Clinical trial: evaluation of a clinical decision-support model for upper abdominal complaints in primary-care practice.

BACKGROUND: Gastro-oesophageal reflux disease (GERD) and dyspepsia affect 25-40% of the general population. In the absence of alarm symptoms, the current recommended policy in young dyspeptic patients is a 'test and treat' strategy for Helicobacter pylori; in GERD patients, a therapeutic trial with proton pump inhibitors is the treatment of choice. AIM: To create a short and simple clinical algorithm, for the diagnosis and treatment of patients with upper gastrointestinal complaints. METHODS: The clinical usefulness and cost-effectiveness of the new algorithm were evaluated in a controlled clinical trial, held in primary-care clinics in Israel. Clinical and economical treatment outcomes were evaluated after 1, 3 and 6 months comparing doctors who used the algorithm (cases) vs. those who did not (controls). RESULTS: 78 cases and 54 controls completed the 6 months of follow up. The improvement in symptom severity and quality of life was greater in the cases than in the controls (P < 0.05). General practitioner clinics visits (P = 0.04), gastroenterology clinics visits (P = 0.02) and medication costs (P = 0.004) were all significantly reduced among cases. Controls underwent also more imaging tests (computerized tomography, ultrasound and X-ray) and endoscopies. The average cost for 6 months' treatment and follow-up was $US 199 for cases compared with an average of $US 336 in the control group. CONCLUSION: The use of a clinical decision-support tool can facilitate and promote the implementation of management guidelines by general practitioners. The short algorithm presented in the study was found to be useful and easy to apply in clinical practice. Its effectiveness can be further increased by implementing it in computerized medical systems.

[The risk of bloodborne infections in health care workers and their patients: possible preventive steps].

Hospital-based bloodborne infections are generally limited to viruses; hepatitis B virus, hepatitis C virus and the human immunodeficiency virus. The risk of infection by an infected patient to the health care worker is substantial. All preventable actions should be taken, including 3 injections of vaccine for hepatitis B, serological confirmation of protection, and further treatment if necessary. Since no preventable risk to a patient is acceptable, policies need to be set on the fitness-for-work of the infected surgeon. This article reviews the risks of bloodborne infections and preventive measures.

The influence of nurses' knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel.

The purpose of this study was to examine the influence of the nurses' knowledge, attitudes, and health beliefs on their behavior and their actual usage of safety measures while handling cytotoxic drugs in their daily work surroundings. The Health Belief Model (HBM) and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical frameworks. Sixty-one nurses participated in the study, 31 hospital-based nurses daily exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An occupational questionnaire was used to test the nurses' actual safe behavior and compliance with the recommended guidelines. A randomly selected group of exposed nurses were observed to validate their compliant behavior. A gap was found between the nurses' knowledge and their actual behavior concerning the potential risks of cytotoxic drugs and their use of protective measures (p < .005). Significant correlations were found among the components of the extensive HBM (perceived susceptibility, barriers, benefits and self-efficacy). The observational findings supported the above results. The study's findings support the need to promote primary prevention by providing a safe environment for the employee by means of education, training with regard to safety measures, clear policy, written guidelines and their enforcement.

Clinical, radiologic, demographic, and occupational aspects of hand osteoarthritis in the elderly.

OBJECTIVE: Osteoarthritis (OA) of the hand is common in elderly patients. The aim of this study was to characterize OA frequency, severity, and distribution and to trace interrelationships between these findings and the demographic, occupational, and medical data from elderly Jewish nonrheumatologic patients. METHODS: Study participants were 253 consecutive patients admitted to a geriatric center for a variety of nonrheumatic medical conditions. Excluded patients were those with rheumatoid arthritis; neurologic, orthopedic, or other conditions that would interfere with symmetric hand function; and mental or medical states that would interfere with history taking and radiographic studies. Patient occupations were graded as workload degree (on a scale of 1 to 3) and as the total occupational score (workload degree multiplied by the duration of each job). Clinical findings of Heberden nodes, Bouchard nodes, and malignment, graded on a scale of 0 to 3, were summed as the clinical OA score. Hand radiographs were independently read (modified Altman method), grading 5 parameters in each joint on a scale of 0 to 3, summed as a radiologic OA score. Statistical analyses included the Student t test, chi(2) test, ANOVA, Pearson correlation, and partial correlation coefficients. RESULTS: Among 253 elderly patients (171 women, 82 men; mean age, 79 years) OA was frequent (occurring in about 80% of patients), involving most severely the second and third distal interphalangeal, right first interphalangeal, and both first carpometacarpal joints. The prevalence of OA was similar in women and men, with higher scores in women, and reached significance only in the distal interphalangeal joints. Metacarpophalangeal joints were more involved in men. Age had a clear influence on OA scores. Ethnicity affected OA severity, with Ashkenazi Jews having significantly higher scores than Sepharadi Jews. Dominant hands had significantly higher global OA scores as well as isolated joint scores (except for the first carpometacarpal joint). Occupational load, housekeeping tasks, and the number of children did not influence the total or specific joint OA scores. Associated conditions such as obesity, diabetes, hypothyroidism, and chondro calcinosis were not associated with more pronounced OA. CONCLUSIONS: Hand OA was prevalent in our elderly cohort, and its severity was influenced by inherent traits such as age, female gender, ethnicity, and handedness. In contrast, acquired factors such as workload, number of children, and associated diseases did not appear to influence OA expression.

Serum total cholesterol and cardiovascular mortality in Israeli males: the CORDIS Study. Cardiovascular Occupational Risk Factor Determination in Israeli Industry.

BACKGROUND: The degree to which serum total cholesterol predicts cardiovascular disease is uncertain. While most authors have placed TC among the most powerful risk indicators of CVD, some have claimed that it predicted CVD in women only, or even not at all. OBJECTIVE: To determine the predictive value of serum total cholesterol relative to diabetes, smoking, systolic blood pressure and body mass index (kg/m2), for cardiovascular disease mortality in 3,461 occupationally active Israeli males. METHODS: A prospective follow-up was carried out for the years 1987-1998 to determine the effect of age, smoking habits, a history of diabetes, SBP, BMI and TC, at entry, on CVD mortality. RESULTS: There were 84 CVD deaths during a total of 37,174 person-years follow up. The hazard ratios (95% confidence intervals) for CVD mortality with respect to variables at entry were: diabetes 5.2 (2.1-13.2), age 2.2 (1.7-2.9), smoking 1.3 (1.0-1.8), SBP 1.4 (1.1-2.0), TC 1.5 (1.0-2.1) and BMI 1.2 (0.7-2.2). Among non-obese, non-diabetic, normotensive subjects the hazard ratio of TC adjusted for age and smoking was 1.16 (1.09-1.22) per 10 mg/dl. In the remaining subjects it was 1.04 (0.98-1.12) only. There was a significant interaction between TC and diabetes, hypertension or obesity (P = 0.003). CONCLUSIONS: In this population of Israeli males we found an interaction between TC and other risk indicators for CVD. Confirmation is required for the unexpected finding that the predictive value of TC for CVD mortality among non-diabetic, non-obese and normotensive subjects exceeded that among subjects with either of these risk factors.

Hematological changes in hospital workers due to chronic exposure to low levels of ethylene oxide.

We conducted a cross-sectional study to determine whether occupational exposure to low levels of ethylene oxide can cause hematological abnormalities. Blood samples were collected from a group of 47 hospital workers who were exposed to ethylene oxide during a mean period of 6.6 years (standard error, 1.1). Ethylene oxide range levels measured were < 0.01 to 0.06 ppm. The control group, individually matched by age, sex, and smoking habits, consisted of 88 workers from the administrative sector. We found significant differences between the exposed and the control group in the frequency of workers with white blood cells lower than the normal range. Although there was no significant difference in the absolute mean number of the total white blood cells, we found an elevation in the absolute mean number of monocytes and eosinophils (P < 0.01) and a decrease (P < 0.01) in the absolute mean number of lymphocytes in the exposed group compared with the control group. We also found an elevation (P < 0.01) in the percentage of hematocrit and the mean absolute number of the red blood cells, and a decrease (P < 0.01) in the mean absolute number of platelets, in the exposed group compared with the control group. The mean absolute number of eosinophils, red blood cells, and percentage of hematocrit was significantly higher, and the mean absolute number of lymphocytes and platelets was significantly lower, in the subgroups with a higher cumulative dose of exposure. A positive dose-response was found between cumulative dose exposure and the absolute mean number of eosinophils. In view of our findings, we suggest that the use of complete blood cells with differential in routine medical surveillance and for early detection of hygiene problems should be reexamined with special attention to the eosinophils count.

Summer-winter differences in 24 h variability of heart rate.

OBJECTIVE: To examine possible seasonal changes in heart rate variability (HRV). BACKGROUND: Greater than normal mortality from cardiovascular disease (CVD) in the winter has been reported for many countries and might be partly explained by considering seasonal changes in CVD risk factors. Depression of HRV is an independent predictor of arrhythmic complications and of cardiac death, and it is also among the variables that may be affected by the season of the year. METHODS: We compared pairs of 24 h HRV data of 120 healthy men who were examined once in the summer and once in the winter. Multivariate analyses were performed for each dependent variable (HRV indexes) in separate statistical models with age, resting heart rate, serum level of cholesterol, cigarette smoking, body mass index, sports habits, alcohol consumption, systolic blood pressure, physical activity at work, years of education, consumption of energy, and season as the independent variables. RESULTS: Although there were no seasonal differences in mean R-R interval, all indexes of HRV were found to be lower in the summer than they were during winter. Differences and 95% confidence intervals were standard deviation (SD) of coupling intervals between normal beats 12 ms, 6-17 ms; SD of 5 min mean R-R intervals 14 ms, 8-20 ms; mean of all 5 min SD of R-R intervals 2.0 ms, 0.6-2.5 ms; proportion of adjacent R-R intervals differing by > 50 ms 1.5%, 0.6-2.5% and root mean square of the difference between successive normal intervals 3.1 ms, 1.5-4 ms. Multivariate analyses showed that HRV in the winter was less than that in the summer even after adjustment for age, serum level of cholesterol, systolic blood pressure, and body mass index. CONCLUSIONS: HRV indexes of healthy men vary physiologically by season, with lowest values obtained in the winter. Since low HRV is linked to pathologic conditions, the significance of seasonal changes for those suffering from CVD and their possible contribution to the greater mortality rates in winter have to be considered.

A multifaceted mental health training program in reducing burnout among occupational social workers.

This article looks at ways of reducing stress through a multifaceted training program involving the acquisition of mental health knowledge and skills and experiential training in a group of occupational social workers. The training group of 13 occupational workers was compared to a group of occupational social workers not attending the program. Post-training revealed statistically significant increases in professional self-efficacy associated with awareness of psychological and psychopathological issues and professional social support. Reduction in cognitive weariness and listlessness associated with burnout was also found. Gaining competence in mental health issues relating to the occupational setting coupled with emotional sharing helped to reduce professional burnout.

Effect of exposure to lead on postural control in workers.

OBJECTIVES: To examine the effect of lead on postural control of workers who have been exposed to lead. METHODS: 63 Male, lead battery workers mean (SD) age 41.0 (7.4) were compared with 48 age matched male controls after excluding those with acute or chronic diseases. Exposed workers had mean (SD) past blood lead concentrations of 37.5 (9.2) micrograms/dl and 11.2 (5.7) years of employment. Postural control was measured with a computerised postural sway measurement system which measured both sway and total movements. RESULTS: Workers standing straight with eyes open on the bare plates had sway and total movements which were not notably different from controls. On the other hand increased movements were needed in the exposed workers to maintain stability (the general stability quotient 18.2 (5.4) v 15.4 (4.4) in controls, p < 0.01) when standing directly on the foot-plates with closed eyes,, and with the head tilted (15.0 (3.8) v 11.5 (3.0) in controls, p < 0.001). Exposed workers also had a trend for less ability to synchronize anterior posterior and lateral sway in the stress positions (0.0625) than had non-exposed workers. Significant but low correlations were found between the estimate of the chronic internal dose of lead and three of 10 of the postural control measurements, and present lead blood concentrations and only one of the 10 measurements and (r values ranged from 0.21 to 0.31, p < or = 0.03). CONCLUSIONS: These findings suggest that lead affects postural control in asymptomatic workers. Further studies are warranted to find whether workers with decreased postural control are at increased risk of accidents and the relation, if any, of these measurements with subsequent morbidity.

Circulating natural killer cells in retired asbestos cement workers.

The effect of past exposure to asbestos on natural killer (NK) cell number and activity is uncertain. We measured NK cell number and activity in 1052 retired asbestos workers without symptomatic lung disease, lung cancer, or mesothelioma and with a long latency period from exposure; results were compared with those for 100 healthy age-matched controls. The exposed workers showed a decreased NK cell activity and increased NK cell number, yielding a 10.8 higher odds ratio for low NK activity per cell compared with controls (95% confidence interval 6.4 to 18.4), which was due to both a decrease in NK cell activity and an increase in NK cell number. Asbestos exposure of 10 years or more increased the risk of low NK activity per cell. We conclude that exposure to asbestos is associated with diminished effectiveness of NK cells and a concomitant increase in the number of NK circulating cells.

Referral to occupational medicine clinics and resumption of employment after myocardial infarction.

Rehabilitation after acute myocardial infarction (AMI) consists of education, exercise, and an encouragement to return to work (RTW). This study attempts to (1) determine whether the time interval between AMI and the visit at occupational medicine (OM) clinics predicts resumption of full employment, and (2) estimate the incidence of work-related recurrent AMI after RTW. We followed 216 consecutive AMI patients at a single OM clinic. The independent variables were clinical and personal data, physical workload and time between AMI, and first visit to the OM clinic. The outcome variables were full employment 24 months after the acute event and recurrent AMI during this period. Of all patients, 168 attempted RTW. Of these, 18 stopped working subsequently. Of the remaining 150 patients, 54 returned to part-time work and 96 were employed full-time after 2 years. Logistic regression indicated that a failure to resume full employment was independently associated with diabetes, older age, Q wave AMI, angina before AMI, heavy work, and a late visit to the OM clinic. For each month's delay in referral to the OM clinic, there was a 30% decrease in the chance for full employment 24 months after AMI. Six (4%) of the 150 patients who resumed employment sustained a recurrent AMI, two of them while at work. A delayed referral to the OM clinic was associated with work disability after AMI. Late referrals to OM clinics should receive a more intensive and sustained rehabilitation than early referrals. Whether an earlier referral to OM clinics will result in increased RTW rates is unknown. Patients who attempted to resume employment had a 1.2% risk of a recurrent ischemic event at their workplace.

Significance of low hematocrit levels in asymptomatic young adults: results of 15 years follow-up.

HYPOTHESIS: Periodic complete blood counts are not recommended for disease prevention in low-risk, non-pregnant adults. Consequently, there are few follow-up studies of the prevalence of incidentally detected anemia in asymptomatic subjects and its significance for their well-being. The objective of this survey is to determine the frequency of anemia and its predictive value for disease over a 15-yr annual follow-up of a cohort of asymptomatic young males, selected for physical fitness and intelligence. METHODS: One thousand Israeli airmen aged 18-30 yr at entry into this historical-prospective study in 1968 were used as subjects. Hematocrit (Hct) levels were examined annually. On the average each subject had 13.2 tests in the course of the 15 yr follow-up. We arbitrarily defined anemia as a Hct of 40% or less on two or more tests, and compared the prevalence of diagnosed disorders in subjects with and without anemia. RESULTS: During follow-up, anemia was found in 125 (12.5%) of the subjects. On successive annual examinations of the same individual Hct levels varied by 3% or more in 3.5% of those without anemia, and in 10.5% of those with anemia. The frequency of diagnosed disorders, excluding inter-current infections and trauma, was 25.6%, and 10.9% among those with and without anemia, respectively (OR = 2.8, 95% CI 1.8-4.6). Anemia was associated with inflammatory bowel disease (OR = 12.1, 95% CI 2.3 78.6) and malignancy (OR = 3.6, 95% CI 1.1-10.7). It preceded diagnosis only in one case with Waldenstr 246 m's macroglobulinemia, in one case of inflammatory bowel disease and two cases of myocardial infarction. CONCLUSIONS: A finding of anemia doubled the likelihood of chronic disease. However, it had a limited predictive value for subsequent morbidity and did not lead to detection of treatable disorders or to disorders that might otherwise have endangered flight safety. Fluctuations of up to 3% in Hct over time may be viewed as normal in young males.

Healthy volunteer effect in industrial workers.

Volunteers for epidemiological research, have lower mortality rates than non-volunteers, thereby producing a bias referred to as the "healthy volunteer effect" (HVE). Occupationally active persons have been similarly shown to have a reduced mortality relatively to the general population (the "healthy worker effect"). To determine whether a HVE exists in occupationally active persons, we followed for 8 years a cohort of Israeli male industrial employees, of whom 71.6% agreed to participate in 1985 in screening examinations for cardiovascular disease. We calculated standardized mortality ratios (SMRs) of the entire cohort relative to the general population, and compared the mortality among participants with that of the non-participants. Over 8 years follow up, SMRs were 78% for the entire cohort, 71% for participants and 99% for non-participants. Participants were older than non-participants and worked more commonly in smaller factories. A proportional hazard model indicated that after adjusting for these variables, the all cause mortality hazard ratio among participants and non-participants was 0.69 (95% CI = 0.51-0.94). During the first and last two years of the 8-year follow-up there were 39.6 and 30.0 age-adjusted deaths per 10,000 person-years among participants, and 58.6 and 51.5 respectively among non-participants. We conclude that the HVE occurs in occupationally active persons, and that it may persist for up to 8 years follow-up.

Increased serum concentrations of growth factor receptors and Neu in workers previously exposed to asbestos.

OBJECTIVES: Epidermal growth factor receptor (EGFR) and oncogene Neu belong to a family of growth factor receptors which may play a part in carcinogenesis. Although increased serum concentrations of Neu and EGFR have been shown in several patients with asbestosis who later developed cancer, serum concentrations have not been studied in workers exposed in the past to asbestos but without asbestos related diseases. METHODS: Serum concentrations of secreted growth factor receptors were studied in 300 workers exposed in the past to asbestos and the results were compared with those of 70 controls. RESULTS: In the controls 4.3% (3/70) had EGFR values > 912 units/ml, compared with 39% (117/299) of the exposed group (p < 0.001). The difference in high values was even more pronounced for Neu with 4.3% of controls having Neu values > 2580 fmol/ml compared with 72% (216/299) of the exposed workers (p < 0.001). Pleural plaques predicted lower serum concentrations of EGFR but not lower Neu concentrations, and this finding remained significant after adjustment for age, exposure time, smoking, and time from initial exposure. CONCLUSIONS: Enhanced secretion of EGFR and Neu was found in a large cohort of retired asbestos workers with a wide range of exposure and latency periods. They did not have asbestosis or cancer and their EGFR values were higher in those without plaques. Further studies are needed to confirm our results, to determine the source of the secreted growth factor receptors, and to study their possible value as risk factors in the development of cancer.

Occupations at increased risk of hepatitis A: a 2-year nationwide historical prospective study.

The recent licensing of active hepatitis A vaccines raises the question of vaccine candidates. Although various groups of workers are at theoretical occupational risk of hepatitis A infection, no comprehensive quantitative data exist to determine which occupational groups should receive active vaccination. Therefore, the aims of this study were to identify occupations at risk for hepatitis A infection and to determine their relative risk. In this nationwide historical prospective study, the relative risk of hepatitis A among different occupations in Israel was determined according to the incidence of hepatitis A in different occupations during 1993 and 1994 compared with the incidence of hepatitis A in two standard populations. After age, gender, ethnicity, and time of immigration to Israel were controlled for, certain occupations showed a significant increased risk of hepatitis A: yeshiva students (standardized incidence ratio (SIR) = 9.98, 99% confidence interval: 7.55, 13.18), day care center and kindergarten staff (SIR = 5.47, 99% confidence interval: 3.50, 8.57), food industry workers (SIR = 5.41, 99% confidence interval: 1.92, 15.25), teachers (SIR = 4.02, 99% confidence interval: 2.92, 5.48), physicians and dentists (SIR = 3.77, 99% confidence interval: 1.78, 8.14), and therapists and medical technicians (SIR = 3.75, 99% confidence interval: 1.75, 8.14). Sewage workers and nurses did not show any significantly increased risk. The results were validated by comparison with an additional standard population. This first nationwide study identified occupations at risk of hepatitis A infection. It emerged that the authors' approach can provide a yardstick for measuring samples in both large and small countries that have a socioeconomic background similar to that of Israel.

Seasonal changes in calcitropic hormones in Israeli men.

Seasonal changes in calcitropic hormones might be expected, being that dietary calcium intake may differ with fluctuations in climate and temperature, and vitamin D is diet- and sunlight-dependent. While there are studies on elderly subjects, prospective data on younger men is limited. The objective of this study was to clarify possible seasonal changes in homeostatic regulators of calcium in Israeli men aged 25-64 years. The study was a prospective follow-up analysis of data collected during June-August 1995 and 1996 (summer) and January March 1995 and 1996 (winter). Subjects were ninety-five industrial male employees with and without occupational lead exposure. The main outcome measures were summer and winter serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OH-D), and 1,25-dihydroxyvitamin D (calcitriol). Summer and winter values of PTH were similar (38.2 and 39.8 ng/l, respectively). 25-OH-D levels were significantly higher in summer (32.8 ng/ml) than in winter (25.4 ng/ml) after controlling for possible confounders (p < 0.0001). Calcitriol levels were significantly higher in summer (79.1 pmol/l) than in winter (73.5 pmol/l) in univariate analyses, but not after controlling for possible confounders. We conclude that healthy men show considerable seasonal changes in 25-OH-D levels even in Israel, a relatively sunny country all the year round. Summer values of 25-OH-D, were 35% higher than in winter. These fluctuations should be taken into account during evaluation of pathological conditions and in research. Given an adequate diet and vitamin D status there are no seasonal variations in PTH or in calcitriol levels.

Adverse work and environmental conditions predict occupational injuries. The Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study.

This study was designed to test whether the total objective adverse work and environmental conditions, expressed as the ergonomic stress level (ESL), would predict occupational injuries over a 2-year period. The study population consisted of 4,096 men from 21 factories in six industrial sectors who were studied as part of the Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study, 1985-1987. The ESL (assigned four levels, 1-4) was based on an ergonomic assessment which covered 17 risk factors pertaining to safety hazards, overcrowding, cognitive and physical demands, and environmental stressors. The ESL was found to be a highly reliable measure and stable over a period of 2-4 years. The incidence of injuries among workers in low ESL conditions (level 1) was 10.3%. It increased with higher ESL's: 11.7% in level 2 (relative risk (RR) = 1.13, 95% confidence interval (CI) 0.86-1.50); 21.6% in level 3 (RR = 2.09, 95% CI 1.68-2.62); and 23.8% in level 4 (RR = 2.31, 95% CI 1.85-2.88). After adjustment for age, job experience, educational level, managerial status, and occupational status (white/blue collar), injury occurrence was significantly elevated for those at level 3 (adjusted odds ratio (OR) = 1.46, 95% CI 1.12-1.91) and level 4 (adjusted OR = 1.81, 95% CI 1.39-2.37) but not for level 2 (adjusted OR = 0.87, 95% CI 0.65-1.18). The authors conclude that adverse work and environmental conditions, objectively assessed, can predict occurrence of occupational injuries.

The association between occupational lead exposure and serum cholesterol and lipoprotein levels.

OBJECTIVES: This study sought to clarify the possible associations between blood lead level and serum cholesterol and lipoprotein levels in subjects occupationally exposed to lead. METHODS: Levels of blood lead, serum total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and triglycerides in 56 male industrial employees who were exposed to lead were compared with those in 87 unexposed employees. RESULTS: Mean blood lead levels were 42.3 (+/- 14.9) micrograms/dL in the exposed group and 2.7 (+/- 3.6) micrograms/dL in the nonexposed group. The exposed subjects had higher mean levels of total cholesterol and HDL cholesterol. CONCLUSIONS: Blood lead levels are positively associated with total and HDL cholesterol.

Accelerated silicosis with mixed-dust pneumoconiosis in a hard-metal grinder.

We describe a fatal case of accelerated silicosis with a component of mixed-dust pneumoconiosis in a young hard-metal grinder that we believe is the first case of its kind in Israel and one of the rare cases reported worldwide. The patient's diagnosis was based on typical features: restrictive lung function, abnormal chest roentgenogram suggesting lung fibrosis, a history of exposure to silica and hard metals, bronchoalveolar lavage (BAL) fluid findings, and mineralogical studies. BAL cells showed an abundance of giant multinucleated macrophages. The CD4/CD8 ratio of T lymphocytes was 1.1, with a high percentage of CD8 and CD8/38 positive cells (37% suppressor/cytotoxic and 12% cytotoxic T lymphocytes, respectively). mRNA transcripts isolated from BAL cells were positive for interleukin-1 (IL-1) and transforming growth factor (TGF) Il-5, IL-2, and IL-10 but not for IL-6, IL-4, and interferon. Polarizing light microscopic studies of BAL and induced sputum cells showed polarizing particles, which are typical for silica. Mineralogical studies of electron microscopy performed on BAL fluid and on dust collected at the patient's workstation revealed silica particles as well as aluminum-titanium and other particles. The latter might have contributed to the patient's lung disease.

Smoking cessation and body mass index of occupationally active men: the Israeli CORDIS Study.

OBJECTIVES: This study estimated weight gain after smoking cessation and identified factors attenuating this gain. METHODS: We conducted a prospective follow-up of 1209 male factory workers for 2 to 4 years. The independent variables were smoking habits. age, sports activity, education, alcohol consumption, ethnicity, duration of follow-up, and body mass index (BMI, kg/m2) at entry. The dependent variable was increase in BMI during follow-up. RESULTS: The mean age-adjusted BMI at entry into the study was 26.6 kg/m2 among past smokers and 25.4 kg/m2 among current smokers. There were no differences in BMI between those who quit less than 3 years before entry and those who quit more than 6 years before entry. During follow-up, the average increase in BMI was 0.07 kg/m2 among never smokers, 0.19 kg/m2 among smokers who had stopped smoking before entry, 0.24 kg/m2 among current smokers, and 0.99 kg/m2 among those who stopped smoking after entry. Cessation of smoking after entry predicted an increased gain in BMI; older age, a higher BMI at entry, sports activity, and alcohol consumption attenuated this gain. CONCLUSIONS: The increased rate of weight gain after smoking cessation is transient. However, the weight gained is retained for at least 6 years.