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.

Clinical guidelines and care pathway for management of low back pain with or without radicular pain.

OBJECTIVE: To develop guidelines for low back pain management according to previous international guidelines and the updated literature. METHODS: A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method. RESULTS: The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5. CONCLUSION: These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.

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.

Epidemiological surveillance of lumbar disc surgery in the general population: a pilot study in a French region.

OBJECTIVES: Disc-related sciatica (DRS) is a significant and costly health problem in the working population. The aim of this pilot study was to assess the feasibility of a surveillance system for DRS using hospital databases for lumbar disc surgery (LDS). METHODS: A total of 272 inpatients (119 men and 153 women) living in a French region and discharged in 2002-2003 from a spine center of a large University Hospital following LDS were compared with demographic and socioeconomic data on the population of the same region. Medical and occupational histories were gathered using a mailed questionnaire. The age-adjusted relative risks and population attributable fraction of risk (PAF) were calculated in relation to occupations and industries. RESULTS: Information on employment was available for the 75 women and 71 men. The risk of LDS varied according to occupations and industries. PAFs ranged between 30% (12-48) for male blue collar workers and 22% (4-40) for female lower white collar workers. PAFs ranged between 7 and 17% in the economic sectors at high risk. CONCLUSION: The surveillance of LDS can identify occupations and industries at risk.

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.