate of RTW between Jews and Arabs was found (45.5% for Jews, 28.9% for Arabs, p = 0.03) three months post HI. In the univariate regression analysis, ethnicity was associated with RTW (OR = 2.05; CI: 1.10-3.81) for Jews vs. Arabs. Using a multivariate analysis, only legal counseling, educational attainment, and the severity of disability were significantly associated with RTW. CONCLUSION: RTW three months post HI among manual workers is directly related to variables such as education and legal counseling and only indirectly related to ethnicity. Patients with a lower level of education and those who were engaged in legal counseling need special attention and close guidance in the process of RTW.

Prevalence of Asthma among Young Men Residing in Urban Areas with Different Sources of Air Pollution.

BACKGROUND: Asthma is a common respiratory disease, which is linked to air pollution. However, little is known about the effect of specific air pollution sources on asthma occurrence. OBJECTIVES: To assess individual asthma risk in three urban areas in Israel characterized by different primary sources of air pollution: predominantly traffic-related air pollution (Tel Aviv) or predominantly industrial air pollution (Haifa bay area and Hadera). METHODS: The medical records of 13,875, 16- 19-year-old males, who lived in the affected urban areas prior to their army recruitment and who underwent standard pre-military health examinations during 2012-2014, were examined. Nonparametric tests were applied to compare asthma prevalence, and binary logistic regressions were used to assess the asthma risk attributed to the residential locations of the subjects, controlling for confounders, such as socio-demographic status, body mass index, cognitive abilities, and education. RESULTS: The asthma rate among young males residing in Tel Aviv was 8.76%, compared to 6.96% in the Haifa bay area and 6.09% in Hadera. However, no statistically significant differences in asthma risk among the three urban areas was found in controlled logistic regressions (P > 0.20). This finding indicates that exposure to both industrial- and traffic-related air pollution is associated with asthma prevalence. CONCLUSIONS: Both industrial- and traffic-related air pollution have a negative effect on asthma risk in young males. Studies evaluating the association between asthma risk and specific air pollutants (e.g., sulfur dioxide, particulate matter, and nitrogen dioxide) are needed to ascertain the effects of individual air pollutants on asthma occurrence.

Prevalence of polyps ≥6 mm on follow-up CT colonography in a cohort with no significant colon polyps at baseline.

AIM: Assess the prevalence of neoplasia ≥6 mm at repeat CT colonoscopy (CTC) in individuals with no significant lesions at baseline. METHODS: Individuals aged ≥18 years, with/without CRC risk factors, with no polyps ≥6 mm on baseline CTC (negative baseline) who underwent repeat CTC in a large HMO from 2001 to 2011 were retrospectively identified. Studies were reviewed by board-certified radiologists with experience interpreting CTC. Demographic details, CRC risk factors, and the number, size, and location of incident lesions were noted. Findings were classified using the C-RADS scale. Lesion prevalence at CTC-2 was determined, and study interval and risk characteristics of patients with- and without findings were compared. RESULTS: Our study included 636 individuals (369 men [58.0%]; mean age 59.9 years) with negative baseline CTC who underwent repeat CTC after a mean 4.6 year interval (SD 1.6 years). At baseline, 469/636 (73.7%) were at average risk for CRC; 418 remained at average risk for CTC-2 with 51 (8.0%) developing new risk factors in the interval between studies. At CTC-2, 47 participants (7.4%) presented 52 significant neoplasia: 35 polyps 6-9 mm, 14 polyps ≥10 mm, and 3 masses in 3/636 participants (0.47%). 2/3 masses, 6/14 polyps ≥10 mm (42.9%), and 12/25 polyps 6-9 mm (48.0%) were in individuals with risk factors for CRC. Histopathology was available for 12/52 lesions (23.1%): 8 tubular adenomas, 2 villous adenomas, 1 hamartomatous polyp, 1 case of normal tissue. CONCLUSION: A mean 4.6 years after negative-baseline CTC, neoplasia ≥6 mm were seen in 7.4% of participants, including masses in 0.47%, supporting recommendations for a 5-year study interval.

Return-to-Work Barriers Among Manual Workers After Hand Injuries: 1-Year Follow-up Cohort Study.

OBJECTIVE: To determine time of return to work (TRTW) in relation to multivariable predictors among male manual workers after hand injury (HI) over a 12-month follow-up. DESIGN: A cohort study with baseline medical information, functional evaluation, and 3-, 6-, 9-, and 12-month follow-up telephone interviews. SETTING: Seven physical rehabilitation community occupational therapy clinics. PARTICIPANTS: Participants (N=178) with acute HI aged 22-65. Two participants were lost to follow-up. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: The dependent variable was TRTW. The independent variables originated from 4 domains: personal factors, environmental factors, body function and structure, and activity limitation and participation restriction. The proportion of return to work (RTW) at each time point was calculated. Multiple Cox regressions established a predictive model for TRTW. RESULTS: At the end of the study, 75.3% participants returned to work. The median TRTW was 94 days. In the final model, only compensation factors and education contributed significantly to overall RTW, but when separate analyses were performed, decreased level of self-efficacy, higher workplace demands, level of pain, level of emotional response to trauma, reduced physical capability of the hand, and higher level of disability were significantly associated with delayed TRTW. CONCLUSIONS: TRTW was determined by the physical capability of the hand, pain, and psychosocial factors, but it was also affected by legal factors. Participants who did not return to work during the first 9 months are at risk for long-term disability. Developing treatment programs for those who are at risk for not returning to work, taking into consideration these factors, is recommended.

Cancer epidemiology fieldwork in a resource-limited setting: Experience from the western Kenya ESCCAPE esophageal cancer case-control pilot study.

BACKGROUND: Case-control studies remain an important study design for aetiologic research on cancer, particularly when cohorts are not available. In addition to the potential biases inherent in this design, conducting fieldwork in settings with weak health care and information systems for cancer, such as in sub Saharan Africa, confer additional challenges which we present here with the aim to share experience to guide future studies. METHODS: We undertook a hospital-based case-control study of squamous cell esophageal cancer at the Moi Teaching and Referral Hospital in Eldoret, West Kenya. Cases were recruited at endoscopy and controls from hospital wards, age and gender frequency-matched to cases. Urine, toenails, blood and tumour biopsy were collected and a questionnaire administered. RESULTS: During this pilot phase, 143 cases and 155 controls were successfully recruited. Complete questionnaire data was obtained through e-data collection. Biospecimen collection was possible with support of an already existing equipped laboratory. We introduce changes made in the main study phase, including on expansion of the control groups to allow to consideration of selection bias. CONCLUSIONS: Extra attention and funding to train and monitor data quality and biospecimen collection and collaboration of a large group held together by strong leadership are essential. We recommend studies based on regional treatment centres with their more defined catchment areas rather than in the capital cities as referral routes in multi-level health care systems are severely attrition prone.

Cross-cultural adaptation of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Hebrew-speaking subjects with and without hand injury.

PURPOSE: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire is used internationally to assess function and disability. The instrument has been translated into several languages, but no Hebrew version exists. The objective of this study was to evaluate the use of the 12-item WHODAS 2.0 questionnaire among Hebrew speakers with and without hand injuries (HI). METHODS: The translated questionnaire was conducted among 155 uninjured subjects (UI) and 77 male workers with HI. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was assessed in UI subjects and calculated using the intraclass correlation coefficient (ICCagreement). Validity was evaluated by correlating the 12-item WHODAS 2.0 to the short-form of health survey (SF-12) in UI subjects and comparing the 12-item WHODAS 2.0 scores and the Quick Disability of Arm, Shoulder, and Hand (QDASH) Outcome Measure in the HI group. RESULTS: The Cronbach's alpha of the WHODAS 2.0 for the entire sample was α = 0.83. The ICCagreement for test-retest reliability was 0.88. A positive significant correlation was found between the 12-item WHODAS 2.0 and the QDASH (rs = 0.53, p < .005). CONCLUSIONS: The results support the reliability and validity of this Hebrew translation of the 12-item WHODAS 2.0. IMPLICATIONS FOR REHABILITATION Measurement tools that assess activities and participation after HI are an essential part of the rehabilitation process. The 12-item WHODAS 2.0 is a useful tool, since it addresses a broader range of activity and participation domains compared to the DASH and enables better implementation of the ICF model. Since the WHODAS 2.0 does not target a specific disease (as oppose to the DASH), it can be used to compare disabilities caused by different diseases or traumas. The WHODAS 2.0 measures both the function and disability in general populations as well as clinical situations; therefore, the instrument is useful for assessing both health and disability.

Different effects of long-term exposures to SO2 and NO2 air pollutants on asthma severity in young adults.

Numerous studies demonstrated that exposure to ambient air pollutants contributes to severity and frequency of asthma exacerbations. However, whether common air pollutants, such as nitrogen dioxide (NO2) and sulfur dioxide (SO2), exert differential effects on asthma occurrence and severity is unclear. The aim of this investigation was to determine whether exposure to NO2 and/or SO2 may initiate different long-term effects on prevalence and severity of asthma in young adults. Medical records of 137,040 males, 17 years old, who underwent standard premilitary service health examinations during 1999-2008 were examined. Air-pollution data for NO2 and SO2 were linked to the place of residence of each subject. The influence of specific air pollutants on asthma prevalence and severity was evaluated using bivariate logistic regression, controlling for individuals' sociodemographic attributes. For both ambient air pollutants, there was a significant dose-response effect on severity of asthma at ambient concentrations below the current National Ambient Air Quality Standards. However, in residential areas with high levels of SO2 (13.3-592.7µg/m(3)) and high levels of NO2 (27.2-43.2µg/m(3)) the risk of asthma occurrence was significantly higher than that in residential areas with high levels of NO2 (27.2-43.2 µg/m(3)) and intermediate levels (6.7-13.3 µg/m(3)) of SO2 pollution. The effects of exposure to SO2 and NO2 air pollutants on the respiratory airways system appear to differ, with possible implications regarding medical management, even in cases of exposure to mixtures of these pollutants.

Air Pollution and Respiratory Morbidity in Israel: A Review of Accumulated Empiric Evidence.

Studies of the respiratory effects of air pollution in Israel published in peer-reviewed journals have been infrequent. Most empiric evidence relates to the association between air pollution and childhood asthma; other air pollution effects on other illnesses are less thoroughly studied. Our evaluation provides a possible explanation for the quite contradictory results demonstrated in the various studies. Actual effect estimates appear to differ considerably, ranging from no air pollution effect to a reasonably strong association detected between PM10 and asthma. We attribute these discrepancies to different research methodologies and different types of data used in various studies.

Obstructive Sleep Apnea: Comparison of Syndrome Severity and Risk Factors for Adult Jewish and Arab Males in Northern Israel.

UNLABELLED: Background: Obstructive sleep apnea (OSA) is a common health problem with an estimated prevalence of 4% among men, many of whom are undiagnosed and untreated. OBJECTIVES: To compare demographic characteristics, health profiles, risk factors, and disease severity in Arab and Jewish men with OSA syndrome. METHODS: In this cross-sectional study we retrospectively analyzed clinical data from the medical files of men ≥ 22 years old who were referred to the Rambam Medical Center sleep clinic during the period 2001-2009 with a suspected diagnosis of OSA. OSA severity was measured using the apnea-hypopnea index (AHI). Categorical variables were compared using the chi-square test. Relations between OSA severity and a set of independent risk factors were assessed by linear regression analysis. RESULTS: A total of 207 men were included (39 Arabs, 19%; 168 Jews, 81%). Arab participants were younger than their Jewish counterparts (45.5 ± 8.9 years vs. 49.8 ± 11.8, P = 0.04) and their body mass index (BMI) was higher (3.1 ± 5.1 vs. 30.0 ± 4.4, P = 0.001). OSA severity (AHI score) was higher among Arab men, with low, medium and high severity scores seen in 10%, 33% and 56% of Arab men vs. 35%, 29% and 37% of Jewish men, respectively [T(198) = 2.39, P = 0.02]. Mean blood oxygen saturation was comparable. CONCLUSIONS: Arab men presenting for evaluation of sleep apnea harbored more severe OSA symptoms, were younger, and had higher BMI compared to Jewish men. Since OSA syndrome evolves for several years until it becomes severe, these findings suggest that Arab men seek medical assistance later than Jewish men with OSA.

Sugarcoated isolation: evidence that social avoidance is linked to higher basal glucose levels and higher consumption of glucose.

OBJECTIVE: The human brain adjusts its level of effort in coping with various life stressors as a partial function of perceived access to social resources. We examined whether people who avoid social ties maintain a higher fasting basal level of glucose in their bloodstream and consume more sugar-rich food, reflecting strategies to draw more on personal resources when threatened. METHODS: In Study 1 (N = 60), we obtained fasting blood glucose and adult attachment orientations data. In Study 2 (N = 285), we collected measures of fasting blood glucose and adult attachment orientations from older adults of mixed gender, using a measure of attachment style different from Study 1. In Study 3 (N = 108), we examined the link between trait-like attachment avoidance, manipulation of an asocial state, and consumption of sugar-rich food. In Study 4 (N = 115), we examined whether manipulating the social network will moderate the effect of attachment avoidance on consumption of sugar-rich food. RESULTS: In Study 1, fasting blood glucose levels corresponded with higher attachment avoidance scores after statistically adjusting for time of assessment and interpersonal anxiety. For Study 2, fasting blood glucose continued to correspond with higher adult attachment avoidance even after statistically adjusting for interpersonal anxiety, stress indices, age, gender, social support and body mass. In Study 3, people high in attachment avoidance consume more sugar-rich food, especially when reminded of asocial tendencies. Study 4 indicated that after facing a stressful task in the presence of others, avoidant people gather more sugar-rich food than more socially oriented people. CONCLUSION: RESULTS are consistent with the suggestion that socially avoidant individuals upwardly adjust their basal glucose levels and consume more glucose-rich food with the expectation of increased personal effort because of limited access to social resources. Further investigation of this link is warranted.

Work Ability Index in Israeli hospital nurses: applicability of the adapted questionnaire.

UNLABELLED: BACKGROUND/STUDY CONTEXT: The Work Ability Index (WAI) questionnaire is widely used for evaluation of the work ability of workers. This is the first application of the validated Hebrew version of this questionnaire to Israeli nurses in order to evaluate factors affecting their work ability. METHODS: A cross-sectional study was conducted among 515 nurses from two general hospitals in Israel (87.3% female). RESULTS: A significant negative correlation was found between the WAI score and age, years in current job, and number of reported diagnoses. The most frequently reported illnesses (as diagnosed by a physician) were musculoskeletal disorders, endocrine/metabolic diseases, and cardiovascular diseases. Agreement between illnesses as diagnosed by a physician and as self-reported by nurses was low, especially with respect to mental/emotional stress, (kappa statistics = 16.4%, p < .001). CONCLUSIONS: Mean WAI score found in Israeli hospital nurses is relatively high as compared with that of European nurses. It gradually decreases with age. The WAI questionnaire enables the early identification of those nurses with compromised work ability and who are in need of assistance in order to prevent early retirement. As retirement age is currently advancing, keeping elderly workers in the workforce is of prime importance.

[Occupational asthma--the case of bakers' asthma].

Occupational asthma (OA) is the most common of all occupational lung diseases in industrialized countries and its prevalence has been rising steadily. It is estimated that occupational factors account for one out of six cases of adult asthmatic patients causing significant morbidity, disability and costs. Due to its high prevalence and substantial health and socio-economic impacts OA represents a significant public health concern. OA can be divided into allergic and non allergic asthma. Allergic OA is further divided into IgE mediated and non IgE mediated. Baker's asthma (BA), is the leading cause of IgE mediated OA caused by high molecular weight antgens in industrialized countries. Innovations in the baking industry during the last few decades have led to the introduction of new allergens inducing OA. OA is potentially preventable, through early diagnosis and exposure cessation interventions. Thus, clinicians should consider the occupational history in every adult patient presenting with newly diagnosed asthma.

[Mediterranean diet in cancer patients and cancer free adult Arabs in Israel--a case-control study].

BACKGROUND: Although several studies have investigated the association of the Mediterranean diet (MD) with overall risk of specific cancers, data on overall cancer risk are sparse, especially in Arab populations. OBJECTIVES: To compare between the score of MD in cancer patients and cancer-free adult Israeli Arabs in order to identify risk factors amenable to intervention. METHODS: A case control study was conducted in northern Israel, involving 200 Arab subscribers of a regional Health Maintenance Organization (HMO). RESULTS: An inverse association was found (p = 0.000) between Mediterranean diet score and cancer, with OR = 0.4, 95% CI = 0.260-0.612. CONCLUSIONS: Greater adherence to Mediterranean diet is associated with lower prevalence of cancer. The adoption of this dietary pattern also seems to moderate the prevalence of obesity and risks of chronic diseases.

Incidence of cancer among diabetic and non-diabetic adult Israeli Arabs.

BACKGROUND: A worldwide epidemic of type 2 diabetes mellitus (T2DM) is in progress. This disease carries a heavy socioeconomic burden. OBJECTIVES: To compare the incidence rate of overall and site-specific cancers among Israeli Arabs with T2DM to that of Israeli Arabs without. METHODS: A retrospective cohort study of all adult Arab members of Clalit Health Care Services in northern Israel was conducted over a 10 year period (1999-2008). RESULTS: During the study period 752 and 2045 incident cases of cancer were diagnosed among 13,450 adults with diabetes and 74,484 without, respectively. The follow-up time involved 817,506 person-years. Diabetes was associated with a standard incidence ratio (SIR) of 3.27 (95% CI 1.49-5.05) and 2.87 (95% CI 1.25-4.50) for pancreatic cancer in men and women, respectively. A significantly reduced SIR (0.67, 95% CI 0.36-0.99) was observed for esophageal, stomach and intestinal cancers in men. CONCLUSIONS: Our findings support an association between T2DM and increased risk of cancer of the pancreas in Arab men and women. A significantly reduced risk of all other cancers was observed only in Arab men. Our findings underscore the need for effective diabetes and cancer prevention and intervention programs.

Occupational exposures and symptoms among firefighters and police during the carmel forest fire: the Carmel cohort study.

BACKGROUND: From 2 to 5 December 2010, Israel experienced the most severe forest fire In its history, resulting in the deaths of rescue workers. Little research exists on the health risks to emergency responders during forest fires, and there is no published research to date on occupational health among firefighters in Israel. OBJECTIVES: To describe the exposures experienced by emer gency responders to smoke, fire retardants and stress; the utilization of protective equipment; and the frequency of corresponding symptoms during and following the Carmel Forest fire. METHODS: A cohort of 204 firfighers and 68 police who took part in rescue and fire-abating activites during the Carmel Forest fire were recruited from a representative sample of participating stations throughout the country and interviewed regarding their activities during the fire and their coinciding symptoms. Unpaired two-sample t-test compared mean exposures and symptom frequency for firefighters and police. Chi-square estimates of OR and 95%CI are provided for odds of reporting symptoms, incurring injury or being hospitalied for various risk factors RESULTS: Of the study participants, 87% reported having at least one symptom during rescue work at the Carmel Forest fire,with eye irritation (77%) and fatigue (71%) being the most comon. Occupational stress was extremely high during the fire; the average length of time working without rest was 18.4 hours among firefighters. CONCLUSION: Firefighter and police were exposed to smoke and ocupational stress prolonged periods during the fire. Further research is needed on the residual health effects from exposure to forest fires among emergency responders, and to identify areas for improvement in health preparedness.