Exposure-response relation for vibration-induced white finger: effect of different methods for predicting prevalence.

A pooled analysis of vibration-induced white finger (VWF) in population groups of workers has been performed using the results of a published meta-analysis as source material (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(7):e0180795. https://doi.org/10.1371/journal.pone.0180795). The methods of data selection follow those described previously by Scholz et al. (in Scholz MF, Brammer AJ, Marburg S. Exposure-response relation for vibration-induced white finger: inferences from a published meta-analysis of population groups. Int Arch Occup Environ Health. 2023a:96(5):757-770. https://doi.org/10.1007/s00420-023-01965-w) to enable comparison with the results of the present work. The analyzed epidemiologic studies contain different prevalences of VWF observed after different durations of employment involving exposure to the vibration of power tools and machines. These prevalences are transformed to 10% prevalence by either linear or polynomial (i.e. "S"-shaped curvilinear) interpolation in order to compare with the exposure-response relation contained in the relevant international standard (ISO 5349-1:2001). An exposure-response relation is constructed using regression analysis for the time (in years) to reach 10% prevalence in a population group, when subjected to a daily vibration exposure calculated according to the procedures specified in the standard, A(8). Good fits to the data are obtained when polynomial and linear prevalence interpolation is used. The 95-percentile confidence intervals (CIs) of the exposure-response relation predicted by polynomial prevalence interpolation lie at somewhat larger lifetime exposures than those obtained by linear prevalence interpolation. Uncertainty in the precision of polynomial prevalence interpolation is mitigated by giving equal weight to linear interpolation when interpreting the results. When the 95-percentile CIs of the exposure-response models obtained by linear and polynomial prevalence interpolation are used to define the most probable exposure-response relation, the resulting common range of values includes the ISO exposure-response relation. It is proposed that an exposure-response relation for the onset of VWF derived from a regression analysis is specified in terms of the lower limit of its CI. Hence, when exposure measures are constructed according to the ISO standard and equal weight is given to the results of the 2 methods for interpolating prevalence described here, the ISO exposure-response relation would be considered to provide a conservative estimate for a 10% prevalence of VWF to develop in a population group, at least for A(8) > 4 m/s2. It thus remains the relation to use for assessing exposure to hand-transmitted vibration in the workplace. Additional research is needed to resolve inconsistencies in the ISO method for calculating daily exposures.

Exposure-response relation for vibration-induced white finger: inferences from a published meta-analysis of population groups.

PURPOSE: It is questioned whether the exposure-response relation for the onset of vibration-induced white finger (VWF) in ISO 5349-1:2001 needs to be revised based on the epidemiologic studies identified by Nilsson et al. (PLoS One https://doi.org/10.1371/journal.pone.0180795 , 2017), and whether the relation they derive improves the prediction of VWF in vibration-exposed populations. METHODS: A pooled analysis has been performed using epidemiologic studies that complied with selection rules and reported a VWF prevalence of 10% or more, and exposure constructed according to the provisions of ISO 5349-1:2001. The lifetime exposures at 10% prevalence were calculated for various data sets using linear interpolation. They were then compared to both the model from the standard and that developed by Nilsson et al. RESULTS: Regression analyses reveal excluding extrapolation to adjust group prevalences to 10% produce models with 95-percentile confidence intervals that include the ISO exposure-response relation but not that in Nilsson et al. (2017). Different curve fits are obtained for studies involving daily exposure to single or multiple power tools and machines. Studies with similar exposure magnitudes and lifetime exposure durations but markedly different prevalences are observed to cluster. CONCLUSIONS: A range of exposures and A(8)-values is predicted within which the onset of VWF is most likely to occur. The exposure-response relation in ISO 5349-1:2001, but not that proposed by Nilsson et al., falls within this range and provides a conservative estimate for the development of VWF. In addition, the analyses suggest that the method for evaluating vibration exposure contained in ISO 5349-1:2001 needs revision.

Cardiovascular and stress responses to short-term noise exposures-A panel study in healthy males.

BACKGROUND: While previous epidemiological studies report adverse effects of long-term noise exposure on cardiovascular health, the mechanisms responsible for these effects are unclear. We sought to elucidate the cardiovascular and stress response to short-term, low (31.5-125Hz) and high (500-2000Hz) frequency noise exposures. METHODS: Healthy male (n=10) participants were monitored on multiple visits during no noise, low- or high-frequency noise exposure scenarios lasting 40min. Participants were fitted with an ambulatory electrocardiogram (ECG) and blood pressure measures and saliva samples were taken before, during and after noise exposures. ECGs were processed for measures of heart rate variability (HRV): high-frequency power (HF), low-frequency power (LF), the root of the mean squared difference between adjacent normal heart beats (N-N) intervals (RMSSD), and the standard deviation of N-N intervals (SDNN). Systolic blood pressure (SBP), diastolic blood pressure (DPB), and pulse were reported and saliva was analyzed for salivary cortisol and amylase. Multivariate mixed-effects linear regression models adjusted for age were used to identify statistically significant difference in outcomes by no noise, during noise or after noise exposure periods and whether this differed by noise frequency. RESULTS: A total of 658, 205, and 122, HRV, saliva, and blood pressure measurements were performed over 41 person days. Reductions in HRV (LF and RMSSD) were observed during noise exposure (a reduction of 19% (-35,-3.5) and 9.1% (-17,-1.1), respectively). After adjusting for noise frequency, during low frequency noise exposure, HF, LF, and SDNN were reduced (a reduction of 32% (-57,-6.2), 34% (-52,-15), and 16% (-26,-6.1), respectively) and during high frequency noise exposure, a 21% (-39,-2.3) reduction in LF, as compared to during no noise exposure, was found. No significant (p<0.05) changes in blood pressure, salivary cortisol, or amylase were observed. CONCLUSIONS: These results suggest that exposure to noise, and in particular, to low-frequency noise, negatively impacts HRV. The frequencies of noise should be considered when evaluating the cardiovascular health impacts of exposure.

Understanding speech when wearing communication headsets and hearing protectors with subband processing.

An adaptive, delayless, subband feed-forward control structure is employed to improve the speech signal-to-noise ratio (SNR) in the communication channel of a circumaural headset/hearing protector (HPD) from 90 Hz to 11.3 kHz, and to provide active noise control (ANC) from 50 to 800 Hz to complement the passive attenuation of the HPD. The task involves optimizing the speech SNR for each communication channel subband, subject to limiting the maximum sound level at the ear, maintaining a speech SNR preferred by users, and reducing large inter-band gain differences to improve speech quality. The performance of a proof-of-concept device has been evaluated in a pseudo-diffuse sound field when worn by human subjects under conditions of environmental noise and speech that do not pose a risk to hearing, and by simulation for other conditions. For the environmental noises employed in this study, subband speech SNR control combined with subband ANC produced greater improvement in word scores than subband ANC alone, and improved the consistency of word scores across subjects. The simulation employed a subject-specific linear model, and predicted that word scores are maintained in excess of 90% for sound levels outside the HPD of up to ∼115 dBA.

Augmented warning sound detection for hearing protectors.

Perception of warning sounds, such as vehicle backup alarms, is reduced when hearing protection devices (HPDs) are worn. A cross-correlation approach is employed to detect a pre-selected warning sound and enable it to bypass the attenuation of the HPD while still attenuating the environmental noise. Computer simulation shows that the algorithm can detect the specified alarm at signal-to-environmental-noise ratios as low as -30 dB. Human subject testing of the algorithm, implemented on a modified commercial HPD, confirms the minimum detection threshold obtained in simulation, and demonstrates a 7 dB improvement in detection threshold compared with the unmodified HPD.

Noise and communication: a three-year update.

Noise is omnipresent and impacts us all in many aspects of daily living. Noise can interfere with communication not only in industrial workplaces, but also in other work settings (e.g. open-plan offices, construction, and mining) and within buildings (e.g. residences, arenas, and schools). The interference of noise with communication can have significant social consequences, especially for persons with hearing loss, and may compromise safety (e.g. failure to perceive auditory warning signals), influence worker productivity and learning in children, affect health (e.g. vocal pathology, noise-induced hearing loss), compromise speech privacy, and impact social participation by the elderly. For workers, attempts have been made to: 1) Better define the auditory performance needed to function effectively and to directly measure these abilities when assessing Auditory Fitness for Duty, 2) design hearing protection devices that can improve speech understanding while offering adequate protection against loud noises, and 3) improve speech privacy in open-plan offices. As the elderly are particularly vulnerable to the effects of noise, an understanding of the interplay between auditory, cognitive, and social factors and its effect on speech communication and social participation is also critical. Classroom acoustics and speech intelligibility in children have also gained renewed interest because of the importance of effective speech comprehension in noise on learning. Finally, substantial work has been made in developing models aimed at better predicting speech intelligibility. Despite progress in various fields, the design of alarm signals continues to lag behind advancements in knowledge. This summary of the last three years' research highlights some of the most recent issues for the workplace, for older adults, and for children, as well as the effectiveness of warning sounds and models for predicting speech intelligibility. Suggestions for future work are also discussed.

Frequency weighting for vibration-induced white finger compatible with exposure-response models.

An analysis has been performed to derive a frequency weighting for the development of vibration-induced white finger (VWF). It employs a model to compare health risks for pairs of population groups that are selected to have similar health outcomes from operating power tools or machines with markedly different acceleration spectra (rock drills, chain saws, pavement breakers and motorcycles). The model defines the Relative Risk, RR(f(trial)), which is constructed from the ratio of daily exposures and includes a trial frequency weighting that is applied to the acceleration spectra. The trial frequency weighting consists of a frequency-independent primary frequency range, and subordinate frequency ranges in which the response to vibration diminishes, with cut-off frequencies that are changed to influence the magnitude of RR(f(trial)). The frequency weighting so derived when RR(f(trial)) = 1 is similar to those obtained by other methods (W(hf), W(hT)). It consists of a frequency independent range from about 25 Hz to 500 Hz (-3 dB frequencies), with an amplitude cut-off rate of 12 dB/octave below 25 Hz and above 500 Hz. The range is compatible with studies of vasoconstriction in persons with VWF. The results provide further evidence that the ISO frequency weighting may be inappropriate for assessing the risk of developing VWF.

Time domain detection of shocks and impacts in whole-body vibration.

A method for detecting shocks and impacts in whole-body vibration time histories has been developed that is suitable for implementation as a computer algorithm. The procedure consists of comparing the magnitudes of a higher-order mean value and the impulsiveness calculated for successive time segments of the acceleration-time history. The indicators were the ratio of the 12th-order root mean value to the root mean square RMT/RMS, and the impulsiveness corresponding to a cumulative probability value of 0.97, I(0.97) (i.e., the magnitude of the positive and negative excursions exceeded 3% of the time divided by 2RMS). Both indicators have a value of 2.16 for random vibration with a Gaussian amplitude distribution, and deviate from this value when the motion possesses other characteristics. For seat motion in the Z-direction analyzed using frequency weighting W(b), and time segments of ~20 s, shocks and impacts could be identified when RMT/RMS ≥ 2.5, and I(0.97) ≤ 2.6. A subjective visual classification of 160 exposures to vibration recorded in a range of military vehicles operating under different conditions was performed by a jury of two observers. The subjective classification agreed with computer identification of shocks and impacts in 94% of the cases.

Quantitative test for sensory hand symptoms based on mechanoreceptor-specific vibrotactile thresholds.

A vibrotactile test for assessing the presence or absence of sensory symptoms in the hand has been developed from thresholds believed mediated by Merkel disks and Meissner corpuscles at the fingertips. It is constructed from the summed differences between the thresholds recorded at the fingertip of an individual and the mean values of the threshold for healthy persons at the same stimulation frequencies. The summed normalized threshold shift, TS(Sum(SD)), is shown to be related to reports by subjects of numbness and pain using three statistical tests for evaluating the significance of associations in 2x2 contingency tables. The small number of subjects (15) restricts direct calculation of a fence value for TS(Sum(SD)), t, between the presence and absence of symptoms: accordingly, interpolation between calculated t values has been performed graphically. A common range of t values can be identified that is judged significantly by each statistical test (3.3

The effect of different warming methods on sensory nerve conduction velocity in shipyard workers occupationally exposed to hand-arm vibration.

OBJECTIVES: Segmental sensory nerve conduction velocity (SNCV) was measured from the wrists to the hands and digits in a population of 134 (126 men and 8 women) vibration-exposed shipyard workers following systemic warming using a bicycle ergometer. Results were compared to earlier nerve conduction tests, identical in execution, except that the warming process was segmental and cutaneous. The study was designed to investigate whether SNCVs, which were selectively slow in the fingers after segmental cutaneous (skin surface) warming, would be affected differently by systemic warming. METHODS: Wrist-palm, palm-proximal digit, and digital sensory nerve segments were assessed antidromically by stimulating at the wrist with recording electrodes placed distally. The same subjects were cutaneously warmed in 2001 to >or=31 degrees C and were systemically warmed 28 months later in 2004 by ramped sustained exercise to 100 W for 12 min. Skin temperatures were measured by traditional thermistry and by infrared thermal images taken over the hand and wrist surfaces. RESULTS: When systemic warming was compared to segmental cutaneous warming, SNCVs were increased by 15.1% in the third digit and 20.4% in the fifth digit of the dominant hand. Respective increases in the non-dominant hand were 11.0% and 19.4%. A strong association between increased surface skin temperature and faster SNCV, which had been observed after segmental cutaneous warming, was largely eliminated for both digit and palmar anatomic segments after systemic warming. Significant differences in SNCV between vibration-exposed and non-exposed workers, which had been observed after segmental cutaneous warming, were eliminated after systemic warming. Systemic warming had only a small effect on the wrist-palm (transcarpal) segmental SNCVs. CONCLUSIONS: Reduced SNCV in the digits was observed in vibration-exposed and non-exposed workers. Substituting exercise-induced systemic warming for segmental cutaneous warming significantly increased SNCV in the digits and appeared to reduce differences in SNCV between vibration-exposed and non-exposed workers. These findings persisted despite a substantial time interval between tests, during which the subjects continued to work. There may be more general implications for diagnosing clinical conditions in industrial workers, such as the carpal tunnel syndrome and the hand-arm vibration syndrome.

Syndromes from segmental vibration and nerve entrapment: observations on case definitions for carpal tunnel syndrome.

OBJECTIVES: The purpose of this paper is to assess the overlap and stability of two different case definitions of carpal tunnel syndrome CTS. The analysis considers the association between different case definitions and objective tests (sensory nerve conduction velocities, SNCVs and vibrotactile perception thresholds, TTS), and the natural history of CTS, in the context of two vibration-exposed cohorts. METHODS: Clinical CTS cases were defined in two ways: (1) by the study physician using fixed criteria, and; (2) by questionnaire and hand diagram. SNCV in median and ulnar nerves was measured for digital, transpalmar, and transcarpal segments, and conventionally as from wrist-digit. Skin temperature was assessed as a point measurement by thermistor and regionally by thermal imaging. VTTs were determined at the bilateral fingertips of the third and fifth digits using a tactometer meeting the requirements of ISO 13091-1 (ISO 2001). The subjects were cohorts of shipyard workers in 2001 and 2004, and dental hygienists in 2002 and 2004. RESULTS: Results are reported for 214 shipyard workers in 2001 and 135 in 2004, and for 94 dental hygienists in 2002 and 66 in 2004. In 2001, 50% of shipyard workers were diagnosed as CTS cases by at least one of the diagnostic schemes, but only 20% were positive by both criteria. Among study physician diagnosed cases, 64% were CTS negative in 2001, 76% were negative in 2004, 13% were positive in both years, 22% became negative after being positive, and 11% became positive after being negative. For only study physician diagnosed CTS did VTTs differ between cases differ and non-cases in digit 3; there was no such distinction in digit 5. The dental hygienists had little CTS. CONCLUSION: Clinical case definitions of CTS based on diagrams and self-assessment, and clinical evaluation have limited overlap. Combining clinical criteria to create a more narrow or specific case definition of CTS does not appear to predict SNCV. The natural history of CTS suggests a protean disorder with considerable flux in case status over time.

The Hand-Arm Vibration International Consortium (HAVIC): prospective studies on the relationship between power tool exposure and health effects.

OBJECTIVES: The Hand-Arm Vibration International Consortium (HAVIC) is a collaboration of investigators from Europe and North America studying health effects from hand-arm vibration (HAV). Features include prospective design, cross-cohort exposure, and health assessment methods. METHODS: Two new cohorts (dental hygienists and dental hygiene students), two existing cohorts (Finnish forest workers, and Swedish truck cab assemblers), and a previous population (US shipyard workers) are included. Instruments include surveys, quantitative medical tests, physical examination, and work simulation and data logging to assess exposure. New methods were developed for nerve conduction and data logging. RESULTS: Findings on the relationship between nerve conduction and skin temperature in HAV-exposed subjects resulted in a new approach to subject warming. CONCLUSIONS: Integrating established cohorts has advantages over de novo cohort construction. Complex laboratory tests can be successfully adapted for field use.

Hand-arm vibration syndrome with use of anti-vibration chain saws: 19-year follow-up study of forestry workers.

OBJECTIVES: Hand-arm vibration syndrome (HAVS) consists of vascular and neurological component. Musculoskeletal component has not been delineated yet. In the present follow-up study, we evaluated the prevalence of HAVS and the cumulative exposure to vibration among a cohort of forestry workers. Special interest was given to numbness and musculoskeletal disorders of upper extremity and neck in forestry workers. METHODS: A follow-up study starting from 1976 was conducted among forestry workers in Suomussalmi in Finland. Total exposure of hand-arm vibration was recorded during 11 cross-sectional surveys. The last study was carried out in 1995. The lifetime dose of vibration energy was calculated. A cohort of 52 forest workers participated to all 11 cross-sectional surveys 1976-1995. HAVS and musculoskeletal disorders were evaluated. RESULTS: The prevalence of active vibration white finger (VWF) decreased from 13 to 4% in the cross-sectional study. In the cohort VWF decreased from 17 to 8% and numbness increased from 23 to 40%. Rotator cuff syndrome (P=0.034) and epicondylitis (P=0.004) associated with numbness. Regional neck pain was diagnosed in 38% of workers and associated with low back pain. In modeling VWF, the lifelong vibration energy (OR 1.03, CI 1.01-1.05), and smoking (OR 7.36, CI 1.07-50.76) were significant. Numbness was modeled by pain in upper extremities (OR 12.43, CI 2.42-63.80) and neck pain (5.97, CI 1.25-28.39), not by lifelong vibration energy. Right rotator cuff syndrome was modeled by age (OR 2.58, CI 1.04-6.41) and lifelong vibration energy (OR 1.04, CI 1.00-1.07). CONCLUSIONS: The prevalence of VWF constantly decreased. Numbness did not follow the vibration exposure profile. Numbness also associated with upper extremity musculoskeletal disorders. Hand-arm vibration associated with the right rotator cuff syndrome in forestry workers.

Vibration exposure and disease in a shipyard: a 13-year revisit.

BACKGROUND: In a 1988 study of shipyard workers, a progressive association was observed between cumulative exposure to vibration and the vascular and neurological symptoms of the hand-arm vibration syndrome (HAVS). In 2001, after a decade of exposure reduction and ageing of the workforce, a second study at the same site was initiated. METHODS: In 2001, 214 subjects were selected; they represented four current weekly vibration exposure time intervals--0 hr, >0 < 5 hr, > or =5 < 20 hr, > or =20 hr. The 1988 and 2000 cross-sectional populations were compared on the basis of exposure duration and current symptoms. RESULTS: In 2001, the study population was 9.6 years older than the 1988 group. Current weekly exposure hours were similar in the low and medium exposure groups 2001 and 1988, but exposure was reduced by an average of 9.7 hr per week in the highest exposure group (> or =20 hr) in 2001. Symptom severity was regressed polychotomously on estimated exposure (log cumulative hours); the OR was weaker in 2001 than in 1988 for sensorineural symptoms-1.44 [CI 1.04-1.98] versus 2.35 [CI 1.48-3.73]. This was also true for vascular symptoms-1.70 [CI 1.06-2.71] versus 3.99 [CI 2.27-7.01]. Vascular symptoms were more prevalent in the highest lifetime vibration exposure group in 1988 (68.7 vs. 43.2% in 2001); sensorineural symptoms were more prevalent in the least vibration exposed group in 2001 (52.6 vs. 20.7% in 1988). CONCLUSIONS: The prevalence of vascular symptoms associated with cumulative vibratory exposure was significantly greater in 1988, but neurological symptoms were more common at lower exposure levels in 2001. The presumption that reducing exposure duration alone is sufficient, in the absence of change in vibration magnitude, is not supported by the results of this study.