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Tekavec E, Löfqvist L, Larsson A, Fisk K, Riddar J, Nilsson T, Nordander C. Adverse health manifestations in the hands of vibration exposed carpenters - a cross sectional study. J Occup Med Toxicol 2021; 16:16. [PMID: 33926509 PMCID: PMC8082821 DOI: 10.1186/s12995-021-00305-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
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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Affiliation(s)
- Eva Tekavec
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Lotta Löfqvist
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Anna Larsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Karin Fisk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jakob Riddar
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Tohr Nilsson
- Division of Sustainable Health and Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Johanning E, Stillo M, Landsbergis P. Powered-hand tools and vibration-related disorders in US-railway maintenance-of-way workers. INDUSTRIAL HEALTH 2020; 58:539-553. [PMID: 32863315 PMCID: PMC7708743 DOI: 10.2486/indhealth.2020-0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Maintenance-of-way workers in North America who construct railroad tracks utilize specialized powered-hand tools, which lead to hand-transmitted vibration exposure. In this study, the maintenance-of-way workers were surveyed about neuro-musculoskeletal disorders, powered-hand tools and work practices. Information about vibration emission data of trade specific powered-hand tools for the North American and European Union markets was searched online to obtain respective user information of manufacturer and compared to non-commercial international data banks. The survey showed that maintenance-of-way workers frequently reported typical hand-transmitted vibration-related symptoms, and appear to be at a risk for neuro-musculoskeletal disorders of the upper extremity. Of all of the powered-hand tools used by this trade, 88% of the selected tools exceeded a=5 m/s2 and were above vibration magnitudes of common tools of other comparable industries. This may create a risk if these tools are used throughout an 8-h work day and management of vibration exposure may be needed. In the North-American market, limited or no vibration emission data is available from manufacturers or distributors. Vibration emission information for powered-hand tools, including vibration emission levels (in m/s2), uncertainty factor K, and the applied testing standard/norm may assist employers, users and occupational health providers to better assess, compare and manage risk.
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Affiliation(s)
| | - Marco Stillo
- Downstate School of Public Health, State University of New York (SUNY), USA
| | - Paul Landsbergis
- Downstate School of Public Health, State University of New York (SUNY), USA
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Fadl H, Saeedi M, Montgomery S, Magnuson A, Schwarcz E, Berntorp K, Sengpiel V, Storck-Lindholm E, Strevens H, Wikström AK, Brismar-Wendel S, Persson M, Jansson S, Ahlsson F, Ursing C, Ryen L, Petersson K, Wennerholm UB, Hildén K, Simmons D. Changing diagnostic criteria for gestational diabetes in Sweden - a stepped wedge national cluster randomised controlled trial - the CDC4G study protocol. BMC Pregnancy Childbirth 2019; 19:398. [PMID: 31675922 PMCID: PMC6823965 DOI: 10.1186/s12884-019-2547-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden (www.cdc4g.se/en) is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches. Methods This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January–December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included. Discussion The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child. Trial registration CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017)
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Affiliation(s)
- Helena Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Maryam Saeedi
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, University Hospital Örebro, Örebro, Sweden
| | - Erik Schwarcz
- Department of Internal Medicine, School of medical health and sciences, Örebro University Hospital, Örebro, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Clinical Research Center Malmö, Lund University, Lund, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Helena Strevens
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Clinical Research Center Lund, Lund University, Lund, Sweden
| | | | - Sophia Brismar-Wendel
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Martina Persson
- Department of Paediatrics, Sachsska Children's and Youth hospital and Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Stefan Jansson
- School of Medical Sciences, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's health, Uppsala University, Uppsala, Sweden
| | - Carina Ursing
- Department of Endocrinology, Södersjukhuset, Stockholm, Sweden
| | - Linda Ryen
- Center for Health Care Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Petersson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Hildén
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbell town, Australia.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Kim AR, Kim DY, Kim JS, Lee H, Sung JH, Yoo C. Application of cold intolerance symptom severity questionnaire among vibration-exposed workers as a screening tool for the early detection of hand-arm vibration syndrome: a cross-sectional study. Ann Occup Environ Med 2019; 31:6. [PMID: 30867931 PMCID: PMC6397473 DOI: 10.1186/s40557-019-0284-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/01/2019] [Indexed: 11/12/2022] Open
Abstract
Background The detection rate of hand-arm vibration syndrome (HAVS) is very low in South Korea compared with other countries. The absence of uniform consensus and guidelines for diagnosing HAVS has been presumed to be one of the reasons. The HAVS has various manifestations including cold intolerance and its severity can be measured using the cold intolerance symptom severity (CISS) questionnaire. This study aimed to determine whether the CISS questionnaire, being used as a screening tool, can aid in the early detection of HAVS. Methods A total of 76 male workers with vibration-induced symptoms were enrolled as the final study participants. To compare the CISS score of healthy individuals, 41 men who had never been exposed to local vibration were included in the study. In addition to the former medical questionnaire, the participants answered the CISS questionnaire. A statistical analysis was conducted to identify the association of CISS scores with vibration induced symptom and to determine its cut off value. Results The reliability of the CISS questionnaire was proven to be good, with a total Cronbach’s alpha of 0.922. The mean CISS score of the exposed group increased in every vascular stage [stage 0 = 42.6 (18.5); stage 1 = 59.4 (14.1); and over stage 2 = 60.2 (21.6)]. They were significantly higher than that of the non-exposed group. The result was fairly consistent with those in the sensorineural stage. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of 30 were 88.5, 65.3, 76.1, 82.1 and 0.769, respectively. From the result of logistic regression, the adjusted odds ratio of both components increased by the CISS score grouped by 30s. Conclusions The self-reported CISS questionnaire, used to measure the degree of cold intolerance, showed high agreement with the Stockholm classification of HAVS. Hence, we recommend the use of this questionnaire to assess the level of cold intolerance among vibration-exposed workers and detect individuals who are at risk of vibration-induced impairment with a cutoff value of 30. Trial registration IRB No. 2018–07–040-001. Registered on 4 September 2018.
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Affiliation(s)
- A Ram Kim
- 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033 Republic of Korea
| | - Dae Yun Kim
- 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033 Republic of Korea
| | - Ji Soo Kim
- 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033 Republic of Korea
| | - Heun Lee
- 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033 Republic of Korea
| | - Joo Hyun Sung
- 2Department of Occupational and Environmental Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Institute of Health Science, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeonsangnam-do 52727 Republic of Korea
| | - Cheolin Yoo
- 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033 Republic of Korea
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Carlsson D, Wahlström J, Burström L, Hagberg M, Lundström R, Pettersson H, Nilsson T. Can sensation of cold hands predict Raynaud's phenomenon or paraesthesia? Occup Med (Lond) 2019; 68:314-319. [PMID: 29750280 PMCID: PMC6012203 DOI: 10.1093/occmed/kqy053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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Affiliation(s)
- D Carlsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - J Wahlström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - L Burström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - M Hagberg
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - R Lundström
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - H Pettersson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - T Nilsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
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Nilsson T, Wahlström J, Burström L. Hand-arm vibration and the risk of vascular and neurological diseases-A systematic review and meta-analysis. PLoS One 2017; 12:e0180795. [PMID: 28704466 PMCID: PMC5509149 DOI: 10.1371/journal.pone.0180795] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Increased occurrence of Raynaud’s phenomenon, neurosensory injury and carpal tunnel syndrome has been reported for more than 100 years in association with work with vibrating machines. The current risk prediction modelling (ISO-5349) for “Raynaud’s phenomenon” is based on a few studies published 70 to 40 years ago. There are no corresponding risk prediction models for neurosensory injury or carpal tunnel syndrome, nor any systematic reviews comprising a statistical synthesis (meta-analysis) of the evidence. Objectives Our aim was to provide a systematic review of the literature on the association between Raynaud’s phenomenon, neurosensory injuries and carpal tunnel syndrome and hand-arm vibration (HAV) exposure. Moreover the aim was to estimate the magnitude of such an association using meta-analysis. Methods This systematic review covers the scientific literature up to January 2016. The databases used for the literature search were PubMed and Science Direct. We found a total of 4,335 abstracts, which were read and whose validity was assessed according to pre-established criteria. 294 articles were examined in their entirety to determine whether each article met the inclusion criteria. The possible risk of bias was assessed for each article. 52 articles finally met the pre-established criteria for inclusion in the systematic review. Results The results show that workers who are exposed to HAV have an increased risk of vascular and neurological diseases compared to non-vibration exposed groups. The crude estimate of the risk increase is approximately 4–5 fold. The estimated effect size (odds ratio) is 6.9 for the studies of Raynaud’s phenomenon when including only the studies judged to have a low risk of bias. The corresponding risk of neurosensory injury is 7.4 and the equivalent of carpal tunnel syndrome is 2.9. Conclusion At equal exposures, neurosensory injury occurs with a 3-time factor shorter latency than Raynaud’s phenomenon. Which is why preventive measures should address this vibration health hazard with greater attention.
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Affiliation(s)
- Tohr Nilsson
- Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- * E-mail:
| | - Jens Wahlström
- Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lage Burström
- Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
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Bast-Pettersen R, Ulvestad B, Færden K, Clemm TAC, Olsen R, Ellingsen DG, Nordby KC. Tremor and hand-arm vibration syndrome (HAVS) in road maintenance workers. Int Arch Occup Environ Health 2016; 90:93-106. [PMID: 27796506 PMCID: PMC5215212 DOI: 10.1007/s00420-016-1175-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 10/18/2016] [Indexed: 12/19/2022]
Abstract
Objectives The aim of this study was to evaluate postural and rest tremor among workers using vibrating hand tools, taking into account the possible effects of toxicants such as alcohol and tobacco. A further aim was to study workers diagnosed with hand-arm vibration syndrome (HAVS) at the time of examination. Methods This study comprises 103 road maintenance workers, 55 exposed to vibrating hand tools (age 41.0 years; range 21–62) and 48 referents (age 38.5 years; range 19–64). They were examined with the CATSYS Tremor Pen®. Exposure to vibrating tools and serum biomarkers of alcohol and tobacco consumption were measured. Results Cumulative exposure to vibrating tools was associated with increased postural (p < 0.01) and rest tremor (p < 0.05) and with a higher Center Frequency of postural tremor (p < 0.01) among smokers and users of smokeless tobacco. Rest tremor Center Frequency was higher than postural tremor frequency (p < 0.001). Conclusions The main findings indicate an association between cumulative exposure to hand-held vibrating tools, tremor parameters and consumption of tobacco products. The hand position is important when testing for tremor. Rest tremor had a higher Center Frequency. Postural tremor was more strongly associated with exposure than rest tremor. The finding of increased tremor among the HAVS subjects indicated that tremor might be a part of the clinical picture of a HAVS diagnosis. As with all cross-sectional studies, inferences should be made with caution when drawing conclusions about associations between exposure and possible effects. Future research using longitudinal design is required to validate the findings of the present study.
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Affiliation(s)
| | | | - Karl Færden
- Department of Environmental and Occupational Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Raymond Olsen
- National Institute of Occupational Health, Oslo, Norway
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Edlund M, Burström L, Hagberg M, Lundström R, Nilsson T, Sandén H, Wastensson G. Quantitatively measured tremor in hand-arm vibration-exposed workers. Int Arch Occup Environ Health 2014; 88:305-10. [PMID: 24996634 PMCID: PMC4353857 DOI: 10.1007/s00420-014-0959-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/27/2014] [Indexed: 11/05/2022]
Abstract
Objectives
The aim of the present study was to investigate the possible increase in hand tremor in relation to hand-arm vibration (HAV) exposure in a cohort of exposed and unexposed workers. Methods Participants were 178 male workers with or without exposure to HAV. The study is cross-sectional regarding the outcome of tremor and has a longitudinal design with respect to exposure. The dose of HAV exposure was collected via questionnaires and measurements at several follow-ups. The CATSYS Tremor Pen® was used for measuring postural tremor. Multiple linear regression methods were used to analyze associations between different tremor variables and HAV exposure, along with predictor variables with biological relevance. Results There were no statistically significant associations between the different tremor variables and cumulative HAV or current exposure. Age was a statistically significant predictor of variation in tremor outcomes for three of the four tremor variables, whereas nicotine use was a statistically significant predictor of either left or right hand or both hands for all four tremor variables. Conclusions In the present study, there was no evidence of an exposure–response association between HAV exposure and measured postural tremor. Increase in age and nicotine use appeared to be the strongest predictors of tremor.
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Affiliation(s)
- Maria Edlund
- Department of Occupational and Environmental Medicine, Sahlgrenska School of Public Health and Community Medicine, University of Göteborg, Göteborg, Sweden,
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