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- Vihlborg, Per, 1978-
(author)
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Health effects from occupational hand-arm vibration
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Hand-arm vibration (HAV) is a common occupational exposure in Sweden and worldwide that causes both acute transient effects and persistent hand-arm symptoms. The health effects include vibration-induced Raynaud’s phenomenon, neuropathic symptoms, carpal tunnel syndrome (CTS), and musculoskeletal disorders. The overall aim of this thesis was to investigate vascular and neurological effects in the hands of workers exposed to hand-arm vibrations.Methods: In study 1, the aim was to investigate the risk of CTS from hand-arm vibration. This study was conducted as a register study using the National Outpatient Register and a job exposure matrix to estimate HAV exposure. Study 2 aimed to investigate the acute effects of HAV on the nerve functions of the hands and the impact of grip force. Nerve function was evaluated before and after vibration exposure. In study 3, the aim was to identify low molecular organic biomarkers in blood samples from vibration-exposed workers using a novel metabolomics approach. HAV-exposed workers underwent medical examination and blood samples were collected and analysed before and after a work shift. In study 4, the aim was to investigate if arterial abnormalities in the hands could be identified in patients with VWF which also had a positive Allen’s test. In this case series, Doppler ultrasound and magnetic resonance angiography (MRA) investigations were performed to investigate the arterial status in the hands. Results: Study 1 showed that the risk of CTS for HAV exposed individuals increased with an OR of 1.61 (95% CI 1.46-1.77) for the whole population. The risk was highest in HAV exposed younger males. Study 2 showed that HAV exposure with high grip force affect nerve function different than with low grip force. In study 3, workers with VWF had metabolic profiles different from participants without VWF, both before and after vibration exposure. In study 4, ultrasound and MRA identified vascular abnormalities in all participants; these abnormalities were a predominantly missing or not complete superficial arch. Conclusion: The overall finding is that HAV exposure, even at levels under legislated values, can give negative health effects. These results add new knowledge about CTS, HAV exposure and gender. Both metabolomics and studies of acute effects of HAV could be further studied to find a level of exposure where no health effects appear. With the findings on MRA, there is the possibility that a subgroup of VWF can be subject for treatment.
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| 2. |
- Westerlund, Jessica, 1983-
(author)
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Exposure to trichloramine, trihalomethanes and endotoxins : adverse respiratory and ocular effects among Swedish indoor swimming pool workers
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Indoor swimming pool facilities often use chlorine for pool water disinfection. Chlorine can also contribute to the formation of unwanted disinfection byproducts (DBPs). Trichloramine and trihalomethanes (THMs) are DBPs formed in swimming pool water and swimming pool air causing occupational exposure. Trichloramine can cause ocular and airway irritation, while some THMs are potentially carcinogenic. Bacterial endotoxins may also cause adverse respiratory effects among swimming pool workers. The overall aim of the study was to measure levels of trichloramine, THMs and endotoxins in the air at conventional, habilitation and rehabilitation, and adventure swimming pool facilities, and to investigate adverse ocular and respiratory effects among indoor swimming pool workers.Trichloramine and THM levels in air were comparable to previous studies. Endotoxin levels in air were low compared to the reference value. Trichloramine concentrations in personal samples were approximately half as high as those measured in stationary samples - an important consideration for a future Swedish occupational exposure limit. The adventure facilities had the highest trichloramine levels while the conventional facilities had the highest THM levels. The adventure workers also reported more ocular and respiratory symptoms compared to referents (office workers) and had a lower FEV1/FVC ratio indicating airway obstruction. Workers both in conventional, and in habilitation and rehabilitation facilities exhibited a difference in FeNO levels compared to referents, implying airway inflammation.The occupational exposure and adverse health effects found in indoor swimming pool environments emphasizes the importance of a personal based Swedish occupational exposure limit for trichloramine in air.
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