| 1. |
- Burström, Lage, 1954-, et al.
(författare)
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Acute effects of vibration on thermal perception thresholds
- 2006
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Ingår i: Diagnosis of injuries caused by hand-transmitted vibration - 2nd International workshop, Göteborg, 2006. - : Springer Science and Business Media LLC.
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Konferensbidrag (refereegranskat)abstract
- Objective This study focuses on the acute effects of vibration and how vibrations influence the measures of the thermal perception thresholds during different vibration magnitudes, frequencies, and durations.Methods The fingers of ten healthy subjects, five males and five females, were exposed to vibration under 16 conditions with a combination of different frequency, intensity and exposure time. The vibration frequency was 31.5 and 125 Hz and exposure lasted between 2 and 16 min. The energy-equivalent frequency weighted acceleration, according to ISO 5349-1, for the experimental time of 16 min was 2.5 or 5.0 m/s(2) (r.m.s.), corresponding to a 8-h equivalent acceleration, A(8) of 0.46 and 0.92 m/s(2), respectively. A measure of the thermal perception of cold and warmth was conducted before the different exposures to vibration. Immediately after the vibration exposure the acute effect was measured continuously on the exposed index finger for the first 75 s, followed by 30 s of measures at every minute for a maximum of 10 min. If the subject's thermal thresholds had not recovered, the measures continued for a maximum of 30 min with measurements taken every 5 min.Results For all experimental conditions and 30 s after exposure, the mean changes of the thresholds compared with the pre-test were found to be 0.05 and -0.67C for the warmth and cold thresholds, respectively. The effect of the vibration exposure was only significant on the cold threshold and only for the first minute after exposure when the threshold was decreased. The warmth threshold was not significantly affected at all. The frequency and the exposure time of the vibration stimuli had no significant influence on the perception thresholds for the sensation of cold or warmth. Increased equivalent frequency weighted acceleration resulted in a significant decrease of the subjects' cold threshold, not the warmth. The thresholds were unaffected when changes in the vibration magnitude were expressed as the frequency weighted acceleration or the unweighted acceleration.Conclusion When testing for the thermotactile thresholds, exposure to vibration on the day of a test might influence the results. Until further knowledge is obtained the previous praxis of 2 h avoidance of vibration exposure before assessment is recommended.
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| 2. |
- Burström, Lage, 1954-, et al.
(författare)
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Influence of vibration exposure on tactile and thermal perception thresholds
- 2009
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Ingår i: Occup Med (Lond). - : Oxford University Press (OUP). - 1471-8405 .- 0962-7480. ; 59:3, s. 174-9
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To establish if intermittent exposure to hand-transmitted vibration had the same effect as continuous exposure on the temporary response of finger tactile and thermal perception thresholds. METHODS: Two laboratory experiments were conducted. In each, 10 healthy subjects, five males and five females, participated. The subjects' fingers were exposed to vibration under four conditions with a combination of different periods of exposure and rest periods. The vibration frequency was 125 Hz and the frequency-weighted acceleration was 5 m/s(2). A measure of the tactile or thermal perception was conducted before the different exposures to vibration. Immediately after the vibration exposure, the acute effect was measured continuously for the first 75 s. This was followed by regular measures for a maximum of 30 min. RESULTS: The results showed that combinations of vibration with different periods of exposure and rest periods significantly influenced vibrotactile perception, but not thermal perception. CONCLUSIONS: These findings suggest that intermittent exposure to hand-transmitted vibration might be more beneficial for the response of the finger vibrotactile sensation than continuous exposure. This finding is inconsistent with the evaluation methods in ISO 5349-1 for vibrotactile sensation, but accurate for thermal perception.
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| 3. |
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| 4. |
- Burström, Lage, 1954-, et al.
(författare)
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Vibrotactile perception and effects of short-term exposure to hand-arm vibration
- 2009
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Ingår i: The Annals of Occupational Hygiene. - : Oxford University Press (OUP). - 1475-3162 .- 0003-4878. ; 53:5, s. 539-47
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Tidskriftsartikel (refereegranskat)abstract
- This study clarifies whether the established frequency weighting procedure for evaluating exposure to hand-transmitted vibration can effectively evaluate the temporary changes in vibrotactile perception thresholds due to pre-exposure to vibration. In addition, this study investigates the relationship between changes of the vibrotactile perception thresholds and the normalized energy-equivalent frequency-weighted acceleration. The fingers of 10 healthy subjects, five male and five female, were exposed to vibration under 16 conditions with a combination of different frequencies, intensities, and exposure times. The vibration frequencies were 31.5 and 125 Hz and exposure lasted between 2 and 16 min. According to International Organization for Standardization (ISO) 5349-1, the energy-equivalent frequency-weighted acceleration for the experimental time of 16 min is 2.5 or 5.0 m s(-2) root-mean-square, corresponding to a 8-h equivalent acceleration, A(8), of approximately 0.5 and 0.9 m s(-2), respectively. A measure of the vibrotactile perception thresholds was conducted before the different exposures to vibration. Immediately after the vibration exposure, the acute effect was measured continuously on the exposed index finger for the first 75 s, followed by 30 s of measures every minute for a maximum of 10 min. If the subject's thresholds had not recovered, the measures continued for a maximum of 30 min with measurements taken every 5 min. Pre-exposure to vibration significantly influenced vibrotactile thresholds. This study concludes that the influence on the thresholds depends on the frequency of the vibration stimuli. Increased equivalent frequency-weighted acceleration resulted in a significant change in threshold, but the thresholds were unaffected when changes in the vibration magnitude were expressed as the frequency-weighted acceleration or the unweighted acceleration. Moreover, the frequency of the pre-vibration exposure significantly influenced (up to 25 min after exposure) recovery time of the vibrotactile thresholds. This study shows that the frequency weighting procedure in ISO 5349-1 is unable to predict the produced acute changes in the vibrotactile perception. Moreover, the results imply that the calculation of the 'energy-equivalent' frequency-weighted acceleration does not reflect the acute changes of the vibration perception thresholds due to pre-exposure to vibration. Furthermore, when testing for the vibrotactile thresholds, exposure to vibration on the day of a test might influence the results. Until further knowledge is obtained, the previous practice of 3 h avoidance of vibration exposure before assessment is recommended.
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| 5. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- 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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| 9. |
- Eriksson, Kåre, et al.
(författare)
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Blood biomarkers for vibration-induced white fingers : A case-comparison study
- 2020
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Ingår i: American Journal of Industrial Medicine. - : John Wiley & Sons. - 0271-3586 .- 1097-0274. ; 63:9, s. 779-786
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vibration induced white fingers (VWF) is one form of secondary Raynaud's phenomenon (RP).Methods: Vibration exposed workers with RP and vibration exposed controls without RP participated. Blood samples were collected before and after cold challenge exposure (COP). The concentration of von Willebrand factor (vonWf), thrombomodulin (TM), serotonin (SER), endothelin‐1 (ET1), calcitonin gene‐related peptide, or thromboxane A2 was calculated. The diagnostic usefulness of the substances for ruling in the diagnosis of Raynaud's was evaluated.Results: The cases showed a significant lower concentration of vonWf before and after COP, a significant increase of ET1 and a decrease of TM after COP. The diagnostic usefulness of vonWf showed a likelihood of defining a true case by 35%.Conclusions: vonWf, TM, SER, or ET1 are suggested biomarkers for VWF. Diagnostic evaluation of vonWf showed a likelihood of defining a true case by 35% in the diagnosis of RP related to vibration.
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| 10. |
- Farbu, Erlend Hoftun, et al.
(författare)
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Cold exposure and musculoskeletal conditions : a scoping review
- 2022
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Ingår i: Frontiers in Physiology. - : Frontiers Media S.A.. - 1664-042X. ; 13
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Forskningsöversikt (refereegranskat)abstract
- Background: Musculoskeletal conditions are major contributors to years lived with disability. Cold exposure can be a risk factor, but any conclusion is obscure.Aim: The aim of the present scoping review was to identify the existing evidence of an association between cold exposure and musculoskeletal conditions. The aim also included to consider pain in different regions and their assessment, as well as different measures of cold exposure, effect sizes, and to assess the feasibility of future systematic reviews and meta-analyses.Eligibility criteria: The studies must have: an epidemiological design, defined cold exposure to come prior to the health outcome, defined exposure and outcome(s), existence of effect estimate(s) or data that made it possible to calculate such an estimate. Further, studies were required to be in English language and published in peer-reviewed journals. Studies that had a specific goal of studying cold exposure as an aggravator of already existing health problems were excluded.Sources: We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions(R), and Embase Classic + Embase for original studies.Charting method: The included studies were reviewed for study population, measurement of exposure and outcome, and effect size. Each publication was assessed for risk of bias.Results: The included studies were heterogeneous in populations, measures of cold exposure and musculoskeletal conditions. Most studies used self-reported data. They were mostly cross-sectional studies, only two were prospective and one was a case-control study. Associations were found for different cold exposures and regional musculoskeletal conditions, but the heterogeneity and lack of studies impeded valid synthesis of risk magnitude, or meta-analyses.Conclusion: The studies identified in this review indicate that cold exposure increases the risk of musculoskeletal conditions. However, there is a need for studies that better assess temporality between exposure and outcome. Future studies should also include better exposure assessment, including both objective measurements and measures of subjective experience of cold exposure. The heterogeneity in measurement of exposure and outcome impeded any meta-analysis.
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| 11. |
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| 12. |
- Hermansson, Jonas, et al.
(författare)
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Interaction between Shift Work and Established Coronary Risk Factors
- 2019
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Ingår i: International Journal of Occupational and Environmental Medicine. - : IJOEM. - 2008-6520 .- 2008-6814. ; 10:2, s. 57-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Shift work is associated with increased risk of cardiovascular disease, but the causes have not yet been fully established. It has been proposed that the coronary risk factors are more hazardous for shift workers, resulting in a potential interaction effect with shift work.OBJECTIVE: To analyse interaction effects of work schedule and established risk factors for coronary artery disease on the risk of myocardial infarction.METHODS: This analysis was conducted in SHEEP/VHEEP, a case-control study conducted in two counties in Sweden, comprising all first-time cases of myocardial infarction among men and women 45-70 years of age with controls stratified by sex, age, and hospital catchment area, totalling to 4648 participants. Synergy index (SI) was used as the main outcome analysis method for interaction analysis.RESULTS: There was an interaction effect between shift work and physical inactivity on the risk of myocardial infarction with SI of 2.05 (95% CI 1.07 to 3.92) for male shift workers. For female shift workers, interaction effects were found with high waist-hip ratio (SI 4.0, 95% CI 1.12 to 14.28) and elevated triglycerides (SI 5.69, 95% CI 1.67 to 19.38).CONCLUSION: Shift work and some established coronary risk factors have significant interactions.
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| 13. |
- Lundström, Ronnie, et al.
(författare)
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Long-term effect of hand-arm vibration on thermotactile perception thresholds
- 2018
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Ingår i: Journal of Occupational Medicine and Toxicology. - : Springer Science and Business Media LLC. - 1745-6673. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Occupational exposure to hand-transmitted vibration (HTV) is known to cause neurological symptoms such as numbness, reduced manual dexterity, grip strength and sensory perception. The purpose of this longitudinal study was to compare thermotactile perception thresholds for cold (TPTC) and warmth (TPTW) among vibration exposed manual workers and unexposed white collar workers during a follow-up period of 16 years to elucidate if long-term vibration exposure is related to a change in TPT over time. Methods: The study group consisted of male workers at a production workshop at which some of them were exposed to HTV. They were investigated in 1992 and followed-up in 2008. All participants were physically examined and performed TPT bilaterally at the middle and distal phalanges of the second finger. Two different vibration exposure dosages were calculated for each individual, i.e. the individual cumulative lifetime dose (mh/s2) or a lifetime 8-h equivalent daily exposure (m/s(2)). Results: A significant mean threshold difference was found for all subjects of about 4-5 degrees C and 1-2 degrees C in TPTW and TPTC, respectively, between follow-up and baseline. No significant mean difference in TPTC between vibration exposed and non-exposed workers at each occasion could be stated to exist. For TPTW a small but significant difference was found for the right index finger only. Age was strongly related to thermotactile perception threshold. The 8-h equivalent exposure level (A (8)) dropped from about 1.3 m/s2 in 1992 to about 0.7 m/s(2) in 2008. Conclusions: A lifetime 8-h equivalent daily exposure to hand-transmitted vibration less than 1.3 m/s(2) does not have a significant effect on thermotactile perception. Age, however, has a significant impact on the change of temperature perception thresholds why this covariate has to be considered when using TPT as a tool for health screening.
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| 14. |
- Lundström, Ronnie, et al.
(författare)
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Vibrotactile and thermal perception and its relation to finger skin thickness
- 2018
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Ingår i: Clinical Neurophysiology Practice. - : Elsevier BV. - 2467-981X. ; 3, s. 33-39
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Quantitative measurements of vibrotactile and thermotactile perception thresholds (VPT and TPT, respectively) rely on responses from sensory receptors in the skin when mechanical or thermal stimuli are applied to the skin. The objective was to examine if there is a relation between skin thickness (epidermis and dermis) and VPT or TPT. Methods: Perception thresholds were measured on the volar side of the fingertip on 148 male subjects, out of which 116 were manual workers exposed to hand-transmitted vibration and 32 were white-collar (office) workers. Skin thickness was measured using a high-frequency ultrasonic derma scanner system. Results: The difference in age, perception thresholds and skin thickness between manual and office workers was small and non-significant except for the perception of cold, which was decreased by vibration exposure. Skin thickness for both subgroups was mean 0.57 mm (range 0.25–0.93 mm). Increased age was associated with decreased perception of warmth and vibration. Lifetime cumulative exposure to vibration, but not age, was associated with decreased perception of cold. Conclusion: No association (p >.05) was found between finger skin thickness in the range of about 0.1–1 mm and vibration perception threshold for test frequencies from 8 to 500 Hz and thermotactile perception thresholds for warmth and cold. Increasing age was associated with reduced perception of vibration and warmth. Vibration exposure was associated with decreased perception of cold. Significance: Skin thickness is a factor that may affect the response from sensory receptors, e.g., due to mechanical attenuation and thermal insulation. Thus, to evaluate perception threshold measurements, it is necessary to know if elevated thresholds can be attributed to skin thickness. No previous studies have measured skin thickness as related to vibrotactile and thermotactile perception thresholds. This study showed no association between skin thickness and vibrotactile perception or thermotactile perception. © 2018 International Federation of Clinical Neurophysiology
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| 15. |
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| 16. |
- Poole, C. J. M., et al.
(författare)
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International consensus criteria for diagnosing and staging hand-arm vibration syndrome
- 2019
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 92:1, s. 117-127
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: In the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand-arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field.Methods: Seven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views.Results: Consensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity.Conclusions: A new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.
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| 17. |
- Rådman, Lisa, 1983-, et al.
(författare)
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Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury : A case series
- 2016
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Ingår i: Burns. - Oxford, United Kingdom : Elsevier. - 0305-4179 .- 1879-1409. ; 42:8, s. 1712-1720
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the "no-let-go phenomenon".Methods: Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers.Results: The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage.Conclusion: Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard).
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| 18. |
- 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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| 19. |
- 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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| 20. |
- 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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| 21. |
- 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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| 22. |
- 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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| 23. |
- 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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| 24. |
- Stjernbrandt, Albin, et al.
(författare)
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Raynaud's phenomenon in Northern Sweden : a population-based nested case-control study
- 2019
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Ingår i: Rheumatology International. - : Springer. - 0172-8172 .- 1437-160X. ; 39:2, s. 265-275
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to determine the association between individual and external exposure factors, and the reporting of Raynaud’s phenomenon, with or without concomitant cold sensitivity. In a population-based nested case–control study, cases with Raynaud’s phenomenon (N = 578), and matched controls (N = 1156), were asked to respond to a questionnaire focusing on different risk factors. Univariate and multiple conditional logistic regression were performed. Analyses were stratified according to whether the cases reported cold sensitivity or not. In total, 1400 out of 1734 study subjects answered the questionnaire (response rate 80.7%). In the final multiple model, the factor with the strongest association to Raynaud’s phenomenon, with and without cold sensitivity, was previous frostbite affecting the hands (OR 12.44; 95% CI 5.84–26.52 and OR 4.01; 95% CI 1.78–9.01, respectively). Upper extremity nerve injury was associated to reporting Raynaud’s phenomenon and cold sensitivity (OR 2.23; 95% CI 1.29–3.85), but not Raynaud’s phenomenon alone. Reporting any exposure to hand-arm vibration or cumulative cold exposure was significant in univariate analyses for cases with both Raynaud’s phenomenon and cold sensitivity, but not in the multiple model. Raynaud’s phenomenon is strongly associated to previous cold injury, with a larger effect size among those who also report cold sensitivity. The fact that only upper extremity nerve injury differed significantly between case groups in our multiple model offers additional support to the neural basis for cold sensitivity.
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| 25. |
- Stjernbrandt, Albin, et al.
(författare)
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Raynaud's phenomenon in the feet of Arctic open-pit miners
- 2024
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Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 83:1
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Tidskriftsartikel (refereegranskat)abstract
- The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.
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| 26. |
- Tekavec, Eva, et al.
(författare)
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Adverse health manifestations in the hands of vibration exposed carpenters - a cross sectional study
- 2021
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Ingår i: Journal of Occupational Medicine and Toxicology. - : BioMed Central (BMC). - 1745-6673. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite EU regulatory standards, many workers suffer injury as a result of working with hand-held vibrating tools. Our aim of this study was to confirm whether carpenters, a highly exposed group, suffer more injuries to their hands than painters, a group assumed to be less exposed to vibration.Methods: 193 carpenters (participation rate 100%) and 72 painters (participation rate 67%), all men, answered a questionnaire and underwent a clinical examination to identify manifestations of neural and vascular origin in the hands. Neurosensory affection was defined as having at least one symptom in the fingers/hands (impaired perception of touch, warmth, or cold, impaired dexterity, increased sensation of cold, numbness or tingling, or pain in the fingers/hands when cold) and at least one clinical finding (impaired perception of touch, warmth, cold, vibration, or two-point discrimination). Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI).Results: Neurosensory affection was fulfilled for 31% of the carpenters and 17% of the painters, age-adjusted OR 3.3 (CI 1.6–7.0). Among carpenters with neurosensory affection 18% reported interference with daily life activities, the most common symptoms being increased sensation of cold, numbness and pain in the fingers/hands when cold, the most common clinical findings were impaired perception of touch and vibration. Neurosensory affection was found in 12% of young carpenters (≤ 30 years old). No difference was found in the prevalence of white fingers between carpenters and painters.Conclusions: Carpenters showed more symptoms and clinical findings of neurosensory affection than painters, probably due to vibration exposure. Also young carpenters showed signs of neurosensory affection, which indicates that under current conditions workers at these companies are not protected against injury. This underlines the importance of reducing exposure to vibration and conducting regular medical check-ups to detect early signs of neural and vascular manifestations indicating hand-arm vibration injuries. Special attention should be given to symptoms of increased sensation of cold, pain in the fingers when cold, and numbness, as these were the most common initiating ones, and should be addressed as early as possible in the preventive sentinel process. It is also important to test clinically for small- and large-fibre neuropathy, as the individual may be unaware of any pathology.
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| 27. |
- Tekavec, Eva, et al.
(författare)
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Concordance between the Stockholm Workshop Scale and the International Consensus Criteria for grading the severity of neurosensory manifestations in hand-arm vibration syndrome in a Swedish clinical setting
- 2023
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Ingår i: Occupational and Environmental Medicine. - : BMJ Publishing Group Ltd. - 1351-0711 .- 1470-7926. ; 80:7, s. 418-424
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Occupational exposure to vibration using hand-held tools may cause hand-arm vibration syndrome (HAVS). Correct diagnosis and grading of severity are crucial in protecting the individual's health and for workers' compensation claims. The International Consensus Criteria (ICC) has been suggested to replace the widely used Stockholm Workshop Scale (SWS). The aims were to, in a clinical setting, assess the concordance between the SWS and the ICC neurosensory severity grading of vibration injury, and to present the clinical picture according to symptoms, type of affected nerve fibres and the relation between vascular and neurosensory manifestations.METHODS: Data were collected from questionnaires, clinical examination and exposure assessment of 92 patients with HAVS. The severity of neurosensory manifestations was classified according to both scales. The prevalence of symptoms and findings was compared across groups of patients with increasing severity according to the SWS.RESULTS: Classification with the ICC resulted in a shift towards lower grades of severity than with the SWS due to a systematic difference between the scales. Affected sensory units with small nerve fibres were far more prevalent than affected units with large nerve fibres. The most prevalent symptoms were numbness (91%) and cold intolerance (86%).CONCLUSIONS: Using the ICC resulted in lower grades of the severity of HAVS. This should be taken into consideration when giving medical advice and approving workers' compensation. Clinical examinations should be performed to detect affected sensory units with both small and large nerve fibres and more attention should be paid to cold intolerance.
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| 28. |
- Tekavec, Eva, et al.
(författare)
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Serum biomarkers in patients with hand-arm vibration injury and in controls
- 2024
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 14, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Hand-arm vibration injury is a well-known occupational disorder that affects many workers globally. The diagnosis is based mainly on quantitative psychophysical tests and medical history. Typical manifestations of hand-arm vibration injury entail episodes of finger blanching, Raynaud's phenomenon (RP) and sensorineural symptoms from affected nerve fibres and mechanoreceptors in the skin. Differences in serum levels of 17 different biomarkers between 92 patients with hand-arm vibration injury and 51 controls were analysed. Patients with hand-arm vibration injury entailing RP and sensorineural manifestations showed elevated levels of biomarkers associated with endothelial injury or dysfunction, inflammation, vaso- or neuroprotective compensatory, or apoptotic mechanisms: intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1); thrombomodulin (TM), heat shock protein 27 (HSP27); von Willebrand factor, calcitonin gene-related peptide (CGRP) and caspase-3. This study adds important knowledge on pathophysiological mechanisms that can contribute to the implementation of a more objective method for diagnosis of hand-arm vibration injury.
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