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  • 1. Andersson, E
    et al.
    Knutsson, A
    Hagberg, S
    Nilsson, T
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Karlsson, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Alfredsson, L
    Torén, K
    Incidence of asthma among workers exposed to sulphur dioxide and other irritant gases.2006In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 27, no 4, p. 720-725Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate whether repeated peak exposure (gassings) to sulphur dioxide (SO2) and other irritant gases increases the risk of new-onset asthma. A questionnaire was sent to 4,112 sulphite workers, of whom 1,919 completed the questionnaire and 396 completed the short-form questionnaire, which was sent out as a last reminder. A sample of 130 nonrespondents completed a telephone interview using the short-form questionnaire. The incidence of adult-onset, physician-diagnosed asthma during employment duration was analysed in relation to exposure to SO2 and gassings giving rise to respiratory symptoms. Incidence rates, as well as incidence rate ratios with 95% confidence interval (CI), were calculated. Further Cox regression models were used allowing assessment of hazard ratios (HR) stratified for sex and adjusted for atopy, smoking habits and age. The incidence rate for asthma among sulphite mill workers reporting gassings of SO2 was 6.2 out of 1,000 person-yrs, compared with 1.9 out of 1,000 person-yrs among subjects unexposed to SO2 and any gassings (HR (95% CI) 4.0 (2.1-7.7)). Among males reporting gassings to SO2, the HR (95% CI) for asthma was 5.8 (2.6-13) compared with unexposed males. In conclusion, repeated peak exposure to sulphur dioxide increased the incidence of asthma during work in sulphite pulp mills, which supports the hypothesis of irritant-induced asthma.

  • 2. Andersson, Eva
    et al.
    Murgia, Nicola
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, Kjell
    Incidence of chronic bronchitis in a cohort of pulp mill workers with repeated gassings to sulphur dioxide and other irritant gases2013In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 12, article id 113Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Occupational exposure to irritants is associated with chronic bronchitis. The aim of this study was to elucidate whether repeated peak exposures with respiratory symptoms, gassings, to sulphur dioxide (SO2) and other irritant gases could increase the risk of chronic bronchitis.

    METHODS: The study population comprised 3,060 Swedish pulp mill workers (84% males) from a cohort study, who completed a comprehensive questionnaire with items on chronic bronchitis symptoms, smoking habit, occupational history, and specific exposures, including gassings. 2,037 have worked in sulphite mills. Incidence rates and hazard ratios (HRs) for the observation period, 1970-2000, in relation to exposure and the frequency of repeated gassings to SO2 and other irritant gases were calculated.

    RESULTS: The incidence rate for chronic bronchitis among workers with repeated gassings was 3.5/1,000 person-years compared with 1.5/1,000 person-years among unexposed workers (HR 2.1, 95% confidence interval (CI) 1.4-3.1). The risk was even higher in the subgroup with frequent gassings (HR 3.2, 95% CI 2.0-5.2), particularly among never-smokers (HR 8.7, 95% CI 3.5-22).

    CONCLUSIONS: Repeated gassings to irritant gases increased the incidence of chronic bronchitis in our study population during and after work in pulp mills, supporting the hypothesis that occupational exposures to irritants negatively affect the airways. These results underscore the importance of preventive actions in this work environment.

  • 3.
    Bergdahl, I A
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Torén, K
    Eriksson, K
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hedlund, U
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Nilsson, T
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Flodin, R
    Järvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Increased mortality in COPD among construction workers exposed to inorganic dust.2004In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 23, no 3, p. 402-406Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to find out if occupational exposure to dust, fumes or gases, especially among never-smokers, increased the mortality from chronic obstructive pulmonary disease (COPD). A cohort of 317,629 Swedish male construction workers was followed from 1971 to 1999. Exposure to inorganic dust (asbestos, man-made mineral fibres, dust from cement, concrete and quartz), gases and irritants (epoxy resins, isocyanates and organic solvents), fumes (asphalt fumes, diesel exhaust and metal fumes), and wood dust was based on a job-exposure matrix. An internal control group with "unexposed" construction workers was used, and the analyses were adjusted for age and smoking. When all subjects were analysed, there was an increased mortality from COPD among those with any airborne exposure (relative risk 1.12 (95% confidence interval (CI) 1.03-1.22)). In a Poisson regression model, including smoking, age and the major exposure groups, exposure to inorganic dust was associated with an increased risk (hazard ratio (HR) 1.10 (95% CI 1.06-1.14)), especially among never-smokers (HR 2.30 (95% CI 1.07-4.96)). The fraction of COPD among the exposed attributable to any airborne exposure was estimated as 10.7% overall and 52.6% among never-smokers. In conclusion, occupational exposure among construction workers increases mortality due to chronic obstructive pulmonary disease, even among never-smokers.

  • 4.
    Bergdahl, Ingvar
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, K
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hedlund, U
    Flodin, R
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Increased mortality in COPD among construction workers exposed to inorganic dust: from the authors2004In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 24, no 3, p. 512-512Article in journal (Refereed)
  • 5.
    Björ, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nathanaelsson, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Fifty-year-follow-up of mortality among a cohort of iron-ore miners in Sweden, with specific reference to myocardial infarction mortality2009In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 66, no 4, p. 264-268Article in journal (Refereed)
    Abstract [en]

    Objectives: This study investigates both general mortality and mortality from myocardial infarction among men employed in iron-ore mines in Sweden.

    Methods: The mortality of employees (surface and underground workers) at the iron-ore mines in Malmberget and Kiruna, Sweden was investigated. The study cohort comprised men who had been employed for at least 1 year between 1923 and 1996. The causes of death were obtained from the national cause of death register from 1952 to 2001. Indirect standardised mortality ratios (SMR) were calculated for four main causes. Mortality specifically from myocardial infarction was also analysed.

    Results: 4504 deaths in the cohort gave an SMR for total mortality of 1.05 (95% CI 1.02 to 1.09). Mortality was significantly higher for lung cancer (SMR 1.73, 95% CI 1.52 to 1.97). There was an increased risk of injuries and poisonings (SMR 1.34, 95% CI 1.24 to 1.46) and respiratory diseases (SMR 1.14, 95% CI 1.00 to 1.28). There were 1477 cases of myocardial infarction, resulting in an SMR of 1.12 (95% CI 1.07 to 1.18). SMR was higher (1.35, 95% CI 1.22 to 1.50) for men aged ≤60 years than for those >60 years of age (1.06, 95% CI 1.00 to 1.13).

    Conclusions: Mortality from myocardial infarction was higher than expected. There was also an increased risk of death from injuries and poisonings, lung cancer and respiratory diseases, as well as higher general mortality. Our findings support the results of previous studies that there is an association between working in the mining industry and adverse health outcomes.

  • 6.
    Björ, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Karlsson, Marcus
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Acute effects on heart rate variability when exposed to hand transmitted vibration and noise.2007In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 81, no 2, p. 193-199Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study investigates possible acute effects on heart rate variability (HRV) when people are exposed to hand transmitted vibration and noise individually and simultaneously. METHODS: Ten male and 10 female subjects were recruited by advertisement. Subjects completed a questionnaire concerning their work environment, general health, medication, hearing, and physical activity level. The test started with the subject resting for 15 min while sitting down. After resting, they were exposed to one of four exposure conditions: (1) only vibration; (2) only noise; (3) both noise and vibration; or (4) a control condition of exposure to the static load only. All four exposures lasted 15 min and the resting time between the exposures was 30 min. A continuous electrocardiogram (ECG) signal was recorded and the following HRV parameters were calculated: total spectral power (P(TOT)); the spectral power of the very low frequency component (P(VLF)); the low frequency component (P(LF)); the high frequency component (P(HF)); and the ratio LF/HF. RESULTS: Exposure to only vibration resulted in a lower P(TOT) compared to static load, whereas exposure to only noise resulted in a higher P(TOT). The mean values of P(TOT), P(VLF), P(LF), and P(HF) were lowest during exposure to vibration and simultaneous exposure to vibration and noise. CONCLUSIONS: Exposure to vibration and/or noise acutely affects HRV compared to standing without these exposures. Being exposed to vibration only and being exposed to noise only seem to generate opposite effects. Compared to no exposure, P(TOT) was reduced during vibration exposure and increased during noise exposure.

  • 7. Björ, Bodil
    et al.
    Burström, Lage
    Liljelind, Ingrid
    Lundström, Ronnie
    Nilsson, Tohr
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Cold health impacts in northern Sweden2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, no 33200Article in journal (Refereed)
  • 8.
    Björ, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vibration exposure and myocardial infarction incidence: the VHEEP case-control study.2006In: Occup Med (Lond), ISSN 0962-7480, Vol. 56, no 5, p. 338-44Article in journal (Refereed)
  • 9.
    Björ, Bodil M
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nathanaelsson, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nilsson, Tohr K F
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mortality from myocardial infarction in relation to exposure to vibration and dust among a cohort of iron-ore miners in Sweden2010In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 67, no 3, p. 154-158Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate myocardial infarction mortality in relation to exposure to hand-arm vibration (HAV) and whole-body vibration (WBW) as well as exposure to dust among men employed in two Swedish iron-ore mines. METHODS: This study comprised employed men at two iron-ore mines in Sweden who had been employed for at least one year from 1923 up to 1996. The causes of death were obtained from the national cause of death register from 1952 to 2001. Myocardial infarction mortality was obtained by linking personal identification numbers to the national cause of death register. Poisson regression was used for risk estimations on exposure-response relation, and analyses were made on the two age groups 60 years. RESULTS: Relative risks for myocardial infarction mortality in relation to exposure were significantly increased for exposure (0/>0) to WBV (RR: 1.18, 95% CI 1.06-1.31) and dust (RR: 1.15, 95% CI 1.02-1.31), and the results indicated an exposure-response relation for WBV and dust separately. For 60 years and younger, exposure to HAV (0/>0) (RR: 1.34, 95% CI 1.03-1.74) and WBV (0/>0) (RR: 1.39, 95% CI 1.13-1.72) increased the risk of MI mortality. An exposure-response was found for HAV and WBV, as the medium and high exposed categories showed significantly increased risk estimates. None of the exposures significantly increased the risk in the group above 60 years. The increased risk estimates for exposure to WBV remained when adjusting for exposure to dust. CONCLUSIONS: The results for the working-age (

  • 10.
    Björ, Ove
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Edström, Clarence
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Long-term follow-up study of mortality and the incidence of cancer in a cohort of workers at a primary aluminum smelter in Sweden2008In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 34, no 6, p. 463-470Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Previous studies on mortality and the incidence of cancer among workers at primary aluminum smelters have produced conclusive results indicating an elevated risk of bladder cancer. An increased risk of lung cancer has also been reported several times. The objective of this study was to examine mortality and the incidence of cancer at a Swedish aluminum smelter when different neighboring reference populations were used to evaluate any relationships to the length of employment. METHODS: A historical cohort--comprised of 2264 male nonoffice workers employed from 1942 on and tracked up to the year 2000--was examined. With the use of three reference populations for mortality and four for cancer incidence, standardized mortality and incidence ratios were calculated, together with hazard ratios derived from Cox regression models. RESULTS: This study showed an excess risk of mortality due to chronic obstructive lung disease, mental disorders, and diseases of the digestive system among the short-term workers. An elevated risk of cancer was found for the lungs, central nervous system, and esophagus. The highest lung cancer risk was observed for the workers employed for > or = 10 years in the factory when they were compared with the reference group from northern Sweden (standardized incidence ratio 1.99, 95% confidence ratio 1.21-3.07). CONCLUSIONS: The results support previous studies that demonstrated an excess risk of lung cancer, but, in contrast to the results of most studies, cancer of the central nervous system was also elevated. This study did not, however, verify an association between this type of exposure and cancer of the urinary organs.

  • 11.
    Björ, Ove
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Sundsvall Hosp, Dept Occupat & Environm Med, Sundsvall, Sweden.
    A comparison between standard methods and structural nested modelling when bias from a healthy worker survivor effect is suspected: an iron-ore mining cohort study2015In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 72, no 7, p. 536-542Article in journal (Refereed)
    Abstract [en]

    Objectives Iron-ore miners are exposed to extremely dusty and physically arduous work environments. The demanding activities of mining select healthier workers with longer work histories (ie, the Healthy Worker Survivor Effect (HWSE)), and could have a reversing effect on the exposure-response association. The objective of this study was to evaluate an iron-ore mining cohort to determine whether the effect of respirable dust was confounded by the presence of an HWSE. Methods When an HWSE exists, standard modelling methods, such as Cox regression analysis, produce biased results. We compared results from g-estimation of accelerated failure-time modelling adjusted for HWSE with corresponding unadjusted Cox regression modelling results. Results For all-cause mortality when adjusting for the HWSE, cumulative exposure from respirable dust was associated with a 6% decrease of life expectancy if exposed >= 15 years, compared with never being exposed. Respirable dust continued to be associated with mortality after censoring outcomes known to be associated with dust when adjusting for the HWSE. In contrast, results based on Cox regression analysis did not support that an association was present. Conclusions The adjustment for the HWSE made a difference when estimating the risk of mortality from respirable dust. The results of this study, therefore, support the recommendation that standard methods of analysis should be complemented with structural modelling analysis techniques, such as g-estimation of accelerated failure-time modelling, to adjust for the HWSE.

  • 12.
    Björ, Ove
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Do physical workload or temperature characteristics in an outdoor workingenvironment explain deviating rates of mortality and incidental cancer? A cohort study based on iron-ore mining.Manuscript (preprint) (Other academic)
    Abstract [en]

    Background A cohort study that examined iron ore mining found negative associations between cumulative working time employed underground and several severe outcomes. In this cohort study, and using the same group of miners, we examined whether heavy physical workload or the temperature characteristics represented by an outdoor working environment could explain these lower rates.

    Method This study was based on a Swedish iron ore mining cohort consisting of 13000 workers employed between 1923 and 1998. Exposure was defined as cumulative employment time in heavy physical workload or outdoor work. Poisson regression models were used to generate smoothed estimates of standardized morbidity ratios and adjusted rate ratios, both models by cumulative exposure time. SMRs for different cohort subgroups were used to compare the occurrence of cerebrovascular disease mortality to the reference population.

    Results The adjusted rate ratio between employment classified as outdoor work ≥25 years and short term outdoor work was 1.62 (95% CI 1.07–2.42). The subgroup underground work ≥15 years deviated most in occurrence of cerebrovascular disease mortality compared with the reference population: SMR (0.70 (95% CI 0.56–0.85)). No elevated rates were associated with cumulative employment time representing heavy physical workloads.

    Conclusion Employment in temperature shifting outdoor environments was associated with elevated rates of cerebrovascular disease mortality. In contrast, work in tempered underground employment was associated with a protecting effect. Based on selected groups of mortalities, physically heavy workloads did not protect for mortality later in life.

  • 13.
    Björ, Ove
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Is outdoor work associated with elevated rates of cerebrovascular disease mortality?: a cohort study based on iron-ore mining2016In: Journal of Occupational Medicine and Toxicology, ISSN 1745-6673, E-ISSN 1745-6673, Vol. 11, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A cohort study that examined iron ore mining found negative associations between cumulative working time employed underground and several outcomes, including mortality of cerebrovascular diseases. In this cohort study, and using the same group of miners, we examined whether work in an outdoor environment could explain elevated cerebrovascular disease rates.

    METHODS: This study was based on a Swedish iron ore mining cohort consisting of 13,000 workers. Poisson regression models were used to generate smoothed estimates of standardized mortality ratios and adjusted rate ratios, both models by cumulative exposure time in outdoor work.

    RESULTS: The adjusted rate ratio between employment classified as outdoor work ≥25 years and outdoor work 0-4 years was 1.62 (95 % CI 1.07-2.42). The subgroup underground work ≥15 years deviated most in occurrence of cerebrovascular disease mortality compared with the external reference population: SMR (0.70 (95 % CI 0.56-0.85)).

    CONCLUSIONS: Employment in outdoor environments was associated with elevated rates of cerebrovascular disease mortality. In contrast, work in tempered underground employment was associated with a protecting effect.

  • 14.
    Björ, Ove
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reduced mortality rates in a cohort of long-term underground iron-ore miners2013In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 56, no 5, p. 531-540Article in journal (Refereed)
    Abstract [en]

    Background Historically, working in iron-ore mines has been associated with an increased risk of lung cancer and silicosis. However, studies on other causes of mortality are inconsistent and in the case of cancer incidence, sparse. The aim of this study was to examine the association between iron-ore mining, mortality and cancer incidence.

    Methods A 54-year cohort study on iron-ore miners from mines in northern Sweden was carried out comprising 13,000 workers. Standardized rate ratios were calculated comparing the disease frequency, mortality, and cancer incidence with that of the general population of northern Sweden. Poisson regression was used to evaluate the association between the durations of employment and underground work, and outcome.

    Results Underground mining was associated with a significant decrease in adjusted mortality rate ratios for cerebrovascular and digestive system diseases, and stroke. For several outcomes, elevated standardized rate ratios were observed among blue-collar workers relative to the reference population. However, only the incidence of lung cancer increased with employment time underground (P<0.001).

    Conclusions Long-term iron-ore mining underground was associated with lower rates regarding several health outcomes. This is possibly explained by factors related to actual job activities, environmental exposure, or the selection of healthier workers for long-term underground employment.

    Am. J. Ind. Med. 56:531540, 2013. (c) 2013 Wiley Periodicals, Inc.

  • 15. Boschman, J S
    et al.
    Noor, A
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sluiter, J K
    Hagberg, M
    Relationships between work-related factors and musculoskeletal health with current and future work ability among male workers2017In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, no 6, p. 517-526Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose was to increase job-specific knowledge about individual and work-related factors and their relationship with current and future work ability (WA). We studied cross-sectional relationships between mental demands, physical exertion during work, grip strength, musculoskeletal pain in the upper extremities and WA and the relationships between these variables and WA 11 years later.

    METHODS: We used a dataset of a prospective cohort study (1997-2008) among employees of an engineering plant (n = 157). The cohort was surveyed by means of tests and written questions on work demands, musculoskeletal health, WA score (WAS; 0-10), and mental and physical WA. Spearman correlation coefficients and logistic regression analysis were used.

    RESULTS: Among manual workers, we found weak correlations between grip strength and current and future physical WA. We did not find predictors for future poor WA among the manual workers. Among the office workers, we found that musculoskeletal pain was moderately and negatively related to current WAS and physical WA. More handgrip strength related to better future WAS and physical WA. Musculoskeletal pain (OR 1.67 p < 0.01) and lower handgrip strength (OR 0.91 p < 0.05) predicted future poor WA among office workers.

    CONCLUSIONS: Our results showed cross-sectional and longitudinal relationships between musculoskeletal health and work ability depending on occupation. However, the present implies that predicting work ability in the far future based on health surveillance data is rather difficult. Testing the musculoskeletal system (grip strength) and asking workers' about their musculoskeletal health seems relevant when monitoring work ability.

  • 16.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Aminoff, Anna
    Björ, Bodil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Manttari, Sate
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rintamaki, Hannu
    Rodin, Ingemar
    Shilov, Victor
    Talykomv, Ljudmila
    Vaktskjold, Arild
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Musculoskeletal symptoms and exposure to whole-body vibration among open-pit mine workers in the arctic2017In: International Journal of Occupational Medicine and Environmental Health, ISSN 1232-1087, E-ISSN 1896-494X, Vol. 30, no 4, p. 553-564Article in journal (Refereed)
    Abstract [en]

    Objectives: This cross-sectional questionnaire study was carried out at 4 open-pit mines in Finland, Norway, Russia and Sweden as part of the MineHealth project. The aim has been to compare the prevalence of musculoskeletal symptoms between drivers of mining vehicles and non-drivers. Material and Methods: The mine workers were asked whether they had suffered from any musculoskeletal symptoms during the previous 12 months in specified body regions, and to grade the severity of these symptoms during the past month. They were also asked about their daily driving of mining vehicles. Results: The questionnaire was completed by 1323 workers (757 vehicle drivers) and the reported prevalence and severity of symptoms were highest for the lower back, followed by pain in the neck, shoulder and upper back. Drivers in the Nordic mines reported fewer symptoms than non-drivers, while for Russian mine workers the results were the opposite of that. The daily driving of mining vehicles had no significant association with the risk of symptoms. Female drivers indicated a higher prevalence of symptoms as compared to male drivers. Conclusions: The study provided only weak support for the hypothesis that drivers of vehicles reported a higher prevalence of musculoskeletal symptoms than non-vehicle drivers. There were marked differences in the prevalence of symptoms among workers in various enterprises, even though the nature of the job tasks was similar.

  • 17.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Björ, Bodil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Carlsson, Daniel
    Hjalmarsson, Ulla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rödin, Ingemar
    Svensson, Mona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hälsoundersökning bland arbetande inom gruvnäring i Barentsregionen: Deskriptiva data från basenkäten, Aitik Boliden november 20122014Report (Other academic)
  • 18.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Björ, Bodil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Rödin, Ingemar
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Thermal perception thresholds among workers in a cold climate2017In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, no 7, p. 645-652Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate whether exposure to cold could influence the thermal perception thresholds in a working population.

    METHODS: This cross-sectional study was comprised of 251 males and females and was carried out at two mines in the northern part of Norway and Sweden. The testing included a baseline questionnaire, a clinical examination and measurements of thermal perception thresholds, on both hands, the index (Digit 2) and little (Digit 5) fingers, for heat and cold.

    RESULTS: The thermal perception thresholds were affected by age, gender and test site. The thresholds were impaired by experiences of frostbite in the fingers and the use of medication that potentially could affect neurosensory functions. No differences were found between the calculated normative values for these workers and those in other comparative investigations conducted in warmer climates.

    CONCLUSIONS: The study provided no support for the hypothesis that living and working in cold climate will lead to impaired thermal perception thresholds. Exposure to cold that had caused localized damage in the form of frostbite was shown to lead to impaired thermal perception.

  • 19.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, SE-405 30 Gothenburg, Sweden.
    Liljelind, Ingrid
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundström, Ronnie
    Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
    Nilsson, Tohr
    Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, SE-851 86 Sweden.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, SE-405 30 Gothenburg, Sweden.
    A follow-up study of welders’ exposure to vibration in a heavy engineering production workshop2010In: Journal of Low Frequency Noise Vibration and Active Control, ISSN 0263-0923, Vol. 29, no 1, p. 33-39Article in journal (Refereed)
    Abstract [en]

    Manual work involving vibrating power tools is associated with symptoms that include vascular, neurological and musculoskeletal disorders. This study examines the vibration exposure of welders to determine the change between 1987 and 2008. Vibration measurements on handheld tools were used to evaluate the acceleration and the daily exposure time was determined by subjective rating. From these data, the 8-hour equivalent vibration exposure A(8), has been calculated. During the period, the A(8) decreased from 3.9 m/s2 to 1.9 m/s2. It was concluded that this decrease is the result of fewer vibrating tools and a decrease in daily exposure time. Although the daily vibration exposure has decreased over the study time, for some welders the daily vibration exposure A(8) is still above the action value set by the EU directive on vibration. This means more effort should be spent to decrease vibration exposure.

  • 20.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Influence of vibration exposure on tactile and thermal perception thresholds2009In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 59, no 3, p. 174-9Article in journal (Refereed)
    Abstract [en]

    AIMS: To establish if intermittent exposure to hand-transmitted vibration had the same effect as continuous exposure on the temporary response of finger tactile and thermal perception thresholds. METHODS: Two laboratory experiments were conducted. In each, 10 healthy subjects, five males and five females, participated. The subjects' fingers were exposed to vibration under four conditions with a combination of different periods of exposure and rest periods. The vibration frequency was 125 Hz and the frequency-weighted acceleration was 5 m/s(2). A measure of the tactile or thermal perception was conducted before the different exposures to vibration. Immediately after the vibration exposure, the acute effect was measured continuously for the first 75 s. This was followed by regular measures for a maximum of 30 min. RESULTS: The results showed that combinations of vibration with different periods of exposure and rest periods significantly influenced vibrotactile perception, but not thermal perception. CONCLUSIONS: These findings suggest that intermittent exposure to hand-transmitted vibration might be more beneficial for the response of the finger vibrotactile sensation than continuous exposure. This finding is inconsistent with the evaluation methods in ISO 5349-1 for vibrotactile sensation, but accurate for thermal perception.

  • 21.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hagberg, Mats
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine. Umeå University, Faculty of Medicine, Radiation Sciences.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Relationship between hand-arm vibration exposure and onset time for symptoms in a heavy engineering production workshop.2006In: Scandinavian journal of work, environment & health, ISSN 0355-3140, Vol. 32, no 3, p. 198-203Article in journal (Refereed)
  • 22.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Björ, Bodil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hjalmarsson, Ulla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Daily text messages used as a method for assessing low back pain among workers2016In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, no 70, p. 45-51Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate a method for collecting data concerning low back pain (LBP) using daily text messages and to characterize the reported LBP in terms of intensity, variability, and episodes.

    STUDY DESIGN AND SETTING: We conducted a cohort study of LBP among workers used by a mining company. The participants were asked to answer the question "How much pain have you had in your lower back in the last 24 hours on a scale from 0 to 10, where 0 = no pain and 10 = the worst pain imaginable" once a day for 5 weeks, with this process being repeated 6 months later.

    RESULTS: A total of 121 workers participated in the first period of data collection, and 108 participated in the second period. The daily response rate was 93% for both periods, and cluster analysis was shown to be a feasible statistical method for clustering LBP into subgroups of low, medium, and high pain. The daily text messages method also worked well for assessing the episodic nature of LBP.

    CONCLUSION: We have demonstrated a method for repeatedly measuring of LBP using daily text messages. The data permitted clustering into subgroups and could be used to define episodes of LBP.

  • 23.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Back and neck pain due to working in a cold environment: a cross-sectional study of male construction workers2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 7, p. 809-813Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study whether work in a cold environment increased the risk of musculoskeletal symptoms in the neck and low back among construction workers. METHODS: This cross-sectional study is based on a cohort of male workers in the Swedish construction industry that participated in regular health examinations through a nationwide occupational health service. The analysis is based on workers examined from 1971 to 1974, who answered a questionnaire including questions about neck and back pain. The cohort consists of 134,754 male workers, including 16,496 office workers and foremen. The health examinations of the workers were conducted in provinces covering Sweden from the south to the north, and temperature data were collected for the provinces. In the analyses, the results were adjusted for age, BMI and use of nicotine. RESULTS: The prevalence's of neck and low back pain were higher among manual construction workers than among foremen and office workers (24.3 vs. 8.6 % and 16.5 vs. 6.2 %, respectively); the corresponding adjusted ORs for low back and neck pain were 1.59 (95 % CI 1.52-1.66) and 1.39 (95 % CI 1.30-1.49), respectively. Workers in the northern and central provinces had higher ORs for low back and neck pain compared to workers in the southern province. The test for trends showed an increased risk of developing low back and neck pain with decreased outdoor temperature. CONCLUSIONS: Outdoor work in a cold environment may increase the risk of low back and neck pain.

  • 24.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, University Hospital of Northern Sweden, Umeå, Sweden.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, SE-851 86 Sweden.
    Wahlström, Jens
    Department of Occupational and Environmental Medicine, University Hospital of Northern Sweden, Umeå, Sweden.
    White fingers, cold environment, and vibration: exposure among Swedish construction workers2010In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, ISSN 1795-990X, Vol. 36, no 6, p. 509-513Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to examine the association between white fingers, cold environment, and exposure to hand–arm vibration (HAV). The hypothesis was that working in cold climate increases the risk of white fingers.

    Methods The occurrence of white fingers was investigated as a cross-sectional study in a cohort of Swedish male construction workers (N=134 757). Exposure to HAV was based on a job-exposure matrix. Living in the north or south of Sweden was, in a subgroup of the cohort, used as an indicator of the exposure to cold environment (ie, living in the north meant a higher exposure to cold climate). The analyses were adjusted for age and use of nicotine products (smoking and snuff).

    Results HAV-exposed workers living in a colder climate had a higher risk for white fingers than those living in a warmer climate [odds ratio (OR) 1.71, 95% confidence interval (95% CI) 1.42–2.06]. As expected, we found that HAV-exposed workers had an increased risk compared to controls (OR 2.02, 95% CI 1.75–2.34). The risk for white fingers increased with increased level of exposure to HAV and also age.

    Conclusions Cold environment increases the risk for white fingers in workers occupationally exposed to HAV. The results underscore the need to keep exposure to HAV at workplaces as low as possible especially in cold climate.

  • 25.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vibrotactile perception and effects of short-term exposure to hand-arm vibration2009In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 53, no 5, p. 539-547Article in journal (Refereed)
    Abstract [en]

    This study clarifies whether the established frequency weighting procedure for evaluating exposure to hand-transmitted vibration can effectively evaluate the temporary changes in vibrotactile perception thresholds due to pre-exposure to vibration. In addition, this study investigates the relationship between changes of the vibrotactile perception thresholds and the normalized energy-equivalent frequency-weighted acceleration. The fingers of 10 healthy subjects, five male and five female, were exposed to vibration under 16 conditions with a combination of different frequencies, intensities, and exposure times. The vibration frequencies were 31.5 and 125 Hz and exposure lasted between 2 and 16 min. According to International Organization for Standardization (ISO) 5349-1, the energy-equivalent frequency-weighted acceleration for the experimental time of 16 min is 2.5 or 5.0 m s(-2) root-mean-square, corresponding to a 8-h equivalent acceleration, A(8), of approximately 0.5 and 0.9 m s(-2), respectively. A measure of the vibrotactile perception thresholds was conducted before the different exposures to vibration. Immediately after the vibration exposure, the acute effect was measured continuously on the exposed index finger for the first 75 s, followed by 30 s of measures every minute for a maximum of 10 min. If the subject's thresholds had not recovered, the measures continued for a maximum of 30 min with measurements taken every 5 min. Pre-exposure to vibration significantly influenced vibrotactile thresholds. This study concludes that the influence on the thresholds depends on the frequency of the vibration stimuli. Increased equivalent frequency-weighted acceleration resulted in a significant change in threshold, but the thresholds were unaffected when changes in the vibration magnitude were expressed as the frequency-weighted acceleration or the unweighted acceleration. Moreover, the frequency of the pre-vibration exposure significantly influenced (up to 25 min after exposure) recovery time of the vibrotactile thresholds. This study shows that the frequency weighting procedure in ISO 5349-1 is unable to predict the produced acute changes in the vibrotactile perception. Moreover, the results imply that the calculation of the 'energy-equivalent' frequency-weighted acceleration does not reflect the acute changes of the vibration perception thresholds due to pre-exposure to vibration. Furthermore, when testing for the vibrotactile thresholds, exposure to vibration on the day of a test might influence the results. Until further knowledge is obtained, the previous practice of 3 h avoidance of vibration exposure before assessment is recommended.

  • 26.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sjödin, Fredrik
    National Institute for Working Life Department of Work and the Physical Environment Umeå Sweden.
    Lindmark, Asta
    National Institute for Working Life Department of Work and the Physical Environment Umeå Sweden.
    Lindkvist, Markus
    University Hospital of Northern Sweden Department of Biomedical Engineering and Informatics Umeå Sweden.
    Hagberg, Mats
    Sahlgrenska University Hospital Department of Occupational and Environmental Medicine Gothenburg Sweden.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Acute effects of vibration on thermal perception thresholds2008In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 81, no 5, p. 603-611Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study focuses on the acute effects of vibration and how vibrations influence the measures of the thermal perception thresholds during different vibration magnitudes, frequencies, and durations. METHODS: The fingers of ten healthy subjects, five males and five females, were exposed to vibration under 16 conditions with a combination of different frequency, intensity and exposure time. The vibration frequency was 31.5 and 125 Hz and exposure lasted between 2 and 16 min. The energy-equivalent frequency weighted acceleration, according to ISO 5349-1, for the experimental time of 16 min was 2.5 or 5.0 m/s(2) (r.m.s.), corresponding to a 8-h equivalent acceleration, A(8) of 0.46 and 0.92 m/s(2), respectively. A measure of the thermal perception of cold and warmth was conducted before the different exposures to vibration. Immediately after the vibration exposure the acute effect was measured continuously on the exposed index finger for the first 75 s, followed by 30 s of measures at every minute for a maximum of 10 min. If the subject's thermal thresholds had not recovered, the measures continued for a maximum of 30 min with measurements taken every 5 min. RESULTS: For all experimental conditions and 30 s after exposure, the mean changes of the thresholds compared with the pre-test were found to be 0.05 and -0.67 degrees C for the warmth and cold thresholds, respectively. The effect of the vibration exposure was only significant on the cold threshold and only for the first minute after exposure when the threshold was decreased. The warmth threshold was not significantly affected at all. The frequency and the exposure time of the vibration stimuli had no significant influence on the perception thresholds for the sensation of cold or warmth. Increased equivalent frequency weighted acceleration resulted in a significant decrease of the subjects' cold threshold, not the warmth. The thresholds were unaffected when changes in the vibration magnitude were expressed as the frequency weighted acceleration or the unweighted acceleration. CONCLUSION: When testing for the thermotactile thresholds, exposure to vibration on the day of a test might influence the results. Until further knowledge is obtained the previous praxis of 2 h avoidance of vibration exposure before assessment is recommended.

  • 27.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Occupational exposure to vibration from hand-held tools: A teaching guide on health effects, risk assessment and prevention2009Book (Other academic)
  • 28.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Whole-body vibration and the risk of low back pain and sciatica: a systematic review and meta-analysis2015In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, no 4, p. 403-418Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this systematic literature review was to evaluate the association between whole-body vibration (WBV) and low back pain (LBP) and sciatica with special attention given to exposure estimates. Moreover, the aim was to estimate the magnitude of such an association using meta-analysis and to compare our findings with previous reviews.

    METHODS: The authors systematically searched the PubMed (National Library of Medicine, Bethesda), Nioshtic2 (National Institute for Occupational Safety and Health (NIOSH, Morgantown), and ScienceDirect (Elsevier, Amsterdam) databases for records up to December 31, 2013. Two of the authors independently assessed studies to determine their eligibility, validity, and possible risk of bias.

    RESULTS: The literature search gave a total of 306 references out of which 28 studies were reviewed and 20 were included in the meta-analysis. Exposure to WBV was associated with increased prevalence of LBP and sciatica [pooled odds ratio (OR) = 2.17, 95 % confidence interval (CI) 1.61-2.91 and OR 1.92, 95 % CI 1.38-2.67, respectively]. Workers exposed to high vibration levels had a pooled risk estimate of 1.5 for both outcomes when compared with workers exposed to low levels of vibration. The results also indicate that some publication bias could have occurred especially for sciatica.

    CONCLUSIONS: This review shows that there is scientific evidence that exposure to WBV increases the risk of LBP and sciatica.

  • 29.
    Carlsson, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Sundsvall Hosp, Dept Occupat & Environm Med, SE-85186 Sundsvall, Sweden.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heldestad Lilliesköld, Victoria
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Sundsvall Hosp, Dept Occupat & Environm Med, SE-85186 Sundsvall, Sweden.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Neurosensory sequelae assessed by thermal and vibrotactile perception thresholds after local cold injury2014In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 73, article id 23540Article in journal (Refereed)
    Abstract [en]

    Background. Local freezing cold injuries are common in the north and sequelae to cold injury can persist many years. Quantitative sensory testing (QST) can be used to assess neurosensory symptoms but has previously not been used on cold injury patients.

    Objective. To evaluate neurosensory sequelae after local freezing cold injury by thermal and vibrotactile perception thresholds and by symptom descriptions.

    Design. Fifteen patients with a local freezing cold injury in the hands or feet, acquired during military training, were studied with QST by assessment of vibrotactile (VPT), warmth (WPT) and cold (CPT) perception thresholds 4 months post-injury. In addition, a follow-up questionnaire, focusing on neurovascular symptoms, was completed 4 months and 4 years post-injury.

    Results. QST demonstrated abnormal findings in one or both affected hands for VPT in 6 patients, for WPT in 4 patients and for CPT in 1 patient. In the feet, QST was abnormal for VPT in one or both affected feet in 8 patients, for WPT in 6 patients and for CPT in 4 patients. Freezing cold injury related symptoms, e. g. pain/discomfort when exposed to cold, cold sensation and white fingers were common at 4 months and persisted 4 years after the initial injury.

    Conclusions. Neurosensory sequelae after local freezing cold injury, in terms of abnormal thermal and/or vibration perception thresholds, may last at least 4 months after the initial injury. Symptoms such as pain/discomfort at cold exposure, cold sensations and white fingers may persist at least 4 years after the initial injury.

  • 30.
    Carlsson, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Neurosensory and vascular function after 14 months of military training comprising cold winter conditions2016In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, no 1, p. 61-70Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aimed to examine the effects of 14 months of military training comprising cold winter conditions on neurosensory and vascular function in the hands and feet.

    METHODS: Military conscripts (N=54) were assessed with quantitative sensory testing comprising touch, temperature, and vibration perception thresholds and finger systolic blood pressure (FSBP) after local cooling and a questionnaire on neurosensory and vascular symptoms at both baseline and follow-up. Ambient air temperature was recorded with body worn temperature loggers.

    RESULTS: The subjects showed reduced sensitivity to perception of touch, warmth, cold and vibrations in both the hands and feet except from vibrotactile perception in digit two of the right hand (right dig 2). Cold sensations, white fingers, and pain/discomfort when exposed to cold as well as pain increased in both prevalence and severity. There were no statistically significant changes in FSBP after local cooling.

    CONCLUSION: Fourteen months of winter military training comprising cold winter conditions reduced sensation from touch, warmth, cold, and vibrotactile stimulus in both hands and feet and increased the severity and prevalence of symptoms and pain. The vascular function in the hands, measured by FSBP after local cooling, was not affected.

  • 31.
    Carlsson, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Avd för samhällsmedicin och folkhälsa vid Institutionen för medicin, Göteborgs universitet.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Can sensation of cold hands predict Raynaud’s phenomenon or paresthesia?2018In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 68, no 5, p. 314-319Article in journal (Refereed)
    Abstract [en]

    Background: Raynaud's phenomenon and neurosensory symptoms are common after hand-arm vibration exposure. Knowledge of early signs of vibration injuries is needed. Aims: To investigate the risk of developing Raynaud's phenomenon and paraesthesia in relation to sensation of cold hands in a cohort of male employees at an engineering plant. Methods: We followed a cohort of male manual and office workers at an engineering plant in Sweden for 21 years. At baseline (1987 and 1992) and each follow-up (1992, 1997, 2002, 2008), we assessed sensation of cold, Raynaud's phenomenon and paraesthesia in the hands using questionnaires and measured vibration exposure. We calculated risk estimates with univariate and multiple logistic regression analyses and adjusted for vibration exposure and tobacco usage. Results: There were 241 study participants. During the study period, 21 individuals developed Raynaud's phenomenon and 43 developed paraesthesia. When adjusting the risk of developing Raynaud's phenomenon for vibration exposure and tobacco use, the odds ratios were between 6.0 and 6.3 (95% CI 2.2-17.0). We observed no increased risk for paraesthesia in relation to a sensation of cold hands. Conclusions: A sensation of cold hands was a risk factor for Raynaud's phenomenon. At the individual level, reporting a sensation of cold hands did not appear to be useful information to predict future development of Raynaud's phenomenon given a weak to moderate predictive value. For paraesthesia, the sensation of cold was not a risk factor and there was no predictive value at the individual level.

  • 32. Cherniack, M
    et al.
    Brammer, A J
    Nilsson, T
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundstrom, R
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Meyer, J D
    Morse, T
    Neely, Gregory
    Peterson, D
    Toppila, E
    Warren, N
    Atwood-Sanders, M
    Michalak-Turcotte, C
    Abbas, U
    Bruneau, H
    Croteau, M
    Fu, R W
    Nerve conduction and sensorineural function in dental hygienists using high frequency ultrasound handpieces.2006In: Am J Ind Med, ISSN 0271-3586, Vol. 49, no 5, p. 313-26Article in journal (Refereed)
  • 33. Cherniack, Martin
    et al.
    Brammer, Anthony J
    Lundstrom, Ronnie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Meyer, John D
    Morse, Tim F
    Neely, Greg
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Peterson, Donald
    Toppila, Esko
    Warren, Nicholas
    The Hand-Arm Vibration International Consortium (HAVIC): prospective studies on the relationship between power tool exposure and health effects.2007In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 49, no 3, p. 289-301Article in journal (Refereed)
    Abstract [en]

    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.

  • 34. Cherniack, Martin
    et al.
    Brammer, Anthony J
    Lundstrom, Ronnie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Morse, Tim F
    Neely, Greg
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Peterson, Donald
    Toppila, Esko
    Warren, Nicholas
    Diva, Ulysses
    Croteau, Marc
    Dussetschleger, Jeffrey
    The effect of different warming methods on sensory nerve conduction velocity in shipyard workers occupationally exposed to hand-arm vibration.2008In: International archives of occupational and environmental health, ISSN 1432-1246, Vol. 81, no 8, p. 1045-58Article in journal (Refereed)
    Abstract [en]

    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.

  • 35. Edlund, Maria
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gerhardsson, Lars
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sandén, Helena
    Hagberg, Mats
    A prospective cohort study investigating an exposure-response relationship among vibration-exposed male workers with numbness of the hands2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 2, p. 203-209Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate the exposure-response relationship of hand-arm vibration exposure to neurological symptoms (numbness) of the hand in a cohort of vibration-exposed workers.

    METHODS: The baseline cohort comprised 241 office and manual workers with or without exposure to hand-arm vibration. Numbness (the symptom or event) in the hand was assessed for all subjects at baseline and follow-ups after 5, 10, and 16 years. The workers were stratified into quartiles with no exposure in the first quartile and increasing intensity of exposure in quartiles 2-4 (groups 1-3). Data analysis was performed using survival analysis (time to event). Information on cumulative exposure and years of exposure to event was collected via questionnaires. Measurements were performed in accordance with the International Organization for Standardization (ISO) 5349-1.

    RESULTS: The hazard ratio (HR) of risk of event (numbness) differed statistically significantly between the non-exposed group (group 0) and the two higher exposure groups (groups 2 and 3). There was also a significant ratio difference between the lowest exposure group (group 1) and the two higher groups. The ratio for group 1 was 1.77 [95% confidence interval (95% CI) 0.96-3.26] compared with 3.78 (95% CI 2.15-6.62) and 5.31 (95% CI 3.06-9.20) for groups 2 and 3, respectively.

    CONCLUSION: The results suggest a dose-response relationship between vibration exposure and numbness of the hands. This underlines the importance of keeping vibration levels low to prevent neurological injury to the hands.

  • 36. Edlund, Maria
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sanden, Helena
    Wastensson, Gunilla
    Quantitatively measured tremor in hand-arm vibration-exposed workers2015In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, no 3, p. 305-310Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate the possible increase in hand tremor in relation to hand-arm vibration (HAV) exposure in a cohort of exposed and unexposed workers. Participants were 178 male workers with or without exposure to HAV. The study is cross-sectional regarding the outcome of tremor and has a longitudinal design with respect to exposure. The dose of HAV exposure was collected via questionnaires and measurements at several follow-ups. The CATSYS Tremor Pen(A (R)) was used for measuring postural tremor. Multiple linear regression methods were used to analyze associations between different tremor variables and HAV exposure, along with predictor variables with biological relevance. There were no statistically significant associations between the different tremor variables and cumulative HAV or current exposure. Age was a statistically significant predictor of variation in tremor outcomes for three of the four tremor variables, whereas nicotine use was a statistically significant predictor of either left or right hand or both hands for all four tremor variables. In the present study, there was no evidence of an exposure-response association between HAV exposure and measured postural tremor. Increase in age and nicotine use appeared to be the strongest predictors of tremor.

  • 37. Gerhardsson, Lars
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Quantitative neurosensory findings, symptoms and signs in young vibration exposed workers2013In: Journal of Occupational Medicine and Toxicology, ISSN 1745-6673, E-ISSN 1745-6673, Vol. 8, p. 8-Article in journal (Refereed)
    Abstract [en]

    Background: Long-term exposure to hand-held vibrating tools may cause the hand arm vibration syndrome (HAVS) including vibration induced white fingers and sensorineural symptoms. The aim was to study early neurosensory effects by quantitative vibrotactile and monofilament tests in young workers with hand-held vibration exposure.

    Methods: This cross-sectional study consisted of 142 young, male machine shop and construction workers with hand-held exposure to vibrating tools. They were compared with 41 non-vibration exposed subjects of the same age-group. All participants passed a structured interview, answered several questionnaires and had a physical examination including the determination of vibrotactile perception thresholds (VPTs) at two frequencies (31.5 and 125 Hz) and Semmes Weinstein's Monofilament test.

    Results: In the vibration exposed group 8% of the workers reported episodes of tingling sensations and 10% numbness in their fingers. Approximately 5-10% of the exposed population displayed abnormal results on monofilament tests. The vibrotactile testing showed significantly increased VPTs for 125 Hz in dig II bilaterally (right hand, p = 0.01; left hand, p = 0.024) in the vibration exposed group. A multiple regression analysis (VPT - dependent variable; age, height, examiner and five different vibration dose calculations - predictor variables) in dig II bilaterally showed rather low R-2-values. None of the explanatory variables including five separately calculated vibration doses were included in the models, neither for the total vibration exposed group, nor for the highest exposed quartile. A logistic multiple regression analysis (result of monofilament testing - dependent variable; age, height, examiner and five vibration dose calculations - predictor variables) of the results of monofilament testing in dig II bilaterally gave a similar outcome. None of the independent variables including five calculated vibration doses were included in the models neither for the total exposed group nor for the highest exposed quartile.

    Conclusion: In spite of the fairly short vibration exposure, a tendency to raised VPTs as well as pathologic monofilament test results was observed. Thus, early neurophysiologic symptoms and signs of vibration exposure may appear after short-term exposure also in young workers.

  • 38. Gerhardsson, Lars
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Lunsdström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    NEUROPHYSIOLOGIC SYMPTOMS AND VIBRATION PERCEPTION THRESHOLDSIN YOUNG VIBRATION-ExpOSED WORKERS: A FOLLOW-UP STUDY2011In: Canadian Acoustics, ISSN 0711-6659, E-ISSN 2291-1391, Vol. 39, no 2, p. 16-17Article in journal (Refereed)
    Abstract [en]

    Vibration exposure may cause the hand-arm vibration syndrome (HAVS), including digital vasospasms (vibration white fingers; VWF), sensorineural symptoms and/or muscular weakness and fatigue (Gemne, 1997). Neurophysiologic symptoms include numbness and/or tingling, impaired touch sensitivity, impaired manual dexterity and reduced grip strength in the hands. The Stockholm Workshop Scale is commonly used for sensorineural (SN) staging (OSN - 3 SN). Sensorineural symptoms of this in combination with difficulties in handling small objects may interfere both with the workers social- and work-related activities (Sakakibara et al., 2005).

  • 39. Hagberg, Mats
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Incidence of Raynaud's phenomenon in relation to hand-arm vibration exposure among male workers at an engineering plant a cohort study.2008In: Journal of occupational medicine and toxicology (London, England), ISSN 1745-6673, p. 3-13Article in journal (Refereed)
    Abstract [en]

    ABSTRACT: BACKGROUND: The objective of this study was to assess the incidence of Raynaud's phenomenon in relation to hand-arm vibration exposure in a cohort consisting of male office and manual workers. METHODS: The baseline population consisted of 94 office and 147 manual workers at an engineering plant. Raynaud's phenomenon (RP) was assessed at baseline and at follow up (at 5, 10 and 15 years). A retrospective and a prospective cohort analysis of data were done. Hand-arm vibration exposure dose was defined as the product of exposure duration and the weighted hand-arm vibration exposure value according to ISO 5349-1. RESULTS: The retrospective/prospective incidence of Raynaud's phenomenon was 16/14 per 1000 exposure years among exposed and 2.4/5.0 per 1000 years among the not exposed. The retrospective dose response curve based on 4 dose classes showed that class 2, 3 and 4 had similar response and showed higher incidence than the not-exposed. The dose with RP response to hand-arm vibration corresponded to a 10 year A(8) value between 0.4-1.0 m/s2. CONCLUSION: The results indicate that the EU directive on an action value for hand-arm vibration of 2.5 m/s2 is not too low. Rather, it suggests that employers should take on actions even at exposure values of 1 m/s2A(8).

  • 40. Hermansson, Jonas
    et al.
    Bøggild, Henrik
    Hallqvist, Johan
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Knutsson, Anders
    Nilsson, Tohr
    Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden..
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gillander Gådin, Katja
    Interaction between Shift Work and Established Coronary Risk Factors2019In: International Journal of Occupational and Environmental Medicine, ISSN 2008-6520, E-ISSN 2008-6814, Vol. 10, no 2, p. 57-65, article id 1466Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Shift work is associated with increased risk of cardiovascular disease, but the causes have not yet been fully established. It has been proposed that the coronary risk factors are more hazardous for shift workers, resulting in a potential interaction effect with shift work.

    OBJECTIVE: To analyse interaction effects of work schedule and established risk factors for coronary artery disease on the risk of myocardial infarction.

    METHODS: This analysis was conducted in SHEEP/VHEEP, a case-control study conducted in two counties in Sweden, comprising all first-time cases of myocardial infarction among men and women 45-70 years of age with controls stratified by sex, age, and hospital catchment area, totalling to 4648 participants. Synergy index (SI) was used as the main outcome analysis method for interaction analysis.

    RESULTS: There was an interaction effect between shift work and physical inactivity on the risk of myocardial infarction with SI of 2.05 (95% CI 1.07 to 3.92) for male shift workers. For female shift workers, interaction effects were found with high waist-hip ratio (SI 4.0, 95% CI 1.12 to 14.28) and elevated triglycerides (SI 5.69, 95% CI 1.67 to 19.38).

    CONCLUSION: Shift work and some established coronary risk factors have significant interactions.

  • 41. Jonsson, David
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Association between Pain in Adolescence and Low Back Pain in Adulthood: Studying a Cohort of Mine Workers2017In: Pain Research and Treatment, ISSN 2090-1542, E-ISSN 2090-1550, Vol. 2017, article id 3569231Article in journal (Refereed)
    Abstract [en]

    Purpose: To study the association of self-reported pain in adolescence with low back pain (LBP) in adulthood among mine workers and, also, study associations between the presence of LBP over 12-month or one-month LBP intensity during a health examination and daily ratings of LBP three and nine months later. Methods: Mixed design with data collected retrospectively, cross-sectionally, and prospectively. Data was collected using a questionnaire during a health examination and by using self-reported daily ratings of LBP three and nine months after the examination. Results: Pain prevalence during teenage years was 55% and it was 59% at age 20. Pain during teenage years had a relative risk of 1.33 (95% confidence interval 1.03-1.73) of LBP 12 months prior to the health examination, but with no associations with LBP intensity or LBP assessed by text messaging. Pain at age 20 years was not associated with any measure of LBP in adulthood. Daily ratings of LBP were associated with LBP during the health examination three and nine months earlier. Conclusions: There were no clear associations between self-reported pain in adolescence and LBP in adulthood. Self-reported daily ratings of LBP were associated with LBP from the health examination. Possible limitations for this study were the retrospective design and few participants.

  • 42.
    Liljelind, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, L
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Persson, M
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Can we explain the exposure variability found in hand-arm vibrations when using angle grinders?: A round robin laboratory study2010In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 83, no 3, p. 283-290Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To quantify variance components of hand-arm vibration exposure from data collected in a laboratory study of four different angle grinders.

    METHODS: Four different angle grinders were sent to seven laboratories for grinding tests by three operators at each laboratory. Vibration in both the throttle and support handles was measured. For one grinder, the experimental set-up was repeated and two measurements were collected for that specific grinder.

    RESULTS: At least one-third of the estimated variability is attributable to the wheel and less than one-third to the operator. In repeated experiments, between-occasion, operator and wheel factors explained 4, 29 and 17% of the total variability, respectively.

    CONCLUSIONS: Since measured vibrations in the support and throttle handles are significantly differed, measurements should be taken at both locations. Factors influencing vibration variability include the presence/absence of an auto balance unit, wheel and operator, but other factors remain to be elucidated.

  • 43.
    Lundström, Ronnie
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Baloch, Adnan Noor
    Hagberg, Mats
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gerhardsson, Lars
    Long-term effect of hand-arm vibration on thermotactile perception thresholds2018In: Journal of Occupational Medicine and Toxicology, ISSN 1745-6673, E-ISSN 1745-6673, Vol. 13, article id 19Article in journal (Refereed)
    Abstract [en]

    Background: Occupational exposure to hand-transmitted vibration (HTV) is known to cause neurological symptoms such as numbness, reduced manual dexterity, grip strength and sensory perception. The purpose of this longitudinal study was to compare thermotactile perception thresholds for cold (TPTC) and warmth (TPTW) among vibration exposed manual workers and unexposed white collar workers during a follow-up period of 16 years to elucidate if long-term vibration exposure is related to a change in TPT over time. Methods: The study group consisted of male workers at a production workshop at which some of them were exposed to HTV. They were investigated in 1992 and followed-up in 2008. All participants were physically examined and performed TPT bilaterally at the middle and distal phalanges of the second finger. Two different vibration exposure dosages were calculated for each individual, i.e. the individual cumulative lifetime dose (mh/s2) or a lifetime 8-h equivalent daily exposure (m/s(2)). Results: A significant mean threshold difference was found for all subjects of about 4-5 degrees C and 1-2 degrees C in TPTW and TPTC, respectively, between follow-up and baseline. No significant mean difference in TPTC between vibration exposed and non-exposed workers at each occasion could be stated to exist. For TPTW a small but significant difference was found for the right index finger only. Age was strongly related to thermotactile perception threshold. The 8-h equivalent exposure level (A (8)) dropped from about 1.3 m/s2 in 1992 to about 0.7 m/s(2) in 2008. Conclusions: A lifetime 8-h equivalent daily exposure to hand-transmitted vibration less than 1.3 m/s(2) does not have a significant effect on thermotactile perception. Age, however, has a significant impact on the change of temperature perception thresholds why this covariate has to be considered when using TPT as a tool for health screening.

  • 44.
    Lundström, Ronnie
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Dahlqvist, Håkan
    Hagberg, Mats
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vibrotactile and thermal perception and its relation to finger skin thickness2018In: Clinical Neurophysiology Practice, ISSN 2467-981X, Vol. 3, p. 33-39Article in journal (Refereed)
    Abstract [en]

    Objective: Quantitative measurements of vibrotactile and thermotactile perception thresholds (VPT and TPT, respectively) rely on responses from sensory receptors in the skin when mechanical or thermal stimuli are applied to the skin. The objective was to examine if there is a relation between skin thickness (epidermis and dermis) and VPT or TPT.

    Methods: Perception thresholds were measured on the volar side of the fingertip on 148 male subjects, out of which 116 were manual workers exposed to hand-transmitted vibration and 32 were white-collar (office) workers. Skin thickness was measured using a high-frequency ultrasonic derma scanner system.

    Results: The difference in age, perception thresholds and skin thickness between manual and office workers was small and non-significant except for the perception of cold, which was decreased by vibration exposure. Skin thickness for both subgroups was mean 0.57 mm (range 0.25-0.93 mm). Increased age was associated with decreased perception of warmth and vibration. Lifetime cumulative exposure to vibration, but not age, was associated with decreased perception of cold.

    Conclusion: No association (p > .05) was found between finger skin thickness in the range of about 0.1-1 mm and vibration perception threshold for test frequencies from 8 to 500 Hz and thermotactile perception thresholds for warmth and cold. Increasing age was associated with reduced perception of vibration and warmth. Vibration exposure was associated with decreased perception of cold.

    Significance: Skin thickness is a factor that may affect the response from sensory receptors, e.g., due to mechanical attenuation and thermal insulation. Thus, to evaluate perception threshold measurements, it is necessary to know if elevated thresholds can be attributed to skin thickness. No previous studies have measured skin thickness as related to vibrotactile and thermotactile perception thresholds. This study showed no association between skin thickness and vibrotactile perception or thermotactile perception.

  • 45.
    Lundström, Ronnie
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hagberg, Mats
    Burström, Lage
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Grading of sensorineural disturbances according to a modified Stockholm workshop scale using self-reports and QST.2008In: International archives of occupational and environmental health, ISSN 1432-1246, Vol. 81, no 5, p. 553-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of the study was to apply, on a group of vibration exposed individuals, a proposed modification of the Stockholm Workshop scale for grading of sensorineural disorders by using self-reports and data from objective testing and to compare grading obtained through the two approaches. METHODS: The study group consisted of 126 young persons with different individual levels of hand-transmitted vibration exposures. Effect measurements included a self-administered questionnaire and vibrotactile perception measurements and Purdue Pegboard testing. For grading using self reports three specific questions, believed to be good markers for complaints of intermittent numbness, sensory deficiency, and reduced performance in fine motor tasks, was picked out from the questionnaire. Results from vibrotactile perception and Purdue Pegboard testing were used for grading based on quantitative sensory testing. The sensorineural grading obtained by the two methods was then compared. RESULTS: The outcome showed that about 60% of all individuals within the study group are graded equally by the two methods for grading. The frequency of individuals graded at advanced SN stages were however higher when using QST, predominantly due to more positive cases for the Purdue pegboard test compared with the corresponding outcome from the self reports. CONCLUSION: The proposed modification of the grading scale reduces the in-built progressiveness and allows different combinations of sensorineural symptoms. The two grading methods seem to be somewhat correlated, something which may be considered as encouraging and promising for those who prefer to use, or must use one of the methods for grading. The proposed model for grading using self-reports should, however, be considered more as a conceptual idea for how this may be done. The models should be applied on a larger, more vibration exposed and more symptomatic study group, compared with the present study group, before any far-reaching conclusions can be drawn.

  • 46.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The gap between evidence on hand-arm vibration hazards and risk management2019In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 69, no 2, p. 80-82Article in journal (Refereed)
  • 47.
    Nilsson, Tohr
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hand-arm vibration and the risk of vascular and neurological diseases: a systematic review and meta-analysis2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0180795Article, review/survey (Refereed)
    Abstract [en]

    Background

    Increased occurrence of Raynaud's phenomenon, neurosensory injury and carpal tunnel syndrome has been reported for more than 100 years in association with work with vibrating machines. The current risk prediction modelling (ISO-5349) for "Raynaud's phenomenon" is based on a few studies published 70 to 40 years ago. There are no corresponding risk prediction models for neurosensory injury or carpal tunnel syndrome, nor any systematic reviews comprising a statistical synthesis (meta-analysis) of the evidence.

    Objectives

    Our aim was to provide a systematic review of the literature on the association between Raynaud's phenomenon, neurosensory injuries and carpal tunnel syndrome and hand-arm vibration (HAV) exposure. Moreover the aim was to estimate the magnitude of such an association using meta-analysis.

    Methods

    This systematic review covers the scientific literature up to January 2016. The databases used for the literature search were PubMed and Science Direct. We found a total of 4,335 abstracts, which were read and whose validity was assessed according to pre-established criteria. 294 articles were examined in their entirety to determine whether each article met the inclusion criteria. The possible risk of bias was assessed for each article. 52 articles finally met the pre-established criteria for inclusion in the systematic review.

    Results

    The results show that workers who are exposed to HAV have an increased risk of vascular and neurological diseases compared to non-vibration exposed groups. The crude estimate of the risk increase is approximately 4-5 fold. The estimated effect size (odds ratio) is 6.9 for the studies of Raynaud's phenomenon when including only the studies judged to have a low risk of bias. The corresponding risk of neurosensory injury is 7.4 and the equivalent of carpal tunnel syndrome is 2.9.

    Conclusion

    At equal exposures, neurosensory injury occurs with a 3-time factor shorter latency than Raynaud's phenomenon. Which is why preventive measures should address this vibration health hazard with greater attention.

  • 48. Oldgren, J
    et al.
    Fellenius, C
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nilsson, TK
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wallentin, L
    Siegbahn, A
    Influence of prolonged dalteparin treatment on coagulation, fibrinolysis and inflammation in unstable coronary artery disease.2005In: J Intern Med, Vol. 258, no 5, p. 420-7Article in journal (Refereed)
  • 49.
    Pettersson, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden.
    Noise and hand-arm vibration exposure in relation to the risk of hearing loss2012In: Noise & Health, ISSN 1463-1741, E-ISSN 1998-4030, Vol. 14, no 59, p. 159-165Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the possible association of combined exposure of noise and hand-arm vibration (HAV) and the risk of noise-induced hearing loss. Workers in a heavy engineering industry were part of a dynamic cohort. Of these workers, 189 had HAV exposure, and their age and hearing status were recorded in the same year and were, therefore, included in the analysis. Data on HAV duration and acceleration was gathered through questionnaires, observations, and measurements. All available audiograms were categorized into normal and hearing loss. The first exposure variable included the lifetime HAV exposure. The lifetime HAV exposure was multiplied by the acceleration of HAV for the second and third exposure variable. Logistic regression using the Generalized Estimation Equations method was chosen to analyze the data to account for the repeated measurements. The analysis was performed with both continuous exposure variables and with exposure variables grouped into exposure quartiles with hearing loss as an outcome and age as a covariate. With continuous exposure variables, the odds ratio (OR) with a 95% confidence interval (CI) for hearing loss was equal to or greater than one for all exposure variables. When the exposure variables were grouped into quartiles, the OR with a 95% CI was greater than one at the third and fourth quartile. The results show that working with vibrating machines in an environment with noise exposure increases the risk of hearing loss, supporting an association between exposure to noise and HAV, and the noise-induced hearing loss.

  • 50.
    Pettersson, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Risk of Hearing Loss Among Workers with Vibration-Induced White Fingers2014In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 57, no 12, p. 1311-1318Article in journal (Refereed)
    Abstract [en]

    Background: We examined the risk of hearing loss for workers who use hand-held vibrating tools with vibration-induced white fingers (VWF) compared to workers without VWF. Methods: Data on 184 participants from a 21-year cohort were gathered with questionnaires and measurements. The effects on hearing status of VWF, hand-arm vibration exposure, smoking habits, age and two-way interactions of these independent variables were examined with binary logistic regression. Analyses were made for the right hand and ear as well as for the hand with VWF and the ear with worse categorized hearing status. Results: Workers with VWF in their right hand had an increased risk of hearing loss (odds ratio 2.2-2.3) in the right ear. Workers with VWF in any hand did not have any increased risk of hearing loss in the ear with worse hearing status. Conclusions: This study supports the hypothesis that VWF increases the risk of hearing loss among workers who use hand-held vibrating tools in a noisy environment. Am. J. Ind. Med. 57:1311-1318, 2014. (c) 2014 Wiley Periodicals, Inc.

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