Adverse work and environmental conditions predict occupational injuries. The Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study.
(17/2515)
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. (+info)
An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men.
(18/2515)
BACKGROUND: The large differences in cardiovascular disease rates between Eastern and Western Europe have largely developed over the last few decades, and are only partly explained by classical risk factors. This study was set up to identify other potential determinants of these differences. METHODS: This was an ecological study comparing random samples of men aged 45-64 years selected from three cities representing populations with different rates of cardiovascular mortality: Pardubice (Czech Republic), Augsburg (Bavaria, Germany), and Jerusalem (Israel). In total, 191 (response rate 70%), 153 (70%) and 162 (62%) men, respectively, participated. All centres followed the same study protocol. Lifestyle, anthropometry and biochemical risk factors were assessed by identical questionnaires, standardized medical examination, and central analyses of fasting blood samples. RESULTS: The mortality rates in the study populations, as well as the prevalence of coronary heart disease in study samples, were highest in Czech, intermediate in Bavarian and low in Israeli men. This pattern was replicated across the three samples by mean blood pressure (P < 0.001), cigarette smoking (not significant), triglycerides (P < 0.05), fibrinogen or D-dimer levels (P < 0.05). On the other hand, the prevalence of diabetes and obesity were similar; total and high density lipoprotein (HDL)-cholesterol, apolipoprotein B, lipoprotein (Lp(a)) and glucose did not differ between Czech and Bavarian men; and Czechs had particularly low levels of serum insulin and factor VIIc. Israelis had low fasting glucose and total cholesterol, as well as HDL-cholesterol levels and a high Lp(a) (each P < 0.001) compared with the two other samples. Striking differences were found for plasma homocysteine (10.5 in Czechs versus 8.9 mumol/l in Bavarians, P < 0.001) and for alpha-carotene (geometric mean in Czechs 16, Bavarians 21 and Israelis 30 micrograms/l), beta-carotene (60, 110 and 102 micrograms/l), and lycopene (84, 177 and 223 micrograms/l), respectively; all P-values < 0.001). Adjustment for obesity or smoking did not change these estimates. There were no differences in the levels of tocopherol and retinol. CONCLUSIONS: Czech men had high levels of blood pressure, triglycerides, fibrinogen and D-dimer but many other traditional risk factors, as well as indicators of metabolic disorders and vitamins A and E, did not differ between the study samples. The low levels of carotenoids and high concentrations of homocysteine in Czech men seem to reflect their low dietary intakes of fruit and vegetables. The results provide indirect support for the importance of dietary factors in the East-West morbidity and mortality divide. (+info)
Occupations at increased risk of hepatitis A: a 2-year nationwide historical prospective study.
(19/2515)
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. (+info)
Elevated serum triglyceride levels and long-term mortality in patients with coronary heart disease: the Bezafibrate Infarction Prevention (BIP) Registry.
(20/2515)
BACKGROUND: The association between elevated blood triglyceride levels and subsequent mortality risk in patients with established coronary heart disease (CHD) has been investigated rarely. The aim of the present study was to investigate this association. METHODS AND RESULTS: We evaluated mortality over a mean follow-up time of 5. 1 years among 9033 male and 2499 female CHD patients who were screened for participation in the Bezafibrate Infarction Prevention (BIP) Study. A stepwise increase in mortality with increasing serum triglyceride levels was observed in patients with desirable or elevated serum total cholesterol levels and in patients with either desirable or abnormally low HDL cholesterol levels. Multivariate adjustment for factors other than HDL cholesterol yielded a slightly increased adjusted mortality risk with a 1-natural-log-unit elevation of triglyceride levels in men (hazard ratio [HR] 1.14, 95% CI 1.00 to 1.30) and women (HR 1.37, 95% CI 1.04 to 1.88). Excess covariate-adjusted risk was noted among patients with elevated total and LDL cholesterol and in women with HDL cholesterol levels >45 mg/dL. After additional adjustment for HDL cholesterol, the risk of mortality with a 1-natural-log-unit elevation of triglycerides declined in men (HR 1.09, 95% CI 0.94 to 1.26) and in women (HR 1.10, 95% CI 0.80 to 1.50). A trend for increased mortality risk remained in patients with elevated total and LDL cholesterol and in women with HDL cholesterol >45 mg/dL. CONCLUSIONS: Elevated triglyceride levels were associated with a small, independent increased mortality risk in CHD patients. This risk may be increased among subgroups of patients with elevated total cholesterol and LDL cholesterol levels. (+info)
Drinking patterns of recent Russian immigrants and other Israelis: 1995 national survey results.
(21/2515)
OBJECTIVES: A large group of Russian Jews has immigrated to Israel since 1989. Russia has one of the highest alcohol consumption levels in the world, while the level in Israel is among the lowest. This study was designed to provide empirical information on the drinking of these Russian immigrants compared with the drinking of other Jewish Israeli residents. METHODS: The data came from a 1995 national survey of drinking in Israel. Of 4984 Israelis, 292 were Russian immigrants who had arrived since 1989. Russians were compared with other respondents on several drinking variables. Logistic regression was the principal method of analysis, allowing the relationship to be tested with demographic and cultural variables controlled. A subsidiary analysis was conducted on data about parents' drinking from a survey of secondary school students. RESULTS: There were significant effects for Russian status for several drinking variables, with significant odds ratios ranging from 1.45 to 2.38. These results indicate that recent Russian immigrants to Israel drink more than their Israeli counterparts. CONCLUSIONS: Further investigation of the stability of these patterns may provide valuable information about cultural effects on drinking. (+info)
A model of efficient and continuous quality improvement in a clinical setting.
(22/2515)
OBJECTIVE: To establish a system of Continuous Quality Improvement (CQI) which does not require substantial resources in a clinical setting. SETTING: A busy department of obstetrics and gynaecology. METHODS: The system is based on seven elements: (i) comprehensive accumulation of data; (ii) involvement of all faculty members and the majority of residents; (iii) continuous monitoring of processes within the organization; (iv) application of clinical indicators; (v) file review system; (vi) task force approach for evaluation of processes within the organization; and (vii) intervention measures. MAIN OUTCOME MEASURES: Quality of contents of files and documentation, satisfaction of customers (patients, family members), trends of clinical indicators, effect of task force work, incidence of complaints. RESULTS: Inadequate documentation was noted in 14.6% before, and 4% 1 year after the initiation of the CQI program. Task force work in a variety of projects led to a substantial improvement in measured outcome. The absolute and relative numbers of complaints against the department decreased from 44 in 1993, to 27 in 1994, 20 in 1995 and 16 in 1996. In terms of the percentage of complaints directed against the hospital these figures represent 12.4, 9.6, 6.9 and 5.4% for 1993, 1994, 1995 and 1996 respectively. CONCLUSION: Our proposed CQI system has proved to be highly efficient and requires only minimal additional resources. (+info)
Workers' right-to-know legislation: does it work?
(23/2515)
Workers' right-to-know (WRTK) laws and regulations were established to empower workers to protect their health by providing them with information about the hazards to which they are exposed while at work. The present study was conducted to examine the implementation of WRTK regulations in Israel. We interviewed 552 workers and 33 safety officers from a random sample employed at 50 industrial plants. The workers' questionnaire included items on awareness and self-management of workplace hazards, and the safety officers answered questions about job experience and hazards communications to workers. In 36% of cases workers and their safety officers disagreed about the existence of hazards in the workplace (p < 0.001). Most (78%) of the workers' knowledge about work hazards was based on informal sources, i.e., not those stipulated by the regulations. There were also discrepancies between worker and safety officer reports regarding the provision of safety training upon employment (p < 0.001), recent instructions about special risks and distribution of relevant printed material. We found that more than 5% of workers were unable to read the language in which the hazards material was written and 22% had levels of education below that required to comprehend the technical terms used. There are serious problems in the implementation of WRTK regulations in Israel. We recommend that employers be made aware of the importance of these laws and of their proactive duty to comply with them and that the material distributed to workers be written in simpler terms and/or explained orally in a language they understand. These findings have important implications for all countries with similar legislation and should form the basis for further and more comprehensive studies world-wide. (+info)
A common mutation A1298C in human methylenetetrahydrofolate reductase gene: association with plasma total homocysteine and folate concentrations.
(24/2515)
Methylenetetrahydrofolate reductase (MTHFR) is one of the main regulatory enzymes of homocysteine metabolism. Previous studies revealed that a common mutation in MTHFR gene C677T is related to hyperhomocysteinemia and occlusive vascular pathology. In the current study, we determined the prevalence of a newly described mutation in the human MTHFR gene A1298C, and the already known C677T mutation, and related them to plasma total homocysteine and folate concentrations. We studied 377 Jewish subjects, including 190 men and 186 women aged 56.8 +/- 13 y (range 32-95 y). The frequency of the homozygotes for the A1298C and the C677T MTHFR mutations was common in the Jewish Israeli population (0.34 and 0.37, respectively). Subjects homozygous (TT) for the C677T mutation had significantly greater plasma total homocysteine concentrations (P < 0.01) than subjects without the mutation (CC). Homozygotes (CC) for the A1298C mutation did not have elevated plasma total homocysteine concentrations. Our study indicated that subjects with the 677CC/1298CC genotype had significantly lower concentrations (P < 0. 05) than those with a 677CC/1298AA genotype. Neither mutation (the A1298C and the C677T) was associated with established cardiovascular risk factors such as hypertension, elevated total cholesterol or body mass index. (+info)