Enhancing interoceptive sensibility through exteroceptive-interoceptive sensory substitution.

Exploring a novel approach to mental health technology, this study illuminates the intricate interplay between exteroception (the perception of the external world), and interoception (the perception of the internal world). Drawing on principles of sensory substitution, we investigated how interoceptive signals, particularly respiration, could be conveyed through exteroceptive modalities, namely vision and hearing. To this end, we developed a unique, immersive multisensory environment that translates respiratory signals in real-time into dynamic visual and auditory stimuli. The system was evaluated by employing a battery of various psychological assessments, with the findings indicating a significant increase in participants' interoceptive sensibility and an enhancement of the state of flow, signifying immersive and positive engagement with the experience. Furthermore, a correlation between these two variables emerged, revealing a bidirectional enhancement between the state of flow and interoceptive sensibility. Our research is the first to present a sensory substitution approach for substituting between interoceptive and exteroceptive senses, and specifically as a transformative method for mental health interventions, paving the way for future research.

Remote Pilates Training Is Effective in Improving Physical Fitness in Healthy Women: A Randomized Controlled Study.

Despite its positive impact on physical and mental well-being, adults may refrain from performing regular physical activity, due to inadequate time, accessibility, or funds. Yet remote platforms could overcome such obstacles and increase participation. This study evaluated the effectiveness of remote-synchronous group-Pilates classes compared to in-studio classes in healthy sedentary women. In a randomized controlled design, 40 women, aged 20-45, were assigned to a Zoom or studio group-Pilates training. The intervention included twice-weekly 45 min sessions over an eight-week period. Attendance (adherence) was recorded, and the participants completed physical motor tests (plank, curl-up, stork, push-up, and V-sit and reach), Profile of Mood State Surveys, and Nordic Musculoskeletal Pain Questionnaires. Evaluations were performed at baseline, mid-intervention (4 weeks), and post intervention (8 weeks). Adherence to training was high in the Zoom and studio groups (80% and 74%, respectively). Improvements in physical motor tests were seen in both groups following the Pilates interventions, thereby indicating the effectiveness of group-Pilates Zoom training. In conclusion, remote online physical activity such as Pilates offers a good alternative to in-studio trainings, as a means for improving physical fitness and promoting a healthy lifestyle in adults, by offering a more accessible and less timely alternative to in-studio physical activity programs.

Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats.

BACKGROUND: Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria. OBJECTIVES: To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties. METHOD: We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS). RESULTS: On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct. CONCLUSIONS: These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

Does sense of threat in civilians during an armed conflict predict subsequent depression symptoms?

OBJECTIVE: We aimed to assess whether peritraumatic threat experienced during a period of armed conflict predicted subsequent depression symptoms. METHOD: Ninety-six Israeli civilians provided real-time reports of exposure to rocket warning sirens and subjective sense of threat, twice daily for 30 days, during the 2014 Israel-Gaza conflict. Depression symptoms were reported 2 months after the conflict. Mixed-effects models were used to estimate peritraumatic threat levels and peritraumatic threat reactivity (within-person elevations in threat following siren exposure). These were then assessed as predictors of depression symptoms at 2 months in an adjusted regression model. RESULTS: Individual peritraumatic threat level, but not peritraumatic threat reactivity, was a significant predictor of 2 months depression symptoms, even after controlling for baseline depression symptoms. CONCLUSIONS: The findings imply that in situations of ongoing exposure, screening for perceived levels of peritraumatic threat might be useful in identifying those at risk for developing subsequent depression symptoms.

Do posttraumatic stress symptoms mediate the relationship between peritraumatic threat and posttraumatic growth? A prospective experience sampling study.

Objectives: The current study examined whether peritraumatic threat predicted posttraumatic growth (PTG), and whether the relationship between peritraumatic threat and PTG was mediated by post-traumatic stress (PTS) symptoms.Design: A prospective experience sampling study. Methods: 96 Israeli civilians provided smartphone reports of their rocket warning siren exposure and peritraumatic threat, twice daily for 30 days, during the 2014 Israel-Gaza conflict. PTS symptoms data were collected one month after entry to the study, PTG data were collected five months after entry to the study. PTG predictors were assessed using a hierarchical multivariate regression model. A mediation analysis was conducted to assess the indirect effect of peritraumatic threat on PTG via PTS symptoms.Results: One month PTS symptoms and level of exposure to the conflict were both significant PTG predictors. After controlling for potential covariates, the relationship between peritraumatic threat and PTG scores was fully mediated by PTS symptoms.Conclusions: PTS symptoms mediated the relationship between peritraumatic threat and subsequent PTG. Screening trauma survivors for levels of threat and PTS symptoms may be helpful in tailoring therapeutic approaches that will aid in alleviating stress symptoms on one hand and increase the likelihood of growth and better health outcomes on the other.

Differences in posttraumatic stress characteristics by duration of exposure to trauma.

Ongoing exposure of civilian populations to war and terror is associated with adverse responses beyond those specified in DSM-5 for PTSD. Current PTSD assessment practices are not fully sensitive to the complex symptomatic picture observed among individuals exposed to ongoing stress and are therefore limited for use in these situations. The current survey aimed to portray the posttraumatic characteristics most salient to ongoing exposure to political conflict. A questionnaire enquiring about various aspects of the posttraumatic consequences of ongoing exposure to political conflict as compared with those associated with a single exposure to trauma was disseminated to therapists throughout the country. Participants were asked to rank 75 posttraumatic characteristics for their relevance to each trauma type (about the symptom frequency and severity) and item mean scores were compared. The sample consisted of 66 responses valid for analysis. Our findings pinpoint some of the posttraumatic characteristics most salient to ongoing exposure to political conflict and highlight the complexity of the posttraumatic picture observed in these situations. Incorporating these in post trauma assessment tools will allow for the development of standardized, reliable definitions, which in turn will allow for more accurate diagnosis and more effective treatment protocols.

A study of the workforce in emergency medicine in Israel 2012: what has changed in the last decade?

OBJECTIVE: In 2003, we published a study on the Israeli workforce in emergency medicine (EM). We repeated the study in 2012 to assess changes in the workforce that have occurred in the interval decade. METHODS: This is an observational cross-sectional study of the physician workforce in EM in Israel in 2012. An online survey was sent to the ED medical directors of all general hospitals in Israel querying the numbers of physicians working in the ED, as well as the specialty and level of training of those manning the ED at various times during the day. The workforce in 2012 was compared to that of 2003. RESULTS: Twenty-four of 28 (86 %) EDs responded. Certified EM specialists have increased from 59 to 164 since 2003. Disparities continue regarding their presence in the ED. Most EM specialists are scheduled during the day whereas they are virtually absent during the night. A total of 58 EM specialists were scheduled countrywide for the weekday day shift and only one overnight. The preponderance of EM specialists working during the day and the large number of supervised and unsupervised residents working at night has not changed substantially since 2003. Eleven departments reported having an EM specialist present during the evenings whereas in 2003, only two departments reported so. CONCLUSION: Since 2003, there are more certified EM specialists and more specialist coverage in the ED into the evening hours. Most ED providers are still not emergency physicians, and there is still a preponderance of EM specialist coverage during the day and a lack thereof overnight.

Varied utilisation of health provision by Arab and Jewish residents in Israel.

INTRODUCTION: Provision of healthcare is considered a basic human right. Delivery and uptake is affected by many complex factors. Routine vaccinations are provided free of charge in Israel to all residents. The Palestinian Israeli Collaborative Research (PICR) group conducted research on vaccine impact at eight primary care facilities in east Jerusalem (EJ) and central Israel (IL) which allowed assessment and comparison of interactions of these Arab and Jewish populations, respectively, with healthcare services. METHODS: Families attending clinic with a child under five years old were invited to participate. Utilisation of healthcare was assessed using data from standardise questionnaires completed after enrolment, using proxies of vaccination status, antibiotic use, primary care physician and hospital visits as well as demographics such as household size. Differences between EJ and IL were assessed using chi squared tests; univariate analyses identified potential confounders which were tested in a multiple logistic regression model for any independent associations between region and outcome. RESULTS: Children in EJ were significantly more likely to live in larger households, with tobacco smokers, to have been breastfed, hospitalised and used antibiotics recently than those in IL, who were significantly more likely to have recently seen a primary care physician (all p < 0.01). Receipt of routine vaccinations, given at well baby clinics, was similar between the regions at above 95% (p = 0.11), except for influenza which was delivered separately at primary physician clinics to 5% (EJ) and 12% (IL). Receipt of pneumococcal vaccine when paid for separately was significantly higher in IL than EJ (3% vs 31%). Multivariate analysis identified the most important independent predictors of these differences as region, age and household size. CONCLUSIONS: Healthcare in Israel is of a very high standard, but it is not uniformly utilised within the community in all geographical areas, though in some key areas, such as uptake of most routine childhood vaccination, equality seems to be achieved. To ensure excellent healthcare is achieved across the population, inequalities must be addressed, for instance in health promotion and other activities, which could improve and normalise health outcomes.

Measuring the effects of pneumococcal conjugate vaccine (PCV7) on Streptococcus pneumoniae carriage and antibiotic resistance: the Palestinian-Israeli Collaborative Research (PICR).

BACKGROUND: The Palestinian-Israeli Collaborative Research (PICR) cross-conflict setting provided a unique opportunity to study overall and indirect effects of pneumococcal conjugate vaccine (PCV7), in two closely related Palestinian populations governed by two distinct health authorities with distinct vaccination policies. Here, PCV7 effects on pneumococcal carriage, serotype distribution and antibiotic resistance are reported. METHODS: Annual cross-sectional surveys of pneumococcal carriage were performed during 2009-2011 among Palestinian children (≤5 years) (a) under Palestinian-Authority (PA) health policy (Ramallah, Nablus and Bethlehem), where PCV7 was unlicensed (b) under Israeli health policy (East-Jerusalem (EJ)) where PCV7 was rapidly implemented from July 2009. Clinical data were collected, pneumococci identified and characterized for antibiotic susceptibilities and serotype. Analyses included multivariate logistic models with an interaction term for PCV7-effect. RESULTS: Altogether, 2755 children from PA (n=1772) and EJ (n=983) were enrolled, of which ~30% were pneumococcal carriers. While overall carriage was not affected by vaccination policy, carriage of vaccine-type (VT7) strains decreased from 52% to 22% (p<0.001) in EJ, where PCV was implemented, but not in PA. This was accompanied by an increase in non-VT13 strains from 34% to 65% (p<0.001) in EJ, but not in PA. Furthermore, within two years post-PCV7 introduction, proportion of multi-drug resistant strains, which was initially 23% in both populations, decreased significantly in EJ, to 10%, while simultaneously it increased in PA to 33% (p<0.001). Similar trends were observed for resistance to most antibiotic groups. The proportion of resistant isolates among non-VT13 strains did not change during the study period. CONCLUSIONS: The unique study design distinguishes secular and seasonal effects from true vaccine effects. While PCV7 did not affect overall pneumococcal carriage rate, VT7 strains, many of which were antibiotic resistant decreased and were replaced by non-VT13 strains, which were mostly not antibiotic resistant, resulting in a net decrease in antibiotic resistance.

A typical hospital-acquired methicillin-resistant Staphylococcus aureus clone is widespread in the community in the Gaza strip.

Epidemiological data on community acquired methicillin-resistant-Staphylococcus aureus (CA-MRSA) carriage and infection in the Middle-East region is scarce with only few reports in the Israeli and Palestinian populations. As part of a Palestinian-Israeli collaborative research, we have conducted a cross-sectional survey of nasal S. aureus carriage in healthy children and their parents throughout the Gaza strip. Isolates were characterized for antibiotic susceptibility, mec gene presence, PFGE, spa type, SCCmec-type, presence of PVL genes and multi-locus-sequence-type (MLST). S. aureus was carried by 28.4% of the 379 screened children-parents pairs. MRSA was detected in 45% of S. aureus isolates, that is, in 12% of the study population. A single ST22-MRSA-IVa, spa t223, PVL-gene negative strain was detected in 64% of MRSA isolates. This strain is typically susceptible to all non-ß-lactam antibiotics tested. The only predictor for MRSA carriage in children was having an MRSA carrier-parent (OR=25.5, P=0.0004). Carriage of the Gaza strain was not associated with prior hospitalization. The Gaza strain was closely related genetically to a local MSSA spa t223 strain and less so to EMRSA15, one of the pandemic hospital-acquired-MRSA clones, scarcely reported in the community. The rapid spread in the community may be due to population determinants or due to yet unknown advantageous features of this particular strain.

Cancer in parents of persons with schizophrenia: is there a genetic protection?

A reduced risk for cancer has been noted among persons with schizophrenia as well as their first degree relatives. One explanation for these findings suggests that genes associated with schizophrenia confer reduced cancer susceptibility. Given the well documented genetic factor in schizophrenia it could thus be expected that cancer incidence rates should be lower in persons with schizophrenia with a known family history of schizophrenia compared to persons with sporadic schizophrenia, as well as their first degree relatives. This study investigated the risk for cancer among the biological parents of persons with schizophrenia accounting for the familial aggregation. Linkage was conducted between national population, psychiatric and cancer databases. Standardized incidence rates for all cancer sites were calculated by comparing the parents' rates with those of the general population. In addition, the association between familial aggregation of schizophrenia and risk for cancer was calculated among the parents. A reduced cancer risk was found among the parents compared to the general population (SIR 0.8, 95% CI 0.8-0.9). However, no evidence of decreased risk was associated with familial schizophrenia. Thus, no association between familial aggregation and cancer incidents was found with regard to most cancer sites. Moreover, a small, but not statistically significant increased risk of colon cancer was associated with familial aggregation scores among the parents (OR 1.2, 95% CI 1.0-1.5). These findings undermine the support to the genetic explanation for the reduced risk for cancer in schizophrenia among patients and their biological parents.

Streptococcus pneumoniae carriage in the Gaza strip.

BACKGROUND: Pneumococcal infections cause major morbidity and mortality in developing countries. We report the epidemiology of S. pneumoniae carriage in a developing region, the Gaza strip, and evaluate the theoretical coverage of carriage strains by pneumococcal conjugate vaccines (PCVs). METHODOLOGY: In 2009 we conducted a cross-sectional survey of S. pneumoniae carriage in healthy children and their parents, living throughout the Gaza strip. Data were collected and nasopharyngeal swabs were obtained. Antibiotic susceptibilities were determined by Vitek-2 and serotypes by the Quellung reaction. PRINCIPAL FINDINGS: S. pneumoniae carriage was detected in 189/379 (50%) of children and 30/376 (8%) of parents. Carriage prevalence was highest in children <6 months of age (63%). Significant predictors for child carriage were number of household members and DCC attendance. The proportion of pediatric and adults isolates with serotypes included in PCV7 were 32% and 20% respectively, and 46% and 33% in PCV13 respectively. The most prominent non-vaccine serotypes (NVT) were 35B, 15B/C and 23B. Penicillin-nonsusceptible strains were carried by 70% of carriers, penicillin-resistant strains (PRSP) by 13% and Multi-drug-resistant (MDR) by 30%. Of all PRSP isolates 54% belonged to serotypes included in PCV7 and 71% in the PCV13. Similarly, 59% and 73% of MDR-SP isolates, would theoretically be covered by PCV7 and PCV13, respectively. CONCLUSIONS: This study demonstrates that, PCV13-included strains were carried by 46% and 33% of pediatric and adult subjects respectively. In the absence of definitive data regarding the virulence of the NVT strains, it is difficult to predict the effect of PCVs on IPD in this region.

Transmission of Staphylococcus aureus from mothers to newborns.

BACKGROUND: The study objective was to define the risk factors and the route of Staphylococcus aureus transmission between mother and newborn. METHODS: Women at late pregnancy were screened for nasal and vaginal S. aureus colonization. Newborns were screened for nasal, auricular, umbilical, and rectal colonization at birth and before discharge. Carrier mothers and their newborns were rescreened at 1 month. Pulse-field gel electrophoresis was used to assess strain genetic relatedness. RESULTS: Of the 208 women screened, 34% were colonized with S. aureus. Overall, by 72-100 hours after birth, the cumulative incidence of S. aureus acquisition was 42.6/100 newborns of carrier mothers versus 7.4/100 newborns of noncarrier mothers (adjusted risk ratio = 5.7; 95% confidence interval [CI], 2.3-13.9). The risk to acquire a maternal strain was significantly higher than nonmaternal strain (adjusted risk ratio = 1.5; 95% CI, 1.3-1.9); Newborns to carrier mothers were also at a risk to acquire nonmaternal S. aureus strains compared with newborns to noncarrier mothers (adjusted risk ratio = 2.9; 95% CI, 1.6-5.4). The cumulative incidence of S. aureus acquisition was similar among newborns delivered by cesarean versus vaginal delivery (24.5 vs. 23.0/100 cases). At 1-month follow-up, the cumulative incidence of S. aureus acquisition reached 69.7/100 newborns of carrier mothers.Genetically identical strains were isolated in 32/40 (80%) mother-newborn pairs, among these, the source of the newborn strain was a maternal nasal strain in 29/32 (90%). CONCLUSIONS: Newborns of carrier mothers are at risk to acquire S. aureus colonization. Most newborns of carrier mothers are colonized within the first month of life. Horizontal transmission from the mother is probably the major source for S. aureus carriage in newborns.

Depressive symptoms, risk factors and sleep in asthma: results from a national Israeli health survey.

OBJECTIVE: The objective was to assess the association between asthma and depressive symptoms (DS) and to evaluate the relationship between DS and risk factors [smoking, physical inactivity, body mass index (BMI) and sleep duration] in asthmatic individuals. METHODS: We analyzed data from the Israeli National Health Interview Survey, conducted among 9509 participants aged ≥21 years in 2003-2004. Data on sociodemographic factors, chronic respiratory disorders, DS and risk factors were obtained through telephone interviews. DS were measured using Short Form 36 mental health items. Analyses were performed using multivariate logistic regression models. RESULTS: A total of 393 participants (4.2%) reported chronic asthma in the 12 months previous to the interview. Of those, 37.4% had DS, compared with 21.8% of nonasthmatic participants [odds ratio (OR), 1.84; 95% confidence interval (CI), 1.47-2.30; P<.001]. DS in asthmatic individuals were significantly associated with physical inactivity [adjusted OR (AOR), 2.01; 95% CI, 1.12-3.61; P=.02], with smoking (AOR 1.80; 95% CI, 1.04-3.12; P=.04) and with less sleep (AOR, 1.81; 95% CI, 1.03-3.19; P=.04). DS in asthmatic participants were not associated with BMI. CONCLUSIONS: DS are common in asthmatic individuals and are significantly associated with physical inactivity, with smoking and with less hours of sleep. Such health-related risk factors may impact on the course of asthma and on overall health.

[Chronic asthma, depressive symptoms and risk behaviors: results from a national health survey].

BACKGROUND: Previous research suggests that depression is common in individuals with asthma. Research on the association between depressive symptoms and health-related risk behaviors in persons with respiratory disorders is scarce. OBJECTIVE: To assess the association between asthma and depressive symptoms; and to evaluate the relationship between depressive symptoms and risk behaviors (smoking, physical inactivity and obesity) in individuals with asthma. METHODS: We analyzed data from the Israeli National Health Interview Survey [INHIS-1), conducted on a large sample (N = 9,509) of the adult Israeli population (age > or = 21 years) in 2003-4. Data on socio-demographic factors, chronic respiratory conditions, depressive symptoms and risk behaviors were obtained through telephone interviews. Analyses were performed using adjusted Logistic regression models. RESULTS: A total of 381 participants (4.0%) reported chronic asthma in the year previous to the interview. Of those, 15.5% had moderate depressive symptoms compared with 7.2% of participants with no respiratory conditions (odds ratio, 1.95; 95% CI, 1.40-2.72; P < .0001). Depressive symptoms in individuals with asthma were significantly associated with smoking (adjusted odds ratio (AOR) 3.31; 95% CI, 1.58-6.91; P = .001 for moderate depressive symptoms; AOR 1.91; 95% CI, 1.05-3.45; P = .03 for mild depressive symptoms); moderate but not mild depressive symptoms were significantly associated with physical inactivity (AOR, 3.05; 95% CI, 1.52-6.12; P = .002). These associations were stronger in females. Depressive symptoms were not associated with obesity. CONCLUSIONS: Among Israelis with chronic asthma, depressive symptoms are associated with important differences in health behaviors (higher rates of smoking and lack of physical activity) which may impact on the course of respiratory illness and on overall health.

Physical inactivity among adults with diabetes mellitus and depressive symptoms: results from two independent national health surveys.

OBJECTIVE: To examine the association between depressive symptoms and physical inactivity in community samples of patients with diabetes mellitus (DM). METHODS: Two representative samples of Israeli adults (age ≥21 years) were analyzed: The First Israeli National Health Interview Survey (INHIS-1) (n=9509) and the Israel National Health Survey (INHS) (n=4859). Information was obtained about past-month depressive symptoms, physician-diagnosed DM and physical activity. Multiple logistic regression models were used to examine the association between level of depressive symptoms and physical inactivity among individuals with DM, adjusting for potential confounders. RESULTS: Prevalence of DM ranged from 7.2% (INHIS-1) to 8.7% (INHS). In both samples, physical inactivity was significantly more prevalent among persons with significant depressive symptoms, compared to those without depressive symptoms [INHIS-1: 67.0% vs. 50.6%; adjusted odds ratio (AOR): 1.57; 95% confidence interval (95% CI), 1.05-2.35, P=.03; INHS: 71.4% vs. 43.9%; AOR: 2.67; 95% CI, 1.67-4.27, P<.0001]. CONCLUSIONS: Depressive symptoms were associated with a higher likelihood of physical inactivity in persons with DM. Body mass index of patients reporting no regular physical activity was elevated compared to persons who were physically active. This finding supports the view that identification and management of depression should be part of interventions designed to improve self care behaviors in patients with DM.

The relationship of chronic pain with and without comorbid psychiatric disorder to sleep disturbance and health care utilization: results from the Israel National Health Survey.

OBJECTIVE: Chronic pain is associated with health problems including sleep difficulties and increased medical utilization. Because chronic pain is frequently comorbid with psychiatric disorders, it is unclear to what degree chronic pain itself is associated with these problems. In a large population sample, we examined the relationship between chronic pain, both alone and comorbid with psychiatric disorders, with sleep disturbance and increased medical utilization. METHODS: We analyzed data from the Israel National Health Survey (INHS) conducted in 2003-2004 on a representative sample (N=4859) of the adult Israeli population. Data were collected in face-to-face interviews using the Composite International Diagnostic Interview. Statistical analyses were performed using multinomial logistic regression models. RESULTS: Past year chronic pain was reported by 29.9% of all study participants (n=1453). Psychiatric disorders were more common among participants with chronic pain; adjusted odds ratios were 2.23 (95% CI 1.49-3.36) for depressive disorders and 2.94 (95% CI 2.08-4.17) for anxiety disorders. Associations of chronic pain and psychiatric disorders were stronger in men. Chronic pain was associated with both sleep problems and increased health care utilization even for individuals with no psychiatric comorbidity. Sleep difficulties but not health care utilization rates were more pronounced in the comorbid group compared to the chronic pain only group. CONCLUSION: Chronic pain was associated with sleep problems and increased health care utilization in this sample, independent of psychiatric comorbidity. Sleep problems were significantly greater in the comorbid vs. non-comorbid group. In contrast, associations of pain with health care utilization were largely independent of psychiatric comorbidity.

The risk of breast cancer in relation to health habits and occupational exposures.

BACKGROUND: The age-adjusted incidence rate of breast cancer has increased for Israeli women. Our aim was to explore the hypothesis that occupational exposures are important risk factors, taking into consideration main known risk factors. METHODS: The study population included 326 breast cancer cases from one hospital in the center of the country and 413 women without known diagnosis of cancer. Every participant was interviewed using a structured questionnaire. RESULTS: We found that working in textile and clothing and in various industries, OR (95% confidence interval), 1.8 (1.1-3.0), 4.3 (2.0-9.3) respectively, and exposure to ionizing radiation OR 5.3 (2.4-14.1) as well as age and having a family history of breast cancer significantly increased the risk of developing breast cancer. Administrative work, adherence to high fiber diet and low salt diet significantly lowered the risk of breast cancer. CONCLUSIONS: Our study supported the assumption that occupational exposure may contribute to the etiology of breast cancer.