Association of occupational and non-occupational risk factors with the prevalence of self-reported carpal tunnel syndrome in a national survey of the working population.

To compare the association of occupational versus personal, nonoccupational risk factors with the prevalence of carpal tunnel syndrome (CTS), data from the 1988 National Health Interview Survey, Occupational Health Supplement, were analyzed. When both occupational factors (bending/twisting of the hands/wrists [B/T] and use of hand-held vibrating tools) and personal nonoccupational factors (gender, race, age, body mass index [BMI], smoking, education, and family income) were included in a multivariate logistic regression model, adjusted odds ratios (AORs) of these factors for reporting medically called CTS (MC-CTS) were: exposure to B/T, 5.5; exposure to vibration, 1.9; white race, 16.7; female gender, 2.3; BMI > or = 25, 2.0; history of cigarette smoking, 1.6; age > or = 40, 1.2; education > 12 years, 1.2; and annual family income > or = $20,000, 1.5. Although both occupational and nonoccupational factors are associated with reporting of CTS, repetitive bending/twisting of the hands/wrists and use of vibrating tools remain important risk factors for work-related carpal tunnel syndrome.

Evaluation of reproductive function among men occupationally exposed to a stilbene derivative: I. Hormonal and physical status.

This is the first of two reports describing a National Institute for Occupational Safety and Health (NIOSH) Health Hazard Evaluation conducted in response to complaints of impotence and decreased libido among male employees who manufactured 4,4'-diaminostilbene-2,2' disulfonic acid (DAS; CAS 81-11-8), an intermediate in the manufacture of fluorescent whitening agents. DAS is structurally similar to the synthetic estrogen diethylstilbestrol (DES). Levels of six reproductive hormones in 30 male workers who manufactured DAS (current DAS workers) and 20 former DAS workers were compared to levels of 35 workers who manufactured plastics additives. Current and former DAS workers had lower mean total testosterone (TT) levels compared to additives workers (458 and 442, respectively, vs. 556 ng/dL; p = 0.05 and 0.04). Current and former DAS workers were 3.6 (95% CI, 0.5-24.4) and 2.2 (95% CI, 0.3-18.0) times more likely than additives workers to have lowest quartile TT levels (< 386 ng/dL) after adjustment for age and body mass index. Duration of employment in DAS production was negatively related to the workers' testosterone levels. These data suggest that occupational DAS exposure may be associated with alterations in male reproductive hormone levels.

Evaluation of reproductive function among men occupationally exposed to a stilbene derivative: II. Perceived libido and potency.

This is the second of two reports of a National Institute for Occupational Safety and Health (NIOSH) Health Hazard Evaluation conducted in response to complaints of sexual dysfunction among men who manufacture the stilbene derivative 4,4'-diaminostilbene-2,2'-disulfonic acid (DAS; CAS 81-11-8), an intermediate in the manufacture of fluorescent whitening agents. The first report [Grajewski et al. (1995): Am J Ind Med 29:53-61] describes results of the analysis of reproductive hormone levels. This second report provides results from the analysis of perceived libido and potency. In a cross-sectional design, self-reported sexual function of 30 male workers who manufacture DAS and 20 former DAS workers was compared to that of 35 workers who manufactured plastics additives in a different manufacturing area. Questionnaire items were examined by factor analysis, reducing the data to these components of sexual function: sexual activity/performance (two factors), interest, satisfaction, and physiologic competence. Adjusting for age, currently exposed workers were more likely than unexposed workers to have a value in the lowest quartile for interest (adjusted odds ratio [OR] = 1.9, 95% confidence interval [CI] 0.5-7.2), physiologic competence (adjusted OR = 1.9, 95% CI 0.6-6.4), and activity/performance factor II (adjusted OR = 5.8, 95% CI 1.3-27.3). Former DAS workers reported problems associated with activity/performance factors I and II compared to unexposed workers (adjusted OR = 2.2, 95% CI 0.5-10.1 and adjusted OR = 6.7, 95% CI 1.2-35.9, respectively). Although the small study size limits the precision of the effect estimates, the pattern of results suggests a possible effect on sexual function of working in the DAS manufacturing area.

Back pain among workers in the United States: national estimates and workers at high risk.

Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.

Prevalence and work-relatedness of self-reported carpal tunnel syndrome among U.S. workers: analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey.

To estimate the prevalence and work-relatedness of self-reported carpal tunnel syndrome (CTS) among U.S. workers, data from the Occupational Health Supplement of 1988 National Health Interview Survey (NHIS) were analyzed. Among 127 million "recent" workers" who worked during the 12 months prior to the survey, 1.47% (95% CI: 1.30; 1.65), or 1.87 million self-reported CTS, and 0.53% (95% CI: 0.42; 0.65), or 675,000, stated that their prolonged hand discomfort was called CTS by a medical person. Occupations with the highest prevalence of self-reported CTS were mail service, health care, construction, and assembly and fabrication. Industries with the highest prevalence were food products, repair services, transportation, and construction. The risk factor most strongly associated with medically called CTS was exposure to repetitive bending/twisting of the hands/wrists at work (OR = 5.2), followed by race (OR = 4.2; whites higher than nonwhites), gender (OR = 2.2; females higher than males), use of vibrating hand tools (OR = 1.8), and age (OR = 1.03; risk increasing per year). This result is consistent with previous reports in that repeated bending/twisting of the hands and wrists during manual work is etiologically related to occupational carpal tunnel syndrome.

The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data.

To estimate the prevalence of carpal tunnel syndrome among US adults, data from the Occupational Health Supplement of the 1988 National Health Interview Survey were analyzed. Based on a sample of 44,233 households (response rate, 91.5%), an estimated 1.55% (2.65 million) of 170 million adults self-reported carpal tunnel syndrome in 1988. Females and Whites had a higher prevalence of self-reporting carpal tunnel syndrome than males and non-Whites, respectively. Among 127 million adults who worked during the 12 months before the survey, 0.53% (0.68 million) reported that their "prolonged" hand discomfort was called carpal tunnel syndrome by a health care provider.