Organizational and psychosocial risk factors for carpal tunnel syndrome: a cross-sectional study of French workers.

PURPOSE: The aim of the study was to examine the organizational and psychosocial risk factors for carpal tunnel syndrome (CTS) in workers exposed to various levels of work-related constraints, with a special focus on factors related to the work organization. METHODS: From 3,710 workers, representative of a French region's working population, trained occupational physicians diagnosed a total of 156 cases of CTS between 2002 and 2005. Diagnoses were established by standardized physical examination, while personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between CTS and personal and work-related factors were analyzed for each gender using logistic regression modeling. RESULTS: Among the factors related to work organization, working with temporary workers was associated with CTS for women (OR = 1.99, 95 % CI 1.23-3.25), but not for men. Task rotation during the job (OR = 2.45 95 % CI 1.41-4.24) and work pace dependent on quantified targets (OR = 1.93 95 % CI 1.08-3.46) were associated with CTS only for men. The work-related psychosocial factors highlighted by the logistic modeling were high psychological demand for women (OR = 1.90, 95 % CI 1.17-3.09) and low skill discretion (OR = 1.77, 95 % CI 1.01-3.11) for men. CONCLUSION: This study has identified some psychosocial factors and factors related to work organization associated with clinically diagnosed and symptom-only cases of CTS as well as personal and biomechanical factors. However, due to the cross-sectional design of the study, no causal conclusion could be drawn and longitudinal studies are necessary to confirm these results.

Risk factors for Raynaud's phenomenon in the workforce.

OBJECTIVE: To assess the prevalence of and risk factors for Raynaud's phenomenon (RP) in a French working population characterized by various levels of exposure to work-related constraints. METHODS: The study population comprised 3,710 workers (2,161 men and 1,549 women) who were followed up by 83 occupational physicians and were representative of the region's workforce. RP, as diagnosed by a questionnaire and a standardized interview, was defined as the occurrence of at least occasional attacks of finger blanching triggered by exposure to environmental cold during the previous 12 months. Personal factors and work exposure were assessed by self-administered questionnaires. The associations between RP and personal and occupational factors were analyzed using logistic regression modeling. RESULTS: A total of 87 cases of RP (56 women and 31 men) were diagnosed. The population-based annual prevalence rates of RP were 3.6% (95% confidence interval [95% CI] 2.7-4.5%) for women and 1.4% (95% CI 0.9-1.9%) for men. Women had a higher risk of RP (odds ratio [OR] 2.1 [95% CI 1.3-3.4]) and the risk decreased continuously with body mass index (OR for 1-kg/m(2) increment 0.87 [95% CI 0.81-0.94]). The risk of RP increased consistently but moderately with age after 35 years (ORs ranging from 2.0 [95% CI 1.1-3.8] to 2.9 [95% CI 1.6-5.2]). Among the work-related factors studied, RP was associated with an exposure to a cold environment or objects (OR 2.2 [95% CI 1.0-4.6]), a high repetitiveness of a task (OR 1.7 [95% CI 1.0-2.7]), a high psychological demand at work (OR 1.7 [95% CI 1.0-2.7]), and low support from supervisors (OR 2.4 [95% CI 1.5-3.8]). CONCLUSION: Personal and work-related factors were associated with RP, with a clear difference between the sexes. Work-related psychosocial stressors played a significant role independently of biomechanical and environmental exposure.

Extraspinal sciatica revealing late metastatic disease from parotid carcinoma.

Sciatica is a clinical symptom usually caused by a disk herniation and less often by other conditions such as tumors, infections, or inflammatory diseases. We report the case of a woman in whom sciatica led to the identification of a large pelvic metastasis from a carcinoma of the parotid gland.