Mortality from myocardial infarction in relation to exposure to vibration and dust among a cohort of iron-ore miners in Sweden

OBJECTIVES

The aim of this study was to investigate myocardial infarction (MI) mortality in relation to exposure to hand/arm vibration (HAV) and whole body vibration (WBV) 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 1 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 < or =60 years and >60 years.

RESULTS

Relative risks for MI mortality in relation to exposure were significantly increased for exposure (0/>0) to WBV (RR 1.18, 95% CI 1.06 to 1.31) and dust (RR 1.15, 95% CI 1.02 to 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 to 1.74) and WBV (0/>0) (RR 1.39, 95% CI 1.13 to 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 (< or =60 years) group showed significantly increased MI mortality for univariate exposure to HAV, WBV and dust. We found an association between increased mortality from MI and occupational exposure to WBV, and the risk remained after adjustment for dust exposure.

Neck pain combined with arm pain among professional drivers of forest machines and the association with whole-body vibration exposure

The purpose of this study was to investigate the existence of neck pain and arm pain among professional forest machine drivers and to find out if pain were related to their whole-body vibration (WBV) exposure. A self-administered questionnaire was sent to 529 forest machine drivers in northern Sweden and the response was 63%. Two pain groups were formed; 1) neck pain; 2) neck pain combined with arm pain. From WBV exposure data (recent measurements made according to ISO 2631-1, available information from reports) and from the self-administered questionnaire, 14 various WBV exposure/dose measures were calculated for each driver. The prevalence of neck pain reported both for the previous 12 months and for the previous 7 d was 34% and more than half of them reported neck pain combined with pain in one or both arms. Analysis showed no significant association between neck pain and high WBV exposure; however, cases with neck pain more often experienced shocks and jolts in the vehicle as uncomfortable. There was no significant association between the 14 WBV measures and type of neck pain (neck pain vs. neck pain combined with arm pain). It seems as if characteristics of WBV exposure can explain neither existence nor the type of neck pain amongst professional drivers of forest machines. The logging industry is important for several industrialised countries. Drivers of forest machines frequently report neuromusculoskeletal pain from the neck. The type of neck pain is important for the decision of treatment modality and may be associated with exposure characteristics at work.

Influence of vibration exposure on tactile and thermal perception thresholds

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.

Fifty-year follow-up of mortality among a cohort of iron-ore miners in Sweden, with specific reference to myocardial infarction mortality

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 <or=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.

Incidence of Raynaud's phenomenon in relation to hand-arm vibration exposure among male workers at an engineering plant a cohort study

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).

Changes in EMG activity in the upper trapezius muscle due to local vibration exposure

Exposure to vibration is suggested as a risk factor for developing neck and shoulder disorders in working life. Mechanical vibration applied to a muscle belly or a tendon can elicit a reflex muscle contraction, also called tonic vibration reflex, but the mechanisms behind how vibration could cause musculoskeletal disorders has not yet been described. One suggestion has been that the vibration causes muscular fatigue. This study investigates whether vibration exposure changes the development of muscular fatigue in the trapezius muscle. Thirty-seven volunteers (men and women) performed a sub-maximal isometric shoulder elevation for 3 min. This was repeated four times, two times with induced vibration and two times without. Muscle activity was measured before and after each 3-min period to look at changes in the electromyography parameters. The result showed a significantly smaller mean frequency decrease when performing the shoulder elevation with vibration (-2.51 Hz) compared to without vibration (-4.04 Hz). There was also a slightly higher increase in the root mean square when exposed to vibration (5.7% of maximal voluntary contraction) compared to without (3.8% of maximal voluntary contraction); however, this was not statistically significant. The results of the present study indicate that short-time exposure to vibration has no negative acute effects on the fatiguing of upper trapezius muscle.

Grading of sensorineural disturbances according to a modified Stockholm workshop scale using self-reports and QST

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.

Acute effects on heart rate variability when exposed to hand transmitted vibration and noise

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.

Relationship between hand-arm vibration exposure and onset time for symptoms in a heavy engineering production workshop

OBJECTIVES

This study examined onset time for reported vascular and neurological symptoms in relation to the vibration load in a group of workers exposed to vibration.

METHODS

Information on the self-stated year for the first occurrence of symptoms was collected by means of questionnaires. During interviews data were obtained on self-stated estimations of daily exposure time, type of tool, and number of months or years with different exposures. The estimations of the vibration magnitudes of exposure were based on conducted measurements. From these data, the individual vibration exposure at the time of onset of symptoms was calculated.

RESULTS

The incidence was 25.6 and 32.9 per 1000 exposure years for vascular and neurological symptoms, respectively, in the group of workers. The first onset of symptoms appeared after an average of 12 years of exposure. For the workers, the symptoms of vascular or neurological disorders started after about the same number of exposure years. The calculated accumulated acceleration correlated best with the onset time of symptoms.

CONCLUSIONS

It was concluded that, since the workers' exposure to vibration was below the action level established in the European vibration directive, the results suggest that the action level is not a safe level for avoiding vascular and neurological symptoms.

Hand-arm vibration syndrome (HAVS) and musculoskeletal symptoms in the neck and the upper limbs in professional drivers of terrain vehicles--a cross sectional study

This study compares the prevalence of symptoms of Hand-arm vibration syndrome (HAVS) and musculoskeletal symptoms in the neck and the upper limbs, between professional drivers of terrain vehicles and a referent group. 769 male professional drivers of forest machines, snowmobiles, snowgroomers and reindeer herders and 296 randomly selected male referents completed a questionnaire about symptoms of HAVS and musculoskeletal symptoms in the neck and the upper limbs. They also gave information about their lifetime exposure duration driving terrain vehicles and their nicotine use. Prevalence odds ratios (POR) were determined and adjusted for age and nicotine use. Results show that there is a relation between exposure to driving terrain vehicles and some of the symptoms of HAVS (POR: 1.2-6.1). Increased odds of musculoskeletal symptoms in neck, shoulders and wrists were also found (POR 1.2-6.4), and it seemed to be related to the cumulative exposure time.

Vibration exposure and myocardial infarction incidence: the VHEEP case–control study

OBJECTIVES

The main objectives of this study were to assess the risk of contracting first episode of myocardial infarction (MI) subsequent to vibration exposure and to assess a possible exposure-response relationship.

METHODS

The Västernorrland heart epidemiology programme (VHEEP, a part of the Stockholm heart epidemiology programme study) was the source of the data. VHEEP is a population-based case-control study of risk factors for acute MI. Exposure information was collected by questionnaire and vibration exposure was assessed in 218 cases and 257 controls. Relative risks were estimated using odds ratios (ORs) from binary logistic regression.

RESULTS

The results show that the OR of acute MI when exposed to vibration was 1.6 (95% CI: 1.1-2.4). It was not possible, however, to determine whether an exposure-response relationship was present.

CONCLUSIONS

Working entailing vibrating machines is associated with an increased risk for acute MI.

The effect of fluid consumption on the forest workers' performance strategy

The heart rate development and time consumption of four Zimbabwean forest workers engaged in manual harvesting were studied to assess their performance strategy and whether this strategy was affected by differences in fluid consumption. Each worker was studied during 8 consecutive working days and produced 2.4 m3 pulpwood/day. They consumed either 0.17 l or 0.6 l of water each 1/2 hour with one fluid scheme assigned to each day according to a randomised block (person) design with four replicates (days). All workers were found to harvest large trees at the start of the working day and small trees at the end. All workers took longer to complete their task when on the low fluid scheme, however, the effect on the heart rate development varied for the individual workers as the strategies adopted to accommodate the stress inflicted by the low fluid scheme, varied for the individual workers. It is recommended that sufficient fluid supply during work be accompanied by training of the workers to convey the need and benefits of sufficient fluid consumption.

Sound levels in classrooms and effects on self-reported mood among school children

The principle of this field study is an investigation of recorded sound levels in 24 classrooms and relations between sound level measures and aspects of children's rated annoyance, task orientation, and inattentiveness. The background sound-exposure levels were distributed within the interval of 33-42 dB(A)eq and the activity sound level exposure ranged between 47-68 dB(A)eq. The recorded levels must be considered as high for work environments where steady concentration and undisturbed communication is essential. Results do not support the hypothesis that lower background-sound level and fewer students per class would improve the sound environment by generating a lower activity noise or the hypothesis that higher sound levels should increase annoyance and inattentiveness as well as deteriorate task orientation ratings.

Power absorption in women and men exposed to hand-arm vibration

OBJECTIVES

The aim of the study was to determine whether there are gender differences as regards the quantity of absorbed power, i.e., vibration absorption per unit of time, during exposure to vibration from a specially constructed handle.

METHODS

The study was conducted on 24 subjects (12 female and 12 male). The experiments were performed with exposure in two vibration directions, X(h), and Z(h), and with two vibration levels, 3 and 6 m/s(2).

RESULTS

The male subjects had significantly higher power absorption during exposure to vibrations in the Z(h) direction at the vibration level of 6 m/s(2) than did the female subjects. When adjusted for anthropometrical measurements the difference did not remain significant. Higher vibration levels resulted in significantly higher absorption of power for both X(h) and Z(h) directions. The absorption was significantly higher in the Z(h) direction than in the X(h) direction.

CONCLUSIONS

No gender difference in power absorption was shown.

A descriptive study of women injured by hand-arm vibration

The aim of this study was to describe the symptoms and the prognosis of vibration injuries in women. The investigation was based on a study of 374 women who had reported an injury due to hand-arm vibration to the Social Insurance Office or had received financial compensation from the Swedish Labor Market Insurance scheme during 1988-1997. Information on, for example, self-rated health symptoms and vibration exposure was collected by means of a questionnaire. On average, the first symptoms started after 7 yr of exposure and the first visit to a doctor took place after 11 yr. Neurological symptoms developed after a shorter period of exposure compared to vascular symptoms, 6.8 and 9.2 yr, respectively. The prevalence of numbness at the time of reporting the injury was 91% and the prevalence of white fingers was reported by 54%. The occupational group with the highest prevalence of vibration injuries was dental technicians. Two thirds of the women had stopped using vibrating machines in their work. Among the women who suffered from white fingers when they reported the injury, 50% declared impairment or no improvement of the symptoms. One woman in five was retired and the same number of women had retrained due to the occupational injury.

Relationship between vibration dose and the absorption of mechanical power in the hand

OBJECTIVES

The aim of this study was to examine the relationship between calculated vibration dose and the measured absorption of vibration power in the human hand, as well as the measured grip and feed forces applied by the subjects.

METHODS

The study was carried out with 10 healthy subjects. A special handle was used during the measurements. The influence of 4 different vibration levels with different durations during a test period of 5 minutes was investigated. The number of exposure intervals varied between 1 and 5. The same overall equivalent acceleration was used in all the experiments.

RESULTS

There is a significant difference between the calculated vibration dose and the amount of measured absorption of power. A higher acceleration level leads to significantly higher absorption. Furthermore, the outcome shows that rest periods contribute to a lower absorption of power in the hand and also lower feed forces. Conclusions This study supports the hypothesis that vibration-free rest periods give the human organism an opportunity to recover.

Exposure-response relationship between hand-arm vibration and vibrotactile perception sensitivity

BACKGROUND

The objectives of the study were to examine whether occupational use of vibrating hand-held tools was associated with an impaired vibrotactile perception, whether any exposure-response relationship exists, and whether the different populations of mechano-receptive afferent units are equally affected.

METHODS

Vibrotactile perception thresholds have been measured at seven frequencies (8-500 Hz) and evaluated among 125 vibration-exposed and 45 non-exposed male employees in a heavy engineering production workshop. Vibration exposure measurements were assessed on tools in accordance with ISO 5349. Vibrotactile perception thresholds have been individually graded in stages and placed in relation to individual vibration exposure.

RESULTS

The outcome did not reveal a clear relationship between vibration exposure and reduced vibrotactile sensitivity on an individual basis. There was a clear tendency on a group basis towards elevated thresholds when the study population was divided into three exposure categories. A fourfold increase in relative risk of reduced vibrotactile sensitivity for test frequencies above 40 Hz was observed between the highest exposure category compared to the non-exposed.

CONCLUSIONS

It was concluded that reduced tactile sensitivity is related to the degree of vibration exposure but it is not at present possible to delineate an exposure-response relationship.

Transmission of vibration energy to different parts of the human hand-arm system

The aim of this study was to investigate the transmission of vibration energy to three selected points along the hand and arm (knuckle, wrist and elbow) and to compare the energy transmission for two different kinds of vibration exposures, i.e. random and sinusoidal. The transmission of vibration energy was estimated for ten subjects during exposure to random (within the frequency range 20-5000 Hz) and sinusoidal vibration at eight different frequencies (20, 40, 80, 160, 320, 630, 1250 and 1600 Hz). The random and sinusoidal vibrations had a frequency-weighted acceleration level of 3 m/s2. The energy transmission was determined by simultaneous vibration measurements at the vibrating handle and in the hand-arm system. The measurements were made with a laser-velocity transducer and specially constructed equipment. The grip and feed forces were held constant at 40 N. The results show that the energy transmission decreases with the distance from the source. The results also show that the energy transmission is dependent on the frequency for the random vibration exposures. No clear frequency dependence of the energy transmission could be found for the sinusoidal vibrations. It may also be concluded that there are differences in the energy transmission due to types of exposure, sinusoidal vibration showing higher transmission of energy to the hand-arm system than random vibration, especially at higher frequencies.

The influence of biodynamic factors on the mechanical impedance of the hand and arm

The purpose of this study was to investigate the mechanical impedance of the human hand-arm system during exposure to random vibration under various experimental conditions and to evaluate statistically whether these experimental conditions have any influence on magnitude and phase of the mechanical impedance. A further aim was to compare the obtained results with other investigations where sinusoidal excitation has been used. The mechanical impedance was estimated in ten healthy subjects during exposure to random vibration, with a constant velocity spectrum within the frequency range 4-2000 Hz, by use of a specially designed laboratory handle. In the study, the influence of various conditions, such as vibration direction (Xh, Yh, Zh), grip force (25-75 N), feed force (20-60 N), frequency-weighted acceleration level (3, 6, 9, 12 m/s2) and hand and arm posture (five flexions, two abductions) were studied. The outcome showed that the vibration direction and the frequency of the vibration stimuli have a strong significant influence on the impedance of the hand. An increased vibration level resulted in a significantly lower impedance for frequencies over 100 Hz. Increase grip and feed forced led on the other hand to an increased impedance for all frequencies. With regard to hand and arm posture, the results show that the flexion and abduction had a significant contribution for frequencies below 30 Hz. Furthermore, the influence of some of the studied variables had a non-linear effect on the impedance but also differed between different exposure directions. It was concluded, moreover, that the vibration response characteristics of the hand and arm differ, depending whether the signal is a discrete frequency signal or a signal consisting of several frequencies.

Comparison of different methods for vibration measurements on hand-held vibrating tools

Vibration measurements have been done on hand-held tools in a group of 48 platers by evaluating the individual vibration acceleration and absorption of vibration energy. The measurement of acceleration has been done frequency-weighted and frequency-unweighted in accordance with ISO 5349 and NIOSH (USA) recommendations for hand-arm vibration standards, respectively. The acceleration and the energy absorption have been measured simultaneously in the three orthogonal directions, the latter by using a specially designed adapter. The exposure time has been determined by both subjective rating and objective measurements. Individual energy-equivalent accelerations and vibration dosages have been calculated from these data. The outcome shows that the type of tool was critical to vibration load when the different measures for determining vibration levels were used. Of the methods used, the evaluation specified by ISO 5349 makes most consideration of low frequencies of vibration (< 50 Hz), absorption of vibration energy middle frequencies (50-200 Hz) and NIOSH of high frequencies (> 200 Hz). The results show a poor correlation between the three methods used. Close agreement between mean subjective rating and objective measurement of the average exposure time was found. Further studies of the relation between results presented here and generated disturbance will be conducted, which may clarify any exposure-response relationship.

The influence of individual factors on the absorption of vibration energy in the hand and arm

The detrimental effects of vibrating hand-held tools upon humans have been known for a long time, and determination of the absorption of vibration energy into the operator's hand and arm could be an alternative method of risk assessment. The energy absorption in the hand and arm during exposure to random vibration has been measured in 84 subjects, 40 males and 44 females. A special handle was used during the measurements. The influence of various experimental conditions, such as vibration level (3-12m/s2), vibration direction (Xh, Yh, Zh), and grip force (25-75 N) were studied. Furthermore, the influence on the absorption of different individual biological factors, such as age, weight, height, hand and arm dimensions as well as blood pressure were also investigated. The subject also provided demographic data through a questionnaire covering work, symptoms of finger blanching and numbness as well as current use of nicotine (snuff of tobacco). The results show that energy absorption is influenced by exposure directions and levels as well as grip forces. Furthermore, the results show that individual biological differences between subjects, for instance age, hand volume and hand thickness, have a significant influence on the amount of absorbed energy. Blood pressure had no influence on the absorption. The same was also found for the subjective reported symptoms of finger blanching or numbness as well as for use of nicotine.

Assessment of heat pain perception in relation to vibration exposure

The effect of vibration on thin unmyelinated sensory fibers was studied by perception threshold measurement of heat pain. The investigation was a cross-sectional study of 98 vibration-exposed and 53 non-vibration-exposed workers. Pain perception was determined by using the "Marstock" method. The perception threshold of contact heat induced pain was assessed by the method of limits. Quantified personal energy-equivalent vibration exposure was assessed for all subjects on a group basis. The cumulated lifetime equivalent frequency-weighted vibration exposure was estimated based on measurements according to ISO 5349. The mean heat perception threshold was 46.2 degrees C (SD 2.6 degrees C) for the right hand and 46.0 degrees C (SD 2.7 degrees C) for the left. The results showed no mean difference (left = 0.1 degree C, right = 0.6 degree C) in heat pain perception between vibration-exposed and non-exposed subjects. There was a high correlation between the right and left hand measurements (r = 0.81). The risk (rate ratio) for impairment was 1.02 (95% CI 0.81-1.30) for the right hand and 1.00 (95% CI 0.79-1.26) for the left. The results of the study did not indicate any impairment as assessed by an increased perception threshold for heat pain. The lack of an increased heat pain threshold among the vibration-exposed workers in our study cannot exclude a possible lesional somatosensory influence from the exposure, as the lesional effect may also be a lowering of the threshold. The multiple and unrelated percepts of thermal sensations imply that it is not legitimate to draw conclusions about the total status of the small calibre afferents when testing only the heat pain perception.

Vibrotactile perception sensitivity and its relation to hand-arm vibration exposure

Vibrotactile perception thresholds (VPT) at seven test frequencies (8-500 Hz) have been measured and evaluated among 170 male employees at a heavy engineering production workshop, 125 of them were at present, or in the past, exposed to hand-arm vibration. All participants were examined by a physician and none had symptoms of diseases or were exposed to other factors known to cause sensory neuropathies. VPTs [for the three lowest (8-32 Hz; non-Pacinian), for the four highest (63-500 Hz; Pacinian) and for all test frequencies together] and a sensitivity index (SI) has been individually graded in four (normal, slightly deteriorated, deteriorated and seriously deteriorated) and two (normal, abnormal) stages, respectively, and put in relation to individual exposure of vibration. The results do not show any clear relationship on an individual basis between vibration exposure and degraded vibrotactile perception. On a group basis, however, there is a clear tendency towards detoriorated VPTs when the study group is divided in exposure categories. The detorioration is most pronounced in the frequency range mediated by Pacinian corpuscles. In this range an approximately four-fold increase of relative risk for elevated VPT for those in the highest exposure category was observed compared to the non-exposed group. Corresponding relative risk estimate for SI is about 6. Therefore, the results suggest an existence of an exposure-response relationship.