Oren Zack

Atopy as a risk factor for the development of asthma in young recruits.

Abstract Objective: Asthma is one of the most common chronic diseases globally. Atopy, and especially allergic rhinitis (AR), was found as an important risk factor for asthma. The purpose of this study was to examine the association between different atopic parameters and military professions to the incidence of asthma. Methods: In a retrospective study, we included 128 591 Israel Defense Forces soldiers drafted between the mid-nineties to the early-2000s. We examined the incidence rates of asthma in relation to atopic background and to military profession. Results: The relative risk (RR) for the development of asthma in persons with a history of AR and the RR for asthma in atopics vs. nonatopics was 1.86 (95% CI: 1.57–2.21) and 1.73 (95% CI: 1.47–2.04), respectively. The RR for the development of asthma in persons with a history of AR was higher in Combat Units (CU) and Administrative and Driving units (ADU) (RR = 2.80; 95% CI: 2.09–3.76 and RR = 1.58; 95% CI: 1.19–2.12, respectively) than in Maintenance Units (MU) (RR = 1.27; 95% CI: 0.93–1.74). When comparing the risk for asthma amongst persons with AR, we found it lower in MU compared to ADU (RR = 0.65; 95% CI: 0.43–0.97). In atopics vs. non-atopics, the risk for asthma was higher in ADU as compared to other occupations. Conclusions: Atopy, particularly AR, is a risk factor for the development of new-onset asthma in young adults. Atopy has the highest significant effect in CU where the physical demands are higher.

Vocational factors which predict seizure prognosis in young adults during military service.

BACKGROUND The vocational parameters regarding epilepsy are not well established. Our aim was to assess the risk of seizures as a function of occupational stress and disease severity in military recruits of the IDF (Israel Defense Force) and to examine the effect of new classification criteria (used between the late nineties and early two thousands) in comparison with that of previous criteria (used during the mid-eighties to mid-nineties). METHODS The medical records of over 150,000 18-year-old men recruited to the IDF between the mid-nineties and the mid-two thousands were used to assemble a cohort, which was followed for a period of 36months. The severity of the disease was determined according to 3 categories, according to the medical history. The recruits were subdivided according to their occupational categories to Combat Units (CUs), Maintenance Units (MUs), and Administrative Units (AUs). We compared the incidence rates of the different groups with the findings from a previous follow-up. RESULTS The annual incidence rates during 36months of follow-up were 0.026%, 4.7%, and 8.8%, in categories 1 to 3, respectively. The relative risk of seizure incidence in CU and MU was lower than in AU (0.42 and 0.81, p<0.0001). Similar findings were found in other disease categories. CONCLUSIONS Job assignment to CU (less convenient conditions like sleep deprivation and strenuous physical activity) did not increase the incidence of seizures. It was found that EEG examination is an important criterion in the vocational evaluation of subjects that have had one or more seizures. This study supports the establishment of vocational criteria and recommends the integration of people diagnosed with epilepsy in most occupations.

P268 The association between the patient health questionnaire-9 and fitness for work among depressive patients

Introduction The Patient Health Questionnaire 9-item (PHQ-9) is a 9-item depression screening and diagnostic tool used in primary care and other medical populations to assess presence of depression and its severity. Our aim was to estimate the association between the PHQ-9 questionnaire and fitness for work. Methods Cross-sectional study of patients who presented at the occupational clinic with a diagnosis of MDD and a PHQ-9 questionnaire was carried out as part of their medical evaluation. From medical records we collected the following characteristics: socio-demographic (age and education data), medical (PHQ-9 score, comorbidities) and occupational characteristics (employment sector, occupation physical demands, scope of employment prior to occupational physician evaluation and the evaluation decision). Results Out of 165 patients eligible for the study, 125 (75%) agreed to participate and had full details. A negative correlation between depression severity (by PHQ-9 score) and the absolute working ability was found in women (β = −0.36, p = 0.0002) as well as in men (β = −0.4, p = 0.0502). Regarding the relative change in working ability, correlation was found significant for women only (β = −0.33, p = 0.0007) as opposed to men (β = −0.29, p = 0.1664). A multivariate linear regression models adjusted for medical, social, demographic and occupational variables revealed that depression severity (compression group – severe depression, PHQ-9 score ≥ 20) is among the significant predictors of the fitness for work (β = 25.8, p = 0.003 with mild depression, β = 14.7, p = 0.066 for moderate depression) as well as a predictor for the relative change in working ability. Conclusions We found Correlation exists between absolute and relative fitness for work and depression severity as evaluated by the PHQ-9, accordingly, the higher severity of depression the higher the scope of work disability. The PHQ-9 could be used as a measure in assessing fitness for work.

0276 The role of various predictors of seizure recurrence in assignment of young men to professions with associated exposure to (seizure) risk factors

Objectives To study the risk of epileptic seizures as a function of disease severity and occupational stress (physical and mental) in new military recruits in the Israel Defense Forces (IDF). Method The medical records of over 145 000 18-year old men, recruited to the IDF between the late-nineties and early two-thousands, were used to assemble a cohort, which was followed for a period of 36 months. The severity of the disease was determined according to 5 categories. Recruits were subdivided according to the following occupational categories: Combat Units (CU), Maintenance Units (MU) and Administrative Units (AU). Results The annual incidence rate for a first seizure was 26/100 000. The rates in CU and MU were lower than AU (0.41 and 0.81 vs. 1 respectively, p < 0.01). Similar findings were found in other disease categories. Conclusions The low rate for a first seizure and the lower overall seizure rate in CU compared to MU and AU may be explained by the recruiting of a healthy population, higher motivation than before, and meticulous adherence to diagnostic criteria. The higher recurrence rate in our research as compared to the previous follow up, may be attributable to the modification of disease categories. Our findings suggest moderating occupational restrictions for epilepsy patients and using EEG and relapse-free periods of 2–6 years as fitness for work criteria. We propose the reassessment of severity criteria currently used by the IDF.

0372 Patients’ views and expectations on social work services in the occupational medicine clinic in the Maccabi Health service organisation

Objectives To explore patients’ expectations regarding the social work service and to deterrmine their satisfaction level with the care provided to them so far by the social worker in the framework of the occupational clinic. Method This is a cross-sectional study which consists of Maccabi members of working age that visited occupational nedicine departments between September 2011 and July 2012 for the purpose of fitness-for-work evaluation who were referred to and met with a social worker. These members filled out an expectation and satisfaction questionnaire after meeting with the social worker. Results A total of 203 questionnaire were filled out. Most of the patients were interested in receiving information about their benefits (85%). A smaller number of patients (39.2%) were interested in receiving help dealing with a family members’ distress due to the loss of work ability of the patient. A very high percentage of the patients (97%) were satisfied with the social worker session. A correlation was found between the patients’ expectations and their satisfaction with the amount of information they received (p > 0.01). Conclusions This is a first study of this kind addressing social work services in a public occupational medicine services. The study shows the positive advantage of this service and a high patient satisfaction level with the social work service. The satisfaction level was high even though the patients’ health status was relatively low. We recommend expanding the service beyond Maccabi onto other health service organisations.