Quality Measures for the Diagnosis and Non-Operative Management of Carpal Tunnel Syndrome in Occupational Settings

Introduction: Providing higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers’ compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations. Methods: Using a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility. Results: Of 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations. Conclusions: These measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level

Desert dust impacts on human health: an alarming worldwide reality and a need for studies in West Africa

High desert dust concentrations raise concerns about adverse health effects on human populations. Based on a systematic literature review, this paper aims to learn more about the relationship between desert dust and human health in the world and to analyse the place of West Africa as a study area of interest. Papers focussing on the potential relationship between dust and health and showing quantitative analyses, published between January 1999 and September 2011, were identified using the ISI Web of Knowledge database (N = 50). A number of adverse health effects, including respiratory, cardiovascular and cardiopulmonary diseases, are associated with dust. This survey highlights obvious dust impacts on human health independently of the study area, health outcomes and method. Moreover, it reveals an imbalance between the areas most exposed to dust and the areas most studied in terms of health effects. None of these studies has been conducted in West Africa, despite the proximity of the Sahara, which produces about half of the yearly global mineral dust. In view of the alarming results in many parts of the world (Asia, Europe, America), this paper concludes by stressing the importance of carrying out impact studies of Saharan dust in West Africa, where dust events are more frequent and intense than anywhere else

The role of exotic plants in the invasion of Seychelles by the polyphagous insect Aleurodicus disperses: a phylogenetically controlled analysis

The accidental introduction of the spiralling whitefly, Aleurodicus dispersus Russell (Homoptera: Aleyrodidae) to Seychelles in late 2003 is exploited during early 2005 to study interactions between A. dispersus, native and exotic host plants and their associated arthropod fauna. The numbers of A. dispersus egg spirals and pupae, predator and herbivore taxa were recorded for eight related native/exotic pairs of host plants found on Mahe, the largest island in Seychelles. Our data revealed no significant difference in herbivore density (excluding A. dispersus) between related native and exotic plants, which suggests that the exotic plants do not benefit from 'enemy release'. There were also no differences in predator density, or combined species richness between native and exotic plants. Together these data suggest that 'biotic resistance' to invasion is also unlikely. Despite the apparent lack of differences in community structure significantly fewer A. dispersus egg spirals and pupae were found on the native plants than on the exotic plants. Additional data on A. dispersus density were collected on Cousin Island, a managed nature reserve in which exotic plants are carefully controlled. Significantly higher densities of A. dispersus were observed on Mahe, where exotic plants are abundant, than on Cousin. These data suggest that the rapid invasion of Seychelles by A. dispersus may largely be due to the high proportion of plant species that are both exotic and hosts of A. dispersus; no support was found for either the 'enemy release' or the 'biotic resistance' hypotheses