A longitudinal study of predictors of research-defined carpal tunnel syndrome in industrial workers: findings at 17 years.

In 1984, we initiated a prospective study of factors associated with research-defined carpal tunnel syndrome (CTS) in 471 industrial workers. Medical history, lifestyle factors and job tasks were assessed by questionnaire and CTS case status was based on both symptoms and electrophysiologic findings. Participants were re-examined in 1989, 1994 to 1995 and 2001 to 2002. This study reports both baseline and aggregated risk factors associated with increased risk of CTS by 2001 to 2002 for 166 participants successfully re-examined after 17 years. In analyses of baseline risk factors, fewer repetitive tasks at work, female gender and greater relative weight were associated with any occurrence of CTS during follow-up. In analyses of aggregate risk factor scores through 1994 to 1995, only greater relative weight and female gender were associated with CTS in 2001 to 2002. Although obesity and gender are consistent predictors of CTS, workplace demands appear to bear an uncertain relationship to CTS. These findings are also discussed in relation to the possible differences between research-defined CTS and medically referred CTS.

Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow.

INTRODUCTION: There is currently little consensus regarding the appropriate surgical approach to treatment of cubital tunnel syndrome (CubTS), and few studies have reported long-term follow-up of patients who have received surgical treatment for ulnar nerve compression at the elbow. METHOD: Seventy-four patients with a total of 102 cases of CubTS treated with simple decompression of the ulnar nerve were examined 1.0-12.4 years postoperatively. Ulnar nerve conduction studies (slowest conducting 5 cm segment of ulnar nerve motor fibers measured at the elbow) were performed both pre- and postoperatively. The primary clinical outcome was percentage relief of symptoms, divided into "excellent" outcome group or less (> or = 90% improvement or < 90% improvement). RESULTS: Ulnar nerve conduction improved pre- to postoperatively, but clinical improvement was not related to changes in velocity. Women reported greater clinical improvement than men, and weight gain in men (but not women) predicted less improvement. Relief of cubital tunnel symptoms was greatest for those arms receiving carpal tunnel release surgery simultaneous or subsequent to cubital tunnel release. DISCUSSION: Simple decompression may offer excellent intermediate and long-term relief of symptoms associated with CubTS. Although improvement in ulnar motor nerve conduction velocity occurs following treatment of CubTS, it may not be a consistent marker of perceived symptom relief. Finally, these findings suggest that less complete relief of symptoms following ulnar nerve decompression may be related to unrecognized carpal tunnel syndrome or weight gain.

The prevalence of atopic dermatitis in Oregon schoolchildren.

BACKGROUND: Although surveys from many parts of the world have shown that the prevalence of atopic dermatitis (AD) in schoolchildren has increased greatly in the past 40 years, there is no current prevalence information from the United States. OBJECTIVE: Our objective was to investigate the utility of a recently developed European questionnaire to estimate the prevalence of AD in urban and rural Oregon schoolchildren. METHODS: The self-administered Schultz-Larsen questionnaire (SLQ) of AD symptoms and history was completed by the parents of a broad socioeconomic and ethnic mix of 5- to 9-year-old schoolchildren from 6 urban and 2 rural elementary schools in Oregon. Validation assessments included comparisons of the questionnaire scores with clinical examination in a group of age-matched children and with specific history components known to correlate with AD. RESULTS: Data showed a prevalence of 17.2% using standard scoring criteria for the SLQ and with a lower limit of 6.8% according to highly stringent criteria derived from the validation study using dermatologic examination. A single question ("Has a doctor ever said that your child has eczema?") was highly concordant with the questionnaire determination, yielding very high predictive accuracy (91.2%). CONCLUSION: This study of childhood AD frequency indicates a high prevalence of AD in the United States, comparable to that recently observed from studies in Europe and Japan. (J Am Acad Dermatol 2000;43:649-55.).

Relation of salivary cotinine to blood pressure in middle-aged cigarette smokers.

BACKGROUND: In laboratory research, nicotine administration is associated with increases in blood pressure. In epidemiologic research, however, the amount of reported cigarette smoking has no consistent relation with blood pressure. The objective of this study was to examine the relation of a nicotine metabolite (salivary cotinine) to systolic and diastolic blood pressure in current smokers being screened for entry to a clinical trial. METHODS AND RESULTS: Data were obtained from 5164 middle-aged cigarette smokers during screening for the Lung Health Study. Multiple linear regression was used to examine the association of salivary cotinine and number of cigarettes smoked per day to systolic and diastolic blood pressure with age, body mass, years of education, alcohol intake, and recent caffeinated beverage use controlled in all analyses. Although smoking frequency was unrelated to blood pressure, salivary cotinine was related to greater systolic blood pressure in both men and women and greater diastolic blood pressure in men. CONCLUSIONS: The association between salivary cotinine and blood pressure in these analyses suggests that long-term nicotine exposure may be related to modest elevations in blood pressure in cigarette smokers.

Levels of cotinine associated with long-term ad-libitum nicotine polacrilex use in a clinical trial.

Studies of nicotine replacement by 2 mg nicotine polacrilex gum (NG) have typically found that one half to one third of plasma nicotine in recent smokers is replaced. This 5-year study sought to find the extent of nicotine replacement among ex-smokers in the longer term and to identify a mechanism for this relationship. The sample was the special intervention group (N = 3923) in the Lung Health Study, a controlled clinical trial involving smoking cessation. The extent of nicotine replacement was assessed by levels of salivary cotinine. Cotinine levels of ex-smokers using NG after 1 year (219 +/- 149 ng/ml) were similar to those in continuing smokers (290 +/- 159 ng/ml). After 5 years, cotinine levels were the same for NG-using ex-smokers (316 +/- 276 ng/ml), NG-using smokers (309 +/- 240 ng/ml), and NG-non-using smokers (311 +/- 198 ng/ml). Salivary cotinine among NG users at 1 year was only weakly correlated with baseline cotinine levels prior to smoking cessation. Although NG users appear to re-establish cotinine levels characteristic of their smoking, the mechanism by which this occurs remains unclear.

Alcohol and morbidity in the Lung Health Study.

OBJECTIVE: There is a well documented J-shaped relationship between alcohol consumption and mortality that is not fully understood. Differences between studies, particularly in the use of cigarette smoking as a covariate, may partially explain inconsistencies in findings. This study sought to clarify the nature of this alcohol-smoking-mortality relationship. METHOD: The Lung Health Study enrolled 5,887 (3,702 male; 95% white) cigarette smokers with airways obstruction, aged 35 to 60. Measures of smoking, drinking and body mass index were available annually over the 5-year duration of the study, and pattern of alcohol use and diastolic blood pressure were assessed at baseline. Heavy drinkers were excluded from the sample. Documented evidence of hospitalizations was used in establishing morbidity. Proportional hazards regression was used for analysis. RESULTS: A significant protective effect of moderate drinking was found among men, but not women. There was also no apparent interaction between smoking status and drinks per week (both time dependent) in these data on morbidity and mortality. A baseline pattern of drinking eight or more drinks per occasion, but less than once a month, among men was associated with fewer hospitalizations and deaths. CONCLUSIONS: This study confirmed the general relationships between use of alcohol and illness or death, but with a few unexpected results. Further investigation is needed to identify whether these unexpected findings were due to our somewhat unique sample, to our use of hospitalization as the primary outcome measure, or to other causes.

The "worth" of routine spirometry in a cystic fibrosis clinic.

In our cystic fibrosis clinic, all patients older than 6 years perform spirometry at each visit just before being seen by the health care team. Upon review, we determined that our perceived rationale for this practice was that the medical history fails to detect deterioration in a sizable minority of patients whose pulmonary decline can be detected by spirometry. Furthermore, the literature and our own experience indicates that physical examination frequently will not detect changes in pulmonary status until the changes are advanced. As part of an ongoing quality/cost assessment, we decided to challenge our rationale for performing routine spirometry. Using standard methodology, we developed a six-item Likert style questionnaire, the purpose of which was to assess perceived changes in pulmonary symptoms since the last clinic visit. The questionnaire had an acceptable degree of internal consistency (Cronbach's alpha = 0.92), although the question about sputum production showed the least correlation with responses to other items. We administered the questionnaire to 103 consecutive different patients and examined the association between reported changes in symptoms and actual changes in spirometric outcomes. Overall, there was a statistically significant, but clinically weak association between symptom scores and change in FEV1, r2 = 0.16, P < 0.001. Twenty-three patients had a decline in FEV1 of > or = 10% from one clinic visit to the next. Depending on the method used to place symptom scores into categories indicating that pulmonary symptoms were "worse," "same," or "better" than at the last clinic visit, 40-60% of these 23 patients indicated they felt the "same" or "better." We conclude that spirometry is a justifiable part of all clinic visits for patients with cystic fibrosis, assuming that one would want to detect and treat declines in pulmonary status before they become advanced.

Does cessation of smoking cause a change in alcohol consumption? Evidence from the Lung Health Study.

Although use of cigarettes and alcohol is positively related, there is a lack of evidence whether changes in smoking are followed by changes in drinking. The Lung Health Study recruited 5,887 adult smokers and randomized 2/3 to a smoking cessation intervention and 1/3 to a control group. "Heavy drinkers" were excluded from the sample. After a year in the study, 42% of the intervention participants reported that they had stopped smoking, compared to 11% of the controls. There was no corresponding difference between intervention and control participants in the use of alcohol after one year, although the study provided a high level of power to detect such a difference.

Relationship of smoking cessation and nicotine gum use to salivary androstenedione and testosterone in middle-aged men.

Cross-sectional studies have associated cigarette smoking in men with elevated androstenedione and little net effect on other sex steroids. However, it is not clear if such findings reflect the impact of nicotine exposure or if sex hormone levels change following smoking cessation. The relationship of the reported number of cigarettes smoked per day and salivary cotinine to salivary testosterone and androstenedione was examined in 221 men aged 35 to 59 years at baseline and 1 year following randomization into a clinical trial including a smoking-cessation intervention. At baseline, salivary cotinine was related to increased salivary androstenedione and testosterone following control for age, body mass, alcohol intake, and time of day of specimen collection (partial r = +.14 and +.30 P < .05 and .01, respectively). The reported number of cigarettes smoked per day was unrelated to either hormone. At the first annual visit, there was a significant decrease in the salivary androstenedione of men who had quite smoking and were currently using nicotine gum (94 v 60 pg/mL, P < .05, n = 34) and of men who had quit smoking and were not exposed to nicotine (86 v 56 pg/mL, P < .05, n = 48), whereas the salivary androstenedione of men who remained smokers at the first annual visit was unchanged (83 v 85 pg/mL, n = 139). Salivary testosterone levels were not significantly affected by a change in smoking status.(ABSTRACT TRUNCATED AT 250 WORDS)

Level of involvement with alcohol and success at smoking cessation in the lung health study.

OBJECTIVE: This analysis examines the role of alcohol consumption in success at quitting smoking. METHOD: Participants were 3,977 men and women in the Lung Health Study, a prospective investigation of the effect of smoking cessation and an inhaled bronchodilator on the airways of smokers with mild lung function impairment. Participants reporting more than 25 drinks per week, or 8 or more drinks per occasion once a month or more, or alcoholics who drank in the past year were excluded from the sample. RESULTS: There was no relationship between amount of alcohol consumed at baseline and smoking status after 1 year. Among both men and women receiving a smoking cessation intervention, those who drank eight or more drinks per occasion (binge drinkers) were more likely to be current smokers after 1 year, and to smoke more cigarettes per day than those without a history of binge drinking. These relationships were largely absent among control participants. Participants who identified themselves as former or recovering alcoholics at baseline did not differ from the other participants in their smoking behavior after 1 year. When volume of drinking and drinking of eight or more drinks per occasion were compared in polychotomous ordinal logistic regressions, only binge drinking predicted failure at smoking cessation. CONCLUSIONS: Binge but not volume of drinking was related to failure in attempts to quit smoking. The common factor may be that binge drinking and relapse to smoking both represent loss of control.

Salivary cotinine, frequency of cigarette smoking, and body mass index: findings at baseline in the Lung Health Study.

This study investigates the relation of salivary cotinine and of the reported number of cigarettes smoked per day to body mass index among middle-aged male (n = 3,538) and female (n = 2,096) cigarette smokers participating in screening for entry to a clinical trial of early intervention in chronic obstructive pulmonary disease (Lung Health Study) from 1986 to 1989. Both before and after controlling for age, education, and alcohol intake, the number of cigarettes smoked per day was positively related to body mass index among both men and women, whereas salivary cotinine levels were negatively related to body mass index among both men and women. The opposite relation of salivary cotinine and of reported number of cigarettes smoked per day to body mass index is discussed with regard to nicotine metabolism, energy intake, and measurement issues in the assessment of cigarette smoke exposure.

Smoking rate, carboxyhemoglobin, and body mass in the Second National Health and Nutrition Examination Survey (NHANES II).

The relationship of body mass and triceps skinfold thickness to both reported number of cigarettes smoked per day and carboxyhemoglobin levels was examined in healthy cigarette smokers in the NHANES II. Among both men and women, higher carboxyhemoglobin levels were related to lower body mass and thinner skinfolds, whereas higher levels of reported daily cigarette smoking were related to increased body mass and thicker skinfolds among men only. These relationships were independent of age, education, caloric intake, physical activity, and exercise. The opposite effects of number of cigarettes smoked per day and a biological index of cigarette smoke exposure on body mass suggest that increased cigarette smoking may covary with factors that would favor increased body weight among men, whereas decreases in body weight with increases in carboxyhemoglobin may reflect the effects of nicotine exposure on energy expenditure in both men and women.

Cigarette smoking and body weight in the Cancer Prevention Study I.

To investigate the generality of the association of heavy cigarette smoking with increased body weight, the relation of number of cigarettes smoked per day to relative body weight was examined in baseline data for 891,589 participants in a prospective study initiated in 1959. Although the relative weight of cigarette smokers was consistently lower than that of never and exsmokers, men and women smoking two or more packs of cigarettes per day were more likely to be categorized as moderately or severely overweight and less likely to be categorized as underweight than those smoking 10-20 cigarettes per day, despite somewhat greater educational attainment by heavier smokers. These analyses offer support for the temporal generality of the relation between heavier cigarette smoking and greater body weight, and suggest that this phenomenon cannot be explained by historic trends in the socioeconomic stratification of smoking prevalence or smoking dose.