Quality of life (EQ-5D) and hand-arm vibration syndrome.

BACKGROUND: The aim of this study was to investigate the quality of life of a population of Finnish metalworkers who were exposed to hand-arm vibration (HAV) and who suffered from white fingers, tingling, or numbness of the fingers, musculoskeletal disorders of the upper extremities, or symptoms of carpal tunnel syndrome (CTS). METHODS: A questionnaire on vibration exposure in the workplace and symptoms relating to the upper extremities was sent to a sample (n = 530) of members of the local Metalworkers Union. Of those who reported vibration-induced white fingers (VWF), numbness or tingling of the fingers, or symptoms of CTS, 131 men participated in clinical examinations. Their cumulative lifelong exposure to HAV was evaluated, and the health-related quality of life was assessed using EuroQoL(EQ)-5D. RESULTS: There was an inverse relationship between the EQ-5D index score and cumulative exposure to HAV: as exposure to HAV increased, the quality of life became more impaired (P < 0.001). Vascular, sensorineural, and musculoskeletal symptoms and symptoms of CTS decreased significantly with the EQ-5D index score, sensorineural symptoms causing the most significant impairment in EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression). The mean EQ-5D index and the visual analogic scale (VAS)-score were lower for those patients who complained of difficulties at work or during leisure time due to HAVS symptoms. CONCLUSION: The findings of the present study suggest that symptoms related to HAV exposure significantly diminish the quality of life. This impairment can be seen in the different dimensions of well-being that are measured by EQ-5D. EQ-5D seems to correlate with both the severity of symptoms and the cumulative exposure index, and can thus be recommended as part of the health examination of workers exposed to HAV.

Dose-response relationship between exposure to hand-arm vibration and health effects among metalworkers.

OBJECTIVES: The aim of this study was to explore the relationship of exposure to hand-arm vibration (HAV) and vascular, sensorineural and musculoskeletal symptoms and symptoms of carpal tunnel syndrome (CTS) in a population of Finnish metalworkers. METHODS: A questionnaire on HAV exposure and symptoms was sent to 530 metalworkers. Those who reported finger blanching, numbness or tingling of the fingers or symptoms of CTS were invited to further examinations (n = 133). Their cumulative lifelong exposure to HAV, the level of current exposure and the history of use of tools causing impulse vibration were evaluated. The association of different symptoms with the HAV exposure was assessed with logistic regression analyses adjusted for age and smoking. The vibration perception thresholds (VPTs) were tested according to ISO 13091-1:2001. RESULTS: The cumulative exposure index varied between 0 and 115,000 m(2) years d s(-4), the mean being 20,591 m(2) years d s(-4). The average of current daily vibration exposure was 1.6 m s(-2) and 39% of the participants had a history of exposure to impulse vibration. Of the respondents, 49% reported white fingers, 66% neurosensory symptoms, 56% symptoms of CTS and 75% musculoskeletal symptoms. The cumulative exposure index was associated with symptoms of white fingers [odds ratio (OR) 2.4-4.5], with symptoms of CTS (OR 4.6-6.1), with neurosensory symptoms (OR 5.7-17.3) and with musculoskeletal symptoms (OR 4.7-5.4). The risk of all these symptoms increased as the cumulative vibration dose increased. The history of exposure to impulse vibration had a significant effect on the occurrence of neurosensory symptoms (P = 0.024). The current exposure to HAV correlated significantly with all of the above-mentioned symptoms. The results of the VPT test were associated with the level of cumulative exposure to HAV. CONCLUSIONS: There seems to be a dose-response relationship between the cumulative lifetime vibration dose of the HAV and finger blanching, sensorineural symptoms, symptoms of CTS and musculoskeletal symptoms of upper limbs and neck in the group of metalworkers of the study. The risk for neurosensory symptoms was the most significantly related to exposure to HAV and also to impulse vibration. Further studies are needed to confirm the present results also in other occupational groups taking into account the possible synergistic effect of workload as well.

Vibration-induced white finger syndrome and carpal tunnel syndrome among Finnish metal workers.

OBJECTIVE: Officially 10-26 cases of vibration-induced white fingers (VWF) have been reported annually in Finland. It has been suggested that the numbers are underestimated. The purpose of the present study was to estimate the cumulative exposure to hand-arm vibration (HAV) and the prevalence of clinically diagnosed cases of VWF and carpal tunnel syndrome (CTS) in a population of Finnish metal workers and to determine the symptoms and clinical tests that would best predict the diagnosis. METHODS: A questionnaire on vibration exposure at the workplace and symptoms of the upper extremities was sent to a sample (n = 530) of members of the local Metalworkers Union. Those who reported finger blanching, numbness or tingling of the fingers or symptoms of CTS were invited to take part in clinical examinations. Their cumulative lifelong exposure to HAV was evaluated. Those whose symptoms referred to VWF or CTS were given a cold provocation test with the measurement of finger systolic blood pressure and electroneuromyography of the upper arms. RESULTS: Altogether 285 metal workers (54%) responded to the questionnaire, and 24 new cases of VWF (8.4%) and 12 cases of CTS (4.2%) were diagnosed. In the group of VWF patients, seven workers had both VWF and CTS. All of the workers diagnosed as having VWF also had numbness or tingling in their fingers. Consequently, questions concerning numbness and tingling, a two-point discrimination test, Phalen's test, and Tinell's test had a high predicting value for VWF. The exposure time of the VWF cases did not differ significantly from that of the study group as whole, but the cumulative exposure index was significantly higher. CONCLUSION: The results suggest that VWF is underdiagnosed in Finland. In screening for the health effects of HAV, sensorineural symptoms of hands should be carefully inquired about and examined in patients complaining of white fingers. More education on the recognition and evaluation of HAV exposure and its health effects is needed.

Audit of quality of diagnostic procedures for occupational asthma.

BACKGROUND: Previous studies have reported deficiencies in the quality of the diagnosis of occupational asthma. A low quality of diagnostic procedures means that the occupational cause of asthma is less likely to be revealed. AIMS: To assess the current quality of the diagnosis of occupational asthma before referral to a specialist occupational medicine centre. METHODS: The quality of diagnostic procedures was assessed by reviewing the files of 150 patients who were referred to the Finnish Institute of Occupational Health in 2003 with a suspicion of an occupational cause of their asthma. The quality indicators used were assessment of workplace exposures, spirometric studies, bronchodilator response, serial workplace measurements of peak expiratory flow (PEF) and the time since first symptoms to the final diagnosis. For each indicator, criteria to differentiate between sufficient and insufficient care were developed. RESULTS: Exposure assessments, spirometric studies and bronchodilator responses were performed in 92, 87 and 79% of cases in the total study group, respectively. Workplace measurements of PEF had been performed in 51% of the cases, and the quality of measurements was sufficient in 52%. Workplace exposures had been assessed significantly more often in occupational health care than in other health care units. The median time from the beginning of symptoms to the final diagnosis was 3.2 years. CONCLUSIONS: Although the diagnostic procedures were mostly of sufficient quality, the performance of serial measurements of PEF at the workplace and the time to diagnosis should be substantially improved.

The effects of secondhand smoke exposure on HRCT findings among asbestos-exposed workers.

OBJECTIVES: There is evidence suggesting that secondhand smoke (SHS) exposure is causally linked to adverse respiratory effects. We examined the relations between the exposure to SHS and radiological signs in chest high-resolution computed tomography (HRCT). METHODS: Asbestos-exposed workers (n=633) were imaged with HRCT, primarily to investigate potential occupational lung disease. After excluding current smokers, the study population included 361 ex- and 141 never-smokers. They answered a questionnaire on occupational exposures, smoking habits and SHS exposure. HRCT images were assessed for emphysema, ground-glass, irregular/linear and rounded opacities, honeycombing and several other signs. Regression analyses were adjusted for asbestos exposure, ex-smoking, age, body mass index and potential reader effect. RESULTS: Due to missing data the multivariate analyses were restricted to 310 participants aged 47.5-87.0 years. Their lifetime SHS exposure ranged between 0 and 193.5 pack-years (mean 23.5), and exposure in the past 12 months 0-30 packs (0.43). Total (B=0.005, 95% confidence intervals (95% CI) 0.002-0.008, p=0.000) and workplace (B=0.006, 95% CI 0.003-0.009, p=0.001) cumulative SHS exposures were significantly related to ground-glass opacities. Total SHS exposure in the last 12 months (B=0.027, 95% CI 0.000-0.054, p=0.048) and workplace exposure (B=0.027, 95% CI 0.000-0.054, p=0.048) were also significantly related to ground-glass opacities. Positive effects of SHS were also detected on irregular/linear opacities. CONCLUSIONS: SHS exposure in the last 12 months and over lifetime significantly increases ground-glass opacity in HRCT, suggesting an early or subclinical desquamative interstitial pneumonia/respiratory bronchiolitis. This study further supports that SHS has adverse effects on the lungs that can be detected by X-ray methods.

Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers.

The objective of this study was to investigate the psychological impact of screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Altogether, 633 workers were screened with chest computed tomography (627 men, 6 women, mean age 64.5 years). Participants' views on the necessity of screening,awareness of asbestos-exposure risks, their perceived lung cancer risk, trial adherence intention, health anxiety,and worry about lung cancer were assessed. Health anxiety was reduced significantly after screening (P < 0.001). After 1 year, no significant long-term psychological differences were found between those who immediately received clear results and those who were submitted to additional examinations because of positive findings. In conclusion,computed tomography screening of pulmonary disease was well accepted and did not produce excessive long-term anxiety or other negative psychological effects,which could prevent the participation in the future screening programs.