Quality of life in Swedish workers exposed to hand–arm vibration

What is well-being? A scoping review of the conceptual and operational definitions of occupational well-being

Well-being is a multifaceted construct that is used across disciplines to portray a state of wellness, health, and happiness. While aspects of well-being seem universal, how it is depicted in the literature has substantial variation. The aim of this scoping review was to identify conceptual and operational definitions of well-being within the field of occupational health. Broad search terms were used related to well-being and scale/assessment. Inclusion criteria were (1) peer-reviewed articles, (2) published in English, (3) included a measure of well-being in the methods and results section of the article, and (4) empirical paper. The searches resulted in 4394 articles, 3733 articles were excluded by reading the abstract, 661 articles received a full review, and 273 articles were excluded after a full review, leaving 388 articles that met our inclusion criteria and were used to extract well-being assessment information. Many studies did not define well-being or link their conceptual definition to the operational assessment tool being used. There were 158 assessments of well-being represented across studies. Results highlight the lack of a consistent definitions of well-being and standardized measurements.

The impact of Raynaud's phenomenon on work ability - a longitudinal study

OBJECTIVE

To determine if having Raynaud's phenomenon (RP) affects the work ability, job retainment, or occurrence of sick leave.

METHODS

Surveys on the working-age general population of northern Sweden were conducted in 2015 and 2021, gathering data on RP, occupation and sick leave. Work ability was assessed using the Work Ability Score.

RESULTS

The study population consisted of 2,703 women and 2,314 men, among which 390 women and 290 men reported RP at follow-up. For women, the mean [standard deviation (SD)] Work Ability Score was 8.02 (2.24) for subjects reporting RP and 7.68 (2.46) for those without RP. For men, the corresponding numbers were 7.37 (2.03) and 7.61 (2.14), respectively. Multiple linear regression did not show an association between RP status and work ability (p = 0.459 for women and p = 0.254 for men), after adjusting for age, body mass index, physical workload, cardiovascular disease, and perceived stress. Having retained the same main livelihood since baseline was reported by 227 (58.5%) women with RP, 1,163 (51.2%) women without RP, 152 (52.6%) men with RP, and 1,075 (54.1%) men without RP (p = 0.002 for women and p = 0.127 for men). At follow-up, any occurrence of sick leave during the last year was reported by 80 (21.4%) women with RP, 410 (18.6%) women without RP, 48 (17.1%) men with RP, and 268 (13.7%) men without RP (p = 0.208 for women and p = 0.133 for men). Among those reporting sick leave, the mean (SD) duration in months was 2.93 (3.76) for women with RP, 3.00 (4.64) for women without RP, 2.77 (3.79) for men with RP, and 2.91 (12.45) for men without RP (p = 0.849 for women and p = 0.367 for men).

CONCLUSION

For neither women nor men was there a significant effect of having RP on work ability. Women with RP reported a slightly higher job retainment compared to those without the condition, while there was no difference in job retainment among men. For neither gender did the presence of RP influence the occurrence of recent sick leave, nor did it affect the length of time away from work.

Evaluation of the bio-dynamic response of the hand-arm system and hand-tool designs - A brief review

Hand-operated tools transmit a high magnitude of vibration exposure to the hand-arm system that causes occupational diseases. The health effects caused in various countries for the past years due to usage of hand tools are necessary to identify the occupational disorders. Researchers have conducted various studies on biological effects, hand-transmitted vibration exposure and biodynamic responses throughout the years. This article goes over each of these studies in detail, as well as identifying areas where more research is needed. The majority of studies deal with the following topics: general guidelines for hand-transmitted vibrations; assessment techniques of vibration exposure; hand-tool evaluation methods; influence of hand-tool design to overcome the biomechanical effects; and finite element modelling for quantifying vibration exposure. In response to this, understanding the biodynamic behaviour of the hand-arm system is useful for better ergonomic intervention in hand tools to reduce fatigue and increase comfort.

Hand-arm Vibration Syndrome in Farmers and its Correlation with Degenerative Triangular Fibrocartilage Complex Injury

Context

Hand-arm vibration syndrome (HAVS) is an occupational disease that affects workers who are exposed to vibrations. Farmers are prone to various musculoskeletal and cumulative trauma disorders. These occur owing to overuse, degeneration, and excess physical efforts along with whole-body vibrations- owing to the use of farming equipment such as tractors and harvesters.

Aims

Aims of the study were to find out the prevalence of various symptoms of HAVS among farmers using tractors, harvesters, etc., and to find out the correlation of triangular fibrocartilage complex (TFCC) injury with HAVS.

Subjects and Methods

A prevalence study was conducted among farmers. Farmers were selected by random sampling method and were asked to fill-up a HAVS surveillance questionnaire. The handgrip strength was recorded with a hand dynamometer. Assessment of carpal tunnel syndrome was done, and correlation of HAVS with TFCC injury was assessed.

Results

Data from 100 farmers was obtained and analyzed. The musculoskeletal symptoms of HAVS, more specifically pain was prevalent (n = 65), followed by sensorineural symptoms (n = 70), and the vascular symptoms were less common (n = 43). HAVS accounts for a prevalence of 64% with 39% of farmers having TFCC injury along with HAVS (P value = <0.0001).

Conclusions

These findings reported in the study provide a better understanding of the impact and extent of HAVS in farmers. There is a significant prevalence of HAVS with mild symptoms of vascular component, mild to moderate symptoms of sensorineural component, and significant involvement of the musculoskeletal component. In addition, TFCC injury is correlated with HAVS.

Functional limitations in workers with hand-arm vibration syndrome (HAVS)

Background

Hand-arm vibration syndrome (HAVS) is a chronic occupational disease affecting workers exposed to hand-transmitted vibration. However, limited information exists on task-related disability experienced by workers with HAVS.

Aims

This study was conducted to characterize the impact of HAVS on task-related disability and daily life activities.

Methods

A retrospective chart review was undertaken of difficulty in carrying out activities reported by workers with HAVS who had been assessed in an Occupational Medicine clinic in 2015. Prior to their clinical assessment, the workers had been asked to complete an open-ended questionnaire regarding activities they were having difficulty performing in the domains of personal care, household activities and recreational activities or hobbies.

Results

Data from 107 workers diagnosed with HAVS were obtained through the retrospective chart review. The activities most affected included: getting dressed (n = 72), lawn maintenance (n = 61), fishing (including ice fishing) (n = 56), snow removal (n = 36), washing the car (n = 26) and doing the dishes (n = 25).

Conclusions

These findings reported in an open-ended fashion by workers with HAVS provide a better understanding of the impact of HAVS on specific activities of daily living in comparison to highly structured questionnaires lacking any open-ended responses. Understanding the implications of HAVS on activities of daily living will contribute to the provision of patient-centred care, by enabling health care providers to effectively support HAVS patients, based on workers' actual experiences of functional limitations.

The psychometric properties of the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions

PURPOSE

The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions.

MATERIALS AND METHODS

One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren's syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test-retest reliability.

RESULTS

The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach's α > 0.90); concurrent validity was strong (Health Assessment Questionnaire: r_s = 0.60-0.92; Short-Form Health Survey v2 Physical Function: r_s = -0.61 to -0.91) and test-retest reliability excellent (Intra-Class Correlation Coefficient(2,1) = 0.77-0.96).

CONCLUSION

The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions. Implications for rehabilitation The Evaluation of Daily Activity Questionnaire evaluates users' ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren's syndrome). Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist. The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility. The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

Hand-arm vibration disorder among grass-cutter workers in Malaysia

INTRODUCTION

Prolonged exposure to hand-transmitted vibration from grass-cutting machines has been associated with increasing occurrences of symptoms and signs of occupational diseases related to hand-arm vibration syndrome (HAVS).

METHODS

A cross-sectional study was carried out using an adopted HAVS questionnaire on hand-arm vibration exposure and symptoms distributed to 168 male workers from the grass and turf maintenance industry who use hand-held grass-cutting machines as part of their work. The prevalence ratio and symptom correlation to HAVS between high and low-moderate exposure risk groups were evaluated.

RESULTS

There were positive HAVS symptoms relationships between the low-moderate exposure group and the high exposure group among hand-held grass-cutting workers. The prevalence ratio was considered high because there were indicators that fingers turned white and felt numb, 3.63, 95% CI [1.41, 9.39] and 4.24, 95% CI [2.18, 8.27], respectively. Less than 14.3% of workers stated that they were aware of the occupational hand-arm vibration, and it seemed to be related to the finger blanching and numbness.

CONCLUSION

The results suggest that HAVS is under-diagnosed in Malaysia, especially in the agricultural sectors. More information related to safety and health awareness programmes for HAVS exposure is required among hand-held grass-cutting workers.

The reliability and validity of the English version of the Evaluation of Daily Activity Questionnaire for people with rheumatoid arthritis

Objectives. The Evaluation of Daily Activity Questionnaire (EDAQ) includes 138 items in 14 domains identified as important by people with RA. The aim of this study was to test the validity and reliability of the English EDAQ.

Methods. A total of 502 participants completed two questionnaires 3 weeks apart. The first consisted of the EDAQ, HAQ, RA Quality of Life (RAQoL) and the Medical Outcomes Scale (MOS) 36-item Short-Form Health Survey (SF-36v2), and the second consisted of the EDAQ only. The 14 EDAQ domains were tested for: unidimensionality—using confirmatory factor analysis; fit, response dependency, invariance across groups (differential item functioning)—using Rasch analysis; internal consistency [Person Separation Index (PSI)]; concurrent validity—by correlations with the HAQ, SF-36v2 and RAQoL; and test–retest reliability (Spearman’s correlations).

Results. Confirmatory factor analysis of the 14 EDAQ domains indicated unidimensionality, after adjustment for local dependency in each domain. All domains achieved a root mean square error of approximation <0.10 and satisfied Rasch model expectations for local dependency. DIF by age, gender and employment status was largely absent. The PSI was consistent with individual use (PSI = 0.94 for all 14 domains). For all domains, except Caring, concurrent validity was good: HAQ (r_s = 0.72–0.91), RAQoL (r_s = 0.67–0.82) and SF36v2 Physical Function scale (r_s = −0.60 to −0.84) and test–retest reliability was good (r_s = 0.70–0.89).

Conclusion. Analysis supported a 14-domain, two-component structure (Self care and Mobility) of the EDAQ, where each domain, and both components, satisfied Rasch model requirements, and have robust reliability and validity.

The content validity and acceptability of the Evaluation of Daily Activity Questionnaire in musculoskeletal conditions

Introduction

The Evaluation of Daily Activity Questionnaire is a detailed self-report measure of activity limitations. It has two parts, 10 scales of symptom severity and 14 daily activity domains, including 138 activities. It has good psychometric properties in rheumatoid arthritis. The aim was next to establish its content validity and acceptability in seven musculoskeletal conditions: ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic hand/upper limb musculoskeletal disorders; and primary Sjögren's syndrome.

Method

Participants completed the Evaluation of Daily Activity Questionnaire in their own time, followed by a cognitive debriefing interview to identify their views of importance of including each item and Evaluation of Daily Activity Questionnaire acceptability.

Results

Six to 12 people with each condition were interviewed ( n = 70): 17 men and 53 women, 57.38 (SD 12.83) years of age and with 13.15 (SD 11.02) years condition duration. Overall, all 10 scales and 138 activities were considered important to include. Most found it: had clear instructions (93%); was easy to complete (87%); included about the right amount of activities (77%); and would help an occupational therapist gain insight into the effects of the person's conditions (87%).

Conclusion

The Evaluation of Daily Activity Questionnaire has good content validity and acceptability in these seven conditions.

Health-care barriers for workers with HAVS in Ontario, Canada

BACKGROUND

Hand-arm vibration syndrome (HAVS) becomes irreversible unless it is identified early and progression prevented.

AIMS

To describe the health-care-seeking behaviours of workers with HAVS and barriers to health care.

METHODS

We invited all patients assessed for HAVS between 15 January and 27 March 2013 at a hospital-based occupational health clinic (OHC) in Ontario, Canada, to complete a questionnaire asking why and from whom they sought health care, reasons they waited to seek care and barriers they encountered in accessing care. We analysed the data using descriptive statistics.

RESULTS

Forty-one (82%) patients agreed to participate. Thirty-seven had confirmed HAVS; 30 (84%) were Stockholm workshop vascular stage 2 or greater and 35 (97%) were sensorineural stage 1 or greater. The commonest employment sectors were construction [21 (57%)] and mining [6 (17%)]. The main reasons for seeking treatment were pain [11 (30%)], finger numbness [8 (22%)] and functional limitations [5 (14%)]. The commonest initial point of health care was the family physician [23 (66%)]. The mean wait between symptom onset and seeking treatment was 3.4 years, while the mean time between onset and OHC assessment was 9 years. Reasons for delay in seeking care were ignorance of the seriousness and irreversibility of HAVS and ability to continue to work. Family physicians suspected HAVS in 17% of cases and recommended job modification in 34%.

CONCLUSIONS

Workers with HAVS in Ontario delay seeking health care. Primary care physicians often fail to recognize HAVS. Barriers to health care include ignorance of HAVS and of the importance of prevention.

Linguistic validation and cultural adaptation of an English version of the evaluation of daily activity questionnaire in rheumatoid arthritis

BACKGROUND

To linguistically validate and culturally adapt the Evaluation of Daily Activity Questionnaire (EDAQ) for use in rheumatoid arthritis (RA) from Swedish to British English. The EDAQ is a patient reported outcome measure of daily activity ability. It includes 11 activity domains (Eating and Drinking; Personal Care; Dressing; Bathing; Cooking; Moving Indoors; House Cleaning; Laundry; Moving and Transfers; Communication; Moving Outdoors) and was developed for use in rheumatoid arthritis (RA).

METHODS

The EDAQ was translated from Swedish to English using standard methods. Activity diaries, cognitive debriefing interviews and focus groups were completed with people with RA to: generate new culturally applicable items; identify important items in the Swedish version to retain in the English version; and develop the English EDAQ based on their views of content and layout. Content validity was established by linking the EDAQ to the International Classification of Functioning RA Core Set.

RESULTS

The English EDAQ translation was harmonized with the Swedish version to ensure equivalence of meaning. Sixty-one people with RA participated. 156 activities were identified from 31 activity diaries and included in a draft English EDAQ. Following interviews (n = 20) and four focus groups, 138 activities were retained and three additional domains added (Gardening/Household Maintenance; Caring; and Leisure/Social Activities). Most ICF RA Core Set activities are in the EDAQ.

CONCLUSIONS

The English EDAQ is a detailed self-report measure of ability in RA with good content validity.

Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy

Prolonged exposure to hand-held vibrating tools may cause a hand-arm vibration syndrome (HAVS), sometimes with individual susceptibility. The neurological symptoms seen in HAVS are similar to symptoms seen in patients with carpal tunnel syndrome (CTS) and there is a strong relationship between CTS and the use of vibrating tools. Vibration exposure to the hand is known to induce demyelination of nerve fibres and to reduce the density of myelinated nerve fibres in the nerve trunks. In view of current knowledge regarding the clinical effects of low nerve-fibre density in patients with neuropathies of varying aetiologies, such as diabetes, and that such a low density may lead to nerve entrapment symptoms, a reduction in myelinated nerve fibres may be a key factor behind the symptoms also seen in patients with HAVS and CTS. Furthermore, a reduced nerve-fibre density may result in a changed afferent signal pattern, resulting in turn in alterations in the brain, further prompting the symptoms seen in patients with HAVS and CTS. We conclude that a low nerve-fibre density lead to symptoms associated with nerve entrapment, such as CTS, in some patients with HAVS.

Physical capacity and psychological mood in association with self-reported work ability in vibration-exposed patients with hand symptoms

BACKGROUND

The aim of this study was to investigate whether self-reports of work ability correlated to the results of quantitative tests measuring physical capacity and a questionnaire assessing psychological mood in vibration-exposed patients with hand symptoms.

METHODS

The participants comprised 47 patients (36 men and eleven women) with exposure to hand vibration and vascular and/or neurological symptoms in the hands. They performed several quantitative tests (manual dexterity, hand grip strength, finger strength) and completed the Work Ability Index (WAI) and Hospital Anxiety and Depression Scale (HADS) questionnaires.

RESULTS

Correlation analysis revealed statistically significant associations between the WAI results, the HADS indices, hand grip and finger strength, and manual dexterity measured using the Purdue Pegboard®. Multiple regression analysis revealed age and HADS indices as the strongest predictors of work ability.

CONCLUSIONS

The patient's age and psychological mood may be stronger predictors of work ability compared with results from tests measuring physical capacity of the hands in vibration-exposed patients with hand symptoms. When using the WAI as an instrument for assessing work ability in these patients, health care providers need to be more aware of the impact of the psychological mood.

A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care on health-related quality of life in acute or subacute low back pain

OBJECTIVE

To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients.

STUDY DESIGN

A randomized, controlled trial during 10 weeks with four treatment groups.

SETTING

Nine primary health care and one outpatient orthopaedic hospital department.

SUBJECTS

One hundred and sixty patients with acute or subacute low back pain.

INTERVENTIONS

Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4).

MAIN MEASURES

The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score.

RESULTS

In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement.

CONCLUSION

The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

Improving hand sensibility in vibration induced neuropathy: A case-series

OBJECTIVES

We report a long-term series of nine workers suffering from vibration-induced neuropathy, after many years of exposure to hand-held vibrating tools at high or low frequency. They were treated with temporary selective cutaneous anaesthesia (EMLA® cream) of the forearm repeatedly for a period up to one year (in two cases four years). The aim was to improve their capacity to perceive touch and thereby improve hand function and diminish disability. The treatment principle is based on current concepts of brain plasticity, where a deafferentation of a skin area results in improved sensory function in adjacent skin areas.

METHODS

All participants had sensory hand problems in terms of numbness (median touch thresholds > 70 mg) and impaired hand function influencing ADL (mean DASH score 22).After an initial identical self-administered treatment period of 8 weeks (12-15 treatments with increasing intervals) they did one treatment every 2-3 month.

RESULTS

After one year sensibility (touch thresholds and tactile discrimination) as well as hand function (mean DASH score 13) were improved in a majority of the cases. Seven of the participants choose to continue the treatment after the first year and two of them have continued at a regular basis for up to four years. A surprising, secondary finding was diminishing nocturnal numbness of the hand and arm in eight of the nine subjects from "frequently" to "hardly ever or never".

CONCLUSIONS

Our observations open new perspectives for treatment of impaired sensibility and hand function in a group of patients with vibration induced hand problems where we have no treatment to offer today.

Neuropathic pain-like alterations in muscle nociceptor function associated with vibration-induced muscle pain

We recently developed a rodent model of the painful muscle disorders induced by occupational exposure to vibration. In the present study we used this model to evaluate the function of sensory neurons innervating the vibration-exposed gastrocnemius muscle. Activity of 74 vibration-exposed and 40 control nociceptors, with mechanical receptive fields in the gastrocnemius muscle, were recorded. In vibration-exposed rats ∼15% of nociceptors demonstrated an intense and long-lasting barrage of action potentials in response to sustained suprathreshold mechanical stimulation (average of 2635 action potentials with frequency of ∼44Hz during a 1min suprathreshold stimulus) much greater than that has been reported to be produced even by potent inflammatory mediators. While these high-firing nociceptors had lower mechanical thresholds than the remaining nociceptors, exposure to vibration had no effect on conduction velocity and did not induce spontaneous activity. Hyperactivity was not observed in any of 19 neurons from vibration-exposed rats pretreated with intrathecal antisense for the IL-6 receptor subunit gp130. Since vibration can injure peripheral nerves and IL-6 has been implicated in painful peripheral neuropathies, we suggest that the dramatic change in sensory neuron function and development of muscles pain, induced by exposure to vibration, reflects a neuropathic muscle pain syndrome.

Self-reported cold sensitivity in normal subjects and in patients with traumatic hand injuries or hand-arm vibration syndrome

BACKGROUND

Cold sensitivity is a common and disabling complaint following hand injuries. The main purpose of this study was to describe self-reported consequences of cold sensitivity and the association with disability and health-related quality of life in patients with hand injuries or hand-arm vibration syndrome (HAVS) and in normal subjects.

METHODS

Responses to the Cold Intolerance Symptom Severity (CISS) questionnaire, Potential Work Exposure Scale (PWES), Disability of the Arm, Shoulder and Hand (DASH) and Short-Form 36 questionnaire (SF-36) were investigated in normal subjects (n = 94), hand injured patients (amputation and nerve injuries, n = 88) and patients with HAVS (n = 30). The results are presented as median (range), percent and mean deviation from norms. The Kruskal Wallis Test or Mann-Whitney U-Test were used to identify significant differences between multiple groups or subgroups. The Spearman rank correlation was used to study the relationship between cold sensitivity and disability.

RESULTS

Abnormal cold sensitivity (CISS score > 50) was seen in 75% and 45% of patients with HAVS and a traumatic hand injury, respectively. Patients were significantly more exposed to cold in their work environment than the normal population, with a consequently negative effect on work ability due to cold sensitivity. Patients with abnormal cold sensitivity were more seriously disabled and had a poorer health-related quality of life than patients with normal cold sensitivity [higher DASH scores and e.g. significantly larger mean deviation from norms in the subscales Role Physical and Bodily Pain (SF-36)].

CONCLUSION

Severe and abnormal cold sensitivity may have a profound impact on work capacity, leisure, disability and health-related quality of life. It is frequently seen in patients with traumatic hand injuries and particularly apparent in patients with HAVS.

An Interpretative Phenomenological Analysis of the Psychological Ramifications of Hand-Arm Vibration Syndrome

With a substantial number of individuals diagnosed with Hand—Arm Vibration Syndrome (HAVS) and the preponderance of research focused on the medical and paramedical issues, the psychological and mental health sequelae of HAVS are largely neglected within the published literature. A series of focus groups and interviews were conducted involving nine people who had been diagnosed with HAVS. Transcripts of these interviews were analysed using Interpretative Phenomenological Analysis. Four key themes were identified within the discourse of individuals affected by HAVS: machismo; coping; psychological impacts; and the development of support services for HAVS. Clinical implications are briefly discussed.

Non-respiratory symptoms and well-being in asthmatics from a general population sample

BACKGROUND

Different instruments have been developed to assess health-related quality of life (HRQL) in asthma patients. However, relatively few studies have assessed HRQL in asthma patients from a general population, and it is still unclear which instrument is most suitable. The purpose of this study was to compare HRQL in clinically verified asthmatics with subjects with respiratory symptoms without asthma and with subjects with no respiratory symptoms from a general population. The generic instrument Gothenburg Quality of Life (GQL) was used. A secondary aim was to study if GQL had any prognostic value in asthma.

METHODS

A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire and GQL. The cohort consisted of 616 subjects with asthma, 488 subjects with respiratory symptoms but no asthma, and 347 subjects without respiratory symptoms. The participants were also investigated by spirometry and allergy testing. In a follow-up study, subjects were identified who had persistent and improved asthma.

RESULTS

The prevalence of 28 of the 30 common symptoms in GQL was significantly increased (p < 0.001) in subjects with asthma as compared to non-asthmatics. All symptoms in the domains heart and lung, head, musculoskeletal, tension, and depression were significantly increased among the asthmatics. The asthmatics also rated their physical well-being lower (p < 0.001) than subjects with no respiratory symptoms. Subjects with persistent asthma had a significantly higher prevalence of 7 of the 30 symptoms and lower social well-being than subjects showing improvement in asthma during the follow-up. All differences remained significant after adjusting for age, sex, and smoking habits.

CONCLUSION

Subjects with asthma had different symptom-profiles compared to those of non-asthmatics, with a higher prevalence of both respiratory and non-respiratory symptoms. Asthma is also a disease that is related to low well-being. The use of quality-of-life questionnaires such as the GQL may provide useful information for evaluating the non-respiratory aspects of asthma as well as for assessing the impact of disease on health status and well-being.

Health problems in cold work

Cold in- and outdoor work can result in different adverse effects on human health. Health problems decrease performance and work productivity and increase the occurrence of accidents and injuries. Serious health problems can also result in absence from work due to sick leave or hospitalization. At its worst, work in cold conditions could be associated with deaths due to cold-related accidents or a sudden health event. Musculoskeletal complaints, like pain, aches etc. are common in indoor cold work. Breathing cold air while working may lead to respiratory symptoms, which can decrease performance in cold. The symptoms are usually worsened by exercise and ageing, being more common in persons having a respiratory disease. Cardiovascular complaints and related performance decrements could be especially pronounced during work in cold weather and involving physical exercise, especially among those with an underlying cardiovascular disease. The article also reviews the current information related to diabetes, skin disorders and diseases, as well as cold injuries and accidents occurring in cold work. Increasing awareness and identifying workplace- and individual-related cold risks is the first step in proper cold risk management. Following this, the susceptible population groups need customized advice on proper prevention and protection in cold work.

Upper extremity disability in workers with hand-arm vibration syndrome

BACKGROUND

Hand-arm vibration syndrome (HAVS) is a common occupational problem and it is important to understand the disability associated with this condition.

AIMS

To measure upper extremity disability using the disabilities of the arm, shoulder and hand (DASH) questionnaire in workers with HAVS and to determine how this disability is affected by the vascular and neurological components of HAVS and other factors, in particular musculoskeletal variables.

METHODS

Subjects were recruited from HAVS patients assessed at St Michael's Hospital, Toronto, Canada, over a 2-year period. All participants were assessed by an occupational medicine specialist to determine the specific components of HAVS and musculoskeletal variables including upper extremity pain score measured by the Borg scale. The DASH questionnaire was completed on the same day as the clinical assessment and before any feedback had been given about the clinical findings.

RESULTS

A total of 141 workers with HAVS were recruited and 139 agreed to participate in the study. This study group had a statistically significantly higher mean DASH score than the US population (P < 0.001). The multiple linear regression analysis indicated that upper extremity pain score (P < 0.001), the Stockholm sensorineural scale (P < 0.01) and the number of fingers blanching (P < 0.05) had a statistically significant association with an increase in the DASH score. The highest partial R(2) value was for the upper extremity pain score.

CONCLUSIONS

Workers with HAVS have significant upper extremity disability and musculoskeletal factors appear to make an important contribution to this disability.