Raynaud's phenomenon in the feet of Arctic open-pit miners

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.

Self-reported exposure to dust and diesel exhaust, respiratory symptoms, and use of respiratory protective equipment among Arctic miners

Arctic miners face significant risks from diesel exhaust and dust exposure, potentially leading to adverse respiratory health. Employers must limit harmful exposures, using personal protective equipment (PPE) as a last line of defense. This study explored the association between reported respiratory exposure and symptoms, and PPE training and usage. Data from the MineHealth study (2012-2014) included a total of 453 Arctic open pit miners in Norway, Sweden, and Finland. Participants answered questions on exposure to dust and diesel exhaust, respiratory symptoms, and PPE use, in addition to age, gender, BMI, smoking, and self-rated health. Estimated exposure to dust was common, reported by 91%, 80%, and 82% and that of diesel exhaust by 84%, 43%, and 47% of workers in Sweden, Finland, and Norway, respectively. Reported dust exposure was significantly related to respiratory symptoms (OR 2.2, 95% CI 1.3-3.7), diesel exposure increased the occurrence of wheezing (OR 2.6, 95% CI 1.3-5.4). PPE use varied between the studied mines. Non-use was common and related to reduced visibility, wetness, skin irritation and fogging of the respiratory PPE. Future research should employ more precise exposure assessment, respiratory function as well as explore the reasons behind the non-compliance of PPE use.

Hand eczema and skin complaints in particulate matter-exposed occupations - firefighters, chimney sweepers, and ferrosilicon smelter workers in Norway

BACKGROUND

The objective was to investigate self-reported hand eczema, and skin complaints at other skin locations among workers exposed to particulate matter, especially ultrafine particles.

METHOD

We conducted a cross-sectional study on workers from one ferro-silicon smelter plant, eight chimney sweeper stations and one firefighter station across Norway. Participants answered an extended version of the Nordic Occupational Skin Questionnaire (NOSQ-2022), with additional questions about whole-body skin complaints and visible dust deposition. Results are presented as descriptive data using firefighters as reference group. Odds ratio (OR) was calculated using logistic regression on lifetime prevalence of hand eczema adjusted for potential confounders and mediators. P-values were calculated using likelihood ratio test against the crude OR.

RESULTS

A total of 186 participants answered the questionnaire: 74 chimney sweepers, 52 firefighters and 60 smelter workers. Participation rate was 95.0, 94.5 and 63.6%, respectively. Lifetime prevalence of hand eczema was 9.5, 9.6, and 28.3%, respectively. The point prevalence of hand eczema was 1.4, 1.9 and 10.0%, respectively. We estimated OR for lifetime hand eczema in smelter workers to 4.36 [95% CI: 1.31-14.43, p = 0.016] and for lifetime skin complaints in other locations to 2.25 [95% CI: 0.98-5.18, p = 0.058]. The lifetime prevalence of skin complaints at other locations was 18.9, 23.1 and 40.0%, respectively. The point prevalence was 14.9, 9.6 and 16.7%, respectively. These estimates were not statistically significant but indicates that smelter workers have more skin complaints also at other locations.

CONCLUSION

This study reports a more than four-fold increased risk of hand eczema in smelter workers, and possibly a higher risk of skin complaints in other body locations, compared to the other occupations. Longitudinal studies with larger population are needed to verify the marked increased risk of eczema among smelters and establish causation.

Neurosensory and vascular symptoms and clinical findings in the hands of Arctic open-pit miners in Sweden and Norway - a descriptive study

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.

Recognition of COVID-19 with occupational origin: a comparison between European countries

OBJECTIVES

This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe.

METHODS

A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022.

RESULTS

The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries.

CONCLUSIONS

COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.

Effects of Interventions to Prevent Work-Related Asthma, Allergy, and Other Hypersensitivity Reactions in Norwegian Salmon Industry Workers (SHInE): Protocol for a Pragmatic Allocated Intervention Trial and Related Substudies

BACKGROUND

Workers in the salmon processing industry have an increased risk of developing respiratory diseases and other hypersensitivity responses due to occupational exposure to bioaerosols containing fish proteins and microorganisms, and related allergens. Little is known about effective measures to reduce bioaerosol exposure and about the extent of skin complaints among workers. In addition, while identification of risk factors is a core activity in disease prevention strategies, there is increasing interest in health-promoting factors, which is an understudied area in the salmon processing industry.

OBJECTIVE

The overall aim of this ongoing study is to generate knowledge that can be used in tailored prevention of development or chronification of respiratory diseases, skin reactions, protein contact dermatitis, and allergy among salmon processing workers. The main objective is to identify effective methods to reduce bioaerosol exposure. Further objectives are to identify and characterize clinically relevant exposure agents, identify determinants of exposure, measure prevalence of work-related symptoms and disease, and identify health-promoting factors of the psychosocial work environment.

METHODS

Data are collected during field studies in 9 salmon processing plants along the Norwegian coastline. Data collection comprises exposure measurements, health examinations, and questionnaires. A wide range of laboratory analyses will be used for further analysis and characterization of exposure agents. Suitable statistical analysis will be applied to the various outcomes of this comprehensive study.

RESULTS

Data collection started in September 2021 and was anticipated to be completed by March 2023, but was delayed due to the COVID-19 pandemic. Baseline data from all 9 plants included 673 participants for the health examinations and a total of 869 personal exposure measurements. A total of 740 workers answered the study's main questionnaire on demographics, job characteristics, lifestyle, health, and health-promoting factors. Follow-up data collection is not completed yet.

CONCLUSIONS

This study will contribute to filling knowledge gaps concerning salmon workers' work environment. This includes effective workplace measures for bioaerosol exposure reduction, increased knowledge on hypersensitivity, allergy, respiratory and dermal health, as well as health-promoting workplace factors. Together this will give a basis for improving the work environment, preventing occupational health-related diseases, and developing occupational exposure limits, which in turn will benefit employees, employers, occupational health services, researchers, clinicians, decision makers, and other stakeholders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05039229; https://www.clinicaltrials.gov/study/NCT05039229.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48790.

The level of health anxiety before and during the COVID-19 pandemic

BACKGROUND

Concerns about disease and an increase in health anxiety levels are expected consequences of the COVID-19 pandemic. However, there have been few longitudinal studies of health anxiety in the general population during this time period. The aim of this study was to examine health anxiety levels before and during the COVID-19 pandemic in an adult, working population in Norway.

MATERIAL AND METHODS

This study included 1012 participants aged 18-70 years with one or more measurements of health anxiety (1402 measurements total) from the pre-pandemic period (2015 to March 11, 2020) and/or during the COVID-19 pandemic (March 12, 2020 to March 31, 2022). Health anxiety was measured with the revised version of the Whiteley Index-6 scale (WI-6-R). We estimated the effect of the COVID-19 pandemic on health anxiety scores with a general estimation equation analysis, and age, gender, education, and friendship were included in subgroup analyses.

RESULTS

We found no significant change in health anxiety scores during the COVID-19 pandemic compared to the pre-pandemic period in our adult, working population. A sensitivity analysis restricted to participants with two or more measurements showed similar results. Moreover, the effect of the COVID-19 pandemic on health anxiety scores was not significant in any subgroup analysis.

CONCLUSION

Health anxiety remained stable, with no significant change observed between the pre-pandemic period and the first 2 years of the COVID-19 pandemic in an adult, working population in Norway.

Cold exposure and musculoskeletal conditions; A scoping review

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.

To tolerate weather and to tolerate pain: two sides of the same coin? The Tromsø Study 7

ABSTRACT

It is a common belief that weather affects pain. Therefore, we hypothesized that weather can affect pain tolerance. This study used data from over 18,000 subjects aged 40 years or older from the general population, who participated in the Tromsø Study 7. They underwent a one-time assessment of cuff algometry pressure pain tolerance (PPT) and cold pain tolerance (CPT), tested with a cold pressor test. The results showed a clear seasonal variation in CPT. The rate of withdrawal in the cold pressor test was up to 75% higher in months in the warmer parts of the year compared with January 2016. There was no seasonal variation in PPT. The study not only found a nonrandom short-term variation in PPT but also indications of such a variation in CPT. The intrinsic timescale of this short-term variation in PPT was 5.1 days (95% % confidence interval 4.0-7.2), which is similar to the observed timescales of meteorological variables. Pressure pain tolerance and CPT correlated with meteorological variables, and these correlations changed over time. Finally, temperature and barometric pressure predicted future values of PPT. These findings suggest that weather has a causal and dynamic effect on pain tolerance, which supports the common belief that weather affects pain.

Comparing the new interdisciplinary Health in work intervention to conventional monodisciplinary welfare interventions at Norwegian workplaces: Protocol for a pragmatic cluster-randomized trial (Preprint)

Background

Musculoskeletal and mental health complaints are the dominant diagnostic categories in long-term sick leave and disability pensions in Norway. Continuing to work despite health complaints is often beneficial, and a good work environment can improve work inclusion for people affected. In 2001, the Norwegian Labour and Welfare Administration began to offer inclusive work measures to improve the psychosocial work environment and work inclusion of people with health complaints. In 2018, the Norwegian Labour and Welfare Administration and specialist health services started offering the new collaborative Health in work program. Its workplace intervention presents health and welfare information that may improve employees’ coping ability regarding common health complaints. It encourages understanding of coworkers’ health complaints and appropriate work adjustments to increase work participation.

Objective

This protocol presents an ongoing, 2-arm, pragmatic cluster-randomized trial. Its aim is to compare the effect of monodisciplinary inclusive work measures (treatment as usual) and interdisciplinary Health in work in terms of changes in overall sickness absence, health care use, health-related quality of life, and costs. The secondary objectives are to compare changes in individual sickness absence, psychosocial work environment, job and life satisfaction, health, and health anxiety at both the individual and group levels.

Methods

Data will be collected from national registers, trial-specific registrations, and questionnaires. Effects will be explored using difference-in-difference analysis and regression modeling. Multilevel analysis will visualize any cluster effects using intraclass correlation coefficients.

Results

Inclusion was completed in July 2021 with 97 workplaces and 1383 individual consents. Data collection will be completed with the last questionnaires to be sent out in July 2023.

Conclusions

This trial will contribute to filling knowledge gaps regarding the effectiveness and costs of workplace interventions, thereby benefiting health and welfare services, political decision makers, and the public and business sectors. The findings will be disseminated in reports, peer-reviewed journals, and conferences.

Trial Registration

ClinicalTrials.gov NCT04000035; https://clinicaltrials.gov/ct2/show/NCT04000035

International Registered Report Identifier (IRRID)

DERR1-10.2196/36166

Is working in a cold environment associated with musculoskeletal complaints 7-8 years later? A longitudinal analysis from the Tromsø Study

Objective

Exposure to a cold environment at work is associated with a higher prevalence of musculoskeletal pain and chronic pain in cross-sectional studies. This study aims to determine the association between working in a cold environment ≥ 25% of the time and musculoskeletal complaints (MSC) 7–8 years later.

Methods

We followed participants from the sixth survey (Tromsø 6, 2007–2008) to the seventh survey (Tromsø 7, 2015–2016) of the Tromsø Study. Analyses included 2347 men and women aged 32–60 years who were not retired and not receiving full-time disability benefits in Tromsø 6. Three different binary outcomes were investigated in Tromsø 7: any MSC, severe MSC, and MSC in ≥ 3 anatomical regions. We excluded participants with severe MSC, MSC in ≥ 3 regions, or missing values in Tromsø 6. The association between working in a cold environment and future MSC were examined using Poisson regression and adjusted for age, sex, number of moderate MSC, education, physical activity at work, smoking status, body mass index, and self-reported health in Tromsø 6.

Results

258 participants reported to work in a cold environment ≥ 25% of the time in Tromsø 6. They had an increased risk of having any MSC in Tromsø 7 (incidence rate ratio 1.15; 95% confidence interval 1.03–1.29). There was no significantly increased risk of severe MSC or MSC in ≥ 3 regions.

Conclusion

Working in a cold environment was associated with future MSC, but not with future severe MSC or future MSC in ≥ 3 regions.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01606-6) contains supplementary material, which is available to authorized users.

Self-reported traffic-related air pollution and respiratory symptoms among adults in an area with modest levels of traffic

Health effects of traffic-related air pollution (TRAP) concentrations in densely populated areas are previously described. However, there is still a lack of knowledge of the health effects of moderate TRAP levels. The aim of the current study, a population-based survey including 16 099 adults (response rate 33%), was to assess the relationship between TRAP estimates and respiratory symptoms in an area with modest levels of traffic; Telemark County, Norway. Respondents reported respiratory symptoms the past 12 months and two TRAP exposure estimates: amount of traffic outside their bedroom window and time spent by foot daily along a moderate to heavy traffic road. Females reported on average more symptoms than males. Significant relationships between traffic outside their bedroom window and number of symptoms were only found among females, with the strongest associations among female occasional smokers (incidence rate ratio [IRR], 1.75, 95% confidence interval (CI) [1.16–2.62] for moderate or heavy traffic compared to no traffic). Significant relationship between time spent daily by foot along a moderate to heavy traffic road and number of symptoms was found among male daily smokers (IRR 1.09, 95% CI [1.04–1.15] per hour increase). Associations between traffic outside bedroom window and each respiratory symptom were found. Significant associations were primarily detected among females, both among smokers and non-smokers. Significant associations between time spent by foot daily along a moderate to heavy traffic road (per hour) and nocturnal dyspnoea (odds ratio (OR) 1.20, 95% CI [1.05–1.38]), nocturnal chest tightness (OR 1.13 [1.00–1.28]) and wheezing (OR 1.14 [1.02–1.29]) were found among daily smokers, primarily men. Overall, we found significant associations between self-reported TRAP exposures and respiratory symptoms. Differences between genders and smoking status were identified. The findings indicate an association between TRAP and respiratory symptoms even in populations exposed to modest levels of TRAP.

Working in a cold environment, feeling cold at work and chronic pain: a cross-sectional analysis of the Tromsø Study

AIM

The aim of this study was to investigate if working in a cold environment and feeling cold at work are associated with chronic pain (ie, lasting ≥3 months).

METHODS

We used data from the sixth survey (2007-2008) of the Tromsø Study. Analyses included 6533 men and women aged 30-67 years who were not retired, not receiving full-time disability benefits and had no missing values. Associations between working in a cold environment, feeling cold at work and self-reported chronic pain were examined with logistic regression adjusted for age, sex, education, body mass index, insomnia, physical activity at work, leisure time physical activity and smoking.

RESULTS

779 participants reported working in a cold environment ≥25% of the time. This exposure was positively associated with pain at ≥3 sites (OR 1.57; 95% CI 1.23 to 2.01) and with neck, shoulder and leg pain, but not with pain at 1-2 sites. Feeling cold sometimes or often at work was associated with pain at ≥3 sites (OR 1.58; 95% CI 1.22 to 2.07 and OR 3.90; 95% CI 2.04 to 7.45, respectively). Feeling cold often at work was significantly and positively associated with pain at all sites except the hand, foot, stomach and head.

CONCLUSION

Working in a cold environment was significantly associated with chronic pain. The observed association was strongest for pain at musculoskeletal sites and for those who often felt cold at work.

Gene expression, function and ischemia tolerance in male and female rat hearts after sub-toxic levels of angiotensin II

To examine the response to chronic high-dose angiotensin II (Ang II) and a proposed milder response in female hearts with respect to gene expression and ischemic injury. Female and male litter–matched rats were treated with 400 ng kg⁻¹ min⁻¹ Ang II for 14 days. Hearts were isolated, subjected to 30-min ischemia and 30-min reperfusion in combination with functional monitoring and thereafter harvested for gene expression, WB and histology. Ang II-treated hearts showed signs of non-hypertrophic remodeling and had significantly higher end diastolic pressure after reperfusion, but no significant gender difference was detected. Ang II increased expression of genes related to heart function (ANF, β-MCH, Ankrd-1, PKC-α, PKC-δ TNF-α); fibrosis (Col I-α1, Col III-α1, Fn-1, Timp1) and apoptosis (P53, Casp-3) without changing heart weight but with 68% increase in collagen content. High (sub-toxic) dose of Ang II resulted in marked heart remodeling and diastolic dysfunction after ischemia without significant myocyte hypertrophy or ventricular chamber dilatation. Although there were some gender-dependent differences in gene expression, female gender did not protect against the overall response.