| 1. |
- Burström, Lage, 1954-, et al.
(författare)
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White fingers, cold environment, and vibration : exposure among Swedish construction workers
- 2010
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 36:6, s. 509-513
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to examine the association between white fingers, cold environment, and exposure to hand–arm vibration (HAV). The hypothesis was that working in cold climate increases the risk of white fingers.Methods The occurrence of white fingers was investigated as a cross-sectional study in a cohort of Swedish male construction workers (N=134 757). Exposure to HAV was based on a job-exposure matrix. Living in the north or south of Sweden was, in a subgroup of the cohort, used as an indicator of the exposure to cold environment (ie, living in the north meant a higher exposure to cold climate). The analyses were adjusted for age and use of nicotine products (smoking and snuff).Results HAV-exposed workers living in a colder climate had a higher risk for white fingers than those living in a warmer climate [odds ratio (OR) 1.71, 95% confidence interval (95% CI) 1.42–2.06]. As expected, we found that HAV-exposed workers had an increased risk compared to controls (OR 2.02, 95% CI 1.75–2.34). The risk for white fingers increased with increased level of exposure to HAV and also age.Conclusions Cold environment increases the risk for white fingers in workers occupationally exposed to HAV. The results underscore the need to keep exposure to HAV at workplaces as low as possible especially in cold climate.
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| 2. |
- Carlsson, Daniel, 1982-, et al.
(författare)
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Can sensation of cold hands predict Raynaud's phenomenon or paraesthesia?
- 2018
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Ingår i: Occupational Medicine. - : Oxford University Press (OUP). - 0962-7480 .- 1471-8405. ; 68:5, s. 314-319
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Tidskriftsartikel (refereegranskat)abstract
- Background Raynaud's phenomenon and neurosensory symptoms are common after hand-arm vibration exposure. Knowledge of early signs of vibration injuries is needed. Aims To investigate the risk of developing Raynaud's phenomenon and paraesthesia in relation to sensation of cold hands in a cohort of male employees at an engineering plant. Methods We followed a cohort of male manual and office workers at an engineering plant in Sweden for 21 years. At baseline (1987 and 1992) and each follow-up (1992, 1997, 2002, 2008), we assessed sensation of cold, Raynaud's phenomenon and paraesthesia in the hands using questionnaires and measured vibration exposure. We calculated risk estimates with univariate and multiple logistic regression analyses and adjusted for vibration exposure and tobacco usage. Results There were 241 study participants. During the study period, 21 individuals developed Raynaud's phenomenon and 43 developed paraesthesia. When adjusting the risk of developing Raynaud's phenomenon for vibration exposure and tobacco use, the odds ratios were between 6.0 and 6.3 (95% CI 2.2-17.0). We observed no increased risk for paraesthesia in relation to a sensation of cold hands. Conclusions A sensation of cold hands was a risk factor for Raynaud's phenomenon. At the individual level, reporting a sensation of cold hands did not appear to be useful information to predict future development of Raynaud's phenomenon given a weak to moderate predictive value. For paraesthesia, the sensation of cold was not a risk factor and there was no predictive value at the individual level.
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| 3. |
- Carlsson, Daniel, et al.
(författare)
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Neurosensory and vascular function after 14 months of military training comprising cold winter conditions
- 2016
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian journal of work, environment & health. - 0355-3140 .- 1795-990X. ; 42:1, s. 61-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to examine the effects of 14 months of military training comprising cold winter conditions on neurosensory and vascular function in the hands and feet.METHODS: Military conscripts (N=54) were assessed with quantitative sensory testing comprising touch, temperature, and vibration perception thresholds and finger systolic blood pressure (FSBP) after local cooling and a questionnaire on neurosensory and vascular symptoms at both baseline and follow-up. Ambient air temperature was recorded with body worn temperature loggers.RESULTS: The subjects showed reduced sensitivity to perception of touch, warmth, cold and vibrations in both the hands and feet except from vibrotactile perception in digit two of the right hand (right dig 2). Cold sensations, white fingers, and pain/discomfort when exposed to cold as well as pain increased in both prevalence and severity. There were no statistically significant changes in FSBP after local cooling.CONCLUSION: Fourteen months of winter military training comprising cold winter conditions reduced sensation from touch, warmth, cold, and vibrotactile stimulus in both hands and feet and increased the severity and prevalence of symptoms and pain. The vascular function in the hands, measured by FSBP after local cooling, was not affected.
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| 4. |
- Eklöf, Mats, et al.
(författare)
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Workplace intervention for improved risk perception and preventive activity among workers : using hand-held vibrating machines: a pilot study
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This article presents a pilot study of a 1-h workplace educational intervention implemented among ten construction workers who were highly exposed to hand–arm vibration. The intervention combined risk communication and normative expert advice intended to reinforce preventive behaviour related to vibration, noise, and biomechanical loads. Data for this study comprised intervention notes and interview data from interventionists, and pre- and post-intervention interview data from participating workers.The results suggested that the intervention was sensitive to disturbances and should be directed only to motivated workers possessing sufficient self-efficacy, and only in circumstances in which exposure may be controlled on the local workplace level and by locally implemented measures. Unless these conditions are present, the studied intervention may fail to influence preventive behaviour, and may instead cause cognitive dissonance and frustration among participants and interventionists.
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| 5. |
- Stjernbrandt, Albin, 1985-
(författare)
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Cold exposure and health : A study on neurological and vascular hand symptoms in northern Sweden
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Living in a cold climate is associated with several adverse health effects. The main purpose of this thesis was to describe cold exposure characteristics in northern Sweden, and investigate the associations between such exposure and the reporting of neurological and vascular hand symptoms. One common cold-related hand symptom is Raynaud’s phenomenon, defined as episodic attacks of acral pallor or cyanosis. There is evidence to suggest that cold exposure can act both as a causal factor and a trigger for such vasospastic symptoms. Other important associated factors include exposure to hand-arm vibration and the presence of rheumatic disease. A somewhat similar clinical entity, cold sensitivity, is defined as a collection of acquired symptoms, resulting in an abnormal aversion to cold, with pain, sensory alterations, stiffness, or color changes, which may occur after a traumatic injury. The condition is hypothesized to mainly originate from nerve injury. The effects of cold exposure on hand function, the occurrence of cold sensitivity in the general population, the link between cold exposure and cold sensitivity, as well as the interface between cold sensitivity and Raynaud’s phenomenon are not fully understood. Therefore, this thesis was also intended to expand the knowledge on Raynaud’s phenomenon and cold sensitivity.Methods: Postal surveys were sent to a sample of men and women between 18 and 70 years of age, living in Norrbotten, Västerbotten, Västernorrland, and Jämtland, drawn from the national Swedish population register. The first survey collected data on 12,627 subjects, and the results were used to describe cold exposure characteristics, and broadly investigate the statistical associations with different neurological and vascular hand symptoms (Paper I). A follow-up survey was sent to a subset of responders, to form nested case–control studies on cold sensitivity (N=1,230; Paper II) and Raynaud’s phenomenon (N=1,400; Paper III). Subjects with cold sensitivity (N=12) from Paper II were subsequently recruited to a laboratory study, to investigate the vascular and neurosensory function of the hands, by means of physical examination, laser speckle contrast analysis before and after cold stress testing, and thermal quantitative sensory testing (Paper IV). Finally, healthy controls (N=1,239) from the case–control studies were used as a reference population for the Cold intolerance symptom severity questionnaire, to establish a cut-off for abnormal cold sensitivity (Paper V).Results: In Paper I, cold exposure was commonly reported, both during work and leisure time. Exposure was most pronounced in alpine regions, generally higher among men than women, and decreased with age. Highly cold-exposed occupational groups were militaries; agricultural, forestry and fishery workers; and crafts and related trades workers (e.g. construction workers). The correlation between occupational and leisure-time cold climate exposure was low. Men reported more occupational exposure to hand-arm vibration than women, but the correlation between occupational cold and vibration exposure was low. A range of neurological and vascular hand symptoms were statistically associated with high cold exposure, such as decreased perception to touch, warmth, and cold, as well as Raynaud’s phenomenon. In Paper II, cold sensitivity was significantly associated with previous frostbite affecting the hands, rheumatic disease, upper extremity nerve injury, migraine, vascular disease, and high body mass index (inversely), in a multiple conditional logistic regression model. In Paper III, Raynaud’s phenomenon was significantly associated with previous frostbite affecting the hands, first degree heredity, and high body mass index (inversely), in a similar model. Previous upper extremity nerve injury was suggested as a separating trait between Raynaud’s phenomenon and cold sensitivity. In Paper IV, laser speckle contrast analysis indicated disturbances in microvascular regulation, while physical examination and thermal quantitative sensory testing mainly yielded normal results. In Paper V, the 95th percentile for the Cold intolerance symptom severity score was 49.5 for men, and 53.0 for women.Conclusions: Cold exposure in the working-age population of northern Sweden varied with age, gender, occupation, and place of residence. Cold exposure was related to the reporting of neurological and vascular hand symptoms in the population as a whole. There was a major overlap between reporting cold sensitivity and Raynaud’s phenomenon, and the conditions shared several associated factors. Previous upper extremity nerve injury was suggested to be a separating trait, supporting the neurosensory pathophysiological hypothesis for cold sensitivity. Cold sensitivity was not effectively assessed by physical examination or thermal quantitative sensory testing. However, laser speckle contrast analysis could prove a useful tool in further studies on cold sensitivity. A Cold intolerance symptom severity score above 50 could be considered to indicate abnormal cold sensitivity, and be used to guide further care.
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| 6. |
- Stjernbrandt, Albin, et al.
(författare)
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Cold sensitivity and associated factors : a nested case–control study performed in Northern Sweden
- 2018
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer-Verlag New York. - 0340-0131 .- 1432-1246. ; 91:7, s. 785-797
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Tidskriftsartikel (refereegranskat)abstract
- Aim To identify possible risk factors for cold sensitivity, by comparing cases to controls with regard to demographic and anthropometric characteristics, previous illnesses and injuries as well as ambient exposures.Methods Through a questionnaire responded to by the general population (n=12,627) cold sensitivity cases (n=502) and matched controls (n=1,004) were identified and asked to respond to a second questionnaire with focus on different aspects of cold sensitivity, hereditary factors, previous diseases, medication, tobacco use as well as exposure to ambient cold climate and hand-arm vibration (HAV).Results In total, 997 out of 1506 study subjects answered the second questionnaire, 374 cases and 623 match controls. Identified risk factors among the cases were frostbite of the hands Odds Ratio (OR) 10.3 (95% confidence interval (CI) 5.5-19.3), rheumatic disease OR 3.1 (95% CI 1.7-5.7), upper extremity nerve injury OR 2.0 (95% CI 1.3-3.0), and vascular disease OR 1.9 (95% CI 1.2-2.9). Sex differences in risk factors were HAV exposure for men and cold exposure for women increased the risk of cold sensitivity. Rheumatic diseases and migraine increased the risk of cold sensitivity among women but not among men.Conclusions The present study shows that cold sensitivity is associated with both inherent factors, acquired conditions and external exposures. Among acquired conditions, frostbite, vascular disease, nerve injury, joint disorders and migraine are significantly related to the reporting of cold sensitivity. Among external exposures, both cold climate and HAV exposure are significantly associated to cold sensitivity, and thus suitable targets for primary preventive measures. There was a difference in risk factors related to sex. HAV exposure for men and cold exposure for women increased the risk of cold sensitivity.
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| 7. |
- Stjernbrandt, Albin, et al.
(författare)
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Defining abnormal cold sensitivity using the Cold Intolerance Symptom Severity questionnaire : a population study
- 2021
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:7, s. 731-737
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Tidskriftsartikel (refereegranskat)abstract
- Cold sensitivity, a common and disabling sequela of hand injury, can be assessed using the Cold Intolerance Symptom Severity (CISS) questionnaire, rating symptoms on a scale from 4 to 100. The primary objective of this study was to define a clinical cut-off for abnormal cold sensitivity based on the CISS score in a healthy working-age population. The secondary objective was to investigate how age, gender and previous injuries and diseases influence CISS scoring. In this study, 1239 out of 1582 selected healthy subjects of working age living in northern Sweden completed the questionnaire, yielding a response rate of 78%. The 95th percentile for the CISS score was 49.5 for men and 53.0 for women. The effects of age, gender and previous injuries and diseases were minor and not considered clinically relevant. The results support that a CISS score above 50 should be considered as abnormal cold sensitivity. Level of evidence: III
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| 8. |
- Stjernbrandt, Albin, et al.
(författare)
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Incidence, remission, and persistence of Raynaud’s phenomenon in the general population of northern Sweden : a prospective study
- 2022
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Ingår i: BMC Rheumatology. - : BioMed Central. - 2520-1026. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Raynaud’s phenomenon is common condition, but little is known about the natural course. The primary aim of this study was to determine the incidence, remission, and persistence proportions of Raynaud’s phenomenon in the general population of northern Sweden. Secondary aims were to determine how individual and exposure factors affect the course of Raynaud’s phenomenon, and to assess gender differences.Methods: A prospective, survey-based, closed-cohort study was conducted on a sample of men and women between 18–70 years of age, living in northern Sweden. Data on Raynaud’s phenomenon characteristics and general health status were collected during the winters of 2015 (baseline) and 2021 (follow-up). Rates of incidence, remission, and persistence were calculated. Binary logistic regression was used to determine the association between baseline variables and the course of Raynaud’s phenomenon. Results: The study population consisted of 2703 women (53.9%) and 2314 men. There were 390 women (14.5%) and 290 men (12.7%) reporting Raynaud’s phenomenon in the follow-up survey. The annual incidence proportion was 0.7% among women and 0.9% among men (gender difference p = 0.04). The annual remission proportion was 4.4% and 5.5%, respectively (p = 0.05). Having sustained a cold injury affecting the hands since baseline was significantly associated with incident Raynaud’s phenomenon (OR 3.92; 95% CI 2.60–5.90), after adjusting for age and gender.Conclusions: In the general population of northern Sweden, Raynaud’s phenomenon is a common but variable condition, where symptoms may remit over time. Men had a higher incidence proportion than women. The results support a possible causal pathway where cold injury can precede the onset of Raynaud’s phenomenon.
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| 9. |
- Stjernbrandt, Albin, et al.
(författare)
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Manifestations of cold sensitivity : a case series
- 2020
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Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 79:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To characterise cold sensitivity using a semi-structured interview, physical examination, thermal quantitative sensory testing (QST), and laser speckle contrast analysis (LASCA).Methods: Eight women and four men, ages 22–74, with cold sensitivity were interviewed andexamined by an occupational physician. Thermal perception thresholds were established using QST, on the pulp of the index and little finger of the most affected hand. Skin perfusion in the dorsum of the hand was measured using LASCA, at baseline, after two-minute 12°C water immersion, and during rewarming.Results: The physical examination yielded few findings indicative of vascular or neurosensory pathology. One subject (8%) had impaired thermal perception thresholds. LASCA at baseline showed absent proximal-distal perfusion gradients in six subjects (50%), and a dyshomogeneousperfusion pattern in five (42%). Perfusion on a group level was virtually unchanged by cold stress testing (median 52.5 PU; IQR 9.0 before versus 51.3 PU; IQR 27.2 afterwards).Conclusions: Physical examination and thermal QST offered little aid in diagnosing cold sensitivity, which challenges the neurosensory pathophysiological hypothesis. LASCA indicated disturbances in microvascular regulation and could prove a useful tool in future studies on cold sensitivity.
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| 10. |
- Stjernbrandt, Albin, et al.
(författare)
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Neurosensory and vascular symptoms and clinical findings in the hands of Arctic open-pit miners in Sweden and Norway : a descriptive study
- 2023
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Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 82:1
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Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud’s phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.
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