Health Disparities Persist in America
CDC finds race, sex, education, location and wealth among key factors in these inequalities

Despite progress in some areas, health disparities remain for many Americans, health officials reported Thursday.

These inequalities are related to income, education, sex, race, ethnicity, employment and sexual orientation, and they all affect Americans’ health and well-being, according to the U.S. Centers for Disease Control and Prevention.

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Researchers link speech and language disorders with the profession

SOURCE: Mayo Clinic, news release, Oct. 15, 2013

Three-quarters of patients still had to have surgery a year later

TUESDAY, Sept. 3 (HealthDay News) — Steroid shots can temporarily relieve the painful symptoms of carpal tunnel syndrome, but three-quarters of patients who are initially helped by these injections will eventually require surgery, new Swedish research says.

About 5 percent of Americans suffer from carpal tunnel syndrome, which occurs due to pressure on a key nerve that runs from the forearm into the palm of the hand. It is a repetitive-motion injury that tends to affect people performing assembly line or data entry work.

The median nerve is housed within the tight confines of the carpal tunnel, a narrow corridor of ligament and bones at the base of the hand. Tendons located in the carpal tunnel can swell and squeeze the median nerve if they become irritated and inflamed. Sufferers feel pain, tingling and numbness in the affected hand and wrist, with pain sometimes shooting up their arm.

Steroid shots frequently are used to reduce tendon swelling and ease pressure on the nerve, said Dr. David Ruch, chief of orthopedic hand service at the Duke University Medical Center and practice division director for the American Society for Surgery of the Hand. Mild cases can be treated with splints worn to keep the wrists straight until swelling inside the carpal tunnel goes down.

However, surgery to open up the carpal tunnel and relieve pressure on the nerve remains the most effective treatment for moderate to severe cases, so much so that carpal tunnel release is one of the most common surgical procedures in the United States, according to the U.S. National Institute of Neurological Disorders and Stroke.

The new study affirms the common perception among doctors that steroid shots serve as only a temporary fix for patients with moderate or severe cases of carpal tunnel syndrome, Ruch said.

“The long-term ability of carpal tunnel syndrome to be treated with an injection is really based upon the severity of your symptoms, how long the symptoms have been in place and how old you are,” he said.

The new research, from doctors at Hassleholm Hospital in Sweden and published in the Sept. 3 issue of the journal Annals of Internal Medicine, involved 111 patients aged 18 to 70 with carpal tunnel syndrome who had no previous steroid injections. Doctors treated two-thirds of the patients with injections of methylprednisolone, a type of steroid.

Within 10 weeks, people who received steroid injections were less likely to report pain, numbness, tingling or other symptoms.

Three out of four patients who received steroids, however, needed surgery within one year.

Those most likely to benefit from steroid shots are people under 30 with mild symptoms and less pressure on their median nerve. “You have a reasonable chance of having your symptoms go away and stay gone with the cortisone shot,” Ruch said.

But steroid shots will improve symptoms for only about six months in people over 35 who have moderate to severe carpal tunnel syndrome, he said.

Despite these findings, doctors will continue to use steroid shots as a first-line treatment for carpal tunnel syndrome, said Dr. Leon Benson, of the Illinois Bone & Joint Institute in Glenview, Ill.

Steroid shots help doctors rule out other potential causes for the symptoms patients are experiencing. If the steroid shots don’t work, then the patient probably has something other than carpal tunnel syndrome.

“Injection is a crucial and important part of treating patients with carpal tunnel syndrome initially, because it helps confirm the diagnosis,” Benson said. “I never operate on anyone unless I’ve given them a steroid injection first.”

The patient’s response to a steroid injection also serves as a good prediction for how well they’ll respond to surgery, Ruch added.

“It does a very nice job of delineating who is going to have a good response to surgery,” he said. “If you had good relief from your cortisone shot, chances are very, very high you’re going to get good results from surgery.”

To avoid carpal tunnel syndrome, you can:

• Perform stretching exercises on your wrists.
• Take frequent breaks.
• Wear splints or braces to keep your wrists straight.
• Ask your employer to rotate your job or perform an ergonomic assessment of your work space.

For more information on carpal tunnel syndrome, visit the National Institute of Neurological Disorders and Stroke.

Study finds on-the-job secondhand smoke still a problem in certain occupations

MONDAY, Nov. 4 (HealthDay News) — State laws have reduced the overall rates of secondhand-smoke exposure for many workers, but people in certain occupations are still vulnerable, according to a new study.

Researchers looked at worker exposure to secondhand smoke in Massachusetts after the state implemented its Smoke-Free Workplace Law in 2004. They found that the overall percentage of people exposed fell from 8 percent in 2003 to 5.4 percent in 2010.

However, the investigators found that workers in three job categories still had much higher rates of exposure to secondhand smoke in 2010: installation, repair and maintenance (about 37 percent); construction and extraction (nearly 23 percent); and transportation and material moving industries (almost 20 percent).

These three occupational groups often work in settings not covered by the law — such as outdoor space or private homes — or in which the law is difficult to enforce, such as vehicles, the study authors pointed out.

Exposure to secondhand smoke at work was more common among male, non-white and younger workers, according to the study, which is scheduled for presentation Monday at the annual meeting of the American Public Health Association in Boston.

“We’re seeing a steady decline in prevalence of exposure, but it’s clear that there are still specific groups of workers that deserve our attention,” lead researcher Kathleen Fitzsimmons said in an association news release.

“Findings like these that combine information about occupation and environmental tobacco smoke provide helpful information for evaluating comprehensive, statewide smoke-free workplace laws and for targeting interventions to reduce risks,” added Fitzsimmons, who is an epidemiologist in the Occupational Health Surveillance Program at the Massachusetts Department of Public Health in Boston.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Cancer Society has more about the dangers of secondhand smoke.

New York (Reuters Health) – Exercising for fun may lower the risk of high blood pressure, but heavy lifting on the job does not offer the same benefit, according to a new review of the evidence.

Researchers looking at studies that followed nearly 137,000 people found that recreational exercise for more than four hours a week was linked to a 19 percent lower risk of developing high blood pressure compared to doing little or no leisure-time exercise.

But people with similar levels of physical activity in the course of work had about the same risk as those in less strenuous jobs. [Read more…]

Most want to be told of screening harms, but only 9.5 percent informed about overdiagnosis, overtreatment

TUESDAY, Oct. 22 (HealthDay News) — Few patients who are eligible for cancer screening are aware of the risks of overdiagnosis and overtreatment, according to a research letter published online Oct. 21 in JAMA Internal Medicine.

Odette Wegwarth, Ph.D., and Gerd Gigerenzer, Ph.D., from the Max Planck Institute for Human Development in Berlin, conducted a national cross-sectional survey involving 317 U.S. men and women, aged 50 to 69 years, to examine whether patients are informed by their physicians about overdiagnosis when discussing cancer screening. [Read more…]

Use of psychoactive substances associated with poor working conditions

TUESDAY, Oct. 22 (HealthDay News) — The use of psychoactive substances, including alcohol, amphetamines, and marijuana, appears common in truck drivers, particularly when working conditions are poor, according to research published online Oct. 21 in Occupational & Environmental Medicine.

Edmarlon Girotto, of the Universidade Estadual de Londrina in Brazil, and colleagues conducted a systematic review of the literature to summarize the evidence for use of psychoactive substances in truck drivers and to identify the factors associated with this behavior. [Read more…]

Brown-bagging it at your desk not as stressful when it’s your choice, study finds

WEDNESDAY, Oct. 9 (HealthDay News) — Working through your lunch break may not be so bad, as long as you make that choice yourself and don’t feel pressured into it, a new study suggests.

“We found that a critical element was having the freedom to choose whether to do it or not,” John Trougakos, an assistant professor of organizational behavior at the University of Toronto’s Rotman School of Management, said in a university news release. “The autonomy aspect helps to offset what we had traditionally thought was not a good way to spend break time.” [Read more…]