Modeling long-term effects attributed to nitrogen dioxide (NO2) and sulfur dioxide (SO2) exposure on asthma morbidity in a nationwide cohort in Israel.

Studies have provided extensive documentation that acutely elevated environmental exposures contribute to chronic health problems. However, only attention has been paid to the effects of modificate of exposure assessment methods in environmental health investigations, leading to uncertainty and gaps in our understanding of exposure- and dose-response relationships. The goal of the present study was to evaluate whether average or peak concentration exerts a greater influence on asthma outcome, and which of the exposure models may better explain various physiological responses generated by nitrogen dioxide (NO2) or sulfur dioxide (SO2) air pollutants. The effects of annual NO2 and SO2 exposures on asthma prevalence were determined in 137,040 17-year-old males in Israel, who underwent standard health examinations before induction to military service during 1999-2008. Three alternative models of cumulative exposure were used: arithmetic mean level (AM), average peak concentration (APC), and total number of air pollution exposure episodes (NEP). Air pollution data for NO2 and SO2 levels were linked to the residence of each subject and asthma prevalence was predicted using bivariate logistic regression. There was significant increased risk for asthma occurrence attributed to NO2 exposure in all models with the highest correlations demonstrated using the APC model. Data suggested that exposure-response is better correlated with NO2 peak concentration than with average exposure concentration in subjects with asthma. For SO2, there was a weaker but still significant exposure response association in all models. These differences may be related to differences in physiological responses including effects on different regions of the airways following exposure to these pollutants. NO2, which is poorly soluble in water, penetrates deep into the bronchial tree, producing asthmatic manifestations such as inflammation and increased mucus production as a result of high gaseous concentrations in the lung parenchyma. In contrast, SO2, which is highly water soluble, exerts its effects rapidly in the upper airways, leading to similar limited correlations at all levels of exposure with fewer asthmatic manifestations observed. These data indicate that differing exposure assessment methods may be needed to capture specific disease consequences associated with these air pollutants.

[The role of occupational exposures in the etiology of bladder cancer].

In a case-control study in southern Israel, 150 male subjects with histologically proven transitional cell cancer (TCC) of the bladder were matched with 150 controls. Both groups were interviewed regarding past occupational exposures, lifestyle habits, and co-morbidities. Significant associations were demonstrated between certain occupational exposures and the risk to develop TCC. These exposures were (a) organic solvents (OR 3.5, 95% CI = 1.4-8.4), (b) aromatic amines and\or paints (OR = 2.7, 95% CI = 1.1-6.3) and (c) PAHs (OR = 1.9, 95% CI = 1.2-4.3). Similarly, significant associations were found between certain occupations (jobs) and the risk of future TCC, such as metal workers and welders. In conclusion, certain types of occupational exposures and industrial jobs bear extra risk for the future development of TCC (in addition to the well established risk of smoking). Thus, better identification and control of these occupational risk factors (chemicals and work processes) is required in order to reduce the risk for this relatively common cancer and improve protection for the relevant groups of workers.

Regional occupational health service - an assessment.

AIM: To present, partially in quantitative terms, the basic characteristics of a regional occupational health service in southern Israel. METHOD: Records of the annual activities of the regional occupational health service were analyzed over a period of about 10 years. RESULTS: Overall there were about 25,000 contacts per year, such that about 15,000-16,000 different individuals were examined each year (out of a population of about 150,000 workers). About 45% of the examinations performed were surveillance (statutory), 38% fitness-to-work, and 15% pre-employment examinations. These proportions were quite stable over the whole study period, even though services are provided to hundreds of work-sites of markedly different sizes, exposures, and technological development. As expected, the type and rate of abnormal findings differ significantly among the 3 categories: 7% for pre-employment examinations, 18% for surveillance, and 53% for fitness-to- work examinations. CONCLUSION: In order to provide adequate occupational health services to a large, non-uniform population of workers, a clear understanding of the "occupational map" of the region is needed. A good insight into the characteristics, aims, and scope of the 3 main categories of examinations used in occupational health could assist in forecasting, planning, and providing adequate regional occupational health service.

Assessment of work-related risks factors for carpal tunnel syndrome.

BACKGROUND: The association of carpal tunnel syndrome with occupational risk factors is well established. However, in clinical practice these factors are only rarely considered and evaluated. Managing these risk factors could prevent the occurrence of future cases and alleviate treatment of the afflicted individuals. OBJECTIVES: To estimate the role of occupational risk factors in a large group of patients diagnosed by electrophysiological studies as suffering from CTS. METHODS: A group of 396 subjects (204 women, 165 men) who were tested in one laboratory by electrophysiological studies were further evaluated (by questionnaire) to determine the possible role of occupational and other risk factors in the etiology of their syndrome. RESULTS: Persons employed in high force--low repetitive or low force--high repetitive jobs, harbor an extra risk for developing CTS as compared with controls, OR = 3.21 (95% C1 = 1.5-6.9) and OR = 4.72 (95% C1 = 1.8-12.5), respectively. These jobs include typists/secretaries, nursing personnel, production workers and housewives. CONCLUSION: Evaluation of a general group of examinees referred for electrophysiological studies on sympathology compatible with CTS may show that occupational risk factors play a substantial role in the development of symptoms. By increasing the awareness of clinicians and the public to these risk factors, appropriate preventive measures can be introduced and the burden of the disease reduced.

Periodical multiphasic screening and lung cancer prevention.

The purpose of this work is to evaluate the utilization of information gathered by multiphasic screening with respect to lung cancer detection and smoking cessation techniques. A cohort (follow-up) study is reported in which cancer incidence and factors affecting its occurrence are evaluated in a group of about 20,000 presumably healthy adults along a period of approximately 10 years following comprehensive multiphasic health examinations. Lung cancer occurrence is primarily related to smoking. The risk is higher in smokers and is dose-dependent; OR = 0.21, (CI = 0.08, .53) in never smokers, OR = 1.53 (CI = 0.8, 3.2) in past and current moderate smokers, OR = 4.92 (CI = 2.18, 11.11) in current heavy smokers. Moreover, smokers with compromised pulmonary function (FEVI/FVC < 75%) are at an even higher risk of developing lung cancer OR = 4.22 (CI = 2.2, 8.2) for past and current moderate smokers; and OR = 10.7 (CI-2.5, 38.6) in current heavy smokers. Information gathered in periodical multiphasic health examinations could be utilized by health professionals to encourage smoking cessation and smoking prevention in the appropriate screenees. Various elements of the multiphasic test results could contribute to such prevention efforts. While every smoker should receive appropriate evaluation and consultation regarding nicotine dependence, smokers with reduced pulmonary function represent an extra high risk group to which special attention should be given.

Herbicide (Roundup) pneumonitis.

A case of acute intoxication presented as toxic pneumonitis after exposure to Roundup (glyphosate) (Solaris Group, Monsanto; San Ramon, CA) herbicide in an agriculture worker. The correct etiologic factor causing this specific clinical picture was identified only 2 weeks later, after a thorough occupational history was taken and meticulous delineation of the working conditions and exposures of the involved worker were made. As a rule, occupational related diseases are not readily elucidated by nonoccupational physicians. However, most acute intoxication events are first encountered by such physicians. In these situations, rapid and comprehensive evaluation is necessary in order to clearly identify the causative agent(s) and to initiate the appropriate treatment. Consulting occupational physicians at this early stage may facilitate early and accurate diagnosis.

The association between smoking and inflammatory bowel disease among israeli jewish patients.

: Our objective was to assess the association between smoking status before the onset of disease and inflammatory bowel disease (IBD) in Israeli Jewish patients through a case-control study conducted at the Hadassah University Hospital in Jerusalem, Israel, and a periodic health examination center. The cases included 71 patients with ulcerative colitis (UC) and 91 with Crohn's disease. Patients younger than 18 years at onset of disease were excluded. The controls included 162 healthy, asymptomatic individuals, matched with the patients with IBD by age at onset of disease and gender. Fewer patients with UC were current smokers (9.8%) than were controls (25.0%; p < 0.05). More patients with UC were former smokers (21.0%) than were controls (14.0%; p < 0.05). The odds ratio for UC in smokers compared with ex-smokers was 0.26 (95% CI, 0.13-0.53), and for smokers compared with never-smokers was 0.34 (95% CI, 0.21-0.54). No significant associations were found between smoking status and Crohn's disease. The results for UC are consistent with most reports and probably reflect a true association between smoking status and disease. The lack of association between smoking and Crohn's disease is in agreement with a previous Israeli study but differs from other reports. This may reflect a genetic predisposition among Jews that obscures the effects of smoking.

Effects of work overload and burnout on cholesterol and triglycerides levels: the moderating effects of emotional reactivity among male and female employees.

The effects of objective and subjective overload, and of physical and emotional burnout, on cholesterol and triglycerides levels were studied in a quasiprospective design. The possible moderating effects of emotional reactivity on these relationships were also investigated. The study's hypotheses were tested separately for male and female employees. Time 1 (T1) data were collected from 665 healthy employees (30% women) while they were undergoing periodic health examinations in a health-screening center. Time 2 (T2) measures of cholesterol and triglycerides were collected 2 to 3 years after T1. The hypotheses were tested by regressing each T2 criterion on its T1 level; the control variables of age, obesity, diet, alcohol consumption, and smoking; and the other predictors. For female employees, the T2-T1 changes in the serum lipids were positively predicted by emotional burnout, as expected, but negatively predicted by physical fatigue. For male employees, both types of T1 burnout were positive predictors of the T2-T1 change in total cholesterol.