Influence of ergonomic factors on peripheral neuropathy under HAV exposure.

BACKGROUND: Hand-arm vibration (HAV) is a risk factor for carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE). It is unclear how ergonomic factors influence the relationship between HAV exposure and CTS and UNE. AIMS: We aimed to assess the relationship between cumulative HAV exposure and CTS and UNE in workers exposed to HAV from two tools with different ergonomic profiles. METHODS: We performed nerve conduction studies (NCSs) of the sensory and motor median and ulnar nerves and recorded symptoms indicating CTS and UNE in workers exposed to HAV from impact wrenches or from rock drills. Exposure was measured as cumulative lifetime exposure. We used linear regression adjusted for age and body mass index to assess linear relationships. RESULTS: Sixty-five workers participated (33 rock drill and 32 impact wrench operators). We found inverse linear associations between cumulative HAV exposure and median nerve sensory conduction velocity in impact wrench operators and ulnar nerve motor conduction velocity in rock drill operators (beta of 0.63 and 0.75). Based on NCS findings and symptoms, seven impact wrench operators had CTS and one UNE, and four rock drill operators had CTS and six UNE. CONCLUSIONS: Our findings indicate that ergonomic factors influence the development of CTS and UNE under HAV exposure. The ergonomic profile seems to influence which type of neuropathy workers exposed to HAV will develop. Design of occupational exposure guidelines and future studies should be based on ergonomic profile and exposure characteristics for different tools and not merely HAV.

Neurosensory component of hand-arm vibration syndrome: a 22-year follow-up study.

BACKGROUND: Knowledge about the long-term course of the neurologic component of hand-arm vibration syndrome (HAVS) is scarce. AIMS: To study the course and prognostic factors of the neurosensory component of HAVS over a period of 22 years. METHODS: Forty male sheet metal workers, with a mean age of 60 (range 45-78) years at follow-up, were examined with a test battery in 1994 and 2017. At baseline, the sample comprised 27 workers with HAVS symptoms and 13 workers without HAVS symptoms. Among the 27 workers, 25 workers reported work-related hand-arm vibration during follow-up (mean 3639 h). In 2017, the mean time since vibration stopped was 8.4 years. RESULTS: Among the 27 workers with HAVS in 1994, no overall statistically significant change was observed in hand numbness (Stockholm Workshop Scale), shoulder/arm pain (pain scale) or finger pain from 1994 to 2017. However, vibration exposure during follow-up was associated with increased finger pain. Cotinine, carbohydrate-deficient transferrin, glycosylated haemoglobin and folate were not associated with changes in neurosensory symptoms or manual dexterity (Grooved Pegboard) from 1994 to 2017. A diagnosis of HAVS in 1994 did not predict poor hand strength 22 years later. Isolated hand numbness (without white finger attacks) was more common at baseline than at follow-up. CONCLUSIONS: This 22-year follow-up study indicates a tendency towards irreversibility of hand numbness and finger pain in workers with HAVS. Continued vibration exposure seems to predict increased finger pain. Our findings highlight the importance of HAVS prevention.

Vascular component of hand-arm vibration syndrome: a 22-year follow-up study.

BACKGROUND: Vibration-induced white finger (VWF) is often assessed using the Stockholm Workshop Scale (SWS) and cold challenge plethysmography. However, long-term longitudinal studies using both methods are scarce. AIMS: To study the long-term course and prognostic factors of VWF assessed with the SWS and photoplethysmography (PPG), and to examine the effects of lifestyle on PPG score, regardless of VWF status. METHODS: Forty male construction workers were examined with a test battery and clinical examination in 1994 and 2016/17. RESULTS: At baseline, the sample comprised 27 workers with, and 13 without, symptoms of hand-arm vibration syndrome (HAVS). Thirty-five workers reported vibration exposure during follow-up. The mean age of the workers was 60 years (45-78) at follow-up. The paired t-test showed that PPG scores deteriorated from 1994 to 2017 in the 27 workers with HAVS in 1994 (mean difference 2.7 min, 95% confidence interval (CI) 0.2-5.2). However, there was no statistically significant change in SWS scores in these workers over time. Smoking and age were associated with PPG score deterioration. Vibration exposure during follow-up predicted SWS score deterioration: 1000 h of exposure predicted a deterioration stage of 0.09 (95% CI 0.03-0.16). Analysis of all 40 workers showed that 2017 PPG scores were associated with positive serum cotinine and self-reported smoking during follow-up. CONCLUSIONS: Whereas age and smoking predicted a PPG deterioration, continued vibration exposure predicted worsening of white finger symptoms. The association of PPG score and smoking should be considered in diagnostic and prognostic factor evaluations.

Systematic review of the cardiovascular effects of occupational noise.

BACKGROUND: Cross-sectional studies of occupational noise and cardiovascular effects show an association between noise and hypertension but for coronary heart disease or other cardiovascular diseases (CVDs) the evidence is not convincing. AIMS: To assess possible associations between occupational noise exposure and the risk for cardiovascular effects in follow-up studies published after 1999. METHODS: We performed a systematic critical literature review of original articles from key literature databases of associations between workplace noise and health. The studies were identified by search in Ovid Medline, Ovid Embase, Web of Science, Scopus and ProQuest Health and Safety Sciences Abstracts. We selected prospective studies of adequate quality with a measure of association between occupational noise exposure and cardiovascular health for the meta-analysis. RESULTS: Twelve papers, all prospective and mostly with high quality but with methodological shortcomings in exposure assessment, were included in the review and meta-analysis. Exposure to noise at work was consistently positively associated with hypertension [Hazard ratio (HR) = 1.68; 95% confidence interval (CI) 1.10-2.57] and CVD [relative risk (RR) = 1.34; 95% CI 1.15-1.56]. In addition, we found a trivial effect of noise exposure on CVD mortality (HR = 1.12; 95% CI 1.02-1.24). CONCLUSIONS: Occupational noise exposure is strongly associated with hypertension. For other cardiovascular effects, this meta-analysis suggests a weak association, but the evidence is limited. More longitudinal studies on the effects of occupational noise on the cardiovascular system are warranted.

Exposure to thoracic dust, airway symptoms and lung function in cement production workers.

Cement dust exposure has previously been associated with airway symptoms and ventilatory impairment. The aim of the present study was to examine lung function and airway symptoms among employees in different jobs and at different levels of exposure to thoracic dust in the cement production industry. At the start of a 4-yr prospective cohort study in 2007, exposure to cement dust, symptoms and lung function were recorded cross-sectionally in 4,265 employees in 24 European cement plants. Bronchial exposure was assessed by 2,670 full-shift dust samples with cyclones collecting the thoracic aerosol fraction. A job exposure matrix was constructed by grouping dust concentrations according to job type and plant. Elevated odds ratios for symptoms and airflow limitation (range 1.2-2.6 in the highest quartile), but not for chronic bronchitis, were found in the higher quartiles of exposure compared with the lowest quartile. Forced expiratory volume in 1 s (FEV(1)) showed an exposure-response relationship with a 270-mL deficit of FEV(1) (95% CI 190-300 mL) in the highest compared with the lowest exposure level. The results support the hypothesis that exposure to dust in cement production may lead to respiratory symptoms and airway obstruction.

Relatives of persons with recently discovered serious mental illness: in need of support to become resource persons in treatment and recovery.

A considerable amount of research on the treatment of young people suffering from serious mental illnesses states that good collaboration with relatives is essential for reducing relapse, improving recovery and enhancing quality of life for patients and relatives. The aim of this study was to explore and describe what facilitates active involvement for relatives in the treatment and rehabilitation of their family member. The present study is a part of a larger cooperative inquiry project carried out in a mental hospital in southern Norway focusing on improving practices for collaboration with relatives. This sub-study presents results from eight focus group interviews with relatives and staff members. Data were analysed by means of qualitative content analysis. The results showed that the relatives had mostly positive experiences from their encounters with the staff, although some negative experiences were articulated. Both relatives and staff underlined the importance of developing a good encounter characterized by sharing information, giving guidance and support according to the relatives' needs as well as addressing existential issues. This was perceived as a necessary basis for the relatives to become active participants in the treatment and rehabilitation process. To activate this basis, the relatives are dependent on the staff members' ability to convey and nurture hope related to the patient's recovery and quality of life.

Determinants of microbial exposure in grain farming.

OBJECTIVES: Exposure to organic dust containing high concentrations of microorganisms is common in grain farming, although the farmers have practices to counteract microbial growth to obtain optimal grain yields. We investigated the influence of weather and production practices on personal microbial exposure during grain work. METHODS: Airborne dust was collected by personal sampling during threshing and storage work on 92 Norwegian farms. The personal exposure for bacteria, endotoxin, fungal spores and hyphae, beta-(1-->3)-glucans and actinomycetes was quantified and compared with climatic data expressed as fungal forecasts from the grain growth season and production practices as reported by farmers. RESULTS: Farmers were exposed to a geometrical mean of 4.4 mg m(-3) inhalable dust [geometrical standard deviation (GSD) = 4.0], 4 x 10(6) m(-3) bacteria and fungal spores (GSD = 5.2 and 5.9, respectively), 5.9 x 10(3) EU m(-3) of endotoxins (GSD = 8.6), 2 x 10(5) m(-3) actinomycetes (GSD = 15.3), 120 mug m(-3) beta-(1-->3)-glucans (GSD = 4.7) and 5 x 10(5) AU m(-3) of hyphae (GSD = 4.4). Univariate associations were found between one or several of these microbial factors and work operation, visible fungal damage, grain species, lodging of grain, storage technology or harvester type. As assessed by general linear models, storage work was the main predictive determinant for microbial exposure, although grain species and visible fungal damage also were also important. Wet and warm weather throughout the grain growth season were associated with elevated exposure for inhalable dust, beta-(1-->3)-glucans, endotoxins and hyphae during threshing. The beta-(1-->3)-glucan exposure could biologically be explained by the fungal spore and hyphal exposure, both variables contributing equally. However, spores were most important during storage work, whereas only hyphae were predictive during threshing. CONCLUSIONS: Farmers were exposed to high levels of microorganisms and their components during dusty grain work. Dust prevention and protection may reduce microbial exposure, and may be particularly important in areas with frequent fungal forecasts, when fungal damage has been observed, during storage work or when handling barley.

Persistence of orally administered Salmonella enterica serovars Agona and Montevideo in Atlantic salmon (Salmo salar L.).

The objective of our experiments was to study the persistence and dissemination of orally administered Salmonella in smoltified Atlantic salmon. In experiment 1, salmon kept at 15 degrees C were fed for 1 week with feed contaminated with 96 most-probable-number units of Salmonella Agona per 100 g of feed and then starved for 2 weeks. Samples were taken from the gastrointestinal tract and examined for Salmonella 1, 2, 8, 9, 15, and 16 days after the feeding ended. In experiment 2, Salmonella Agona and Montevideo were separately mixed with feed and administered by gastric intubation. Each fish received 1.0 x 10(8), 1.0 x 10(6), or 1.0 x 10(4) CFU. The different groups were kept in parallel at 5 and 15 degrees C and observed for 4 weeks. Every week, three fish in each group were sacrificed, and samples were taken from the skin, the pooled internal organs, the muscle, and the gastrointestinal tract and examined for the presence of Salmonella. The results from the two experiments showed that the persistence of Salmonella in the fish was highly dependent on the dose administered. Salmonella was not recovered from any of the fish that were fed for 1 week with the lowest concentration of Salmonella. In the fish given the highest dose of Salmonella, bacteria persisted for at least 4 weeks in the gastrointestinal tract as well as, to some extent, the internal organs. The present study shows that under practical conditions in Norway, the risk of Salmonella in fish feed being passed on to the consumer of the fish is negligible.

Molecular epidemiology of Salmonella spp. isolates from gulls, fish-meal factories, feed factories, animals and humans in Norway based on pulsed-field gel electrophoresis.

The molecular epidemiology of 98 isolates of Salmonella serovar Agona (n = 27), S. Montevideo (n = 42) and S. Senftenberg (n = 29) from wild-living gulls, fish-meal factories, feed factories, humans and domestic animals was investigated using pulsed-field gel electrophoresis (PFGE) and computerized numerical analysis. Two of the S. Agona profiles were identified both in gulls and in two of the factories. In addition, one of these profiles was detected in two infected poultry farms. Two of the S. Montevideo profiles were also identified both in gulls and in two of the factories, and one of these profiles was observed in a human isolate. Four factories shared an identical S. Senftenberg profile. The S. Senftenberg profile found in gulls was not identified in any other source investigated. The presence of isolates with identical PFGE profiles indicates potential epidemiological links between different factories, as well as between gulls and factories.

Incidence of lip cancer in the male Norwegian agricultural population.

OBJECTIVE: To explore lip cancer (LC) associations with work environmental exposures in a record-linkage study of Norwegian farmers. We hypothesize immunosuppressive substances (e.g. mycotoxins, pesticides) to influence LC incidence. METHODS: A cohort of 131,243 male Norwegian farmers born 1925-1971 was established by cross-linkage of national registers and followed up through 1999 for incident LC, (ICD-7 site 140) in the Cancer Registry of Norway. Farm production data from agricultural censuses 1969-1979 and meteorological data on solar radiation and fungal forecasts (events of wet and temperate conditions known to favour fungal growth and mycotoxin formation) served as exposure proxies. Adjusted rate ratios (RR) and 95% confidence intervals (CI) were estimated using Poisson regression. RESULTS: We identified 108 LC cases (rate 4.4 per 100,000 person-years). We found LC to be moderately associated with horses on the farm (RR = 1.6, CI = 1.0-2.4), construction work employment (RR = 1.7, CI = 1.1-2.6), pesticide use (RR = 0.7, CI = 0.4-1.0), grain production (RR = 1.3, CI = 0.9-2.1) and increasing levels of fungal forecasts (RR = 1.6, CI = 0.9-2.8 in the highest two quartiles). CONCLUSION: Moderate associations of LC with grain production and fungal forecasts and the negative association with pesticide could possibly be explained by exposure to immunosuppressive mycotoxins. Some of the associations observed could be explained by solar exposure.

Effects of moderate doses of alcohol on immediate recall of numbers: some implications for information technology.

OBJECTIVE: Moderate doses of alcohol will have detrimental effects on memory functions used in various aspects of human interaction with information technology. The need to deal with multidigit numbers while under alcohol intoxication (e.g., making telephone calls) is a reality of life. To determine these relations, the effects of alcohol on immediate ordered recall were studied in a practical number-dialing task. METHOD: Immediate ordered recall of eight-digit numbers, presented visually or auditorily, was tested in read-and-dial or listen-and-dial forced ordered recall tasks with male subjects (N = 11) under two levels of blood alcohol concentration (BrAC = 0.05% and BrAC = 0.1%) and a no-alcohol placebo control condition (BrAC = 0.0%). RESULTS: With increasing alcohol level, immediate ordered recall of whole numbers (all eight digits correct and in the right order) fell by 9% (visual presentation) and 15% (auditory presentation). No significant interaction effect between alcohol level and digit position in the number was found for visually presented numbers, while a weak, but significant, effect was found for auditorily presented numbers (most prominent at digit positions 5, 6 and 7). This is probably due to the difference in rehearsal opportunities in the two presentation modes. No significant interaction effects between alcohol level and presentation modality were found. CONCLUSIONS: The results, tailored to a practical everyday task of dialing unfamiliar eight-digit telephone numbers, show that even moderate doses of alcohol will affect the performance of an already fragile short-term memory system engaged whenever reproduction of digit strings is required.

Is the rod visual field temporally homogeneous?

Cone vision has been shown to be temporally inhomogeneous across the visual field. In the periphery, contrast sensitivity is lower for low temporal frequencies and higher for high temporal frequencies. Here we ask a similar question for rod vision at mesopic luminances. Isolation is obtained by testing a well documented rod monochromat. We show that the rod visual field exhibits only a modest degree of temporal inhomogeneity.

Rod temporal channels.

Mechanisms underlying rod temporal contrast sensitivity have been considered in terms of a fast retinal signal predominating at mesopic levels and a slower retinal signal predominating at scotopic levels. Here we use a small signal masking method, which has previously been used to delineate the cone-mediated cortical temporal channels, to investigate their rod-mediated cortical counterparts. The results suggest that there are three different rod-mediated cortical temporal channels, one which is lowpass and two which are bandpass. These mechanisms co-exist at all light levels and their relative sensitivity depend on the stimulus spatio-temporal frequency.

Two signals in the human rod visual system: a model based on electrophysiological data.

In the human rod visual system, self-cancellation of flicker signals is observed at high rod intensity levels near 15 Hz, both perceptually and in the electroetinogram (ERG). This and other evidence suggests that two rod signals are transmitted through the human retina with different speeds of transmission. Here we report a series of flicker ERG recordings from a normal observer and an observer who lacks cone vision. From these results, we propose a quantitative model of the two rod signals, which assumes (1) that the amplitude of the slow signal grows linearly with log intensity but then saturates at approximately 1 scot. td; (2) that the amplitude of the fast signal grows linearly with intensity; (3) that there is a difference in time delay of approximately 33 ms between two rod signals of the same polarity (or of approximately 67 ms if the signals are of inverted polarity); and (4) that the time delay of both signals declines linearly with log intensity (by approximately 10 ms per log scot. td). These simple assumptions provide a remarkably good account of the experimental data. Our results and model are relevant to current anatomical theories of the mammalian rod visual system. We speculate that the slower signal in the human ERG may reflect the transmission of the rod response via the rod bipolars and the AII amacrine cells, while the faster signal may reflect its transmission via the rod-cone gap junctions and the cone bipolars. There are, however, several objections to this simple correspondence.

[Access to family practitioners by telephone. A practical example of quality assurance]. / Telefontilgjengelighet i allmennpraksis. Et praktisk eksempel på kvalitetssikring.

A record of telephone calls in a Norwegian town (Molde) in 1987 showed that fewer inquiries were answered by general practitioners and their receptionists than by personnel in any other profession or trade. The general practitioners and the receptionists agreed on measures to improve accessibility, and more records of telephone calls were made. The measures and the process are described. At local level, a record of calls which differentiates between those answered by the providers of primary care and those answered by automatic machines seems to be a simple and useful means of quality assurance which we encourage others to apply.