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Archive for August, 2010

 Blog Post by Elizabeth Ninan:
Posted on July 27, 2010 by elizan

Everyone who earns a living has an occupation. The occupation we involve ourselves in has a lasting impact on our health. Just like making good memories have a lasting impression in our lives.

When we start to have health related problems related from our time spent working, we are no longer enjoying the occupation we once committed ourselves to or will end up having to change occupations to cope with our health problems.

For the most part, trying to practice job safety and prevention practices should be the goal to reap our rewards from the occupation that we practice routinely. In this aspect, I ponder over the stress related problems most people have in their jobs. This is to say that the stress starts even before one reaches the job environment, getting the kids ready for school, driving in traffic and reaching work already stressed out. After a 5 day burn out, is just the weekend enough to relax and wind back to start another work week. It is each one’s responsibility to wind down after a stressful day or week or month , if not for yourself but for others around you !!! Can you remember the last time you took care to do exactly that ?

 

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Official forms often have a category asking for an individual’s “occupation”, and one of the options available is being a “student”.  Being a student in any educational system should definitely be considered nothing less than an occupation.  Students are often required or strongly recommended to attend classes and meetings, spend hours working, and are under the supervision of professors and administrators alike.  In fact being a student is a “high strain” occupation in which students have little control or say, and are subjected to many demands.

Moreover, being a student myself and being surrounded by hundred of them, I can safely say that students clearly are not subjected to good health practices.  Many experience high levels of stress, a lack of sleep, inadequate physical activity, subpar diets, and increased alcohol intake.  In fact a study published in The College Student Journal showed that students are much more likely self-report increased stress levels than their working-world counterparts (1).  Additionally students are noted to have a much higher suicide rate, in fact there are more suicides in the 15-24 age group than there were homicides in the the past two years (2).

So far the burden of student health has fallen on the shoulders of Administrators.  When suicides do take place on campus they usually try to keep it as under-wraps as possible, instead of trying to pinpoint the cause of increased student suicides.  Similarly while there are some “student health” initiatives in place, administrators and professors often do not emphasize the importance leading a healthy lifestyle.  For example at most of the institutions I’ve been at the department with decreased funds and most students complaints has often been the Student Health and Wellness center.  With the numbers of people in educational institutions increasing every year I believe there should be a greater push to protect the health of students.  Maybe OSHA should start making recommendations or regulations for students!

1. Hudd, S., and J. Dumlao. “STRESS AT COLLEGE: EFFECTS ON HEALTH HABITS, HEALTH STATUS AND SELF-ESTEEM.” College Student Journal 34.2 (2000): 217-28. Print.

2. Ross, M. “Suicide Among College Students.” American Journal of Psychiatry 126 (2000): 220-25. Print.

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Blog post from Sarah Neill:

At one time or another we have all been sleep deprived.  In addition, at some point in medical school/residency all individuals pull a night shift.  We have all heard the statistics demonstrating that working the night shift can lead to increased accidents for our patients, but increasing evidence shows that pulling the night shift may be as dangerous for us as it is for our patients (1).  Circadian rhythms and the melatonin that goes with them govern our sleep cycle and help to protect against cancer.  Individuals that regularly have that rhythm disrupted are at increased risk of developing cancer because melatonin levels as well as other hormone levels are disrupted (2).  Patients are not going to stop getting sick at night so how do we protect our health care workers?  Perhaps we should switch to rotating work hours or have limitations on the amount of night shifts a person can work.  Thoughts?

1. Sleep Loss and Fatigue in Shift Work and Shift Work Disorder. Akerstedt T, Wright KP. Sleep Med Clin. 2009 Jun 1;4(2):257-271.

 2. Circadian disruption induced by light-at-night accelerates aging and promotes tumorigenesis in rats. Vinogradova IA, Anisimov VN, Bukalev AV, Semenchenko AV, Zabezhinski MA. Aging (Albany NY). 2009 Oct 2;1(10):855-65.

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Post from Julie St. John:

As I’m sitting here typing after working on other assignments and thinking about this blog, my wrists are tingling and I’m thinking, “Great—now I have carpal tunnel syndrome,” and I’m thinking, “Hmm…good idea for the blog.”   SO…

Defining Carpal tunnel syndrome:
This pain occurs when the median nerve—running from the forearm into the hand—becomes compressed or squeezed at the wrist. Why is this important? Well, this nerve controls sensations to the palm side of the thumb and fingers and sends impulses to some of the small muscles in the hand that cause thumb and finger movements. The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand, and it houses the median nerve and tendons. At times, thickening from irritated tendons or other swelling can constrict the tunnel and cause the median nerve to be compressed. This often results in pain, weakness, or numbness in the hand and wrist—which can radiate up the arm.  Other reasons can cause these tingling, painful sensations; however, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies—where peripheral nerves are compressed or squeezed.

Symptoms of carpal tunnel syndrome:

 

  • Symptoms often start gradually and include: frequent burning, tingling, or itching numbness in the palm of the hand and the fingers
  • Fingers may feel useless and swollen (though little or no swelling is apparent)
  • Symptoms can first appear in one or both hands during the night
  • Feeling tingling during the day
  • Decreased grip strength
  • Muscles atrophy at the base of the thumb
  • Inability to tell between the difference between hot and cold by touch

 

What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome is likely caused by a combination of factors causing an increase of pressure on the median nerve and tendons in the carpal tunnel.  Other factors can include: 1) trauma or injury to the wrist that cause swelling (sprain or fracture); 2) over-activity of the pituitary gland; 3) hypothyroidism; 4) rheumatoid arthritis; 5) mechanical problems in the wrist joint; 6) work stress; 7) repeated use of vibrating hand tools; 8) fluid retention during pregnancy or menopause; and 9) the development of a cyst or tumor in the canal.

Contrary to what I have often heard, the NIH says that there is little clinical data to prove that repetitive and forceful movements of the hand and wrist during work or leisure activities cause carpal tunnel syndrome. The NIH also says that repeated motions during normal work or other daily activities can result in repetitive motion disorders like bursitis and tendonitis and that Writer’s cramp is not a symptom of carpal tunnel syndrome.

Those at risk of developing carpal tunnel syndrome:
According to the NIH, women are three times more likely than men to develop carpal tunnel syndrome—which might be because the carpal tunnel may be smaller in women than in men. It’s usually developed first in one’s dominant hand and is found only in adults.

The NIH says that risk for developing carpal tunnel syndrome is not confined to a single industry or job but is common in assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing.

Diagnosis of carpal tunnel syndrome:
The NIH states that early diagnosis and treatment are important to avoid permanent damage and that the following tests may be used to diagnose carpal tunnel syndrome: Tinel test, Phalen, or wrist-flexion, test, and electrodiagnostic tests.

 

Treatment of carpal tunnel syndrome:

Treatment usually involves resting the affected hand and wrist for at least 2 weeks and avoiding activities that may worsen symptoms.  Doctors may immobilize the wrist in a splint to avoid further damage from twisting or bending.  Cool packs may be applied to help reduce swelling. Some doctors prescribe nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, and other nonprescription pain relievers), orally administered diuretics, or corticosterioids.  Doctors might also prescribe exercise, acupuncture, chiropractic care, and yoga.  Severe cases may require surgery (the NIH says that carpal tunnel release is one of the most common surgical procedures in the US).

 

Carpal tunnel syndrome prevention:

  • on-the-job conditioning
  • perform stretching exercises
  • frequent rest breaks
  • wear splints to keep wrists straight
  • use correct posture and wrist position
  • wear fingerless gloves to keep hands warm and flexible
  • resigned workstations, tools and tool handles, and tasks to enable the worker’s wrist to maintain a natural position during work
  • job rotation

 

 

Discussion:

So, the main point I find interesting is that the NIH says little research supports that repetitive work or leisure actions cause carpal tunnel syndrome.  Though—that’s all I’ve ever heard.  I have heard of insurance companies (work insurance—Workman’s Comp, etc.) paying for expenses and medical leave related to carpal tunnel syndrome.  My question is in terms of occupational exposure (and liability), given this EXTREMELY technologically advanced age with computers, email, Facebook, cell phones and texting, how can one possibly separate out the actual cause of this?  Even at work, people are often doing non-related work behaviors (surfing the internet, texting, etc.) and does that mean that the workplace is still responsible? 

Resources/links:

NIH: National Institute of Neurological Disorders and Stroke, http://www.nlm.nih.gov/medlineplus/carpaltunnelsyndrome.html

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov

Information also is available from the following organizations:

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA   95677-0850
ACPA@pacbell.net
http://www.theacpa.org
Tel: 916-632-0922 800-533-3231
Fax: 916-652-8190
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health, DHHS
31 Center Dr., Rm. 4C02 MSC 2350
Bethesda, MD   20892-2350
NIAMSinfo@mail.nih.gov
http://www.niams.nih.gov
Tel: 301-496-8190 877-22-NIAMS (226-4267)
Centers for Disease Control and Prevention (CDCP)
U.S. Department of Health and Human Services
1600 Clifton Road, N.E.
Atlanta, GA   30333
inquiry@cdc.gov
http://www.cdc.gov
Tel: 800-311-3435 404-639-3311/404-639-3543
Occupational Safety & Health Administration
U.S. Department of Labor
200 Constitution Avenue, NW
Washington, DC   20210
http://www.osha.gov
Tel: 800-321-OSHA (-6742)
American Academy of Orthopaedic Surgeons/ American Association of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL   60018
hackett@aaos.org
http://www.aaos.org
Tel: 847-823-7186
Fax: 847-823-8125
American Society for Surgery of the Hand
6300 North River Road
Suite 600
Rosemont, Il   60018-4256
info@assh.org
http://www.assh.org
Tel: 847-384-8300
Fax: 847-384-1435

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So I got the point. Some jobs are a little more dangerous than others. Taxi drivers get assaulted, long haul truckers get fat, and soldiers get shot.  This blogger isn’t concerned with the health and social  effects of alcohol abuse, but the social determinants of its development in a military environment When I joined the ARMY an alcohol problem was the least of my health concerns. As a young guy, I was the perfect example of the notorious healthy worker effect. I embraced the ARMY culture that included early morning physical trainings and nightly Bud Light drinking

While there are constant safety briefings of suicide, rape, and the notorious company commander anti-DWI lectures, alcohol abuse is stitched into the uniform of a service member’s career. Why? the answer is most certainly multifactoral, but underlying the causal factors is a culture of drinking. One study (1) has found that 43% of military personnel have reported binge drinking, 25% have reported driving drunk, and 7% have shown up for work drunk (1).  These data  shouldn’t be surprising in light of the fact that positive normative beliefs about drinking reinforce the behavior (3). You’re even rewarded with days off after nights of heavy drinking i.e. the Super Bowl as I remember from every unit to which I was assigned. With this being stated, it should be a given to learn the military has made zero progress in reducing heavy drinking (3).

It does not take too much to realize that when you put individuals in a high stress position, by PTSD removed from known support networks, little to do outside of the duty day,  and lots of free time mixed with depression or PTSD , shenanigans will ensue. But this is further compounded by lowering recruiting standards and allowing people with pre-existing substance abuse problems into the service as the New York Times has astutely reported on (4).So barring a member’s discharge from the military, as in my case, sobriety is as likely as the US’s immediate withdrawal from Iraq and Afghanistan.

1. Stahre MA, Brewer RD, Fonseca VP, Naimi TS. Binge drinking among U.S. active-duty personnel. AJPM; 2009(36)3:207-218.

2. Ames GM, Cunradi CB, Moore RS, Stern P. Military culture and drinking behavior among U.S Navy careerists. J of Stud onAlco and Drugs; 2007(68)3:336-344

3.Bray RM, Hourani LL. Substance use trends among active duty military personnel: findings from the United States Department of Defense health behavior surveys, 1980-2005.  Addiction; 2007(107)7:1092-1101.

4.Bumiller E. Petagon report places blame for suicides. NYT. July 29, 2010. Accessed on July 30, 2010. http://www.nytimes.com/2010/07/30/us/30suicide.html?scp=1&sq=military%20alcohol&st=cse

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In general, when people think about physicians, they think about physicians treating others, not themselves.  However, a recent study calls the safety of this occupation into question.  In a French University Hospital, there was the “oral report of eight cases of cancer over a period of 3 years among physicians” (Maitre 24).  “The findings pointed out the risk of lymphatic and haematopoietic cancer among physicians who started working after 1945 when the first rules pertaining to protection from ionising radiation came into effect” (Maitre ). 

However, others studies have suggested that physicians are not at an increased risk of cancer. Study performed in Finland concluded that physicians who are exposed to ionizing radiation are not at an increased risk of cancer.  The study stated that “According to the results from a nationwide cohort, occupational exposure to medical radiation is not a strong risk factor for cancer among physicians. Possible excess risk could not be reliably demonstrated even after the follow-up of a nationwide cohort for up to 30 years” (Jartti).  

Because there are different suggestions in the literature, there needs to be more research on the topic before a definitive conclusion can be made.

 

Maitre, Anne, Mark Colonna and et. al. “Increased Incidence of Haematological Cancer Among Physicians in a University Hospital.” International Archives of Occupational and Environmental Health 1 2003: 24-28.

P, Jartti, Pukkala E and et. al. “Cancer Incidence Among Physicians Occupationally Exposed to Ionizing Radiation.” Scandanavian Journal of Work and Environment and Health October 2006: 368-373.

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