Journals watch: Causes for carpal tunnel syndrome

Too busy to read the journals? Let Dr Elisabeth Croton guide you through the latest research

Risk factors for carpal tunnel syndrome

Br J Gen Pract 2007; 57: 36–9 

I have seen three cases of carpal tunnel syndrome this week, all of which I believe were caused by the patient’s occupation.

This study compared the incidence rates of carpal tunnel syndrome in two different years through analysis of Dutch general practice national survey data.

The incidence of carpal tunnel syndrome per 1,000 increased in both sexes between 1987 and 2001, although this was not statistically significant after subdividing for age and sex.

The peak incidence rate of carpal tunnel syndrome is the 45 to 64 age group in both sexes.

In both years the female-to-male ratio was three to one.

Women who performed unskilled or semi-skilled work were 1.5 times more likely to develop carpal tunnel syndrome compared with their counterparts in higher-skilled jobs. This effect was not seen in men.

Chest pain and CHD

Br J Gen Pract 2007; 57: 40–4 

Self-reported chest pain could be an important sign of CHD (which sounds obvious) according to this English population-based study.

Researchers sent the Rose Angina Questionnaire to 4,002 adults.

They then examined GP records to identify responders who had no record of CHD. The researchers then looked at survival in those with and without self-reported chest pain up to the date of GP diagnosis or death.

The follow-up period was seven years. They found that incidence of CHD consultations was higher with any chest pain compared to no pain and this was maintained throughout the seven-year period.

The results were strongly age related, although the message remains that we should take chest pain seriously in those with high-risk lifestyles.

Insomnia in older patients

Am J Geriatr Psychiatry 2006; 14: 860–6 

The sleep problems of older people are not addressed frequently by their primary care doctors, despite the fact that treatment of could improve their physical and mental health.

During this US study, researchers interviewed 1,503 participants from a primary care setting. The age range was from 62 to 100 years. A total of 69 per cent of patients reported at least one sleep complaint and 40 per cent reported two or more complaints. However, the researchers found that doctors only reported a sleep complaint 19 per cent of the time.

The researchers found that excessive daytime sleepiness was the best predictor of physical and mental health and that by asking the patient if they felt sleepy during the day would help them decide if further questioning was needed.

Deaf women and antenatal care

Fam Med 2006; 38: 712–6 

We are all aware that good communication improves patient satisfaction. However, the deaf community experience significant communication barriers in many clinical settings.

The study circulated a standardised antenatal care satisfaction questionnaire among equal groups of hearing and non-hearing women.

Deaf women were less satisfied with doctor communication and the quality of care. They were more likely to be satisfied where there was consideration given to the use of interpreters. Hearing women were offered more antenatal appointments and information from clinicians.

The conclusion from this is that we should pre-empt the use of interpreters and allow time for discussion and questions when caring for deaf women in an antenatal care setting. 

Dr Croton is a GP registrar in Northumberland and a member of our team who regularly review the journals

The quick study

Carpal tunnel syndrome is 1.5 times more likely in women in unskilled jobs.

Chest pain is a strong indicator of CHD.

Sleep problems in elderly patients are often ignored by doctors.

Deaf women receive less satisfactory antenatal care and receive less information than hearing women.

Research of the week 

Self-management of lower urinary tract symptoms

BMJ 2007; 334: 25–8 

Self-management has already been shown to be effective in diabetes and asthma. In this study researchers randomised men with lower urinary tract symptoms to either standard care or self-management within secondary care.

The self-management group took part in small group sessions where they were taught to modify their lifestyle by fluid restriction, bladder retraining and double-voiding, among other things.

The self-management group had a lower rate of treatment failure as measured by the international prostate symptoms score and this was maintained at 12 months.

Small groups of this nature may be difficult to run in primary care but it might be possible to incorporate self-management techniques into our consultations before resorting to drugs.

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