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.

Shift work, mental distress and job satisfaction among Palestinian nurses.

BACKGROUND: Associations between shift work (SW) schedules, mental distress and job satisfaction have never been completely described. AIMS: To examine gender-specific associations of SW with mental distress and job satisfaction in nurses in Hebron District, Palestine, in 2012. METHODS: Detailed information on work schedules (day versus shift), socio-demographic status, mental distress (General Health Questionnaire, GHQ-30) and job satisfaction (Generic Job Satisfaction Scale) in nurses employed in Hebron District, Palestine, was obtained through a questionnaire survey. Associations of SW and outcomes were examined by linear regression analysis. RESULTS: Of 372 nurses eligible for the study, 309 and 338 completed surveys regarding mental distress and job satisfaction, respectively. The sample comprised 62% women and 38% men. After adjusting for covariates, women working shifts reported significantly higher levels of mean mental distress [ß coefficient 3.6; 95% confidence interval (CI) 0.3-7.0] compared with women working regular day shifts. Men working shifts reported significantly lower levels of job satisfaction (-3.3; 95% CI -6.2 to -0.5) than men working regular day shifts. Women reported higher levels of mental distress than men, but this was unrelated to work schedule. CONCLUSIONS: In this study, nurses working shifts reported higher levels of mental distress and lower levels of job satisfaction, although these associations were weaker when adjusted for potential covariates. There was no evidence of a gender differential in the association between SW and mental distress and job satisfaction.

Neuropsychological effects of low mercury vapor exposure in chloralkali workers.

Neuropsychological effects were examined in 47 mercury vapor exposed male chloralkali workers with current low concentrations of urinary mercury (mean U-Hg 5.9 nmol/mmol creatinine (Cr)). Their average duration of exposure was 13.3 years, and the calculated mean concentration of U-Hg was 9.0 nmol Hg/mmol Cr per year (exposure intensity) during their time of exposure. They were compared with 47 age-matched male referents in a cross-sectional study. The two groups were not statistically significantly different with respect to neuropsychological test performance or number of self-reported subjective symptoms. The test results of the Static Steadiness Test, which assesses tremor, were not associated with exposure to mercury vapor. However current smokers had more hand tremor than non-smokers. Statistically significant associations were found between indices of current exposure (the concentration of inorganic mercury in whole blood) and the results of the WAIS Digit Symbol Test and the Benton Visual Retention Test (number of correct responses). This could indicate a small effect of current exposure on visuomotor/psychomotor speed and attention, and immediate visual memory. Whether the association found between the historical exposure intensity and the Digit Symbol Test results may represent long-term consequences of exposure cannot be determined in this study.

Neurobehavioral performance in aluminum welders.

METHODS: Twenty aluminum welders (mean age 33 years; range 21-52), who had been exposed to aluminum for an average of 8.1 years (range 2-21), were tested for tremor and reaction time and screened for neuropsychiatric symptoms in a cross-sectional study. The welders' median urinary aluminum concentration was 1.5 micromol/L (range 0. 7-4.8). Aluminum in air, measured inside the respiratory protection, was 0.9 mg/m(3) (range 0.6-3.8). The welders were compared with twenty construction workers matched for age. RESULTS: Welders reported more symptoms than referents did (median 2 vs. 1; P=0.047). Although the welders as a group performed better than the referents on a tremor test, years of exposure, but not age, was predictive of poorer performance. The welders' reaction times were rapid by clinical standards (mean simple reaction time (SRT): 221 milliseconds; mean continuous performance test (CPT): 364 milliseconds). Although, as a group, they performed better than the referents, there was a statistically significant relation between longer reaction times and aluminum in air (air-Al). CONCLUSIONS: The relations between hand steadiness and years exposed, and between reaction time and air-Al, could indicate slight effects from exposure to aluminum. The possibility of selection of workers with high manual skills into welding work and a possible job-related training effect, might partly serve to explain the good performance among the welders.

Long-term neuropsychological effects in non-saturation construction divers.

BACKGROUND: Since the early 1980s, there has been much debate about whether shallow water diving may lead to long-term adverse effects on the nervous system. HYPOTHESIS: The aim of the study was to investigate possible neuropsychological effects from repeated diving in divers without overt neurological insult. METHODS: Twenty construction divers recruited from two companies of contractors were tested with a neuropsychological test battery in a cross-sectional study. The divers were on average 40 (range 24-54) yr old. They had worked as divers for an average of 18 (range 5-33) yr. Their mean diving experience was more than 4000 (range 450-13200) dives. A group of younger trainees at a diving school and a group of age-matched construction workers were recruited as controls. RESULTS: The construction divers did not show clinical signs of mental impairment. However, their neuropsychological test results indicated slight effects in the form of longer reaction time. CONCLUSIONS: The main finding in this study of non-saturation construction divers was that there was no clear evidence of neuropsychological deficit due to extensive diving experience. However, it is suggested that the prolonged reaction time can be ascribed to extensive non-saturation diving.

[Health care personnel in Norway]. / Helsepersonell i Norden.

In 1990, the Nordic Council of Ministers initiated the joint Nordic project on "Work and health among health care personnel". The main aims were: To review and evaluate research data concerning the health and work of health care personnel in the Nordic countries, initiate joint Nordic projects and promote collaboration between Nordic researchers. Altogether more than one million people in the Nordic countries are employed in the health care sector, or almost 10% of the labour force. In all the Nordic countries the labour force in the health sector is dominated by women; the proportion of women being between 84 and 87%. In Norway and Sweden a large share of the labour force works part time. When controlled for sex and level of education, sick leave is the same among health personnel as among the general working population. As in the whole population, sick leave is higher among women, and among persons with a lower level of education. In general, workers in the health care sector in the Nordic countries run no greater risk of developing occupationally related injuries than other workers do. In a register-based study of Swedish workers it was found that the risk of being absent from work because of violence or threats is higher among health personnel than in the general working population.

[Treatment with hyperbaric oxygen. Illustrated by the treatment of a patient with retinitis pigmentosa]. / Behandling med hyperbart oksygen. Illustret ved behandling av en pasient med retinitis pigmentosa.

A 26 year old man, who was physically fit and occupationally active but had retinitis pigmentosa and a slight hearing impairment, received hyperbaric oxygen treatment for 97 minutes at a pressure of 240 kPA for five days a week over a period of four weeks. After cessation of the treatment his lateral vision was found to be improved. The patient was examined both prior to and after the hyperbaric oxygen treatment to assess possible adverse effects. The examination consisted of a comprehensive neuropsychological test battery, audiometry and spirometry. The patient showed a reversible reduction in gas diffusion for CO (TLCO). No adverse effects on the central nervous system were found. He achieved higher scores in an intelligence test when retested. The gain was greater than usually found as a practice effect. The article discusses possible indications for hyperbaric oxygen treatment.

Neuropsychological deficit among elderly workers in aluminum production.

A cross-sectional study was conducted at a Norwegian primary aluminum plant. All workers aged 61-66 years were offered early retirement benefits. Among the workers, 47 met the study criteria and 38 (81%), comprising 14 potroom workers, 8 foundry workers, and 16 controls, volunteered to participate. They were tested with a neuropsychological test battery. Workers in potrooms with Søderberg electrolytic cells were found to show signs of impairment of the nervous system. A test for tremor discriminated significantly between the potroom group and the controls. There was a suggestion of increased risk of impaired visuospatial organization and a tendency to a decline in psychomotor tempo in the potroom workers. We suggest that the above findings may be related to long-term occupational exposure in the potroom, and further to chronic low-dose exposure to aluminum.