Interventions for the primary prevention of work-related carpal tunnel syndrome.

OBJECTIVE: To evaluate interventions for the primary prevention of work-related carpal tunnel syndrome (CTS). SELECTION CRITERIA: Studies had to include an engineering, administrative, personal, or multiple component intervention applied to a working or working-age population. All study designs that included comparison data were considered. Outcome measures included the incidence, symptoms, or risk factors for CTS, or a work-related musculoskeletal disorder of the upper extremity that included CTS in the definition. RESULTS: Twenty-four studies met our inclusion criteria. Engineering interventions included alternative keyboards, computer mouse designs and wrist supports, keyboard support systems, and tool redesign. Personal interventions included ergonomics training, splint wearing, electromyographic biofeedback, and on-the-job exercise programs. Multiple component interventions (e.g., ergonomic programs) included workstation redesign, establishment of an ergonomics task force, job rotation, ergonomics training, and restricted duty provisions. Multiple component programs were associated with reduced incidence rates of CTS, but the results are inconclusive because they did not adequately control for potential confounders. Several engineering interventions positively influenced risk factors associated with CTS, but the evaluations did not measure disease incidence. None of the personal interventions alone was associated with significant changes in symptoms or risk factors. All of the studies had important methodologic limitations that may affect the validity of the results. CONCLUSIONS: While results from several studies suggest that multiple component ergonomics programs, alternative keyboard supports, and mouse and tool redesign may be beneficial, none of the studies conclusively demonstrates that the interventions would result in the primary prevention of carpal tunnel syndrome in a working population. Given the societal impact of CTS, the growing number of commercial remedies, and their lack of demonstrated effec- tiveness, the need for more rigorous and long-term evaluation of interventions is clear. Fund- ing for intervention research should prioritize randomized controlled trials that include: (1) adequate sample size, (2) adjustment for relevant confounding variables, (3) isolation of speci- fic program elements, and (4) measurement of long-term primary outcomes such as the inci- dence of CTS, and secondary outcomes such as employment status and cost.

Effects of high school driver education on motor vehicle crashes, violations, and licensure.

OBJECTIVE: We sought evidence in the research literature to determine if (1) high school-aged persons who enroll in a driver education course have fewer motor vehicle-related crashes or violations, or are more likely to obtain a drivers license, than those who do not enroll in driver education courses, and (2) the availability of high school driver education courses is associated with lower community rates of motor vehicle crashes among young drivers. METHODS: To be included, a study must: (1) assess the effects of driver education courses or legislation for high school-aged persons; (2) present non-self-reported data for at least one of the following outcome measures: driver licensure rates, motor vehicle-related violations, or crashes; (3) include some form of no intervention comparison group; (4) adequately control for potentially confounding variables; (5) randomly assign participants to control or treatment groups, if a controlled trial. RESULTS: Nine studies met our inclusion criteria. Based on these studies, there is no convincing evidence that high school driver education reduces motor vehicle crash involvement rates for young drivers, either at the individual or community level. In fact, by providing an opportunity for early licensure, there is evidence that these courses are associated with higher crash involvement rates for young drivers. CONCLUSIONS: Although few driver education curricula have been carefully evaluated, in the absence of evidence that driver education reduces crash involvement rates for young persons, schools and communities should consider other ways to reduce motor vehicle-related deaths in this population, such as graduated licensing.

Eating attitudes, dieting, and bulimia among junior high school students.

Students in a western New England (U.S.) junior high school (ages 11-15) were surveyed in 1986 to identify attitudes and behaviors about eating and dieting which might foster disordered eating habits. Although few students met official criteria for disordered eating habits, at least 12 percent did practice dieting and 28 percent were frequently preoccupied with the desire to be thinner and/or were terrified of being overweight. One-quarter of girls (vs. only 3.2% of boys) mistakenly classified themselves overweight. Perception of one's own weight seems to be more highly correlated with measures of eating attitude and behavior than does actual weight. Differences also were found in how males and females viewed their own weight although both dieted to about the same extent. Females also were more interested in having school classes on eating and dieting. Recommendations were made for prevention and education regarding eating disorders among this age group.